Healthcare Resource Guide: Liberia

 

Liberia Statistics



Summary

Market Entry

Current Market Trends

Main Competitors

Current Demand

Registration Process

Reimbursement

Barriers

Procurement and Tenders

Trade Events

Local Associations

FAQs

Government Links

Best Prospects

Statistics Snapshot

CS Contacts

 

Capital: Monrovia

Population: 4.6 million (2016)

GDP: $3.2 billion

Currency: Liberian dollar and

U.S. dollar

Language: English

Summary

Liberia has a free market system and the government encourages foreign direct investment (FDI). The economy primarily relies on commodity exports, mainly gold, iron ore, and rubber, as the major sources of export earnings. Liberia is a low-income country with a gross domestic product (GDP) of $2.10 billion and a per capita gross national income (GNI) of less than $400. More than 60% of Liberians live on less than $1.25 a day (est. 2016, World Bank). In addition to natural resource extraction, Liberia’s domestic economy depends largely on foreign aid, foreign direct investment, and remittances from the Liberian diaspora. The International Monetary Fund (IMF) has projected a 3.2% real GDP growth rate for Liberia in 2018. Liberia’s leading trade partners include the United States, China, Europe, and the Middle East, as well as neighboring African nations. The economy is slowly recovering from the twin shocks of the 2014-2015 Ebola Virus Disease (EVD) epidemic and the concurrent sharp decline in export commodity prices, which together reversed post-war economic progress and resulted in years of low, zero, or negative growth.

The EVD crisis overwhelmed Liberia’s healthcare system due to pre-existing structural vulnerabilities such as inadequate infrastructure and a poorly motivated workforce with limited training, exposing the system’s fragility and vulnerability. During the EVD outbreak, many health facilities closed and healthcare professionals who contracted the virus while caring for patients lost their lives.

Liberia is a low-income country, and healthcare statistics reflect the country’s low level of development. In 2015, the World Health Organization (WHO) reported the average life expectancy (at birth) at around 60 years, the maternal mortality rate at 640 per 100,000 live births, and infant (under five) mortality rate at 71 deaths per 1,000 live births. Liberia has some of the highest prevalence rates for malaria and tuberculosis in Africa. There are sporadic outbreaks of other infectious diseases with high fatality rates, such as meningitis, Lassa fever, and other viral hemorrhagic fevers, which are required to be reported according to international health protocols. Communicable waterborne diseases such as cholera, typhoid, and shigella are common in Liberia, particularly during the six-month rainy season. Serious medical conditions require emergency evacuation outside Liberia for adequate treatment. Liberia’s national medical center is the John F. Kennedy Medical Center, which is composed of John F. Kennedy Memorial Hospital, Maternity Hospital, the Tubman National Institute of Medical Arts (a paramedical and nursing school), and the Catherine Mills Rehabilitation Hospital (a psychiatric care facility that is not currently operating). Currently, JFK serves as the nation’s largest referral hospital financed entirely by the government and international donors.

Liberia’s healthcare system depends heavily on international donor support. Many healthcare facilities are run by the government, donors, or through non-governmental organizations (NGOs), including faith-based organizations. Generally, there is minimal private sector involvement in the health sector. In the national budgets for the fiscal years 2017-18 and 2018-19, the government appropriated 14% and 13%, respectively, to the health sector. The sector is constrained by weak supply chain management, particularly in terms of distribution and storage of pharmaceuticals and other supplies, as well as limited human resources, particularly in terms of doctors, specialists, pharmacists, and laboratory technicians. There is limited availability of essential genuine medical equipment and pharmaceutical products, and there are frequently reported stock outages, especially in areas of the country not currently supported by international donor agencies.

  • Leading Sub-Sectors

Sub-sector best prospects for U.S. companies include investing in health infrastructure such as health facilities, essential medical equipment, and pharmaceutical products, and providing medical education for the growing number of young high school graduates who see the health sector as a potentially rewarding career path.

