title: Which doctor?: Determinants of utilization of formal and informal health care in postconflict liberia.
abstract: BACKGROUND
  Liberia is rebuilding its health system after a lengthy civil war in which traditional health care was the only reliable source of care.
  
  
  OBJECTIVE
  This study explored individual, village, and health system factors related to the utilization of health clinics versus informal providers (eg, healers, medicine sellers) in Liberia. RESEARCH DESIGN, PARTICIPANTS, AND MEASURES: This was a cross-sectional population-representative survey of 1435 adults living in rural Nimba County, Liberia. Participants were asked about past year visits to traditional and formal health care providers and demographics, health, and trauma indicators. The association between formal and informal visits and potential determinants was estimated in separate models using generalized estimating equations to adjust for village-level clustering.
  
  
  RESULTS
  The median number of visits in the past year to formal and informal providers was 3 and 10, respectively. Clinic visits increased with younger age and female sex, past trauma exposure, the number of traditional healers, and the presence of a facility dispenser. Frequency of informal visits increased with poor self-reported mental and physical health, the presence of facility fees and decreased with literacy and wealth and satisfaction with the formal health system.
  
  
  CONCLUSIONS
  Rural Liberians use both formal and informal health care extensively and as complements rather than substitutes. The reliance on traditional medicine to address health needs is of concern in a country with a high disease burden. Health system investments that build public confidence in the health system may help shift demand from informal to formal health care.
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. mkruk@columbia.edu
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Kruk
authors.forename: Peter C
authors.initials: PC
authors.lastname: Rockers
authors.forename: S Tornorlah
authors.initials: ST
authors.lastname: Varpilah
authors.forename: Rose
authors.initials: R
authors.lastname: Macauley
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001294:Attitude to Health; D003153:Community Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007988:Liberia / Q000453:epidemiology; D008297:Male; D016488:Medicine, African Traditional / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D017678:Sex Distribution; D055815:Young Adult