Perceptions on the implementation of sexual and reproductive health services through a basic package of health services : a qualitative case study in post-conflict Liberia

Abstract

Countries recovering from war increasingly use the approach of a Basic Package of Health Services (BPHS) as a means of rapidly scaling-up health care services in a coordinated way. Liberia started the implementation of a BPHS in 2007 after emerging from 14 years of civil war. The sexual and reproductive health (SRH) situation in Liberia was particularly critical (maternal mortality ratio: 990/100000 live births). No study has explored how the BPHS has influenced the provision of SRH services in Liberia or indeed globally. The aim of this study was to explore the implementation of a BPHS and its influence on the provision of SRH services in post-conflict recovery. The objectives were to (i) assess the availability of sexual and reproductive health services at facility level; (ii) explore health service providers' and policy makers' perception on how the implementation of the basic package has influenced the provision of SRH services using a health systems framework; (iii) develop recommendations for policy making regarding SRH and BPHS in postconflict recovery. The conceptual framework was based upon Lipsky's bottom-up theory on policy implementation which was then applied to a health systems framework.