Exploring The Concept Of Sustainability In A Fragile State’s Health System: The Case Study Of Liberia

Degree Name

MA in Sustainable Development

First Advisor

Nikoi Kote-Nikoi


After a series of brutal civil wars that lasted close to 14 years, Liberia has emerged in the international community to be a poster-child for development. Under the leadership of President Ellen Sirleaf-Johnson, the first democratically elected African female president, Liberia has proved to make worthwhile strides towards rebuilding the country.

Liberia appears promising because as a post-conflict state it offers opportunities for a renewed nation to emerge. However, the country continues to be a fragile state as the root causes of its conflict still remain an underlying threat to peace and human security for the majority of its citizens. Peace in Liberia exists in its most vulnerable form – peace that is defined as the absence of war. By using a public health lens to explore Liberia’s fragility, this research paper investigates the country’s high maternal mortality and why despite being led by the Liberian Ministry of Health and Social Welfare, generously funded by foreign donors and implemented by international NGOs, the system still fails to meet basic needs of its citizens.

The paper portrays how social determinants of health are threatened by systemic deficiencies. This form of structural violence does not only produce sustainable results, it causes more harm by perpetuating historical inequities embedded in this conflict-prone state. In states heavily dependent on foreign aid such as Liberia, the country exists in an artificial climate of donor objectives where northern hegemony is filtered through aid and grassroots involvements are tactfully silenced.

By using a peace-based approach to health care, the paper makes recommendations for health programming to be centered around equity and human security. Sustainability of a health system in a fragile state is conceivable if (1) states understand the interconnectedness between peace, community and health and parallel investments are made to build peaceful communities as well as healthy communities; (2) national and international actors address social determinants of health as emphatically as treatment interventions and do so in a context-specific, culturally-relevant way and finally; (3) community engagement is promoted through culturally established practices to foster peace, dialogue and create an environment of community well-being. This kind of programming is tedious and gradual and relies heavily on social cohesion. Nevertheless, given the fragile environment of post-conflict states, interventions have to view peace and social justice as the vehicle to reaching sustainable development


Health and Medical Administration | Health Policy | Health Services Administration | Health Services Research | Inequality and Stratification | Public Administration

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