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*24510$aPartnering for Transformational Change, Strengthening Liberia’s Surgical Health System 2021-2023” Mercy Ships Norway$bNorad Collected Review
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*520  $aThis report describes the main findings of the end review of the project two-year Partnering for Transformational Change: Strengthening Liberia’s Surgical Health System project in Liberia. Liberia has a population 5,4 million, of which close to one million lives in the capital Monrovia. In 2019, health expenditure was 8% of Gross Domestic Product (GDP) vs 15% as per the Abuja commitment. The health system suffered considerably during the civil war (1989-1996) and the devastating Ebola outbreak in 2013/2014. The main challenges the country’s health system faces currently are related to overall limited (national and donor) funding. The national capacity to implement the country’s national health policies and strategic plans is insufficient. The Covid-19 pandemic further weakened the health system. Mercy Ships, established in 1978, is a large international faith-based organisation that aims to improve the quality of life of people living with disease, disfigurement, and disability through provision of free surgical care in the poorest countries in the world. Motivated by its Norwegian affiliate Mercy Ships Norway (MSNo), in March 2021, Mercy Ships International Programs (IP) launched A Programmatic Strategy to Achieve Lasting Change describing the organisation’s new direction that adds a more prominent role to capacity building. The project under review aims to make a significant, concentrated impact in Liberia by strategically focusing on strengthening the health system; specifically, by improving the availability, accessibility, and quality of its surgical system in Liberia. It consists of three main components, implemented in different hospitals: training, the provision of anaesthesia equipment, and the provision of nursing kits for nurses and nursing drug reference books, and tool kits for Biomedical Technician (BMETs). The project, with a total budget of NOK 29 152 635, started in June 2021, and its end date has been extended to December 2023. The grant, managed by MSNo, has a monitoring plan including an overall Theory of Change (ToC), and a logical framework approach (LFA). Mercy Ships in country representation was ceased in July 2023 due to a strategic discussion of Mercy Ships leadership to suspend all activities in Liberia. The aim of the review was to independently assess the programmatic performance of the project, with a focus on effectiveness, (cost) efficiency, and sustainability. The review used a mixed-method approach. Data required to answer the review questions were collected in June and August 2023 through document review, interviews with key informants (25) and a country visit (10 sites). Data obtained through different data sources and data collection methods allowed for rigorous triangulation.
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