This is an excerpt from ‘The Viral World’ journal from the GP-ORF Series. Find information on the viral world in the following link: https://www.orfonline.org/research/the-viral-world-67801/
By Casely Ato Coleman
On 12 March, Ghana confirmed its first COVID-19 case. Over three months later, Ghana has 7303 confirmed cases and 34 deaths, as at 29 May 2020(1). Sierra Leone was hit by the Ebola virus from 2014 to 2016, with 14,124 cases—the highest recorded in the outbreak in any country. This included 3,589 confirmed deaths, 208 probable deaths, and 158 suspected deaths. Using frontline experiences from handling the Ebola virus, it is important to examine how leadership is the critical enabler in managing complex humanitarian crises. Lessons learnt from Sierra Leone’s experience with Ebola will show how leadership and engagement, accountability, depth of theory of change, execution and rigour can mitigate crises.
Leadership is the art of motivating a group of people to act towards achieving a common goal. This definition of leadership captures the essentials of being able to inspire others and being prepared to do (2). A crisis is any event that is going (or is expected) to lead to an unstable and dangerous situation affecting an individual, group, community, or the whole society. Crises are deemed to be negative changes in security, economic, political, societal, or environmental affairs, especially when they occur abruptly, with little or no warning. It is a period of adversity. The Business Dictionary defines it as a “Critical event or point of decision which, if not handled in an appropriate and timely manner (or if not handled at all), may turn into a disaster or catastrophe” (3).
Over the 2014-16 period, Sierra Leone had the highest number of Ebola cases ever, with each of its 14 districts affected. The first case was declared on 25 May 2014 in a region bordering Guinea, and its final case was recorded in the last week of January in 2016. By 17 March 2016, when Sierra Leone was declared free of Ebola transmission for the second time, a total of 14,124 confirmed, probable and suspected cases (nearly half the regional total) and 3,956 deaths had been reported to the World Health Organization (WHO). It was an epidemic that was defined by the UN as a threat to international security (4).
The initial response to the outbreak was characterised by confusion, chaos and denial. Sierra Leone’s health system was already weak, and the government was unable to mount a robust response. WHO did not mobilise the level of assistance and expertise expected—a failure for which it has been widely criticised. The rest of the international community was slow to react to the alert sounded by Médecins Sans Frontières, which recognised the severity of the threat early on (5).
Managing a complex humanitarian crisis requires values-driven leadership. The successful Ebola response strategy had an overarching aim of building trust, confidence and support between the general public and the leadership, which was facilitated by faith-based, traditional and secret society leaders. Their integrated response effort helped to bring the epidemic to a quick end. Leadership during times of crises require courage, political will, and the commitment to take risks. For instance, the strategy by Plan International Sierra Leone to engage with Secret Societies, with the support of the former First Lady Sia Nyamaa Koroma, greatly facilitated the social mobilisation and community engagement aspect of the fight to defeat EBOLA (6).
Leadership also requires firmness. Former President Ernest Bai Koroma’s decisions to impose a stay-at-home policy and to ban public gatherings, coupled with the decision of the presidents of Ghana and Senegal to create a humanitarian corridor to facilitate and coordinate the mobilisation of support and resources from the UN and other development agencies are examples of leaders making strong, if unpopular, decisions to manage the crisis. Sub-Saharan Africa needs leaders who will be resilient enough to take the risk of innovating during a complex humanitarian crisis (7).
Another key aspect of leadership during the Ebola epidemic was the opposition’s support of the government. Koroma reached out to two opposition leaders, Julius Maada Bio (Sierra Leone’s current president and the leader of the Sierra Leone Peoples Party at that time) and Kande Yumkella. Bio and Yumkella provided visible support to the government. Their parties also worked with the government in parliament to address key issues around the Ebola response. During emergency situations, such as Ebola, political leaders ought to work together to confront a common foe, and that is exactly what the political leaders in Sierra Leone did.
