Recovery of the health sector in post-conflict countries is increasingly initiated through a Basic Package
of Health Services (BPHS) approach. The country government and partners, including international
donors, typically contract international and local NGOs to deliver the BPHS. Evidence from routine data
suggests that a BPHS approach results in rapid increases in service coverage, coordination, equity, and
efficiency. However, studies also show progress may then slow down, the cause of which is not
immediately obvious from routine data. Qualitative research can provide insight into possible barriers in
the implementation process, particularly the role of health workers delivering the BPHS services. The aim
of this study was to explore perceptions of health service providers and policy makers on the implementation
of the BPHS in post-conflict Liberia, using SRH services as a tracer and Lipsky’s work on
“street-level bureaucrats” as a theoretical framework. In JulyeOctober 2010, 63 interviews were conducted
with midwives, officers-in-charge, and supervisors in two counties of Liberia, and with policy
makers in Monrovia. The findings suggest health workers had a limited understanding of the BPHS and
associated it with low salaries, difficult working conditions, and limited support from policy makers.
Health workers responded by sub-optimal delivery of certain services (such as facility-based deliveries),
parallel private services, and leaving their posts. These responses risk distorting and undermining the
BPHS implementation. There were also clear differences in the perspectives of health workers and policy
makers on the BPHS implementation. The findings suggest the need for greater dialogue between policy
makers and health workers to improve understanding of the BPHS and recognition of the working
conditions in order to help achieve the potential benefits of the BPHS in Liberia.