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ISS MONTHLY NEWSLETTER
When Ebola first appeared in West Africa in late 2013, Guinea, Sierra Leone, and Liberia, the three most affected countries, had few defenses. A new series of ISS case studies profiles key public management challenges governments, NGOs, and international organizations confronted as they tried to contain the infectious disease outbreak. It highlights important innovations and the continuing need for new approaches.
The five cases in this release focus on national coordination, social mobilization, disease surveillance, supply chain management, and filling skill gaps. An additional profile of the US interagency disaster response will follow.
UNICEF conducted a "mop up" campaign in the Tewor district of Liberia to help communities wipe-out Ebola,
In mid 2014, Liberia's fragile health-care system, damaged by a 14-year civil war, could not respond to the demands posed by the largest-ever outbreak of Ebola. The rate of new infections rose, and schools and health facilities closed. Collaborating with international partners, the Liberian government created a dedicated Incident Management System (IMS) to coordinate the country's fight against the disease. The IMS team created a clear decision-making framework, facilitated coordination, and set up a coherent procedure for communicating with an anxious public.
Liberia had few defenses when Ebola entered the country. Lacking an effective vaccine, containment efforts focused on restricting contact with those who were infected and anything they had touched. That advice countermanded basic human instincts to comfort a sick child or shake hands with a friend. After top-down tactics to win citizens' cooperation failed to stem the rate of infection, officials recruited community residents to go door-to-door, explain how people could protect themselves, and answer questions---helping to stem the spread of the disease and saving countless lives.
International Organization for Migration Ebola treatment unit in Sinje, Grand Cape Mount, Liberia.
When Ebola appeared in Liberia, a critical first step was to identify those who had contracted the virus. However, Liberia's post-civil war disease surveillance capacity remained feeble, and citizens' distrust of the government posed a challenge for public health teams tasked with surveillance. To overcome these challenges, the government and its international partners engaged local leaders and community health workers in hunting the disease and developed data management practices to more effectively track and analyze the evolution of the epidemic. By year-end, most new Ebola infections involved Liberians who were already under observation.
When Ebola began to spill over national borders in West Africa, halting the epidemic depended as much on logistics as on addressing the medical challenge the virus posed. Without chlorine, protective gear, and other critical items, doctors and nurses could not work safely. But responders faced obstacles at every level of the supply chain. After initial disarray, the government, international organizations, nonprofit groups, and private companies developed a more centralized and integrated system. The volume, speed, and responsiveness of delivery increased across Liberia just as the epidemic began to wane. The challenges triggered a search for innovations that could address similar constraints during future infectious-disease outbreaks.
Mobilizing and coordinating the assistance needed to respond to the Ebola outbreak challenged the Liberian government and international responders alike. Without adequate facilities and equipment, fear slowed recruitment, a problem made worse by constrained medical evacuation services and reduced airline access. Responding organizations owed a duty of care to their employees, and they worked to assemble the "space, supplies, and systems" that could reduce risk. They also sought to promote equity between Liberian and international responders and resilience in Liberia's health system. Gradually governments, international organizations, and voluntary groups were able to deploy thousands of health workers to help contain the epidemic. Lessons drawn from the experience prompted changes in policy and practice.
In a 2015 interview with ISS, Dr. Mosoka P. Fallah discusses the evolution of the Ebola response in Liberia, highlighting the failure of the initial top-down approach in city districts and describing the process of developing a bottom-up approach which engaged local leaders in finding cases and building knowledge about the disease. The founding director of the newly established National Public Health Institute of Liberia, Fallah also provides insight on how a lack of resources and coordination among various supporting NGOs and government teams led to a prolonged epidemic in Liberia.
May 31-June 1, 2017
Marking the launch of our new series of case studies about innovative practices and technologies in the land sector, we're hosting a two-day workshop to highlight key lessons and provoke thinking about implications for tenure security around the world. Co-sponsored by the Omidyar Network and New America Foundation, the event will feature insights from reform leaders, critical discussion with experts, and sessions focused on property rights case development and teaching. Sign up here to receive more details.
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Innovations for Successful Societies (ISS) is a joint program of Princeton University's
ISS Monthly Newsletter Archive