title: Can the health system deliver? Determinants of rural Liberians' confidence in health care.
abstract: BACKGROUND
  Following a protracted civil war, Liberia is rebuilding its health system. One of the aims of reconstruction is to expand access to health care to a previously underserved rural population.
  
  
  OBJECTIVE
  This study analysed the determinants of Liberians' confidence in their ability to obtain needed care for themselves or their children in case of serious illness.
  
  
  METHODS
  A cross-sectional survey of 1435 adults in Nimba County, Liberia was conducted. Logistic regression models were estimated with reported ability to obtain needed health services for serious illness as the dependent variable, and demographics, health need, health system characteristics and informal health care as independent variables.
  
  
  RESULTS
  Overall, 50.56% of respondents reported that they could obtain needed services for themselves or their children. Confidence in the ability to obtain care increased with education [odds ratio (OR) 1.62, 95% confidence interval (CI): 1.19-2.21] and poor physical health in the past 30 days (OR 1.38, 95% CI: 1.01-1.88), and decreased with poverty (OR 0.66, 95% CI: 0.47-0.93), exposure to previous trauma (OR 0.50, 95% CI: 0.36-0.71), dissatisfaction with respondent's last formal health visit (OR = 0.70, 95% CI: 0.54-0.91) and high utilization of the informal health sector (OR = 0.84, 95% CI: 0.73-0.96). No correlation was found between health system confidence and being female, being 35 years old or younger, formal health sector use, being within an hour of a clinic and the closest clinic having basic capabilities.
  
  
  CONCLUSIONS
  Respondents' experiences with the health care system had a greater correlation with their confidence in obtaining needed health care than proximity or quality of medical equipment in health clinics. Despite pro-poor policies guiding health system reconstruction, poor and less educated individuals have less confidence that the health system can meet their health needs.
authors: Harvard University PhD Program in Health Policy, 14 Story Street, Cambridge, MA 02138, USA tsvoronos@fas.harvard.edu.
authors: Theodore
authors: T
authors: Svoronos
authors: Institute for Population Studies, University of Liberia, Capitol Hill, Monrovia, Liberia and.
authors: Rose Jallah
authors: RJ
authors: Macauley
authors: Department of Health Policy and Management, Mailman School of Public Health at Columbia University, 600 W 168th Street, New York, NY 10032, USA.
authors: Margaret E
authors: ME
authors: Kruk
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007988:Liberia; D008297:Male; D017060:Patient Satisfaction; D012424:Rural Population; D035502:Trust
keywords: Confidence; Liberia; health systems; patient satisfaction; post-conflict