This cross-cutting analysis draws on five case studies conducted by Innovations for Successful Societies under the auspices of a grant from the British Academy-Department for International Development Anti-Corruption Evidence Program. Published February 2018.

When an outbreak of Ebola virus disease began to spill over national borders in West Africa in 2014, halting the epidemic depended as much on logistics as on addressing the medical challenge the virus posed. As the rate of infection in Liberia rose in June and July, J. Dorbor Jallah of the government’s Incident Management System knew that without chlorine, protective gear, and other critical items, it would be impossible for doctors and nurses to work safely. But Jallah faced obstacles at every level of the supply chain. Uncertain estimates of need, competing product standards, and limited vendor partnerships initially hampered procurement. Cargo volume strained capacity at ports of entry, and warehouse space was inadequate—or nonexistent. The country’s limited road network hampered the transport of materials to rural areas during the rainy season. At clinics, safe disposal of contaminated items presented additional difficulties. And to make matters worse, responding organizations all had different policies and approaches. After initial disarray, the Liberian government, international organizations, nonprofit groups, and private companies began cooperating to simulate some of the features of a centralized and integrated supply chain. The volume, speed, and responsiveness of delivery increased across Liberia—just as the epidemic began to wane. The experience triggered a search for innovations that could address similar constraints more effectively during any future infectious-disease outbreak whether in Liberia or elsewhere. 

David Paterson, Jennifer Widner, and staff drafted this case study based on interviews conducted in Liberia and other countries from 2015 to August 2016.

Pfizer Inc. supported the research and development of this case, which is part of a series on public management challenges in the West African Ebola outbreak response.

Timeline: West African Ebola Outbreak (poster infographic)

Timeline: West African Ebola Outbreak (page version)

At the end of March 2014, the nongovernmental organization Médecins Sans Frontières warned that an Ebola virus disease outbreak on the border between Guinea and Liberia could unleash an epidemic of unprecedented scale. Its capacity still limited after a 14-year civil war, Liberia’s government was struggling to mobilize and coordinate the extra assistance its health ministry needed to respond. How to recruit, train, protect, and pay a labor force that included government employees, temporary workers, and many international volunteers were central concerns. In the best of times, coordinating this kind of skills supply chain would be challenging. But from June to the end of August, conditions became increasingly difficult. As the infection spread, many health workers died. In the absence of facilities and equipment that could provide protection, fear slowed recruitment—a problem made worse by severely constrained medical evacuation services and reduced airline access. Mobilizing personnel to respond raised questions about how to fulfill a duty of care toward employees, adhere to commitments to equality, and promote longer-term institutional sustainability. The Liberian government, UN agencies, and a wide variety of other organizations worked together to identify and deploy essential skills, develop shared practices, and find ways to pay Liberian temporary workers whose support was essential. UN organizations alone recruited and deployed 19,367 staff during the crisis, including Liberians, but questions remained about how to best meet the ethical and practical challenges that arose.

David Paterson and Jennifer Widner drafted this case study with advice from Béatrice Godefroy.

Princeton University’s Grand Challenges program supported the research and development of this case study, which is part of a series on public management challenges in the West African Ebola outbreak response.

Timeline: West African Ebola Outbreak (poster infographic)

Timeline: West African Ebola Outbreak (page version)