Monrovia — A new health financing report launched Wednesday has revealed that the Liberian government disbursed just over one-third of the funds approved for primary health care over a five-year period, raising concerns about the country's ability to sustain critical health services as international support declines.
The report, released by Public Health Initiative Liberia (PHIL) in partnership with the Global Health Advocacy Incubator (GHAI), found that of the US$79.36 million approved for primary health care between 2020 and 2024, only US$28.21 million, about 35.5 percent, was actually disbursed. The findings were presented during the launch of the Budget Gap Analysis for Primary Health Care (PHC) and Immunization in Liberia (2020-2024) in Sinkor, Monrovia.
The analysis examined government budget approvals, allocations, and actual spending on health services using official data from the Ministry of Finance and Development Planning and the Ministry of Health, along with international health databases.
According to the report, the execution gap left US$51 million in approved primary health care funding undistributed over the five-year period.
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Health advocates say the gap means funds approved by lawmakers often fail to reach clinics and communities where they are needed most.
"Liberia's health financing challenge is not only about finding new resources--it is about ensuring that the resources already approved by our Legislature actually reach the clinics, health workers, and communities that need them," the report states.
Understanding Primary Health Care
Primary health care refers to the basic health services delivered at the community level, often through clinics, health centers, and community health workers. It is usually the first point of contact between individuals and the health system.
According to the World Health Organization, primary health care focuses on prevention, early treatment, and health promotion, including vaccination, maternal and child health services, treatment for common illnesses such as malaria and respiratory infections, nutrition services, and family planning.
In Liberia, these services are largely provided through community clinics and frontline health workers operating under the Ministry of Health, particularly in rural areas where hospitals may be several hours away.
Health experts say strong primary health care systems can address most common health needs while reducing the burden on hospitals.
Heavy Burden on Families
The report also paints a troubling picture of the financial burden placed on ordinary Liberians.
Government spending on primary health care stands at US$3.94 per person annually, while households spend about US$40.16 out of pocket per year, creating a 10-to-1 ratio in which families shoulder most of the health costs.
Researchers say this imbalance exposes many households to financial hardship when seeking care.
The analysis further found that primary health care accounts for only 9.6 percent of total health sector spending, far below the 40 percent benchmark recommended by the World Health Organization.
Falling Short of Continental Commitments
The report also notes that Liberia continues to fall short of the health financing commitment made under the African Union's Abuja Declaration, which calls on African governments to allocate at least 15 percent of their national budgets to health.
Between 2020 and 2024, Liberia allocated about 9 to 10 percent of its national budget to the health sector, leaving an estimated US$40 million to US$50 million annual financing gap needed to meet the continental target.
Immunization Risks Ahead
The report also warns of mounting risks for Liberia's immunization program.
While the global vaccine alliance GAVI contributed US$13.36 million to Liberia's immunization program between 2020 and 2024, the government provided US$2.33 million, about 15 percent of total costs, below the required 20 percent co-financing threshold.
The situation could worsen in 2026 when the World Bank is expected to exit its financing of traditional vaccines, including measles. The withdrawal will add more than US$1 million annually in costs that Liberia will have to cover domestically.
Speaking at the launch, Dr. Adolphus T. Clarke, head of immunization at the Ministry of Health, acknowledged the government's role in supporting vaccination efforts but warned that the country is approaching a critical point.
"We like to thank the Government of Liberia for the continued support to the immunization program, but we are at a critical junction for which the government probably needs to take two steps if it took one before, based on the information we just received during the call with GHAI," Dr. Clarke said while delivering remarks on behalf of the Minister of Health.
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Officials from the World Health Organization also emphasized the urgency of strengthening domestic financing for health programs.
"Let me say thank you to PHIL and the team. I think this budget gap analysis could not have come at a better time, particularly looking at the fact that donor funding is declining in our country," said Dr. Tiala Mulbah, Immunization Officer at the WHO. "It is particularly important for us as a country to start talking about domestic resource mobilization."
Recommendations
The report outlines six key recommendations for the government, including improving budget execution, increasing domestic health financing toward the Abuja target, and establishing a clear transition plan for vaccine financing before donor support declines.
It also calls for improved transparency and stronger systems to ensure funds approved for health programs reach frontline health services.
The findings come as policymakers and health advocates push for stronger domestic investment in Liberia's health system to reduce dependence on international donors and ensure long-term sustainability.
