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Liberia

Last Updated: February 9, 2012

Senior Program Officer:

Clifford Kamara, MD, MPH

Program Activities:

  • November 2008: Drs. McQuestion and Kamara met with MOH officials (including the EPI manager) as well as representatives of the World Bank, UNICEF, and WHO based in Liberia.
  • July 2009: Program Officer Cliff Kamara met with EPI Manager Thomas Nagbe and briefed EPI supervisors and coordinators in Katata, Margibi County.
  • December 2009: EPI Manager Thomas Nagbe conferred with counterparts in Sierra Leone during an SVI-sponsored peer exchange.
  • Jan -February 2010: After a series of visits with members of the Ministry of Health & Sanitation and external partner counterparts, Mike McQuestion and Cliff Kamara work to prepare a congressional briefing for SIF.
  • March 2010: Peer exchanges from Sierra Leone and the WHO EPI Managers meeting in Ouagadougou set the stage for Liberia's first congressional briefing, which took place on 25 March.
  • August 2010: Senior Financial Expert/ Financial Advisor, Public Financial Management, Ministry of Finance sponsored to participate in a Peer Exchange/ Study Tour of the Health Financial Management System of Uganda with visits to the Ministries of Health and of Finance.
  • March 2010: SIF Program peer exchanger Hon. Edwin Gaye, Chairman of the Congressional Health Committee, accompanied the national immunization manager to the WHO West African EPI Managers meeting in Ouagadougou, Burkina Faso, 15-17 March 2010.
  • August 2011: Senior Program Officer Clifford Kamara consulted with government and parliamentary counterparts in Monrovia.
  • February 2012: Clifford Kamara visited Monrovia to consult counterparts, follow up on draft vaccine-related legislation and arrange a second Congressional briefing.

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Health Sector Architecture:

  • Liberia is neither a SWAp nor an IHP+ country.
  • The national health system consists of three main levels of care, namely primary, secondary and tertiary. The Basic Package of Health Services (BPHS) is the cornerstone of the new Liberian health care delivery strategy, and includes preventive and curative services.
  • The EPI Program is located in the Preventive Services Division, Health Services Department, Ministry of Health & Social Welfare. A National EPI Manager and the network of Country Health Officers oversee and coordinate all EPI-related activities. Immunizations are delivered through 5 Regions, 15 Counties, 88 districts and 457 health centers and clinics. Private and NGO providers deliver up to half of all immunizations.
  • The health sector is being restructured in line with government’s commitment to decentralization. The County Health Authorities manage the county health services, whilst the Ministry focuses on health legislation and law enforcement, policy formulation, resource mobilization and allocation, planning, monitoring and evaluation, technical oversight and Research and Development.

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    Health Financing:

    • In 2007, Liberians spent US$39 per capita on health. Health accounted for 17% of recurrent government expenditures. (Source: Countdown to 2015 Report, 2010)
    • In 2008, Liberia received US$56.9m in Official Development Assistance for health, up from US$23.7m in 2007. (Source: OECD Creditor Reporting System)
    • All external aid is coordinated by two government entities: the Presidency (Liberia Reconstruction and Development Committee) and the Ministry of Planning and Foreign Affairs.
    • A Poverty Reduction Strategy Paper was prepared for 2008-2011. The Government will finance 32% of its total US$1.612 billion budget.
    • Highly Indebted Poor Countries (HIPC) / Multilateral Debt Relief (MDR) Initiatives:
      As an Interim HIPC country, Liberia began receiving HIPC debt relief credits in March 2008. As of mid-2009, the country had received credits totaling US$3.2m (of a total commitment of $4.01b). Source: IDA/IMF. HIPC and MDRI- Status of Implementation: September 15, 2009.

    • In June 2010, Liberia passed the HIPC Completion Point. The country will receive US$4.6b in additional debt relief.
    • Immunization Financing:
      • According to Liberia’s 2006-2010 comprehensive Multi-Year Plan (cMYP), US$2.4m were spent on the routine EPI program in 2005, about $16 per infant. Adding shared health services costs increases the figure to $2.5m. The government financed $ 128,526 (5%) of the routine EPI-spefic expenditures, about $1 per infant.
      • According to the WHO/UNICEF JRF data, government routine expenditures were $100,000 in 2006- 3% of all routine EPI expenditures. The figures for 2007 and 2008 were, respectively, $66,000 (3%) and $217,125 (2%).
      • According to Liberia’s cMYP 2011-2015, routine immunization expenditures in 2009 totaled $6.4m.
      • Amount spent (USD) by the government of Liberia on routine immunization per infant (2000-2010)
        <Liberia routine imm spend 2000 2010_1.jpg

        • Source:
        1. WHO Vaccine Preventable Disease Monitoring System, 2008. Immunization Profile: Republic of Liberia. All data derived from the WHO/UNICEF Joint Reporting Form as follows:
        a: C_6450. This % excludes any external financing from donors.
        b: C_6490. This % includes all recurrent, immunization-specific spending financed solely with government funds. This includes vaccines, injection supplies, salaries, and per diems of health staff working full-time on immunization, transport, vehicles, and cold chain maintenance, training, social mobilization, and monitoring and surveillance. "NA" indicates data not available.

