Ebola, health systems and the human face of capacity

The West African Ebola crisis exposed two things: the underlying weaknesses of the sub-region’s health systems, and the limits of aid-driven approaches to capacity building. While the first has received extensive coverage, the second has been far less talked about – even though it helps account for why health system weakness persisted for so long.

Capacity building is the backbone of international development. As an idea it is broadly defined: spend foreign aid in a way that enables ‘recipient’ countries to become ‘self-sufficient’, to be able to solve domestic problems without international assistance. But in practice it tends to be narrowly operationalised. More often than not, capacity building is reduced to the transfer of knowledge to specific individuals: provide frontline health workers with technical know-how, run a workshop for management professionals, instruct communities how to act when the symptoms of an escalating virus emerge.

They say that knowledge is power. But there are constraints on what a knowledgeable person can do. The extent of these constraints depends on who you are and what the nature of your wider environment looks like. Do you, for example, have ‘enough’ autonomy to act in a certain way? And does your environment provide the right incentives for you to translate new knowledge into sustained behaviour? Because if it doesn’t, chances are you won’t.

Since 2013, we have been doing research in Sierra Leone, looking at how state capacity can be strengthened to prevent malnutrition – a condition that accounts for almost half of all under-five mortalities in the country. Together with Focus 1000, a Freetown-based NGO, we studied how international capacity support has been practiced in the nutrition sector…until Ebola’s spread intervened.

To read the full text of this blog, visit the Lancet Global Health blog.