Published: July 18, 2025
Gbarnga, Bong County – Liberians are lashing out at the government after it imposed mandatory fees on public health services, accusing officials of deepening hardship in a country already buckling under economic strain.
Under a new directive announced by the Ministry of Health on July 15, patients seeking care at public facilities must now pay L$2,000 for ambulance services, L$1,500 for a birth certificate (for teenagers and adults), and L$500 per night for hospital admissions. The new fees are set to take effect in August 2025.
Authorities say the charges are necessary to keep hospitals and clinics afloat following a massive cut in foreign aid. In May 2025, the Trump administration canceled 27 of 29 USAID programs in Liberia—part of a broader global freeze—resulting in a loss of nearly US$360 million in aid. The health and education sectors are among the hardest hit, according to Finance Minister Augustine Kpehe Ngafuan.
But many Liberians say the government’s response has added insult to injury, especially with inflation soaring, unemployment rampant, and poverty deepening.
“I don’t appreciate the government’s decision because public hospitals should be free,” said Robert S. Kollie, a commercial motorcyclist in Gbarnga. “Why impose these fees when there are no jobs and the country is suffering?”
Kollie questioned whether the move signals a quiet privatization of public health services, while others worry the new costs will put basic care out of reach for thousands.
“Many Liberians are impoverished. People won’t have the money to pay, and this will result in more deaths,” said Jerry Kuyon, another motorcyclist whose partner is expecting their third child. “If the government insists, then it means they want us to die.”
According to the World Bank, nearly one million Liberians live in extreme poverty, and an estimated 2.5 million face absolute poverty.
In Gbarnga’s Sirleaf Market, vendors echoed similar concerns. “The fees make sense in theory, but most people don’t have the money,” said vendor Rachel Sumo. “If payments could be made in installments, that would help.”
Others were less forgiving.
“I’m selling grains, but some days I only get two customers,” said vendor Annie Flomo. “Government’s decision is not necessary. We are really suffering.”
From the Bassa Community Market, vendor Nowah Kermue supported the principle of government self-reliance but said the ambulance charge should be reduced. “Things are very hard. We may not be able to pay L$2,000 for an emergency.”
Some residents noted that public hospitals were already charging unofficial fees—even when foreign aid was flowing.
“Even when USAID was active, patients were still paying under the table,” said Moses Flomo, a father of four. “Now these official charges will just worsen the situation. Government should find another way. Even after paying, you still get a prescription and no medicine.”
Human rights advocates are also pushing back, warning the new policy could effectively block access to life-saving care for the most vulnerable.
“The government can design a better way than having hospitals collect fees directly from poor citizens,” said Jesse Cole, Lead Human Rights Defender at DELTAL. “Why not allocate a portion of national revenue or taxes to support health facilities? The current approach risks excluding those who can’t pay.”
In response, local health officials argue the move is necessary to stabilize service delivery.
“This is not a new system,” said Dr. Moses Beyan, Medical Director of C.B. Dunbar Hospital, during a radio appearance in Gbarnga. “Before international aid, patients paid for services in the 1980s. We are simply returning to that model to raise funds for drugs and operations.”
Beyan described the fee structure as a “financing mechanism” to help health centers address recurring shortages in medical supplies. He said the new charges will take effect in August and are part of a broader national plan to make the sector more self-sustaining in the wake of donor cuts.
Still, critics remain unconvinced.
They argue that without safety nets or income-based exemptions, the fees could spell disaster for poor households already struggling to access basic care. As calls mount for the Boakai administration to reconsider or revise the policy, the debate underscores growing tension between economic survival and public health in post-aid Liberia.
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