Since the civil war, Liberia has had a chronic shortage of doctors which was exacerbated by the Ebola outbreak, an epidemic that killed hundreds of health workers.
While we know that Liberia has very few doctors, that number has always been presented as an aggregate for the entire country. Recent data provided by the Liberian Medical and Dental Council provides data for individual counties, allowing us to compare and rank the counties based on the number of patients per doctor.
The list is called ‘the worst counties for health care’ because even the best performing counties fall short of the World Health Organization’s recommended ratio of 1,000 patients per doctor. However, the number of doctors in the country continues to increase, from 231 in 2015 to 298 now.
Unsurprisingly, counties that are more remote and lack good access by roads take the top five spots while Montserrado, Lofa, and Nimba – Liberia’s most populous and some of the most urban counties – take the bottom three spots, making them the best regarding the number of patients per doctor. It is likely easier to recruit doctors to counties which have other amenities such as entertainment options, restaurants, and good schools.
In countries like Kenya, one research showed that younger health workers tended to prefer urban to rural settings. Additionally, health workers tended to shun rural posts because of “inadequate education facilities and opportunities, higher workloads, and inadequate supplies and supervision.â€
Being urbanized, however, did not guarantee that a county would rank well. More urbanized counties like Margibi and Grand Bassa did not perform well, as they were all out of the bottom five. The surprising overachievers were Bomi and Rivercess, which ranked 11th and 12th respectively.
There are undeniably better measures for determining the quality of healthcare systems in a county than the patient-doctor ratio. For one, if the majority of doctors in a county are concentrated in a hard-to-reach area, that limits their usefulness to the population.
The specialties of the doctors also matter. It is less than ideal if the majority of a county’s doctors specialized in psychiatry or dermatology when there’s a greater need for obstetricians or family doctors. In our ranking, we lumped all doctors together for simplicity. Moreover, the number of nurses, midwives, and community health workers can also factor into improving health care in a county. However, due to the limited data available, using the number of patients per doctor is enough to provide a glimpse of the quality of healthcare across the country.
*The estimated 2016 population is based on the assumption that all counties grew at the same rate since the 2008 census as the overall country, based on UN and World Bank figures.
Featured photo by Dominic Chavez/World Bank
