USAID/Liberia's G2G Promotes and Strengthens Decentralization in Health Sector

Following Liberia’s 14-year period of civil war, USAID/Liberia’s Government-to-Government (G2G) Fixed Amount Reimbursement Agreement (FARA) mechanism provided much-needed cash to the health sector. Commencing primarily in three of Liberia’s 15 counties, the FARA has grown to an eight-county performance-based financing approach to enable delivery of critical services through sub-national or county levels of the Ministry of Health (MOH). Cultivating a culture of continuous learning and improvement, embracing adaptive management, and monitoring and evaluation (M&E) for learning has shaped the G2G mechanism over more than a decade.

This is a story of meaningful localization in a context where the partner’s needs, ambitions and capacities changed over time. It also demonstrates the commitment of Liberian institutions and leaders to developing and growing their capabilities and capacity. USAID/Liberia and the Government of Liberia (GOL) use implementation letters to revise and update the strategy, taking into consideration lessons learned and changes to the local context. The constant evolution of the arrangement has allowed USAID and the MOH to iteratively shift focus over time, from contracting-out to contracting-in; from central Ministry focus to decentralized county administration; and from service delivery quantity to quality at point of care. Through this experience, the MOH has worked alongside USAID in applying learning to activity management. Now, the MOH is using M&E for learning as they set the standards of their own performance-based financing program, based on evidence from USAID and World Bank experiences.