IMPACT STUDY; JOHN F. KENNEDY MEDICAL CENTER

Kennedy National Medical Center (NMC) to serve as the key institution in the nation's health care delivery system. This special evaluation, focusing on NMC's impact, covers the life of the project, 1963-1979, and is based on interviews and a review of files. USAID assistance was provided to three of NMC's four components -- the JFK Memorial Hospital, the Maternity Hospital, and the Tubman National Institute of Medical Arts (NIMA). Over the years, NMC has grown into a modern medical center and teaching complex providing services, personnel, and supplies to the entire health care delivery system. The JFK Hospital has a daily in-patient load of over 300 and an outpatient load of 450. Since it is used as a last resort, mostly by malnourished children, it has a high death rate (20%). In 1979, the Maternity Hospital served over 20,000 and 56,000 in- and out-patients, respectively; while NIMA enrolled 285 students and graduated 93 certified technicians and service personnel. NMC patients are a cross-section of society. Children under five and the poor are admitted free. Through payroll, purchases, and development expenditures together totalling over $10 million, NMC has also had a positive economic impact. NMC drawbacks include overcrowding due to free care; overuse by the wealthy; high operational costs (over 40% of the national budget); and low wages which compel staff to hold two jobs and cause absenteeism and long patient waiting periods. NMC is also viewed as a U.S. transplant, especially because the level of technology is difficult for Liberians to absorb and causes operational and maintenance problems. Lessons learned include the inadequacy of prior consultation with Liberian counterparts and of follow-up of U.S.-trained participants; the need to screen contractors to identify potential conflicts; the preferability (in hindsight) of a smaller, less costly institution; and the success of the institution building goal because A.I.D. stayed with the project to its completion. Overall, NMC has had a quite positive impact on health care in Liberia.