Governance, State Fragility, and Ebola Response in Sierra Leone: Lessons from Nigeria

1. State fragility, governance, and the response to Ebola Dr Walt Kilroy Institute for International Conflict Resolution and Reconstruction Dublin City University walt.kilroy@dcu.ie @waltkilroy

2. Outline • Governance and state fragility as a factor in how effective was response to Ebola in Sierra Leone • Comparison with very effective response in Nigeria • What lessons can we learn • Very early collection of thoughts – feedback welcome

3. Where I’m coming from • Don’t have any medical training • Wasn’t involved in Ebola response • Not from the countries affected • However have carried out research in SL and Liberia on post-war reconstruction/peacebuilding – specifically how the DDR programmes were run • Governance and accountability arose, and especially corruption • Came up repeatedly, entirely unprompted, with very strong feelings

4. Parellels • Looking at the enabling environment for the war, and at the process of peacebuilding/recovery, is inextricably linked to • Governance and political will (not the same thing) • State effectiveness • Control and use of state resources/institutions • Service delivery • Social contract • Social capital – norms, networks, and trust

5. Prompts • In reading and listening about Ebola, these are factors too – along with added issues of fear, denial, and need to respond quickly, holistically, and imaginatively • Prompted by comment from a friend from the region who was clearly angry about the slow response by his own government – “months before they issued a statement” • Prompted by hearing MSF warning in first half of last year how poor the response had been and how urgent the need was to prevent Ebola spreading • Prompted by very effective response in Nigeria (timing)

6. Context • What I’m not saying • Governance issues are unique to low-income countries • That fear or denial are unknown outside W Africa • That the response was all done by outsiders – huge price paid by medical staff and community workers from the region • Ebola was as new to W Africa as it was to us • Failings of WHO overshadow all of this and have been well documented • By making that clear, I hope we can have an open discussion without our words being taken to stand for more than we actually mean

7. World Bank view of fragility • Fragility is where “states or institutions lack the capacity, accountability or legitimacy to mediate relations between citizen groups and between citizens and the state, making them vulnerable to violence.” World Bank (2011), World Development Report: Conflict, Security and Development, p xvi • “Thus, fragility and resilience are multidimensional categories that form a spectrum along which states and societies move, but in non-linear ways. Conflict and violence may feature in different ways along this spectrum.” (WB 2013, p 6)

8. OECD DAC • Fragile states “have weak capacity to carry out basic functions of governing a population and its territory, and lack the ability to develop mutually constructive and reinforcing relations with society […] [thus] trust and mutual obligations between the state and its citizens have become weak” OECD-DAC (2011), Supporting Statebuilding in Situations of Conflict and Fragility: Policy Guidance, p 21

9. Failed/Fragile State Index • Fund for Peace  http://ffp.statesindex.org/ • Like index or measure, it can be useful, if treated with caution • Twelve indicators of equal weight • Social and economic • Mounting Demographic Pressures • Massive Movement of Refugees or Internally Displaced Persons • Vengeance Seeking Group Grievance • Chronic and Sustained Human Flight • Uneven Economic Development • Poverty, Sharp or Severe Economic Decline • Political and military • Legitimacy of the State • Progressive Deterioration of Public Services • Violation of Human Rights and Rule of Law • Security Apparatus • Rise of Factionalized Elites • Intervention of External Actors

10. The Fragile States Index in 2014

11. Comparison with Nigeria • Credit to Dr Máire Connolly, School of Medicine in NUIG – DFAT seminar and follow up conversations • Nigerian outbreak • One person travelled from Liberia • Sense this was a nightmare situation, but in fact a very effective response limited this • Case often overlooked • 19 cases, 800+ direct contacts, thousands of others • People traced to Port Harcourt • Key: effective polio eradication network in place

12. Polio mechanism adapted for Ebola response • Largely Nigerian health ministry staff • Gates Foundation and CDC were also working with ministry • Key tasks for polio matched those for Ebola • Identify cases • Respond and isolate • Follow up contacts • Monitor • Effective network was in place: trained, financed, staffed • Also good leadership WHO in Nigeria with dynamic team, boosted by Ebola team from HQ as soon as initial cases were confirmed • Advantage of learning from other countries in W Africa where delays had been disastrous • Ability for quick decision-making • Generally greater capacity within health services that other W African countries

13. Sierra Leone • Poorly resourced health systems • Low staffing levels • Delays in recognising Ebola • Delays in notifying cases to Minister of Health • Weak WHO office • Poorly organised public health teams • Weak governance and state capacity are factors, especially with regard to timing • Not the only factors: other low-income countries have dealt with Ebola (DRC, Uganda) so international response is also a factor

14. Some implications • There is a need to discuss these honestly and openly, in a culture of learning rather than simply of blame • Look again at governance and state fragility theories and adapt them to this situation – social accountability and service delivery are relevant • Adding temporal aspect: speed of information flows, decision-making, and follow through