Similar health emergencies, different commitments: Comparative strategies to end Ebola and COVID-19 in "post-conflict" Liberia.

Abstract

Liberia, in the face of two consecutive health emergencies - the Ebola epidemic in 2014 and COVID in 2019 - offers a unique, comparative perspective on health crisis management within a fractured healthcare system. In dialogue with a feminist-informed political economy of health in the African context, this paper has two central objectives. First, it examines the strategies employed by community-based women's organisations - many of whom remain invested in peacebuilding after a 14-year civil war (1989-2003)) - to contain the Ebola and COVID-19 disease outbreaks. Second, it explores the implementation strategies under two political administrations, Sirleaf (Ebola) and Weah (COVID-19), at two distinct political moments. Results from five focus group discussions (n = 27) and seven in-depth interviews (n = 7) suggest that, while there was a relative collective effort from the Liberian government, grassroots women's organisations and community members to contain the Ebola epidemic response, the COVID-19 response witnessed an individualistic approach. Overall, participants suggested that lessons learned from the Ebola epidemic did not seem to be transferred to managing the COVID-19 pandemic in Liberia. The study suggests that while local-government-international partnerships are instrumental in ending health emergencies, grassroots community organisations require economic and social resources and sustained political will to effectively build and maintain various health infrastructures in post-conflict countries. This is relevant not just for managing disease outbreaks and health emergencies but also for entrenching public health services to support population health. Here, lessons from Ebola and COVID-19 rooted in everyday experiences of women's reproductive labour can provide an educational foundation for responding to future disease outbreaks in Liberia and other post-conflict contexts.