The document discusses Liberia's Ministry of Health and Social Welfare's (MOHSW) capacity building initiative following its civil war. It outlines a framework to build comprehensive capacity at the individual, organizational, and health system levels based on the WHO's six health system building blocks. Capacity assessments identified strengths and weaknesses at the central MOHSW and county levels. A strategic plan and operational plans were developed to implement capacity building interventions across the six building blocks. Examples provided show how performance-based financing improved health service coverage and efforts to strengthen health information systems improved data quality. The next steps involve a second round of assessments to measure progress.

1. Comprehensive capacity-building in
a post-conflict country:
The Liberian experience
APHA 143nd
Annual Conference
Boston, 2013

2. Presenter Disclosures
The following personal financial relationships with
commercial interests relevant to this presentation
existed during the past 12 months:
No relationships to disclose

3. Need for capacity building
• As in many low-income countries the low
coverage and quality of evidence-based
interventions are the result of
underperforming processes and weak
support systems.
• Capacity building is needed to make efficient
use of investments, strengthen health
systems, and improve performance, thereby
leading to better processes and health
outcomes
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4. Define capacity building
Capacity building is a process that enables the health sector to
meet its objectives and better perform, resulting in improved
health outcomes. The MOHSW capacity building framework
focuses on building capacity synchronously at three levels in
order to achieve maximum effect
• Individual: to improve the capacity of individual health
workers to meet objectives;
• Organizational: to improve the organizational setup and
communications of implementing organizations (central
MOHSW, counties, communities, other sectors);
• Health system: to strengthen various elements such as
policies, strategies, operational plans; and management of the
overall health system and sub-systems
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5. MOHSW Capacity Building
Initiative
• Initiated in January 2012 with technical
assistance from RBHS
• Focus on building comprehensive capacity –
individual, organizational, and health systems
• Follows the six building blocks of a health
system framework defined by WHO
• Capacity Assessments conducted at Central
MOHSW and three CHSWTs – Bong, Lofa,
and Nimba
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6. WHO Health System Framework

7. Capacity
Assessment
s
Capacity
Assessment
s
Capacity
Building
Strategic
Plan
Capacity
Building
Strategic
Plan
Capacity
Building
Operational
Plan
Capacity
Building
Operational
Plan
•Six
Building
Blocks of a
Health
System1
•NHSWPP
•County
Operationa
l Plans
•FARA
•Six
Building
Blocks of a
Health
System1
•NHSWPP
•County
Operationa
l Plans
•FARA
MOHSW
CHSWT
MOHSW
CHSWT RBHSRBHS
STAKEHOLDER
S (partners,
donors, other
govt. agencies)
STAKEHOLDER
S (partners,
donors, other
govt. agencies)
•Improved
quality of data
•Better
documentatio
n of
supervision
•LMIS rollout
complete
•Trainings
conducted
•Better
financial
record
keeping
•Improved
quality of data
•Better
documentatio
n of
supervision
•LMIS rollout
complete
•Trainings
conducted
•Better
financial
record
keeping
•Responsiv
e health
system
•Improved
service
delivery
indicators
(quality and
utilization)
•CHSWTs
capable of
managing
PBCs
•Responsiv
e health
system
•Improved
service
delivery
indicators
(quality and
utilization)
•CHSWTs
capable of
managing
PBCs
Improved
population
health
outcomes
Improved
population
health
outcomes
InputsInputs Outputs Outcome
s
ImpactProcessesProcesses
1
1) Health Service Delivery; 2) Health Workforce; 3) Health Information Systems; 4) Access to Essential Medicines; 5) Health Systems Financing; 6)
Leadership and Governance. World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their
measurement strategies. Available at: http://www.who.int/healthinfo/systems/monitoring/en/index.html
Diagram 1: MOHSW Capacity Building Framework
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8. Capacity Building Process
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9. Capacity Assessments
• Central MOHSW and CHSWT levels
• Mixed methods approach – quantitative and
qualitative
• Quantitative provides a baseline
• Qualitative provides in-depth information on
specific areas to build capacity
• Conducted by Capacity Assessment Team (CAT)
9

10. Rank ordered scores - Central
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11. 11

12. 12

13. 13

14. Capacity Building
• One strategic plan and four operational plans to
build capacity across the six building blocks
• One operational plan for Central MOHSW and
three operational plans for each counties
• Capacity building is integrated in to the overall
annual county operational plans
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15. Strategic Principles
• Innovation
• Coordination
• Ownership
• Protection and promotion of health and social
welfare
• Leadership and good governance
• Transparency and accountability with necessary
authority
• Accessibility and equity of quality health services
• Proficiency
• Sustainability
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16. Strategic approaches
• Community participation and empowerment
• Integration
• Decentralization
• Partnership and coordination
• Synchronized operational plans
• Performance-based Financing
• Monitoring and Evaluation
• Effective communication
• Single planning cycle
• Human resource management
16

17. Strategic Objectives
• Listed in the strategic plan by each
building block
• Separate objectives for Central MOHSW
and each CHT
• Further organized across three levels –
individual, organizational, and health
systems
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18. Operational plans
• Strategic objectives need to be operationalized
for implementation
• Templates created by taking the Central
MOHSW work plan and CHT two year
operational plans in to consideration
• Expanding the Central MOHSW and CHSWT
two year operational plan templates
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19. Example 1 of capacity building
• Building block 1: Delivering essential health services
• PBF to improve coverage

20. Results of PBF

21. Example 2 of capacity building
• Building block 3: Health Information Systems
• Improve quality of data collected at health facilities

22. Results on Data quality
• Counterverification reports

23. Process Results
• XX interventions developed to strengthen
capacity across the six building blocks.
• XX interventions completed
• NEXT STEPS
• Second round of capacity assessments to
measure progress

24. Thank you!
Questions?
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