Ebola shocked us all. In early 2014, Guinea and Liberia thought they had eradicated the apparently small outbreaks in their countries. But in the middle of 2014 the disease came back, spreading at an exponential rate as it moved into the urban areas of Liberia, Sierra Leone and Guinea. It was the first time an Ebola outbreak had reached such densely populated regions. The situation was unforeseen and the right response untested. While the catastrophic predictions of 10,000 cases per day never materialized, the epidemic has been a tragedy for the three countries, killing over 10,000 people and setting back development after the progress each made in recent years.
The Tony Blair Africa Governance Initiative (AGI) had never worked in a crisis before and yet by December 2014 one third of our 50-person organisation was working on the Ebola response. Why? First, we’d worked in Sierra Leone, Liberia and Guinea for years. Being government-led is at the core of our approach, so we asked our partner governments frankly if they wanted us to stay and what they wanted us to focus on. They answered ‘yes’ and ‘Ebola.’ Second, in July and August as the epidemic worsened, our staff, who live and work in the affected countries, began to see that while Ebola looked like a purely medical problem, in reality it was 'a systems problem', in the words of Peter Graaff, today Acting Special Representative for the UN Mission for Ebola Emergency Response. One of the biggest challenges would be how the governments could manage this complex response. Unlike running a special treatment unit or advising on the epidemiology of the disease, this was something we and our partner governments felt AGI could be useful in supporting.
We have worked on different things as the disease and the response took different paths in different countries. From working with the Presidents and their top advisors directly in each of the three countries, to supporting technical areas like social mobilisation in Liberia and data systems in Sierra Leone, to the setup and management of different coordination bodies, such as the National Ebola Response Centre in Sierra Leone and the Incident Management System in Liberia. One of the lessons is that there is no off-the-shelf approach to a crisis like this, so the shape of our advisors’ work was different according to what each country needed.
The Ebola outbreak in West Africa is not over, but we think there is already a lot to be learned for governments and international partners facing the next complex crisis. In the words of OB Sisay, Director of Sierra Leone’s National Ebola Response Centre ‘there are no perfect Ebola fighters, everyone is learning.” We have developed this piece, part of an ongoing series of case studies on our work, by reflecting on AGI’s experience and by gathering the views of government colleagues and international partners. The lessons in this paper are for three groups: political leaders, governments and international partners (including AGI).
Lessons for Political Leaders
AGI has had the privilege of working with the Presidents of Sierra Leone, Liberia and Guinea for several years and we have supported the Presidents’ engagement in the Ebola response. We have seen how indispensable political leaders were in this crisis and seen these Presidents play three critical roles: symbol, system-builder and decision-maker.
There is no substitute for political leadership.
The leaders have been essential in getting their countries through this unprecedented crisis. They have played three special roles:
i) Symbol: being seen to lead
ii) System-builder: putting top people in charge to manage the crisis
iii) Decision-maker: the buck stops with you, you can delegate work but you cannot delegate accountability
Lessons for Governments
The Ebola response was complicated, with lots of moving parts, including thousands of national staff. In October 2014, the UN estimated that only two percent of those involved in the response would be internationals. Underneath the countries’ political leaders, governments needed to manage a multitude of activities and people to make sure they fit together in a coherent system, which recognises the cultural and political context.
Don’t go it alone - Governments need to steer but everyone needs to row
Put in place systems and structures to allow government to make the right decisions
Effective management systems are the beating heart of an effective response. Two important lessons for how to get this right are:
i) Keep it simple, get it started and adapt it
ii) Work out what information decision makers need
Lessons for International Partners
International partners have been heroes during this epidemic. International expertise and financing have been essential. But there are also things that international partners, and we include ourselves in this category, could have done differently. We need to keep these in mind for next time.
This is not OUR response
No one had more at stake than the governments and people in the affected countries. The other half of the ‘don’t go it alone’ lesson for governments is for international partners: the response was most effective when international partners supported the governments’ leadership, strategies and plans rather than pushing their own.
Underpinning this are two things:
i) You will save more lives if you help government manage the crisis without creating parallel systems
ii) Be clear about what you can and cannot do
Because this Ebola outbreak was unprecedented in scale and complexity and evolved in unexpected ways, the response needed to be constantly adapted.
Understand the culture and context
For more obviously cultural issues – like the fact that many traditional burial practices in West Africa involve touching the deceased which increased the spread of the disease - partners generally did their best to tailor their approach. But too often partners failed to see that local context and politics mattered for seemingly more technical aspects of the response.
These lessons are for political leaders, governments and international partners, for the next crisis, whatever and wherever it is. But they are equally important to driving improvements in Liberia, Sierra Leone and Guinea as the governments begin to transition from managing Ebola, to economic recovery. As the three countries look to rebuild their health systems, political leadership, collaboration and effective systems are as important as ever. As international partners, we should not forget what we have learned in taking our cues from the government, continuing to be flexible and remembering the importance of context. It took these elements to manage Ebola, it will take them too to rebuild better.