In 2003, after 14 years of civil war and as many failed treaties, representatives of Liberia’s government, rebel groups, and civil society came together in Accra, Ghana, to negotiate a peace agreement. They chose Gyude Bryant, a businessman unaffiliated with any of the factions, to head a transitional government made up of ministers from the incumbent political party, the two main rebel groups, and independents, including opposition politicians and civil society leaders. Bryant’s primary goals were to maintain peace and pave the way for elections by the end of 2005—an assignment that entailed disarming and demobilizing more than 100,000 combatants, creating the means to deal with crucial issues ranging from truth and reconciliation to governance reform, and addressing a long list of other tasks—all of it under the scrutiny of Liberia’s legislature as well as regional and international organizations. Although successful democratic elections in late 2005 marked the achievement of Bryant’s primary aims, his fractious government failed to reach many other objectives, including building capacity and ensuring that resources earmarked for development served their intended purposes. The difficulties led to a novel, temporary system of governance—shared with international partners—that targeted procurement, spending, and other aspects of financial management. This case offers insights useful for planning transitions in low-income, divided societies where prolonged conflict has gutted institutional capacity.

Tyler McBrien drafted this case study based on interviews conducted in Monrovia, Liberia in November 2019. Case published in January 2020.

This series highlights the governance challenges inherent in power sharing arrangements, profiles adaptations that eased those challenges, and offers ideas about adaptations. 

The United States Institute of Peace funded the development of this case study.

During the first decade and a half after Nigeria returned to democracy in 1999, the country struggled to adequately fund its primary health care system. Despite a nearly 10-fold increase in the size of the economy, Nigeria in 2014 was still spending only US$11 per capita on health care—equal to only 6% of total government expenditure and far below regional norms and the nation’s own stated aspiration. As a result, Nigerian citizens were paying 69% of their medical expenses out of pocket, and the cost discouraged many from seeking treatment. A new National Health Act, adopted in 2014 after a decade of delay, raised hopes for a solution by stipulating that at least 1% of the government budget go into a new fund to improve basic services provided at the thousands of primary health care clinics located throughout the country. However, owing to Nigeria’s longstanding neglect of primary health care, there was a real risk that the fund might never become reality. To demonstrate the viability of the program and press for its implementation, the federal health ministry, led by Minister Isaac Adewole, developed operational procedures that spelled out crucial steps to ensure financial accountability and transparency, won international backing for a pilot project that would validate the system, and built a support coalition that spanned the government and civil society. The effort took three years, but in 2018 the Nigerian legislature passed an appropriations bill that for the first time included the 1% allocation for the fund—significantly boosting the resources available to improve the quality and accessibility of primary health care services across Nigeria. Even more significantly, in September 2019, the government declared the fund a statutory allocation that it would automatically renew every year, and clinics in three states began receiving the new resources in November 2019.

Leon Schreiber drafted this case study based on interviews conducted in Abuja, Nigeria, in July and August 2019 with the help of Bunmi Otegbade. Case published November 2019.

Narrowing the gap between rich and poor was a top priority for Teresa Surita, five-time mayor of Boa Vista, Brazil. Surita had long viewed early childhood development services as crucial for improving life chances and attaining that goal, and she had partnered with several programs to expand parent coaching and other opportunities. As her fifth term began in 2017, she turned to a program called Urban95, which called for making a top priority the needs of young children and their families in all of the city’s planning and programs. Building on work the city had already done, Surita and her department heads undertook projects that included adapting a neighborhood to the needs of young children and their caregivers and building a cutting-edge data dashboard and alert system designed to ensure citizens would get help when they needed it. The city sought to keep those efforts on track while also extending assistance to families among the refugees fleeing deprivation and violence in neighboring Venezuela. As the term of the initial phase drew to a close in September 2019, municipal officials began to take stock of progress and results. Despite some philosophical disagreements and some uncertainties about the future of vital federal funding, the city was on track to achieve its project goals. 

Bill Steiden drafted this case study based on interviews conducted in Boa Vista and Sao Paulo, Brazil, in July and August 2019. Case published October 2019. The Bernard van Leer Foundation supported this case study to foster early-stage policy learning.