  • Opportunities

The general weakness of Liberia’s healthcare system means that there are numerous fields that could benefit from U.S. investment. For instance, the limited capacity translates into ample investment opportunities such as provision of health facilities, medical logistics and equipment, training of laboratory technicians, midwives, and pharmacists, as well as provision of reliable medical supplies to community-based health centers. Investment opportunities include health system strengthening through education, training, capacity building, and skill development programs. There are also opportunities in providing specialized equipment to healthcare providers targeting the expatriate community, including diagnostic and critical care equipment such as ultrasound, MRI, electrocardiography, advanced life support equipment, and digital x-ray machines.

                             

Market Entry

U.S. companies wishing to enter the Liberian market are advised to hire a local representative who is familiar with the sector to market their products. Representative(s) should be an agent or distributor who possesses a thorough understanding of the local economy as well as deep understanding of the health system’s regulatory framework. U.S. companies are also advised to consider hiring qualified personnel and maintaining a reasonable inventory of spare parts, particularly if their medical equipment or products require regular maintenance and servicing. It is worth noting that local agents or distributors may represent other suppliers or product lines in the market. The U.S. Embassy Monrovia can help locate agents, distributors, and commercial representatives and provide due diligence through its fee-based commercial and trade promotion services. Liberia’s historically close relationship with the United States can provide a competitive advantage for U.S. companies entering the Liberian market. In general, Liberians favor U.S.-made products relative to other foreign products, and upper- and middle-class Liberians may be willing to pay a higher price for U.S. pharmaceutical products of a higher quality. Key issues in marketing U.S. pharmaceutical products and equipment to the Liberian market include registration with the appropriate authorities, training local representatives to carry out after-sales service, and supplying spare parts.

Current Market Trends

No medical equipment or pharmaceutical products are locally manufactured. The Ministry of Health (MOH) provides subsidized or free drugs to government-run health facilities through the state-owned pharmaceutical supply outlet, the National Drug Service (NDS). Overall, both publicly- and privately-run health facilities are constrained by inadequate financial resources to procure quality pharmaceuticals and medical equipment. There is potential for used equipment with private health institutions, which are usually underequipped and ill-staffed. Health facilities and pharmacies in Liberia import most of their drugs from India, Europe, the United States, and other African countries. Although U.S. products are highly regarded in Liberia for their quality, their higher price may limit broad market penetration. Liberia’s health sector priorities include building a resilient healthcare system through an inter-sectoral approach and sustained health financing. This will require building the capacity of health workers, strengthening the supply chain system, and sustaining health financing. The most dynamic and exciting growth opportunities can be found in privately owned hospitals and clinics as well as in the non-state-controlled portion of the pharmaceutical sector.

Main Competitors

Liberia’s historical relationship with the United States still impacts the presence of competitors in the market: American brands have a distinct advantage with Liberian consumers. However, price differentials play a vital role in shaping individual purchasing decisions. Rich and middle-class Liberian consumers generally follow American standards, providing an additional advantage to American companies. In the last several years, there has been a growing presence in Liberia of Indian and Chinese pharmaceuticals. As Indian and Chinese products become more prevalent in the market, there has been a corresponding rise in the amount of counterfeit and expired drugs, which can be life-threatening and contribute to antimicrobial resistance, a major global health security threat.

Current Demand

According to the World Health Organization (WHO), Liberia’s total expenditure on health per capita is low, less than $100/year (compared to neighboring Sierra Leone at $224/year). By regulation, government institutions can accept used/refurbished equipment. Low-end equipment that is affordable and easy to use are more useful than high-end equipment. The major types of used or refurbished equipment in greatest demand in the private sector include scanners, thermometers, hospital beds, furniture, X-ray machines, and laboratory equipment. Other products that have good prospects for U.S. companies include malaria drugs, antibiotics, anthelminthic drugs (for common parasites), diabetes drugs, and drugs for high blood pressure (anti-hypertensives). Prospects also exist in supplying used/refurbished and low-cost mortuary refrigerators, ambulances, diagnostic equipment, electrocardiographs (ECGs), ultrasound scanning equipment, operating theater equipment, and pharmaceuticals. In the long-term, as road networks connecting regions of the country improve, U.S. companies could profit in Liberia by providing mobile health equipment that can be used in rural settings, often in areas that are off the power grid. Outside of the mainstream healthcare market, opportunities exist to serve the higher-end needs of Liberia’s middle- and upper-class as well as the expatriate community in Monrovia.

