When Ebola crossed into Liberia in early 2014, the West African nation had few defenses. Because no effective vaccine was available at the time, the only way to limit the spread of the viral disease was to restrict physical contact with those who were infected, what they had touched, and the bodies of victims. But that advice countermanded the most basic of human instincts: to comfort a sick child, hug an ill relative, or shake hands with a friend or coworker. The challenge of changing human behavior was especially difficult because Liberia was still recovering from a long civil war. Public distrust of government, persistent rumors, linguistic diversity, and limited communication capacity hobbled efforts to send a clear public message and win citizens’ cooperation. After top-down tactics—including forcible quarantines of whole communities—failed to stem the rate of infection, a small team of Liberian officials, supported by international partners, realized that effective steps to contain the disease would require active participation by citizens themselves. The officials engaged Liberians in developing an information campaign and recruited people throughout the country to visit their neighbors door-to-door, explain the steps people could take to protect themselves, and respond to questions. Although the complexity of the Ebola response and the volatility of the outbreak had made it hard to measure the success of the social mobilization effort in reducing new infections, an analysis of timing together with anecdotal evidence strongly suggested that the effort helped save lives and contributed to the disease’s decline during the final months of 2014.

Leon Schreiber drafted this case study based on interviews conducted in Monrovia, Liberia in April and May 2016, with guidance and additional information provided by Jennifer Widner and Beatrice Godefroy.

Princeton University’s Health Grand Challenge 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)

When the first cases of Ebola virus disease appeared in Liberia at the end of March 2014, a critical first step in preventing an epidemic was to identify those who had contracted the virus. However, Liberia’s disease surveillance capacity remained feeble in the wake of a 14-year civil war that had weakened the health system, and citizens’ distrust of the government sometimes raised risks for public health teams dispatched to carry out that vital surveillance function. In August, as the number of new infections began to escalate, the government and its international partners shifted to a proactive strategy. Rather than wait for families to call for help, they began to engage local leaders and community health workers in hunting the disease. They also developed data management practices to more effectively track and analyze the evolution of the epidemic. By year-end, most of the new Ebola infections involved Liberians who were already under observation. In another important measure of success, the time between patients’ onsets of symptoms and their medical isolations shortened markedly. The ability to hunt down Ebola slowed the spread of the disease and helped bring an end to the epidemic in May 2015.

Leon Schreiber and Jennifer Widner drafted this case study based on interviews conducted in Monrovia, Liberia, in April and May 2016 and with international organizations from June to August 2016. Béatrice Godefroy provided initial guidance.

Princeton University’s Health Grand Challenge 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)

Jonathan (Yoni) Friedman drafted this case study on the basis of interviews conducted in Monrovia, Liberia, during June and July 2011, and on the basis of interviews conducted by Arthur Boutellis in Monrovia in May 2008 and text prepared by Christine MacAulay.  Case published September 2011. A separate case study, “Building an Inclusive, Responsive National Police Service: Gender-Sensitive Reform in Liberia, 2005-2011” describes efforts to increase gender diversity and respond to high rates of sexual and gender-based violence in Liberia.

Associated Interview(s):  Bruce Baker, Ibrahim Idris, Joseph Kekula, Mark Kroeker, Robert Perito, Paavani Reddy, Aaron Weah, Peter F. Zaizay

In 2006, Saidi Mwema, Tanzania's newly appointed Inspector General of Police, launched a long-term reform program that sought to address the rising incidence of crime, the negative public perception of the police, and the lack of police personnel and resources.  The police service suffered from decades of financial neglect and a poor reputation.  Its initial mandate emphasized regime policing, which oriented the police toward maintaining law and order for the protection of the state rather than the protection of the citizenry.  On taking office, Mwema took bold steps to set a new tone for the police, including releasing the private telephone numbers of the police hierarchy and initiating investigations into suspected donors to the ruling Revolutionary State Party.  He followed these initial reforms with a strategy-delineated by a "team of experts" comprising senior police officers and academics from the University of Dar es Salaam-to address the weaknesses of the police service.  Though the reform process remained in its early stages in 2009, some progress was evident, primarily in the improved reputation of the police and more amicable relations between the police and the public.  The case offers lessons for police services seeking to overcome poor reputations and community distrust through the adoption of a community-based ethos after decades of state-oriented policing.

Daniel Scher drafted this case study on the basis of interviews conducted in Dar es Salaam, Tanzania, in August 2009. Jonathan Friedman contributed. 

Associated Interview(s): Lucas Kusima, Benson Bana, Semboja Haji, Sifuni Mchome

Morgan Greene, Jonathan Friedman and Richard Bennet drafted this case study on the basis of interviews conducted in Priština and Mitrovica, Kosovo, in July 2011, as well as interviews conducted in Kosovo by Arthur Boutellis in July 2008. Case published February 2012.

Associated Interview(s):  Shantnu Chandrawat, Julie Fleming, Iver Frigaard, Oliver Janser, Reshat Maliqi, Muhamet Musliu, Robert Perito, Behar Selimi, Riza Shillova, Mustafa Resat Tekinbas

Nitish Kumar was elected chief minister of Bihar, India’s poorest state, in December 2005, when the state’s government was weighed down by two decades of institutional decline, widespread lawlessness and a society deeply divided by caste and religion. Improving law and order was a major priority of his new government. The main challenges were rampant criminal activity that curtailed social and economic life, a short-staffed and under-motivated police force, widespread corruption in the ranks, and the poor image of the Bihar police. Using innovative measures, Kumar and his top police officers set out to rid Bihar of its so-called jungle raj, or law of the jungle.