In 2014, an unprecedented outbreak of Ebola virus disease in Liberia, Sierra Leone, and Guinea shined a harsh spotlight on global capacity to deal effectively with a fast-moving epidemic that crossed international borders.  By the end of July, the outbreak had started to overwhelm health care systems in all three affected countries. In Liberia, health centers began to close, and President Ellen Sirleaf appealed for help from the United States. President Barack Obama tasked USAID’s Office of US Foreign Disaster Assistance (OFDA) to lead an interagency response. From early August 2014 to January 2016, an OFDA Disaster Assistance Response Team, or DART, deployed to Liberia to help coordinate efforts to stop the spread of infection. The DART was the first to involve a large-scale partnership with the US Centers for Disease Control and Prevention (CDC) to combat an infectious disease outbreak. Although the deployment, which scaled up earlier assistance, took place five months after the first reported cases and required extensive adaptation of standard practices, it succeeded in helping bring the epidemic under control: the total number of people infected—28,616—was well below the potential levels predicted by the CDC’s models. This US–focused case study highlights the challenges of making an interagency process work in the context of an infectious disease outbreak in areas where health systems are weak.

Jennifer Widner drafted this case study based on interviews from August 2016 to August 2017. The case is part of a series about the Liberian response to the 2014 Ebola outbreak, available through the Innovations for Successful Societies website. Case published June 2018. IBM’s Center for The Business of Government helped finance this case study.

By the early 2000s, traffic in Senegal's capital city of Dakar had become unbearable. A skyrocketing number of vehicles strained the city's infrastructure, and traffic jams choked not only the major road into and out of town but also the region's economic growth. A new highway that would ease road congestion had been planned decades earlier but had been shelved because of the cost, complexity, and difficulty of financing. Abdoulaye Wade, elected president in 2000, sought a new solution: a public-private partnership. The plan called for a private company to contribute a portion of the cost of the highway's construction and then to maintain the highway-in exchange for toll revenues-with the rest of the up-front costs borne by the government. Executing the first such partnership of its kind in the region would not be easy. In addition to identifying and resolving complex technical and financial aspects of the partnership, government planners had to find ways to mitigate extensive social and environmental impacts of the project-including the displacement of 30,000 people from their homes and businesses. Senegal's newly created Agency for Investment Promotion and Major Works led the process of selecting the partner company, overseeing construction, and coordinating implementation with institutions ranging from Senegalese ministries to international development banks and community associations. Once it opened in August 2013, the Dakar-Diamniadio toll highway saw greater use than expected and alleviated congestion in the capital. But delays in the resettlement of people displaced by the project meant that some problems persisted into 2016.

Maya Gainer, ISS Research Specialist, and Stefanie Chan of Sciences Po's Paris School of International Affairs, drafted this case study based on interviews conducted in Dakar, Senegal, and Abidjan, Côte d'Ivoire, in January 2016. This case study was funded by the French Development Agency. Case published May 2016.

In mid 2014, health-care services in Liberia were being overwhelmed by the largest-ever outbreak of Ebola virus disease. Transmitted through contact with the bodily fluids of an infected person, the disease was spreading at a rate of 80 new cases per week by the end of July, killing up to 70% of the people it infected. The country’s fragile health-care system, damaged by a 14-year civil war, could not respond to all of the demands it faced. The rate of new infections rose, and schools and health facilities closed. Collaborating with international partners and five months into the epidemic, the Liberian government created a dedicated Incident Management System (IMS) to coordinate all elements of the country’s fight against the disease. The IMS team created a clear decision-making framework, provided responders with adequate infrastructure and technical support, and set up a coherent procedure for communicating with a frightened and anxious public. At the end of the outbreak, the question was whether Liberia’s approach had provided a model for managing responses to infectious disease outbreaks in other, similar settings or whether the approach had left room for making the system work better.

Leon Schreiber drafted this case study in consultation with Jennifer Widner of Princeton University based on interviews conducted in Monrovia, Liberia and London in November and December 2015.

Princeton University’s 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)

The January 2009 presidential transition in Ghana, the West African country’s second democratic transfer of power between opposing parties, was a significant step in the nation’s democracy. A contentious handover eight years earlier had widened political divisions and hindered policy continuity. In the aftermath, leaders in government and civil society tried to create new norms and practices that would ease transitions. Ahead of the December 2008 election, the Institute of Economic Affairs, a Ghanaian public policy think tank that promoted good governance, led major political parties in talks aimed at setting rules for the presidential transition process. At the same time, a policy unit in President John Kufuor’s administration worked separately to improve the government’s procedures for transferring power. Although a tight timeline and political complications prevented both groups from achieving all of their goals, their work helped ease Ghana’s political tensions and improved the quality of information exchanged between the outgoing and incoming governments. The new government, led by President John Atta Mills, benefited from improved transition reports prepared by civil servants and aides who had taken part in the Institute of Economic Affairs talks. The changes helped the new administration organize, identify priorities, and maintain focus on effective projects and programs.

Robert Joyce drafted this case study based on interviews conducted in Accra, Ghana, during July and August 2015. Case published in November 2015.

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)

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)