A Health Practitioner’s Handbook and Toolbox for Identifying the Poor and Vulnerable >
Liberia Inter-Agency Technical Working Group Implementation Case Study


Liberia Inter-Agency Technical Working Group Implementation Case Study


With more than half of its 4.7 million population living below the national poverty line, Liberia faces a great many challenges in improving health and development. Currently, three major reforms are moving ahead in parallel, which, if they can work together, will be a major step forwards in poverty alleviation over the next decade:

    1. The Ministry of Health is in the early stages of creating a social health insurance scheme, to be known as the Liberia Health Equity Fund (LHEF). This will hopefully use existing targeting systems to identify a proportion of the population (yet to be determined) who will be exempted from paying premiums into this scheme. The intention is to launch the scheme in 2023 and achieve universal coverage by 2030.
    2. The National Identification Register (NIR) is being created as the foundational identity system for everyone in Liberia, and features a unique ID number, a smart card and a biometric verification system. Enrollment began in 2017 with a plan to achieve total coverage by 2023.
    3. The Social Registry Information System (SRIS) will be Liberia’s social registry of poor and vulnerable households. Presently in development by the Ministry of Gender Children and Social Protection (MoGCSP), data collection for the registry began in December 2020 with an expected completion date in 2022. The registry will be used to deliver a national cash transfer scheme, but also – it is hoped – a wide range of other social protection programs, including health.

As the implementation dates for each of these show, the next few years are a critical period for all three reforms. Successful coordination will enable the data gathered on the poor and vulnerable to flow seamlessly to the new LHEF, allowing automatic coverage of these households when the social health insurance scheme launches. However, if each agency takes a more narrow view and focuses just on its own mandate and (sizable) responsibilities, then separate systems may develop which lumber Liberia with fragmented and non-interoperable processes for many years.

Recognizing this challenge, in April 2021 a joint team of officials from the MoH, MoGCSP and NIR put themselves forward as an implementation case learning example for the JLN Learning Collaborative on Population Targeting. They hoped to use the JLN platform as a means of bringing their agencies together and devising mechanisms that would more effectively coordinate their respective reforms. The approach meant that participants of the LCPT would be able to accompany the Liberian team through their initial thinking and plans – providing support and challenge as they developed them, but also taking the learning from this back to their own systems, many of which also had comparable issues of sub-optimal inter-agency coordination.

The group undertook a series of four 90-minute virtual workshops over five months through which to formulate a joint plan for an additional technical coordination group between the three agencies (and other key players). These virtual meetings began with mapping of current coordination mechanisms, key issues and challenges, with extended group discussion to understand where the experiences of other countries in the group might help. Asynchronous collaboration and offline activities and tasks supported three further workshops as the plans took shape, focusing on in particular on key lessons from equivalent groups in other systems such as their scope, structures, legal basis, composition and success factors.

During the course of these meetings, the Liberia team were able to make significant progress towards their goal of better coordination at the operational and technical levels. Their proposed Technical Working Group (TWG) now has a guiding objective, which is “To improve coordination in support of effective targeting for universal health coverage in Liberia”, draft terms of reference, a proposed membership structure, and an action plan that they would propose to follow in creating the TWG.

Though implementation of this plan is being held up until there is official approval from relevant ministers to move forward, such that there is no current timeline by which the Liberia team expect the TWG to be operational, the process of working together on these topics alone has created a much better level of cooperation at the interpersonal level among the individuals involved. The team are now finding it easier to invite and participate in each other’s policy and strategy development meetings, and the process was also helpful for the many other countries that participated in reflecting on how their own systems of institutional coordination could be improved in future.