It had been less than a week since the first case of the new coronavirus was confirmed in Bolivia when, on March 29, businessman Richard Sandoval died of the virus on his way to a hospital in El Alto, the city that adjoins La Paz. He was one of the very firsts fatal victims of the virus in the country, but his death was especially shocking for Bolivians because of his relatively young age (he was 50) and because he apparently had enjoyed good health before getting the new virus, two uncommon traits of those dying from COVID-19. It was also shocking, particularly for the elites, that Sandoval’s upper-class status –which in countries like Bolivia dramatically improves the access to good healthcare– apparently didn’t help him. Based on what was already known at the time, Sandoval’s chances to survive should have been high, even if he had to lay unconscious at an ICU bed –which in those early days of the emergency were still available– for weeks. But he didn’t even have the chance to fight the illness.
Once the details surrounding Sandoval’s death were known they revealed a serious lack of preparedness and coordination between the different actors in the health sector. In the weeks that followed, Bolivians would face more anguishing consequences of bad governance in the response to the health crisis, just as many other countries –including some developed ones– would do. Although corruption and the political crisis Bolivia was facing since October 2019 played a big role in diminishing the country’s capacity to deal with the emergency, it was also evident that the decision-makers’ inability to recognize the nature of the crisis (as highly complex and uncertain) and to respond accordingly led to actions and strategies that lacked the necessary flexibility to correct mistakes on the way. This plunged the country into vicious dynamics where any effort made didn’t seem to make any difference on the outcomes.
In a globalized and increasingly complex world where temperatures rise and technological hazards multiply, we can expect more and more challenges with uncertain outcomes to appear. It is pressing thus to rethink the way we deal with those challenges; Adaptive Governance may provide us a suitable framework to do so. For now, I think it provides us with useful tools to understand why our crisis management systems fail when they do, as they did during the COVID-19 emergency.
Understanding ‘governance’ as the set of processes and interactions between the governmental and non-state actors from which the decisions steering societies arose, Adaptive Governance focuses on the aspects of governance that help to increase societal resilience by strengthening the adaptive capacity of its institutions and actors. Its principles lie under the assumption that, in order to deal with uncertain situations such as those posed by disasters, a system should be able to constantly gather information, learn from it, and be flexible enough to take corrective actions based on what is learned [1].
The uncertainties surrounding a crisis can be both scientific –when science is contested due to lack of research– as well as about social values when perceptions and judgments regarding threats vary within a community. The scientific uncertainties surrounding COVID-19 at the beginning of the pandemic were unusually high if we compare it with other challenges we had dealt with in recent years: being a new virus strain, specific research on the virus was nonexistent. Social values surrounding the COVID-19 crisis were also highly contested. Concerns over threats to the well-being of the population most vulnerable to the illness clashed with distress regarding the fears of future shocks to the economy. In developing countries with high rates of informal employment, as in Bolivia’s case, people also had to internally negotiate between the risks of getting infected while making their day-to-day income, and the risks of hunger or eviction if they stopped going to work and getting that income. Finding the right way to respond was not an easy task.
In such situations counting with agreed protocols or plans, although potentially useful if they are conceived as general guidelines, may backfire if too strict: as the emergency unfolds, new information that was not considered during the elaboration of those protocols or plans will certainly come, making them obsolete. This is why, along with learning, flexibility is one of the core features of Adaptive Governance. Its importance when facing contingencies is perhaps no better expressed than in Eisenhower’s immortal quote “plans are useless, but planning is central”, which suggests the unavoidable iteration of the processes we use to approach uncertain situations.
It was in fact an ill-conceived protocol along with the incapability of first responders to recognize its limitations and make corrective decisions on the spot which prevented Sandoval from getting timely assistance. He had started to feel the symptoms the day after arriving in La Paz from New York (a global hotspot at the time). After self-isolating at his home for a week, his condition worsened and he decided to seek medical assistance at a private hospital that was well-equipped with ICU beds and respirators. In the meantime, he was tested positive for the virus. After being informed about it by the authorities, the private hospital decided to transfer the patient to a public hospital that was designated by the Health Ministry to treat COVID-19 patients. Once there, Sandoval would realize that the public hospital lacked ventilators and intensive caretakers. His health kept deteriorating, so his family, according to their statements, tried to take him back to the private hospital where he was first attended, or to any other that could give proper assistance. All the private hospitals rejected the demands, arguing lack of conditions to receive a COVID-19 patient. He died while being transferred to another public hospital.
