The Importance of Mutual Transparency and Accountability to Effectively Coordinate Aid in Liberia’s Health Sector

When the Ebola virus disease (EVD) outbreak exposed the cracked foundations of Liberia’s health system in 2014 it raised one important question: Why was the health sector still fragile, struggling to initially respond to the crisis, despite the billions of post-war dollars invested to strengthen it? With a growing pool of partners and limited resources to track external aid, the Ministry of Health (MoH) faced complex coordination challenges that constrained its —and fellow public health institutions’- ability to respond to Ebola, and to effectively develop Liberia’s health care system. Two years on, the government and partners have devoted much work to more effectively coordinating through committees and taskforces, such as the multi-donor Health Sector Pool Fund or Global Financing Facility. Partners have put time and effort into maintaining government relationships, linking their activities and projects back to the 2015 Health Sector Investment Plan.

However, with a large group of organizations active in Liberia’s public health sector, identifying who is investing where, when, how much, and why continues to be a challenge. Just over 50 percent of all health partners responded to MoH’s resource mapping exercise for the fiscal year 2015/16 and a significant proportion of aid is still managed off-budget. The lack of timely, accurate, and coordinated information blurs each stakeholder’s big picture understanding of how their efforts complement the larger system. This has led to duplication of effort, inconsistent investments in public health care services between different regions, a focus on disease- or project-specific programs over integrated and interdepartmental support systems, and aid offsetting domestic investments. Such inefficiencies are rooted in the challenges of short versus long-term needs and perspectives, varied institutional incentives and a lack of integrated information and coordination among health sector actors.

This paper explores the ways in which the Liberian government and its partners can come together to (1) build one mutually beneficial, transparent and live aid tracking and analysis mechanism; (2) upgrade and, where needed, formalize existing communication channels; and (3) prioritize actions that can be effectively implemented despite local regulations, to meet the Liberian health system’s most urgent needs. Ultimately, MoH requires more complete and updated resource mapping information to effectively expose investment gaps in its list of system priorities, and action different implementing partners to fill these gaps.