Registration Process

The import of pharmaceuticals and medical devices, including diagnostic and testing equipment and syringes is regulated. The Ministry of Health (MOH) works closely with other state-run regulatory bodies, such as the Liberia Medicines and Health Products Regulatory Authority (LMHRA) and the Liberia Pharmacy Board, to register, monitor, and regulate pharmacies and medicine stores. U.S. companies must register their equipment with the LMHRA, as well as with the MOH and the National Public Health Institute of Liberia (NPHIL), for testing. The U.S. Embassy’s commercial section can provide additional details.

Reimbursement

In Liberia, there is a “pay as you go” system in the medical market, where patients, most of whom are uninsured, are required to pay cash prior to consultation, hospital admission, and treatment. Many healthcare services are funded and supported by international and religious organizations, where individuals are only required to pay minimal admission fees. Expatriates and working Liberians who have insurance coverage are responsible for organizing reimbursement of medical services with their insurance providers. Expatriates and long-term visitors in Liberia must obtain an international health insurance policy to ensure access to healthcare services.

Barriers

Liberia is currently using the Harmonized System (HS) Customs Code and Common External Tariff in classifying goods for customs purposes. Taxes are assessed on the basis of weight, value, and volume and are subject to change based on new regulations in line with the Liberia Revenue Code. Medical equipment and pharmaceuticals are subject to duties and taxes except for those imported by the government or for non-profit, donations, and charity purposes. Goods entering the country are subject to an import duty assessed by and paid to the Liberia Revenue Authority (LRA) and destination inspection is conducted by Bureau Veritas Liberia (BIVAC). The Liberia Pharmacy Board has a responsibility for ensuring that medical equipment imported into Liberia meets the quality certification as required by the government of Liberia. The Liberia Medicines and Health Products Regulatory Authority (LMHRA) is responsible for registering and controlling import, export, and transit of medicines and health products in Liberia, and all licenses or permits relating to medicines and health products are issued by the LMHRA.

Procurement & Tenders

The Ministry of Health (MOH) will normally issue a national or international competitive bidding advertisement on its website (http://moh.gov.lr/) or in the press for expensive/complex capital items, as well as for the procurement of health sector goods. While national competitive bidding notices are advertised in the local press, international competitive bidding processes are advertised both in the local press and on the MOH’s website. See sample tenders http://moh.gov.lr/procurement-of-health-sector-goods-bidding-document-health-sector-drugs-2018-liberia/, for the procurement of health sector goods.

Trade Events

There are no upcoming trade events in the healthcare sector. Such events are rare and information about them is generally published on the Ministry of Health (MOH)’s website.

Government Links

Ministry of Health (MOH), http://moh.gov.lr/

National Public Health Institute of Liberia (NPHIL), http://nationalphil.org/

Saint Joseph’s Catholic Hospital, http://www.sjcatholichospital.com/

ELWA Hospital, https://www.elwaministries.com/elwa-hospital-2/

Liberia Pharmacy Board, http://lpb.gov.lr/

Liberian Nurses Association, http://www.liberiannursesassociation.org/

 

Best Prospects

  • Basic medical equipment (new, used/refurbished)
  • Basic laboratory/X-ray equipment, including rapid diagnostic test kits
  • Quality pharmaceuticals/drugs and vaccines
  • Training of health professionals/practitioners
  • Private health facilities for middle class and expat community

U.S. Commercial Service Contact Information

Embassy Monrovia Economic & Commercial Section

Email: Monrovia-Commerce@state.gov

Alusine Sheriff

Economic and Commercial Assistant

Email: SheriffAM@state.gov

Phone: +231 777-958-140


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