Technical Support to Develop a Quality-of-Care Framework for a Hospital Health Care Improvement Project in Liberia


Liberia is a fragile, post-conflict country. Although quick restoration of some basic health services, including immunization, has helped improve some health outcomes, significant health system challenges remain, such as low coverage of basic health interventions, weak health information systems, limited focus on the quality of care, and a shortage of providers with appropriate skills.

Based on Liberia’s national priorities, a recently launched World Bank health project aims to support the MOHSW to improve the quality of health care services in selected secondary hospitals. This five-year project is supporting and incentivizing the expansion of health worker skills and enhanced quality of services in target hospitals through two primary strategies: 1) improving the quality of health interventions via several approaches, including use of financial incentives as part of a results-based financing scheme, and 2) improving health worker competencies through technical support to post-graduate specialty residency training.

Due to the relative lack of experience in low-resource settings with supply-side financial incentives focused on the quality of clinical care (as opposed to quantity of care or structural quality measures), the World Bank Group contracted URC to provide technical support for the development of an overall quality framework to support implementation of the five-year hospital program and to develop quality of care checklists to help structure financial incentives in priority clinical areas, including maternal, newborn, and pediatric infectious disease; malnutrition; and general safe surgery (using the World Health Organization’s Surgical Safety Checklist).

Through this technical support, URC also helped to build the capacity of Liberian stakeholders to adopt hospital standards of care in priority clinical areas based on international standards and to help support quality improvement efforts.

Key Activities

  • Prepared a hospital performance-based financing/quality framework disaggregated by the project’s main clinical focus areas: maternal, newborn, and pediatric infectious diseases; malnutrition; and general safe surgery.
  • Reviewed and planned for incorporation of the quality framework into the broader hospital program in collaboration with the World Bank, the MOHSW, and other project stakeholders.
  • Developed first drafts of quality checklists based on high-impact clinical interventions for priority conditions. The checklists will be used to track incentivized performance in project focus clinical areas.
  • Revised/finalized checklists based on the results of pre-testing in hospitals and country expert technical feedback.
2013 to present
The World Bank Group
MOHSW Liberia
Regions/ Countries 
Geographic Scope 
Ministry of Health and Social Welfare (MOHSW) secondary-level, semi-urban and semi-rural health facilities (including five county-level hospitals) that cover about 30% of Liberia’s population