Executive Summary
Introduction
The government-to-government (G2G) Partnership for Improved Health Outcomes (Health Partnership) Activity is a $55 million activity between the United States Government through the United States Agency for International Development—Liberia (USAID/Liberia) and the Government of Liberia through the Ministry of Finance and Development Planning (MFDP) and the Ministry of Health (MoH). The implementation period of the Health Partnership Activity is January 2022 to December 2026. Verification of outputs or milestones by USAID/Liberia (either directly or through a third party) is required for a fixed-amount reimbursement-type agreement. USAID/Liberia requested DELTA to lead the verification of outputs (milestones) contained in the G2G agreement on behalf of the Mission. DELTA identified ADARA-RMC, a local firm, to implement the data collection for the verification activity. The data verification activity involved two rounds of data collection at the central Ministry of Health (MoH), County Health Teams (CHTs), and G2G-supported health facilities (HF) in eight counties - Bong, Lofa, Nimba, Grand Cape Mount, Grand Gedeh, River Gee, Grand Bassa, and Margibi.
This report presents the findings for the first round (Round One) which covered the period April to December 2022: April to June (Q2); July to September (Q3); October to December (Q4).
METHODS
Through a health facility assessment method in the first round, the team verified, cumulatively, data from 193 HFs distributed across three quarters - 64 HFs for Q2, 64 HFs for quarter 3, and 65 HFs for quarter 4. The selection of HFs across each of the eight counties was based on simple random sampling techniques while ensuring district representation and inclusion of secondary health facilities (SHFs). Additionally, the team conducted a desk review of data/reports as well as collected primary data at the counties and MoH. More specifically at the selected HFs, the team conducted a review of records, and collected data through observation and interviews. All tools for data collection were those approved by USAID and to a large extent aligned with those of the MoH. to a large extent aligned with those of the MoH.
Data was cleaned and, with guidance from USAID, analyzed to provide findings on milestones of the Health Partnership Activity. The findings, below, are presented by the category of milestones: service delivery outputs, service delivery bonus milestones, administrative milestones, and quality of care. The number of sampled HFs in each county per each quarter is the major limitation of the Round One verification activity. Thus, the findings reflect the results in the sampled HFs and cannot be generalized as those for each county. Despite this limitation, the findings could be used to inform health system improvements across the G2G counties.
Based on the findings, the following recommendations are made:
- Comprehensive Review: The Ministry of Health should conduct a comprehensive review of the data systems and processes from the availability of ledgers, proper recording of data, accurate reporting, storage of data collection tools, and analysis and utilization of data.
- Targeted Interventions to Data Quality Issues: The findings highlight the need for targeted interventions in counties with persistent data accuracy issues to ensure reliable health service delivery. The Ministry of Health should design targeted training and capacity-building interventions for CHTs and facilities to enhance the effectiveness of data recording and improve data accuracy across all milestones. Additionally, targeted interventions should be made at the county level on required financial management and procurement activities and strengthen accountability measures for compliance.
- Timely Data Verification: The persistent discrepancies across multiple counties underscore the need for MoH to conduct robust and timely data verification processes and training to ensure more accurate and reliable reporting. Addressing these issues is crucial for effective monitoring and vaccination coverage among pregnant women. USAID should ensure timely counter-verification or verification of milestones and support the Ministry of Health in addressing system-level gaps and ensuring timely accountability measures are implemented by the MoH.
- Ensure Financial Management Compliance: The MoH internal audit office should ensure compliance with the financial management checklist throughout FM processes
Read more about the USAID G2G Project here