What first stands out from these events is the centralization of the response in the State, which left treatment and care in the hands of only a few facilities and healthcare professionals, even when it was clear that the virus would very likely spread quickly across the population. It was clear that this protocol was fundamentally wrong. The best way to deal with scientific uncertainties is through multi-disciplinary collaboration. Eisenhower’s point with his plan-vs-planning take was also that the process of planning allows us to think who the relevant actors to collaborate with are and to bring them together to discuss and come up with the plan. Only the fact of actors from different disciplines and sectors meeting each other, seeing their faces, and exchanging presentation cards is already almost as important as coming up with a plan. In other words, the process of planning should foster self-organizing networks, another relevant feature of Adaptive Governance that allows actors to see beyond written plans and abstract systems and reach each other also through informal channels.
Since it is unrealistic to believe that the idea of making private hospitals part of the process was never considered in Bolivia, Sandoval’s death suggests that, while acknowledging their relevance, for some reason they never get to sit at the table with the government to discuss the way the crisis would be handled. The reason was likely a profound lack of trust between both sectors, which is still no excuse for privates hospitals to stand out from the response to one of the biggest health emergencies the country has ever dealt with. Sandoval’s family believe something like the latter happened and the hospital just got rid of him because they didn’t want to have anything to do with the COVID-19 response. This would be outrageous, but it would also show political inability from the government, which was unable to persuade important actors.
But if a private hospital was hard to engage with, the civil society was even a greater challenge. Bolivia’s known high vulnerability to the pandemic meant that there were not many response options besides stiff lockdowns, which would put thousands under high pressure giving the country’s high rates of poverty and informal jobs. In order to mitigate the impacts of lockdowns on households, the government transferred cash to the most vulnerable. But many in the popular sectors were still extremely distrustful of the government. Trust in public institutions had been decreasing in the last couple of years and the country was living in a constitutional crisis since 2016. Not only had President Jeanina Áñez come to power after political turmoil in 2019 that many saw as a coup d’état, but she was a complete stranger for many who didn’t even know about her existence only four months before. This complicated things, since distrust in the government would mean even lower motivation to comply with measures. In other words, there was high uncertainty regarding social values, so the flow of information had to be facilitated as much as possible. People had to be informed and sensitized about the hazards they were facing and authorities had to have a clear picture of what was worrying people the most. Then, being conscious about its unpopularity, the government should have looked for the right communication channels, which may involve approaching third parties that have both the trust of the people, and a presence at the grass-roots level.
Unfortunately, the Bolivian government chose the opposite and took a command-and-control approach as if it was crystal clear what to do and how to do it. There are painful videos showing authorities ineffectively yelling at people to comply with lockdown measures, or soldiers abusing people for standing outside their doors. At a certain point, the Minister of Interior threatened to put local authorities into jail after they pointed out that some orders were simply not possible to fulfill due to specific local conditions, which is probably the best example of how a command-and-control approach blocks information flow and blinds decision-makers.
It would be foolish however to think that problems like the ones described are unique to developing countries. Many countries around the world were also slow in taking timely actions due to similar reality-vs-expectations-vs-plan issues. As author Debora MacKenzie points out [1], one of the first failures around the world was responding to a Coronavirus pandemic using national plans that were made to control new types of flu, which up until 2019 was expected to be the big pandemic hitting us and which requires a different type of response. The UK’s decisions regarding who to sit at the decision-making table (their Scientific Advisory Group for Emergencies) was also deemed as not only inappropriate but disgraceful. Not to mention the US, where the Federal government’s willingness to support States was conditioned on political loyalty, and whose president showed something like real concern for the first time only on March 17, a day after Sandoval had returned to Bolivia carrying the virus with him from New York.
So why do institutions fail to adapt?