Culture plays a key role in determining the success or failure of the management of a humanitarian crisis. Culture refers to core values, artefacts, symbols, processes, systems, and stories that collectively influence the “way things are done” over some time (8). Sierra Leone’s experience with Ebola shows that a recognition of culture and customs helps to frame the level of engagement at the community, national, and global levels to effectively manage crises. In Sierra Leone, at the community level, secret society, faith-based and traditional leaders facilitated and supported ownership for community care centres, social mobilisation and community engagement. At the national level, the government actively engaged with development partners, the youth, media and political and business elites to assess the quality of the response to ensure accountability, speed and rigour. Youth groups played a key role in developing a feedback mechanism using information technology to report on real-time issues and challenges. At the regional/global level, there was active engagement with several agencies, such as the Economic Community of West African States, the African Union, the United Nations and the WHO. The EU Brussels Conference (2015) also adopted resolutions committing to mobilise resources to address the Ebola crisis (9).
Accountability and Structure
Leadership during crises requires clarity on decision space and decision mandate, backed by transparency in the communication of indicators of success to ensure that everyone involved in the response is held accountable for their actions before, during and after the emergency is over.
Sierra Leone set up a National Ebola Response Centre (NERC), which supervised the District Ebola Response Centres (DERC). The NERC was led by a CEO who reported directly to the president (10). The command and control structure during the crisis brought discipline to the response. Civil society groups and non-state actors, such as youth groups that used feedback mechanism to evaluate the response and the press that highlighted suspected cases of fraud, were also actively engaged in the process.
During the Ebola epidemic, the feedback mechanisms provided the space to hold people accountable. It is important to have a network of informants who will provide alerts and intelligence to support surveillance, isolation, contact tracing and testing strategies. Youth reporters, information focal points and community reference groups were in action to gather data on sick people in the community to alert the DERC, whose workers would then visit and confirm and be able to provide food and other basic supplies to the quarantined households.
Governments can now leverage technology and social media to ensure the availability of real-time data to guide decision-making.
Depth and Breadth of Theory of Change to Tackle Crises
Managing a complex humanitarian crisis requires conceptual clarity in a theory of change to frame the overall goals, strategic objectives and results in a framework with a focus on intermediate outcomes, outputs, indicators, and measurable activities. Sierra Leone’s Ebola response was framed around the following thematic areas: surveillance, case management, testing (of the living and dead), isolation and treatment, social mobilisation, burials and psychosocial support. This conceptual clarity helped to develop sub-themes around child protection, education, social mobilisation, community engagement, health and livelihood. In effect, the theory of change was multi-disciplinary in nature and combined biological and social science as well as preventive and curative solutions. It was not only a health issue but a socio-cultural issue, with faith and culturally based undertones. This created space for many development and social actors to support the response.
Execution and Rigour
The core humanitarian standards, launched in Copenhagen in 2014, describe the essential elements of principled, accountable and high-quality humanitarian action. Humanitarian organisations may use it as a voluntary code with which to align their internal procedures. It can also be used as a basis for verification of performance (11). They include the following nine commitments that response is appropriate and relevant; effective and timely; strengthens local capacities and avoids negative effects; based on communication, participation and feedback; complaints are welcomed and addressed; response is coordinated and complementary; actors continuously learn and improve; staff are supported to do the job effectively and are treated fairly and equitably; and resources are managed and used responsibly for the intended purpose.
Effective leadership during a crisis requires effective talent management driven by a total rewards strategy that covers compensation, benefits, performance, recognition and continuous professional development of key frontline staff and responders who design, manage and evaluate the crisis response program in alignment with the core humanitarian standards.
Execution and rigour must be backed by reliable data. Management, coordination and logistics are critical towards responding effectively to an emergency. In the case of Sierra Leone’s Ebola response, there was a clear definition of the organisational model for leadership, management, professionals, specialists, administrative roles, and the skills and expertise needed. This was backed by a clear structure with emphasis on clarity of decision space and decision mandate by key state and non-state actors. This drove execution and rigour. Also, the structured coordination of the efforts of other stakeholders via technical subject matter pillars or thematic areas was important to ensure synergy of efforts during this period. Logistics—defined as roles that facilitate disaster risk response operations and include estimating equipment needs, procurement and distribution of supplies, transport of patients and samples and other response execution resources—is very critical during a complex humanitarian crisis and must be well-planned and consistently monitored and evaluated in that regard.
