Table 1 The way forward for chronic disease in Liberia

1. The 2007 National Health Policy's 'one size fits all' approach met aggregate planning targets but resulted in significant gaps and inefficiencies throughout the system.

• Fully implement the legal and administrative framework necessary for decentralization of the health sector;

• Emphasize a Primary Health and Social Welfare Care approach that encompasses decentralization, community empowerment, and inclusive partnership; and

• Base resource allocation criteria on the services to be provided and the size, density, and geographic location of the catchment population.

2. The innovative Health Sector Pool Fund proved to be an effective financing mechanism to recruit and align health actors with the 2007 National Health Policy.

• Establish a National Health and Social Welfare Financing Policy to build on the Health Sector Pool Fund experience; and

• Progressively increase government contribution to the health and social welfare sector, towards its Abuja commitment of 15% of total government expenditures.

3. A substantial rural health delivery gap remains, but it could be bridged with a robust cadre of community health workers integrated into the primary health care system.

• Revise the National Strategy and Policy for Community Health to improve integration of Community Health Workers (CHWs) into all levels of the health system; and

• Strongly consider paying CHWs, given the critical role they will be asked to play and the well-documented challenges of volunteerism.

4. Effective strategies for HIV/AIDS care in other settings should be validated in Liberia and adapted for use in other chronic diseases.

• Apply lessons learned from HIV/AIDS care to other chronic disease care (e.g., task-shifting, community-based care, reducing or eliminating out-of-pocket costs to patients); and

• Test innovative methods to improve long-term retention in care (e.g., linking clinical and social services, adapting CHW home-based care to mental health disorders).

5. Mental health disorders are extremely prevalent in Liberia and should remain a top chronic disease priority.

• Continue to prioritize mental health in the 2011 National Health Policy and Plan; and

• Implement basic mental health services at the health center and community level.

6. Better information systems and data management are needed at all levels of the health system.

• Implement a National Health Information System; and

• Explore and deploy low-cost mobile technologies to improve community-based data collection and care delivery.