IS THERE A SILVER LINING IN THE EBOLA CRISIS IN SIERRA LEONE?
The Ebola epidemic has had a serious impact on the social and economic life in Sierra Leone. After an ambivalent initial response, the measures taken by the government, and external partners, are expected to control and, eventually, end the epidemic. But, even after the epidemic ends, the physical and emotional exhaustion will slow down efforts to re-establish normal levels of activity. As people try to return to their daily routine, and businesses strive to regain normal levels of productivity, they will be constrained by the pace at which critical support services are restored. In the changed environment, standard solutions may, in some cases, no longer apply. In others, completely new problems may need to be solved. The new demands on government could overwhelm its depleted capacity.
In spite of these challenges, the impact of the crisis does not have to be exclusively negative. Ebola should not define the national identity. A crisis can create incentives for more effective government that ordinarily, economic activity cannot. Periods of crisis can be transformative, and inspire innovation to solve persistent problems. But, profound change of this nature often requires deliberate action to exploit the opportunity which the crisis creates to achieve some desirable objectives. A silver lining could emerge from the shadow of the Ebola crisis, if it becomes the pretext for initiating a serious reflection and dialogue to resolve critical issues holding back progress and development in the country. The sober mood which the crisis has created is ideal for initiating a process of introspection, aimed at using lessons from the past to construct a more inclusive path to development in the future.
Fixing the health system in the country is the obvious top priority when the crisis ends. This effort is likely to attract an influx of expert advice and funding from international donors. Many of these interventions however, may be selective, with resources concentrated in areas that are more appealing to donors, than in others which are less visible, but equally critical and deserving of support. Donor-supported projects may produce some short-term benefits. But, they will be of limited value unless they coalesce into a strong and lasting health system.
The health system however, does not function in isolation. It was evident, from the quality of the initial response to the Ebola outbreak, that institutional capacity in the country is generally weak. The Ebola crisis is, essentially, a manifestation of this weak capacity. This is cause for concern, as no country has been able to transform itself, from a weak state, to a prosperous nation, without first creating strong and competent institutions. The post-crisis response strategy should therefore be guided by a clear agenda for building quality institutions. This is where a simple process of national consultations and reflection can make a big difference, in building consensus on how this objective can be achieved.
The Structure of the Process
The intention of the national reflection is not to engage in a long process of preparing a detailed plan. It is to stimulate thinking on a post-crisis response, to enhance the capacity of government to deal with the challenges it is likely to face in the aftermath of the epidemic. The goal is to build broad consensus on applying already known solutions to some of the key problems that restrain the pace of development in the country. In addition to offering recommendations for rebuilding a health system, more capable of providing basic services, and preventing epidemics in the future, the process would also outline a strategy for creating a strong state-wide capacity with the competence to manage development more efficiently than in the past.
Institutional capacity building, however, is not a new development objective. It has been at the core of much of the external assistance that the country received over the past 50 years. The national reflection would identify why weaknesses persist, despite decades of support, and propose an appropriate strategy for the future. This effort, to construct a more sustainable development structure, would be incomplete without a clear plan of coordination, to capture the wealth of donor experiences, optimize resource allocation, minimize waste, and achieve a balanced response to the multiplicity of needs that would emerge at the end of the epidemic.
An open process that solicits contributions from a wide spectrum of views, which could be expressed through the internet and other means of communication, would give the process and its outcome wide credibility. The contributions could be synthesized by a small team of independent and apolitical citizens, with a broad range of expertise, willing to provide their services without compensation. By planning in advance, government would be able to act with agility, and decisively, when the epidemic ends. Without it, decisions on important issues may have to be made in circumstances that would increase the risk of making the wrong choices.
Some Areas of Broad Consensus
The weaknesses in the health system, which the Ebola outbreak exposed, were not a secret. The President referred to them in statements he made as early as 2009. The origins are a decade-long civil war, which pillaged an already inadequate infrastructure which, for years before the war, was deprived of resources needed to provide basic care to the population. The country’s low Human Development ranking is largely due to the poor health status in the country. Sierra Leone was already a very challenging place to expect some of the most basic health care, well before the Ebola outbreak occurred.