Lessons for Ghana’s COVID-19 Response
The Ebola epidemic in Sierra Leone has shown that managing a complex humanitarian crisis that poses an existential threat to a country requires strong leadership at the national level, which engages broadly with key actors, and is guided by a coherent theory of change with clear strategic objectives and intended outcomes. This is reinforced by accountability for the utilisation of funds, which helps to ensure execution and rigour in the delivery of humanitarian services to the affected population.
COVID-19 has exposed Ghana’s weak health delivery system, just like Ebola did in Sierra Leone. However, the adversity caused by COVID-19 has also brought positive developments. The Ghanaian president has launched an ambitious plan to expand the number of hospitals and laboratory testing centres across the country. COVID-19 has also triggered one of the most innovative models of private-public partnerships in healthcare delivery, as the Private Sector COVID-19 Fund (put together by business and industry actors) and the military combine efforts to construct a modern Infectious Disease and Isolation Centre in Ghana (12).
The Ghanaian government has approved a stimulus package for small and medium scale enterprises to help them bounce back to business. This is undoubtedly a positive leadership step towards building resilience to kickstart the country’s economy. On the downside, the level of engagement with traditional authorities, faith-based leaders and community leaders to drive social mobilisation and community engagement around behaviour change to fight COVID-19 has been weak and needs to be strengthened. Besides, on many occasions, the execution and rigour underlining the delivery of relief items to affected communities during the lockdown period have been chaotic as social distancing protocols were not respected. Ghana’s COVID-19 response will be enhanced if there is a renewed focus on strengthening the engagement of all political leaders, so the response is devoid of partisan considerations.
- Worldometer, accessed May 29, 2020, https://www.worldometers.info/coronavirus/ country/ghana/
- Susan Ward, “Leadership Definition What is Leadership? And Can You Learn to Be a Good Leader?” The Balance, July 17, 2017. https://www.thebalance.com/leadership-definition2948275. https://www.thebalance.com/leadership-definition-2948275
- “Crisis Definition,” Business Dictionary, accessed May 5, 2020, http://www.businessdictionary. com/definition/crisis.html
- “Ebola ‘threat to world security’- UN Security Council,” BBC News, accessed May 29, 2020, https://www.bbc.com/news/world-africa-29262968
- “Report: Ebola 2014-15 Facts and Figures,” Doctors without Borders, https://www. doctorswithoutborders.org/what-we-do/news-stories/research/report-ebola-2014-2015- facts-and-figures
- Casely Ato Coleman, “The role of secret societies in the fight against Ebola in Sierra Leone,” Africa Update, Volume XXIII, Issue 2 (Spring 2016), Central Connecticut State University, http://web.ccsu.edu/afstudy/upd23-2.html#Secret
- Casely Ato Coleman, “Investing in Leadership For Development of Africa,” Africa Update, Volume XXI, Issue 4, (Fall 2014), Central Connecticut State University, http://web.ccsu. edu/afstudy/upd21-4.html#Investing
- Edgar H Schein, Organizational Culture & Leadership, Jossey Bass-A Wiley Imprint, 2004
- “The Politics Behind the Ebola Crisis,” International Crisis Group, https://www.crisisgroup. org/africa/west-africa/politics-behind-ebola-crisis
- Emma Ross, Gita Welch and Philip Angelides, “Sierra Leone’s Response to the Ebola Outbreak, Management Strategies and Key Responder Experiences,” Chatham House, March 2017, https://reader.chathamhouse.org/sierra-leones-response-ebola-outbreakmanagement-strategies-key-responder#introduction
- “Core Humanitarian Standard,” CHS Alliance, accessed on May 23, 2020, https:// corehumanitarianstandard.org/
- Naa Adjorkor Sowah, “Akufo-Addo commends Ghana Covid-19 Private Sector Fund for 100- bed treatment and isolation facility,” Joy Online, April 19, 2020, https://www.myjoyonline. com/news/national/akufo-addo-commends-ghana-covid-19-private-sector-fund-for-100- bed-treatment-and-isolation-facility/
Featured Photo: UNMEER/Martine Perret