REPUBLIC OF LIBERIA INVESTMENT CASE FOR REPRODUCTIVE, MATERNAL, NEW-BORN, CHILD, AND ADOLESCENT HEALTH 2016–2020 Table of Contents Table of Contents ........................................................................................................................................... 2 ACRONYMS ................................................................................................................................................... 5 Foreword ........................................................................................................................................................ 7 PREFACE ...................................................................................................................................................... 8 ACKNOWLEDGEMENTS ............................................................................................................................. 10 EXECUTIVE SUMMARY .............................................................................................................................. 11 CHAPTER I: COUNTRY CONTEXT AND SITUATION ANALYSIS............................................................... 16 1.1 Country Context .................................................................................................................................. 16 Maternal Health .................................................................................................................................... 17 New-Born Health.................................................................................................................................. 18 Child Health ......................................................................................................................................... 18 Quality of Services Provided .............................................................................................................. 18 Inequity in Service Delivery ................................................................................................................ 20 1.2 The Impact of the Ebola Crisis ............................................................................................................ 20 1.3 Health System Issues ......................................................................................................................... 22 1.4. Gender and Social Cultural Influence on RMNCAH ............................................................................ 28 CHAPTER 2: RMNCAH RESULTS............................................................................................................... 29 2.1 RMNCAH Baselines ............................................................................................................................ 29 2.2 Estimated Impact and Outcomes ........................................................................................................ 31 2.3 Guiding Principles ............................................................................................................................... 32 CHAPTER 3: PRIORITY AREAS FOR RMNCAH INTERVENTIONS ........................................................... 33 Introduction ............................................................................................................................................... 33 3.1 Priority Investment I: Quality Emergency Obstetric and Neonatal Care ............................................... 33 Construction and Renovation of Health Facilities ............................................................................ 33 Focused Antenatal Care ...................................................................................................................... 34 Maternal and New-Born Health—Labor and Delivery: Emergency Obstetric and New-Born Care 34 Child Health ......................................................................................................................................... 35 Postnatal Care ..................................................................................................................................... 35 Improve Community Participation in Maternal Child Health Outcomes .......................................... 36 Quality Assurance and Improvement of RMNCAH and EmONC Services ....................................... 37 Prevention and Treatment of Breast and Cervical Cancers ............................................................. 38 3.2 Priority Investment II: Strengthening the CRVS System ...................................................................... 39 3.3 Priority Investment III: Adolescent Health ............................................................................................ 40 Prevent Mortality and Morbidity during the Antenatal, Childbirth, Postpartum Periods ................ 41 Page 2 Prevent Unsafe Abortion, and Mortality and Morbidity from Unsafe Abortions ............................. 42 Prevent Early and Unintended Pregnancy and Sexually Transmitted Infections Including HIV .... 44 Prevent Gender-Based Violence and the Response to It When It Occurs ....................................... 45 3.4 Priority Investment IV: Emergency Preparedness, Surveillance, and Response, Especially Maternal Neonatal Death Surveillance and Response ............................................................................................. 45 Surveillance and Notification of Epidemic Prone Diseases (IDSR) .................................................. 46 Notification of Maternal and Neonatal Deaths (MNDSR) ................................................................... 46 3.5 Priority Investment V: Sustainable Community Engagement ............................................................... 47 The Role of Civil Society Groups ....................................................................................................... 48 3.6 Priority Investment VI: An Enabling Environment: Leadership, Governance and Management at All Levels ....................................................................................................................................................... 48 CHAPTER 4: FINANCING THE INVESTMENT CASE .................................................................................. 50 What Package of Interventions Shall We Implement? ............................................................................... 50 4.1 Estimated Costs and Current Resource Allocation .............................................................................. 51 4.2 Resource Gap Analysis ....................................................................................................................... 53 4.3 Financing Mechanisms........................................................................................................................ 54 Challenges in the Health Sector Affecting RMNCAH Service Provision.......................................... 54 Health Financing Strategy for RMNCAH Service Provision .............................................................. 56 Reversing Impact of Regressive Financing for Health ..................................................................... 56 Contributions from Development Partners ........................................................................................ 57 Managing Resources .......................................................................................................................... 58 Role of the Private Sector ................................................................................................................... 58 Greater Efficiency for RMNCAH Resource Utilization: Performance-Based Financing (PBF) ....... 59 CHAPTER 5: GOVERNANCE AND MANAGEMENT OF THE RMNCAH INVESTMENT FRAMEWORK ..... 60 5.1 Country Management Platform ............................................................................................................ 60 5.2 Civil Registration and Vital Statistics (CRVS) ...................................................................................... 61 5.3 Monitoring, Evaluation, Accountability, and Learning .......................................................................... 61 CHAPTER 6: THE IMPLEMENTATION PLAN .............................................................................................. 64 6.1 Selection Criteria for Phase One of Implementation ............................................................................ 64 6.2 Key Risk Factors to the Successful Implementation of the Investment Case and Mitigation Mechanisms ................................................................................................................................................................. 68 6.3 Costing of Phase One of the Investment Case for RMNCAH .............................................................. 68 REFERENCES ............................................................................................................................................. 73 ANNEXES .................................................................................................................................................... 75 Annex 1: Indicators for the National Investment Plan for a Resilient Health System, 2016–2021 .............. 75 Annex 2: Organogram Ministry of Health, Liberia ...................................................................................... 77 Page 3 Annex 3: Key Health System Constraints and Priority RMNCAH Interventions ........................................