Charting health system reconstruction in post-war Liberia: A comparison of rural vs. remote healthcare utilization

Katherine Kentoffio, John D. Kraemer, Thomas Griffiths, Avi Kenny, Rajesh Panjabi, G. Andrew Sechler, Stephen Selinsky, Mark J. Siedner

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: 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. Methods: 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. Results: 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). Conclusions: 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.

Original languageEnglish (US)
Article number478
JournalBMC Health Services Research
Issue number1
StatePublished - Sep 7 2016
Externally publishedYes

Bibliographical note

Funding Information:
Funding to conduct the Konobo Baseline Survey was provided by Last Mile Health, Inc. MJS receives research support from the National Institutes of Health (MH K23099916) and the Harvard Center for AIDS Research (P30AI060354).

Publisher Copyright:
© 2016 The Author(s).


  • Child health
  • Health services accessibility
  • Liberia
  • Maternal health
  • Rural health services


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