Preface     xi
Acknowledgments     xvii
Introduction and Overview     1
Background and Scope     1
Liberia's Civil War     2
Impact of the Civil War on Health and the Health Care Delivery System     3
Resiliency and Perseverance of the Liberian People     4
Opportunities for Building Long-Term Organizational Change     7
Institutional Corruption and Bribery: Factors to Consider in the Postwar Era     10
Lessons Learned: Creating an Enabling Environment for Health     14
The Country Profile: Political, Economic, and Social Factors     21
Overview     21
Geography and Land     23
Population Dynamics     26
Economy     27
Government     27
The Liberian People, Ethnic Groups, and Belief Systems     28
Political Transition and Postwar Reconstruction Development     29
Health Status of the Liberian Population: Critical Analysis and Priority Areas     33
Concepts of Health and Illness: The Liberian Health Belief Systems     33
Population Health Trends: Major Causes of Morbidity and Mortality in Liberia     34
Suggestions for Improvement of Maternal-Child Health (MCH) Programs     41
AFramework for Research on Reducing Excess Infant and Child Morbidity and Mortality     44
Description of Endemic Health Conditions and Population Health Trends     47
Other Population Wide Health and Social Problems     56
Opportunities and Implications for New Directions for Health Care Delivery in Both Rural and Urban Settings     69
Health Care in Liberia: Understanding its Organization and Delivery     73
The Concept of a Health Care System: Liberia     73
Organizational Structure of the Liberian Ministry of Health and Social Welfare (MOH & SW)     74
Bureaus and Autonomous Health-Related Agencies of the MOH & SW     76
An Understanding of Structural Factors Including Inputs and Outputs of the Health Care System     81
Major Stakeholders in the Organization and Delivery of Health Care     85
Opportunities and Implications for New Directions     92
Financing Health Care Services in Liberia     107
Postwar Economic Strife in Liberia     107
Factors Influencing Health Care Organization, Financing and Delivery in Liberia     111
A Legacy of Disparities in Urban/Rural Health Development and Financing     113
The Contribution of Health Services Development in Liberia     116
Lack of National Health Planning Leading to Incongruent Health Policies      119
Major Challenges to Financing Health Care in Liberia     124
Health Care Not a Priority in Allocation of Funds     124
Bureaucratic, Inefficient Government Programs for Distributing Funds     128
Inequity in Distributing Benefits of Scarce Resources     130
Sources of Health Care Financing and Delivery in Liberia     132
Reforms Suggested by the World Bank for Financing Health Care in Developing Countries     133
Proposal for Change: Health Care Financing in Postwar Liberia     135
Sustaining Health and Development Programs in Postwar Liberia     145
Human Resource Development: A Crisis in the Prewar and Postwar Liberian Health Sector     151
Background Issues: Human Resources Development in Sub-saharan Africa     151
The Impact of the Liberian Civil War on Development of Health Human Resources     155
Poor Coordination of the Centralized Ministry of Health and Social Welfare Personnel Management Systems     160
Low Salary Scales, Lack of Motivation, and Poor Morale among Health Care Workers     162
Patterns of "Brain Drain" among Health Care Workers     164
Impact of the HIV Epidemic on the Health Care Delivery System, the Health Care Workforce, and the Development of New Health Care Professionals     170
Opportunities and Challenges: Mitigating the Health Care Human Resources Crises in Postwar Liberia     176
The Role of Technology and Essential Pharmaceuticals in the Liberian Health Care System     183
The Global Burden of Infectious Diseases in Sub-Saharan Africa     183
Disparities in Pharmaceutical Health Services Research on Neglected Endemic Diseases     185
HIV/AIDS in Sub-Saharan Africa and the Pharmaceutical Industry     187
The Pharmaceutical Industry's Contributions to Improving the Health Care of Countries Emerging from Civil Conflicts in Sub-Saharan Africa     188
Traditional Healing Practices and Remedies: An Ecological Perspective     191
Creating a Paradigm Shift: Integrating Traditional Healers into the Modern Health Care System in Postwar Liberia     195
Proposals for Pharmaceutical Reforms in Postwar Liberia     197
Reviving the Intellectual Capital of Liberia to Inform the Rebuilding Process     205
Introduction and Brief Overview     205
Western Influence on Health Knowledge in Liberia     211
Dissemination of Health Knowledge in Liberia     212
The Role of Liberian Institutions of Higher Learning in the Reorganization of the Health Care Delivery System     213
The Role of Liberian Institutions of Higher Learning in Developing Specific Health and Development Programs     217
Liberia's Health Care System: Framework for Reform in the Postwar Era     221
The Search for Concepts and Strategies     221
A Realistic Appraisal of the Current Health Care System     224
Defining a Strategic Vision for Health Care Delivery in Postwar Liberia: Understanding Structural Barriers     229
Minimizing Corruption Within the Health Care System in the Postwar Era     238
Epilogue     243
Rising to the Challenges of Rebuilding the Liberian Health Care Infrastructure     243
Enhancing the Health System and the Health of the Liberian People in the Postwar Era     244
Is Achievement of Optimal Health Possible in Sub-Saharan African Countries Emerging from Civil Conflicts?     247
Creating an Environment for Change and Moving Forward     249
Conclusion     251
Bibliography     255
Subject Index     263
Author Index     277
About the Author     281