Perhaps the greatest challenge of Adaptive Governance is fostering the adaptive capacity of institutions, which are by definition conservative and non-flexible. Rigidity in the form of bureaucracy is the way institutions guarantee public trust; for instance, the methods for gathering the data regarding the COVID-19 sick and deceased must be rigid enough to ensure quality standards and trust, which takes time. But there are other reasons why sometimes institutions and organizations are slow to adapt. Corrective actions and institutional learning are not very popular and they can lead to a loss of legitimacy. Just as an example, the US CDC stating that masks are not necessary for healthy people at the beginning of the pandemic and then stating the opposite at a later stage of the emergency was taken as ineptitude by many Americans who were unaware of the inherent uncertainties of situations like the one we have experienced this year. This is part of what has been called a secondary risk (physical risk being the primary) or an institutional risk, and it can also lead to people in charge to justify actions or inactions by putting the blame on institutions: What was the response of the private hospital that “got rid” of Sandoval when questioned about it in Bolivia? that they were simply following protocol.
One way to deal with secondary risks is building trust in the institutions by improving communication and strengthening transparency. These are some of the elements researcher Joyeeta Gupta and others have identified as key indicators for the adaptive capability of institutions and organizations, which are summarized on what they have called “The adaptive capacity wheel”[2]. The wheel is a useful collection of 22 indicators grouped in 6 categories which include fair governance and learning capacity. Some of these indicators have been addressed above: legitimacy, trust, multi-actor, -level and -sector approach, and collaboration. But what about learning?
We have seen a specific case at a specific stage of Disaster Risk Management (DRM) — the response to a pandemic. But adaptive governance is not only about the DRM cycle — prevention/mitigation, preparedness, response, and recovery — and their application to a particular hazard. It requires taking an integral view of hazards and going beyond crisis management towards resilience. The capacity to learn is the cornerstone of resilience. A way to understand and address institutional learning is through what is called single and double-loop learning. Single loop learning happens when a routine, procedure, or strategy is improved after showing deficiency, while double-loop learning happens when customary assumptions and models behind actions and strategies are put into question. A third scope of learning has been proposed to deal with more infrequent challenges, and since we are in the middle of one such challenge, it is worth mentioning. Under a triple loop learning process, the values, principles, and norms behind assumptions are questioned, and as a result, the institutional values, goals, and vision are modified. In order for these learning loops to happen some conditions must be fulfilled. Having trained staff with low turnover are some of the conditions which are especially challenging for developing countries such as Bolivia.
Learning is key to adaptation and resilience, but so are decentralization and collaboration. In capitalist societies, decision-making processes are supposed to be decentralized. Private companies have a greater capacity to adapt to short-term changes and they can give flexibility to governance systems. Those are some of the reasons why the State has been handing over to private companies the responsibility of providing many services that were traditionally in its hands. Far-reaching, long-term challenges are however less fit to the profit-oriented private sector. Thus, the market and the State are not and should not be the only actors making relevant decisions. Grassroots communities, NGOs, and Academia are key components of the national governance constellation as well, and they all will have to closely collaborate in order to deal with future challenges. They will also have to not only strengthened formal relationships with international actors (a task that is facilitated by organizations such as the WHO) but also build informal bridges with other institutions around the world. Such overlapping, sectoral and institutional diversity grants strength to the system given that an organization may work where other fails. After all, one of the few success stories from the current pandemic came from an informal international network, which was the first to sound the global alarm of COVID-19 in a time when the Chinese government was erratic and the WHO was facing a legitimacy crisis: ProMED, a non-profit online moderated forum where doctors, vets, epidemiologists, farmers, and others report medical events regarding infectious diseases.
[1] A. Hurlbert, M. (2018). Adaptive Governance of Disaster. Springer International Publishing.
[2] MacKenzie, Debora (2020). COVID-19: The Pandemic that Never Should Have Happened, and How to Stop the Next One. Hachette Books. New York.
[3] Gupta, J., Termeer, C., Klostermann, J., Meijerink, S., van den Brink, M., Jong, P., Nooteboom, S., & Bergsma, E. (2010). The Adaptive Capacity Wheel: A method to assess the inherent characteristics of institutions to enable the adaptive capacity of society. Environmental Science and Policy, 13(6), 459–471.