When the international health workers drafted-in to help contain the epidemic depart, they will leave behind a health infrastructure in deep crisis. Sierra Leone spends less than $300 per person per year on its health system and has about 22 doctors per 100,000 population, some of whom have now been lost to the epidemic. This ratio compares to 245 in the United States of America. Clearly, national investments in the health sector must increase significantly to restore services to a minimum acceptable level, and to provide leverage for additional contributions from donors and private investors. But the decline in capacity in the sector is not due to inadequate resources alone. An over-centralized management structure in the Health Ministry, in Freetown, gutted the primary health care strategy without any explicit policy being pronounced to replace it. The new investments would have to be structured for the whole-scale reform that the health sector now requires.
The Ebola crisis also complicated matters in other sectors as well. Schools and colleges were closed, in the effort to check the virus. When they reopen many students may not return. More teenagers will end up in the streets with serious social consequences. Food prices have risen appreciably, because farmers abandoned their farms. Many will not return to farming. Those who choose to stay in the urban areas will add to the large numbers looking for work. They will impose additional strains on already inadequate infrastructure in perilously over-crowded places. Scarcity of housing will push many to the slum tenements expanding on dangerous lands.
Household incomes have plummeted, as many small and medium enterprises have had to close down temporarily, or reduce working hours. Large employers, like the mining companies, have faced the challenge of scaling back their operations, while having to incur new costs to cover the contingency measures necessary to remain minimally operational. Government revenues have taken a hit, and may not recover for a while. New investments will be delayed, as investors re-assess risk factors. The state of poverty could worsen, leaving many more people living on the edge. There are new security risks as well. A weakened state could become prey to extremist groups exploiting ethnic or religious differences to foment unrest.
The most serious capacity gaps exposed by the epidemic are in the districts outside Freetown. This is an impediment to development, because the real potential of the country resides in the districts. The districts make up 90% of the land mass and provide livelihood for the majority of the population. But this potential lies fallow, as the districts are not at the centre of development policy and planning. The few districts with some minimal infrastructure have become popular destinations at weekends and public holidays. But, they are not yet places where serious investments can be made with the full assurance that property rights will be protected by internationally recognized law.
The national reflection and conversation cannot, in the circumstance, avoid a number of basic questions. Can the country develop its full potential, with 90% of the land, the biggest asset providing livelihood for most of the population, excluded from legally enforceable ownership rights? If it cannot, what then are the credible solutions that satisfy the social and cultural apprehensions that underpin the resistance to land tenure reform? Would resolving the land tenure issue lead to a better spread of development? If it will, what are the cost-effective options for decentralized development management in the country? Many of these issues have been kept out of the public discourse for too long. Any expectation that the problems they spawn will disappear, by simply ignoring them, is an illusion that only makes their resolution more difficult. It is hard to envisage any tangible progress without the land issue being resolved.
Making these issues a part of the consultations does not mean that they can all be resolved in the short time the process is expected to last. But, it will serve two ends. First, it will demonstrate that the political will and visionary leadership exist to address difficult problems. Too few leaders in the region have been willing to take decisive action to resolve critical issues on which future progress in their country depend. Second, it will serve to differentiate between institutional capacity gaps which can be addressed in the short to medium term, from those that require more in-depth exploration. Political legacies are sometimes built, not on the popular decisions governments take, but on their resolve to tackle difficult problems.
Going Back to the Future
One of the few tangible legacies of the colonial administration was the multi-disciplinary capacity that was created in each district to provide basic services to the community. This capacity was maintained for a while after independence, before it was allowed to crumble, as management in the public service was centralized in Freetown. The infrastructure in the health sector was arguably the most developed. The colonial administrators had a vested interest in maintaining a basic service to treat tropical diseases to which they had minimal resistance.
The district health service included a hospital, served by a team of doctors, dispensers, nurses, laboratory technicians, and other essential health workers. The capacity also included an Area Engineer’s office with responsibility for the maintenance of staff housing, roads, water supply, and electricity. There were teachers and agriculturists, as well as law officers in charge of safety in the district. The capacity functioned well, because each unit was led by a competent and qualified manager, with long professional experience, selected on merit. The presence of a multi-disciplinary team of professionals, with different ethnic backgrounds, created a community in which entrepreneurs could set up businesses employing the local people.
This experience demonstrates that, with the right capital, (a strong team of professionals, good organization and infrastructure, adequate financing, and trust capital), competent basic services can be provided at district level with a small team at minimal cost. Going back to the district level structure could provide an effective means for re-building minimal capacity rapidly, at decentralized levels throughout the country.