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Budgeting:

  • The annual budget is prepared by the Bureau of the Budget, Ministry of Finance. The 2007/8 budget totaled US$183m. The budget had about 2000 line items.
  • Budgets are annual and must be balanced by law. There is no deficit spending.
  • The budget cycle begins in November. The Bureau of the Budget sends the Budget Circular to line ministries in February. Initial spending limits are specified.
  • During March- April line ministries negotiate their budgets with the MoF and inter-ministerial Budget Committee.
  • Cabinet approves the budget in May. It is then presented to Congress where both houses must approve it. The fiscal year begins on 1 July.
  • Following Congressional approval, the Executive can veto any part of the budget.

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    Budget Flows and Reporting:

  • Line ministries receive monthly cash flow schedules. Expenditures cannot exceed these amounts.
  • The MoF produces quarterly, mid-year and end of year budget performance reports.
  • In mid-2009, the IMF reported, external audits of some 25 government entities, including the Ministry of Finance, were completed in FY2005/06 and 2006/07. Audits are planned for other line ministries.

  • According to the 2007 CABRI/OECD survey, the government has difficulty tracking external aid disbursements.

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    Budget Performance:

    • In 2008, Liberia's routine EPI Program immunized 144,469 children with DTP3 and spent around US$26 per DTP3 immunized child (US$3,772,028 total), down from $52 per DTP3 immunized child in 2007. (Source: GAVI Annual Progress Report, 2008 and GAVI Annual Progress Report, 2007)
    • According to the CABRI/OECD (2007) survey, between 61-80% of budget expenditures by line ministries are tested by the MoF against non-financial performance goals or objectives (which are set by line ministries and specific programs). Performance affects subsequent annual line ministry budgets. The information is reported to the President, the Congress and the public.
    • Open Budget Index: Liberia scored 2% out of a possible 100% on the Open Budget Index 2008. This indicates that the government provides scant budgetary information to the public. Read more here.

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      Parliamentary Notes:

      • Free elections took place in October 2005, ending fifteen years of turmoil. The last Presidential Elections were held in late 2011.
      • According to the 2007 CABRI/OECD survey, there are no constraints on when Liberia's Congress must approve the annual budget. The National Assembly is free to shift funding across sectors and programs. In fiscal year 2007/8, Congress re-appropriated about 6% of the budget.
      • Liberia has a bicameral legislature. There are 64 members of the House of Representatives and 30 senators. House committees directly concerned with EPI financing include Committee on Health & Social Welfare, Committee on Ways, Means, and Finance and Committee on Public Accounts & Expenditures. Senate committees include Ways, Means, Finance & Budget Committee and the Committee on Gender, Health, Social Welfare, Women & Children Affairs.
      • Legislative (and presidential) elections were held in October 2011 (Source: ElectionGuide).
      • In Chapter II, Article 8 of the 1984 Liberian Constitution, guaranteeing a healthy citizenry is one of the essential government policy goals.
      • A national Public Health Act (Title 33), written in 1976, is currently being updated.
      • An Act to create a drug regulatory authority and regulate the pharmaceutical sector (including vaccines) in Liberia is currently under preparation. A new bill on vaccines and vaccination activities has been drafted by the Standing Committe on Health and Social Welfare.

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        Immunization Performance Indicators:*

        Percent of districts reporting at least 80% coverage (DPT3), 2008: 93%

        Percent of districts reporting at least 80% coverage, DPT3, 2001-2008

        *Source:
        WHO Vaccine Preventable Disease Monitoring System, 2008. Immunization Profile: Republic of Liberia. Data derived from the WHO/UNICEF Joint Reporting Form, Indicator GSA17ap. "NA" indicates data not available.

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        Disease Burden:

        Population (2008): 3,793,000
        Births (2008): 145,000
        U5 Deaths (2008):
        - total 20,000
        - preventable by routine EPI: 2,8001
        - preventable by routine EPI and new vaccines: 5,0002

        (Source: UNICEF "State of the World's Children" 2009 )

        1 Assumes use of BCG, DPT, polio, and measles vaccines prevent 14% of U5 deaths.
        2 Assumes use of BCG, DPT, polio, measles, HepB, Hib, yellow fever, and pneumococcal antigen-containing vaccines prevent 25% of U5 deaths.

        Note: Vaccine preventable death estimates assume that force of infections, individual susceptibility, and probability of exposure are constant at all mortality levels.

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        Useful Links:

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        Articles on SIF Activities:

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