Charting health system reconstruction in post-war Liberia: a comparison of rural vs. remote healthcare utilization.
Despite a growing global emphasis on universal healthcare, access to basic primary care for remote populations in post-conflict countries remains a challenge. To better understand health sector recovery in post-conflict Liberia, this paper seeks to evaluate changes in utilization of health services among rural populations across a 5-year time span.



We assessed trends in healthcare utilization among the national rural population using the Liberian Demographic and Health Survey (DHS) from 2007 and 2013. We compared these results to results obtained from a two-staged cluster survey in 2012 in the district of Konobo, Liberia, to assess for differential health utilization in an isolated, remote region. Our primary outcomes of interest were maternal and child health service care seeking and utilization.



Most child and maternal health indicators improved in the DHS rural sub-sample from 2007 to 2013. However, this progress was not reflected in the remote Konobo population. A lower proportion of women received 4+ antenatal care visits (AOR 0.28, P < 0.001) or any postnatal care (AOR 0.25, P <0.001) in Konobo as compared to the 2013 DHS. Similarly, a lower proportion of children received professional care for common childhood illnesses, including acute respiratory infection (9 % vs. 52 %, P < 0.001) or diarrhea (11 % vs. 46 %, P < 0.001).



Our data suggest that, despite the demonstrable success of post-war rehabilitation in rural regions, particularly remote populations in Liberia remain at disproportionate risk for limited access to basic health services. As a renewed effort is placed on health systems reconstruction in the wake of the Ebola-epidemic, a specific focus on solutions to reach isolated populations will be necessary in order to ensure extension of coverage to remote regions such as Konobo.
Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA. kkentoffio@partners.org.|Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. kkentoffio@partners.org.
Katherine
K
Kentoffio
Georgetown University Medical Center, 231 St. Mary's Hall, 3700 Reservoir Road NW, Washington, DC, 20057-1107, USA.
John D
JD
Kraemer
Last Mile Health, Hospital Road, Zwedru, Grand Gedeh, Liberia.
Thomas
T
Griffiths
Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA.
Avi
A
Kenny
Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA.|Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.|Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
Rajesh
R
Panjabi
Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA.|Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.|Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
G Andrew
GA
Sechler
Last Mile Health, 1 Congress Street, Boston, MA, 02114, USA.
Stephen
S
Selinsky
Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.|Harvard Medical School, Boston, MA, USA.
Mark J
MJ
Siedner
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006078:Government Programs; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007988:Liberia / Q000453:epidemiology; D008297:Male; D000068101:Maternal-Child Health Services / Q000458:organization & administration; D008507:Medically Underserved Area; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011320:Primary Health Care / Q000458:organization & administration; D012423:Rural Health; D012424:Rural Population; D055815:Young Adult
Child health; Health services accessibility; Liberia; Maternal health; Rural health services