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dc.rights.licenseAttribution 4.0 International (CC BY 4.0)
dc.contributor.authorSmith Jr, John Soluntaen
dc.contributor.authorDiaconu, Karinen
dc.contributor.authorWitter, Sophieen
dc.contributor.authorWeiland, Stefanieen
dc.contributor.authorZaizay, F. Zeelaen
dc.contributor.authorTheobald, Sallyen
dc.contributor.authorMcCollum, Rosalinden
dc.contributor.authorKollie, Karsoren
dc.contributor.authorKollie, Jerryen
dc.contributor.authorBerrian, Hannahen
dc.contributor.authorHotopf, Indiaen
dc.contributor.authorSempe, Lucasen
dc.contributor.authorTate, Wedeen
dc.contributor.authorDean, Lauraen
dc.identifier.citationSmith, J.S., Diaconu, K., Witter, S., Weiland, S., Zaizay, F.Z., Theobald, S., McCollum, R., Kollie, K., Kollie, J., Berrian, H., Hotopf, I., Sempe, L., Tate, W. and Dean, L. (2022) ‘Financing care for severe stigmatizing skin diseases (Sssds) in Liberia: challenges and opportunities’, International Journal for Equity in Health, 21(1), p. 160. Available at:
dc.descriptionSophie Witter - ORCID: 0000-0002-7656-6188
dc.description.abstractIntroduction Neglected tropical diseases (NTDs) are an important global health challenge, however, little is known about how to effectively finance NTD related services. Integrated management in particular, is put forward as an efficient and effective treatment modality. This is a background study to a broader health economic evaluation, seeking to document the costs of integrated case management of NTDs versus standard care in Liberia. In the current study, we document barriers and facilitators to NTD care from a health financing perspective. Methods We carried out key informant interviews with 86 health professionals and 16 national health system policymakers. 46 participants were active in counties implementing integrated case management and 40 participants were active in counties implementing standard care. We also interviewed 16 patients and community members. All interviews were transcribed and analysed using the thematic framework approach. Findings We found that decentralization for NTD financing is not yet achieved – financing and reporting for NTDs is still centralized and largely donor-driven as a vertical programme; government involvement in NTD financing is still minimal, focused mainly on staffing, but non-governmental organisations (NGOs) or international agencies are supporting supply and procurement of medications. Donor support and involvement in NTDs are largely coordinated around the integrated case management. Quantification for goods and budget estimations are specific challenges, given the high donor dependence, particularly for NTD related costs and the government’s limited financial role at present. These challenges contribute to stockouts of medications and supplies at clinic level, while delays in payments of salaries from the government compromise staff attendance and retention. For patients, the main challenges are high transportation costs, with inflated charges due to fear and stigma amongst motorbike taxi riders, and out-of-pocket payments for medication during stockouts and food/toiletries (for in-patients). Conclusion Our findings contribute to the limited work on financing of SSSD services in West African settings and provide insight on challenges and opportunities for financing and large costs in accessing care by households, which is also being exacerbated by stigma.en
dc.relation.ispartofInternational Journal for Equity in Healthen
dc.rightsThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.
dc.subjectHealth financingen
dc.subjectSevere Stigmatizing Skin Diseasesen
dc.subjectNeglected tropical diseasesen
dc.subjectIntegrated case managementen
dc.titleFinancing care for Severe Stigmatizing Skin Diseases (SSSDs) in Liberia: challenges and opportunitiesen
rioxxterms.typeJournal Article/Reviewen
qmu.authorDiaconu, Karinen
qmu.authorWitter, Sophieen
qmu.authorSempe, Lucasen
qmu.centreInstitute for Global Health and Developmenten

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Attribution 4.0 International (CC BY 4.0)
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