President Joseph Nyuma Boakai Sr. has received a landmark piece of legislation that could establish Liberia's first national health insurance system, a major reform aimed at reducing out-of-pocket medical spending and advancing the country toward Universal Health Coverage (UHC).
The proposed Liberia Health Equity Fund for Universal Health Coverage Bill, along with the framework for the establishment of the Health Equity Authority of Liberia (HEAL), was formally submitted to the President on Monday, June 22, at the Executive Mansion by Health Minister Dr. Louise M. Kpoto.
The initiative is designed to create a nationwide health financing system that would improve access to affordable healthcare services for citizens across all fifteen counties.
Presenting the proposal, Dr. Kpoto said the reform represents a critical step in addressing longstanding gaps in healthcare financing and delivery.
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"This framework is intended to ensure that every Liberian, regardless of income or location, has access to essential healthcare services without financial hardship," she said.
According to the Ministry of Health, the Liberia Health Equity Fund (LHEF) would serve as the central financing mechanism for the proposed national health insurance scheme, pooling resources to reduce the burden of direct payments by patients.
The Fund would be administered by the Health Equity Authority of Liberia (HEAL), a new statutory body responsible for managing the system nationwide.
Under the proposed structure, HEAL would oversee beneficiary registration, define health benefit packages, accredit healthcare facilities, process claims, and ensure timely payments to service providers. The Authority would also establish offices in all fifteen counties to guarantee nationwide coverage and effective service delivery.
"The goal is to build a system that is efficient, transparent, and accessible at every level of the healthcare system," a senior Ministry official noted.
The draft legislation further empowers HEAL to monitor service quality and enforce standards across both public and private healthcare facilities; a move aimed at improving accountability and patient care outcomes.
Governance of the system would be overseen by a Board of Directors comprising representatives from government institutions, civil society, and professional health bodies. The Board would approve budgets, contribution rates, and benefit packages while providing overall policy direction.
The reform comes against a backdrop of heavy reliance on out-of-pocket healthcare spending in Liberia. Ministry of Health data indicates that more than 40 percent of total health expenditure is currently paid directly by households--one of the highest rates in the sub-region--often pushing families into financial distress.
Health officials say the proposed insurance system is intended to reduce this burden by pooling risk across the population and ensuring more predictable funding for healthcare services.
"Too many families are forced to choose between treatment and survival because of cost," a health official said. "This system is designed to change that reality."
Public health facilities are also expected to benefit significantly. Many hospitals and clinics currently depend on user fees and irregular government transfers, which often disrupt service delivery.
Under HEAL, facilities would receive structured and timely reimbursements, which authorities say could improve drug availability, staffing levels, equipment maintenance, and overall service quality.
The proposed financing model for the Liberia Health Equity Fund includes annual budget allocations, mandatory payroll contributions from formal sector workers, and dedicated health-related taxes approved by the Legislature based on actuarial assessments.
The bill also provides full government subsidies for vulnerable populations, including extremely poor households, persons with disabilities, pregnant women, children under five, and citizens aged 70 and above. Local social welfare offices would support identification and enrollment of eligible beneficiaries.
Implementation would be phased. The first phase would cover salaried public and private sector workers and their dependents, followed by gradual expansion to informal sector workers such as market vendors, farmers, and transport operators. The final phase would extend coverage to indigent populations.
The Ministry estimates that full national coverage could be achieved within five to seven years, depending on financing capacity and institutional readiness.
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President Boakai is currently reviewing the proposal with his legal and health policy advisors before determining the next steps. If approved, the bill will proceed to the National Legislature for debate, public hearings, and possible enactment.
Meanwhile, technical teams within the Ministry of Health are conducting actuarial studies to determine contribution levels, benefit packages, and long-term financial sustainability. Work is also underway to develop a digital health management system for enrollment, claims processing, and fraud monitoring.
The initiative aligns with Liberia's commitments under the African Union's Agenda 2063 and the United Nations Sustainable Development Goals, both of which emphasize achieving Universal Health Coverage by 2030.
Health authorities say they have also studied similar systems in countries such as Ghana, Rwanda, and Kenya to inform the design of the proposed scheme.
If enacted, the Liberia Health Equity Fund and the Health Equity Authority of Liberia would represent one of the most far-reaching healthcare reforms in the nation's history, with the potential to significantly reshape access to healthcare and provide stronger financial protection for millions of Liberians.
