Help row, not steer: Lessons from the Ebola crisis response

The World Health Organization has been given a long to-do list, following its lackluster performance at the height of the Ebola outbreak in West Africa.

As it turns out, the U.N. health agency shouldn’t be the only one carrying such a list.

In a new report by the African Governance Initiative titled “State of Emergency,” the charity, known for working alongside government leaders to accomplish their national development goals, identified a number of instances when international development actors’ well-intentioned but uninformed actions led to delays, complications and gaps in the response.

In Guinea, surveillance teams were only able to move ahead with their policy to conduct tests on deceased persons in districts to rule out Ebola after the problem reached the government, which then released a circular making the tests compulsory. Working with the government, which is a formal structure that citizens respond to in the country, was crucial, but was missing in the early part of the response because development actors didn’t take local contexts into consideration.

In one instance, an international expert allegedly pressed for change in the way one district task force was set up, applying a structure that worked in another country. But failing to understand the local circumstances that make it unfit in that particular situation — the members of the team were not willing to be supervised by someone they considered as having less experience than them — the structure “collapsed” within a week.

In Liberia, a nongovernmental organization’s critical ambulance dispatch service delayed the work of government contact tracers, simply because the service was ran outside the government system.

Many of these instances happened because international actors had limited understanding of local contexts, adhered too much to best practices, or shied away from working with government and therefore “missed the point,” Nick Thompson, CEO of AGI, told Devex.

Thompson said local politics is a tricky situation for international organizations to navigate, and for good reason.

“But I think it comes back to the point that development ultimately has to happen in the country, and by the country, and led by the people of the country. It can’t be done to them, but by them, and facilitated by the international community,” he pointed out. “So to get to sustainable development, then we need local leaders running local systems. And it is the job of the outside world to take stock of that point, and adapt to local contexts rather than hope that local contexts will adapt to the solutions that we’re bringing.”

In reality, though, that’s easier said than done. At the height of the Ebola crisis, for example, organizations had to mobilize people quickly. And because of the nature of the crisis, most organizations’ international staff, AGI included, had to run on short-term rotation, some as short as six weeks.

The rapid turnaround meant little time to build relationships, trust and local understanding.

Some organizations also tend to focus too much on sending people with the right technical skills, but without the ability to read, adapt and understand local contexts.

The problem with flexibility

The same is true with flexibility — a critical element of the response, which was changing almost every single day.

In the report, AGI underscored the importance for international organization to be flexible, as it “often made the difference between whether things got done, and whether they stalled.”

One organization for example refused to use the protective equipment the government of Guinea purchased for those working in Ebola treatment centers, because it went against its internal policy. Another organization meanwhile was not able to immediately shift available funding to where it became more needed.

But Thompson understands it’s a real challenge, and one where a conversation needs to be had between actors, for instance, between development organizations and funding agencies.

“I do think we need a conversation about risks and how development and funding organizations understand risk taking … because the ability to flex does involve risk-taking,” he said.

He also thinks a conversation should be started on accountability — the tension between accountability to funders and “domestic audiences in the West,” as well as to the governments development organizations work with and support.

The importance of assessment, feedback

Many times in the response AGI also found itself falling into the same spheres of error.

Thompson recalled moments in Sierra Leone where AGI would push for actions on laboratory systems that it thought was the “right answer,” only to realize it’s not working and had to change its approach weeks after.

But he noted that these instances didn’t just happen within the context of Ebola, but also in normal development work.

“The crisis in some ways to me was a development story in macrocosm,” he said.

In AGI’s experience, there were times when it was working on a performance management system in another country and realized it was pushing its own ideas “too much” and had to step back, reassess with partners about what they were trying to achieve, and realign around the outcome that they wanted to work on.

This likely happens in other settings as well, and with other development organizations.

So it’s important, according to AGI’s CEO, for organizations to adopt a learning mindset and put a short feedback loop in place — which in the case of the Ebola crisis was “almost daily.” Equally — if not more critical — is the need for development organizations to be aware that they are there to facilitate change and not impose their best practice solutions.

As AGI states in its report, “This is not OUR response.”

“The response was most effective when international partners supported the governments’ leadership, strategies and plans rather than pushing their own,” according to the report.

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