Elevating the Trust Factor
Public confidence and trust in the initial response to the crisis was limited. The skepticism that this engendered, gave rise to a number of conspiracy theories which further compromised the effectiveness of the response. What this reaction confirms is that strong institutions are desirable, not only as a source of competent professional advice, but also because they cultivate social trust. Without trust, the best actions of government may be received with suspicion and derision.
A set of complex factors are involved in the way strong and effective institutions cultivate social trust. But a glimpse of this relationship can be obtained from the experiences in some advanced countries. Germany, arguably the most successful country in Europe today, and with one of the highest levels of social trust between the government and its citizens, inherited a strong and merit-based modern state bureaucracy, well before its citizens were granted full democratic rights. Like its Scandinavian neighbours, a competent public service oversees the provision of a wide range of services to the population. In Britain, France and Belgium, where trust levels are equally high, the process of building strong, impersonal and modern state structures also preceded the consolidation of democratic contestation.
In contrast, Greece and Italy are modern countries, which have not transformed their public sector into strong and independent institutions. And, because citizens have full democratic rights, their political leaders have used public employment as a means of mobilizing voters. With the weak state institutions subservient to the interest of the political leaders, successive governments have placed family and friendship ties ahead of the national interest. The end result is a weak state bureaucracy with a chronic inability to manage national affairs to avoid repeated crises. Trust level, confidence and legitimacy of government, in these countries are among the lowest in the western world.
The United State was also, for a while, a country in which people with political connections enjoyed unbridled favours up till the mid-19th century. The country was on a path to becoming a weak state, until a strong reform coalition of the middle class emerged, following rapid economic growth, that galvanized change to replace the perverse system with a merit-based bureaucracy. The process was difficult, as without a cohesive elite class exercising a monopoly on power, reform ideas had to be argued out with a diverse society.
These examples, of the experiences in the advanced countries, show that using political patronage and jobs to mobilize votes is not an uncommon practice, and often occurs when full democracy is implanted in an undeveloped country. Distributing favours on an individual basis may have short term benefits for the recipients. However, a patronage system is a shortsighted way of managing a country’s economy. This is because it does not conduce to a broad, pragmatic policy agenda that builds a strong nation and a big economy with the potential to offer far more benefits to everybody.
Changing a weak state administration into a strong bureaucracy, in a country where full democratic rights already prevail, is always very challenging. But, the experiences in successful countries demonstrate that it can be done using a variety of methods. Reform does not have to follow a single path. The primary requirement is a strong commitment to a merit-based and impersonal state structure. It is unlikely that Sierra Leone can make rapid progress without this commitment. What is critical for this change is strong social mobilization around a reform agenda, supported by a leadership that recognizes sound institutions, operating impartially, as a pre-condition for rapid development.
The country has two choices in responding to the aftermath of the Ebola outbreak. It can choose to lament the social, economic and psychological disorientation that the crisis has caused, hoping and praying that the situation will improve over time. Alternatively, the country can seize the opportunity to develop strong institutional capabilities. Every country is an embodiment of its institutions. The weak institutions in the country made the initial response to the Ebola epidemic ineffectual and needlessly prolonged the duration of the outbreak. The crisis, none the less, could be treated as a seed which, if properly planted and nurtured, can lead to a harvest much bigger than could have been imagined before the crisis started.
In 2004, the Island of Aceh, in Indonesia, was hit by a severe tsunami. Prior to the disaster, a civil war had been raging in the territory for decades. The destruction caused by the tsunami had a catalytic effect in unifying the people, and became the turning point in the search for peace. A decade after reconciliation, there is very little evidence of the devastation the region suffered. Most important of all, the people of Aceh are now far better off than they were before the tsunami. There is no reason why Sierra Leone cannot have a similar experience with the Ebola epidemic.
(Key words: Ebola, Sierra Leone, Institutional capacity building, National development)
Babashola Chinsman is a founding partner in Manzel Prospero Consulting, MPC,—a technology and business development firm specializing in project design, management and evaluation. (www.manzelprosperoconsulting.com) Prior to joining MPC, he was a university teacher and researcher, and held senior management positions in international organizations with responsibility for technological advisory services, and national development .