Trust in government has long been viewed as an important determinant of citizens' compliance with public health policies, especially in times of crisis. Yet evidence on this relationship remains scarce, particularly in the developing world. We use results from a representative survey conducted during the 2014-15 Ebola Virus Disease (EVD) epidemic in Monrovia, Liberia to assess the relationship between trust in government and compliance with EVD control interventions. We find that respondents who expressed low trust in government were much less likely to take precautions against EVD in their homes, or to abide by government-mandated social distancing mechanisms designed to contain the spread of the virus. They were also much less likely to support potentially contentious control policies, such as "safe burial" of EVD-infected bodies. Contrary to stereotypes, we find no evidence that respondents who distrusted government were any more or less likely to understand EVD's symptoms and transmission pathways. While only correlational, these results suggest that respondents who refused to comply may have done so not because they failed to understand how EVD is transmitted, but rather because they did not trust the capacity or integrity of government institutions to recommend precautions and implement policies to slow EVD's spread. We also find that respondents who experienced hardships during the epidemic expressed less trust in government than those who did not, suggesting the possibility of a vicious cycle between distrust, non-compliance, hardships and further distrust. Finally, we find that respondents who trusted international non-governmental organizations (INGOs) were no more or less likely to support or comply with EVD control policies, suggesting that while INGOs can contribute in indispensable ways to crisis response, they cannot substitute for government institutions in the eyes of citizens. We conclude by discussing the implications of our findings for future public health crises.

IntroductionThe recent Ebola virus disease (EVD) outbreak was unprecedented in magnitude, duration and geographic scope. Hitherto there have been no population-based estimates of its impact on non-EVD health outcomes and health-seeking behaviour.MethodsWe use data from a population-based panel survey conducted in the late-crisis period and two postcrisis periods to track trends in (1) the prevalence of adult and child illness, (2) subsequent usage of health services and (3) the determinants thereof.ResultsThe prevalence of child and adult illness remained relatively steady across all periods. Usage of health services for children and adults increased by 77% and 104%, respectively, between the late-crisis period and the postcrisis periods. In the late-crisis period, (1) socioeconomic factors weakly predict usage, (2) distrust in government strongly predicts usage, (3) direct exposure to the EVD outbreak, as measured by witnessing dead bodies or knowing Ebola victims, negatively predicts trust and usage and (4) exposure to government-organised community outreach predicts higher trust and usage. These patterns do not obtain in the post-crisis period.InterpretationSupply-side and socioeconomic factors are insufficient to account for lower health-seeking behaviour during the crisis. Rather, it appears that distrust and negative EVD-related experiences reduced demand during the outbreak. The absence of these patterns outside the crisis period suggests that the rebound after the crisis reflects recovery of demand. Policymakers should anticipate the importance of demand-side factors, including fear and trust, on usage of health services during health crises.

How to restore citizens’ trust and cooperation with the police in the wake of civil war? We report results from an experimental evaluation of the Liberian National Police’s (LNP) “Confidence Patrols” program, which deployed teams of newly retrained, better-equipped police officers on recurring patrols to rural communities across three Liberian counties over a period of 14 months. We find that the program increased knowledge of the police and Liberian law, enhanced security of property rights, and reduced the incidence of some types of crime, notably simple assault and domestic violence. The program did not, however, improve trust in the police, courts, or government more generally. We also observe higher rates of crime reporting in treatment communities, concentrated almost entirely among those who were disadvantaged under prevailing customary mechanisms of dispute resolution. We consider implications of these findings for post-conflict policing in Liberia and weak and war-torn states more generally.

D ispute resolution institutions facilitate agreements and preserve the peace whenever property rights are imperfect. In weak states, strengthening formal institutions can take decades, and so state and aid interventions also try to shape informal practices and norms governing disputes. Their goal is to improve bargaining and commitment, thus limiting disputes and violence. Mass education campaigns that promote alternative dispute resolution (ADR) are common examples of these interventions. We studied the short-term impacts of one such campaign in Liberia, where property disputes are endemic. Residents of 86 of 246 towns randomly received training in ADR practices and norms; this training reached 15% of adults. One year later, treated towns had higher resolution of land disputes and lower violence. Impacts spilled over to untrained residents. We also saw unintended consequences: more extrajudicial punishment and (weakly) more nonviolent disagreements. Results imply that mass education can change high-stakes behaviors, and improving informal bargaining and enforcement behavior can promote order in weak states.

How can governments in low-trust settings overcome their credibility deficit when promoting public welfare? To answer this question, we evaluate the effectiveness of the Liberian government’s door-to-door canvassing campaign during the 2014–2015 Ebola epidemic, which aimed to persuade residents to voluntarily comply with policies for containing the disease. Combining data from an original representative survey of Monrovia during the crisis with variation in the campaign’s reach and using multiple identification strategies, we find that the informational campaign was remarkably effective at increasing adherence to safety precautions, support for contentious control policies, and general trust in government. To uncover the pathways through which the campaign proved so effective, we conducted over 80 in-depth qualitative interviews in 40 randomly sampled communities. This investigation suggests that local intermediaries were effective because their embeddedness in communities subjected them to monitoring and sanctioning, thereby assuring their fellow residents that they were accountable and thus credible.

Does theory contribute to forecasting accuracy? We use event data to show that a parsimonious model grounded in prominent theories of conflict escalation can forecast civil war onset with high accuracy and over shorter temporal windows than has generally been possible. Our forecasting model draws on “procedural” variables, building on insights from the contentious politics literature. We show that a procedural model outperforms more inductive, atheoretical alternatives and also outperforms models based on countries’ structural characteristics, which previously dominated models of civil war onset. We find that process can substitute for structure over short forecasting windows. We also find a more direct connection between theory and forecasting than is sometimes assumed, though we suggest that future researchers treat the value-added of theory for prediction not as an assumption but rather as a hypothesis to test.

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Informal institutions govern property rights and disputes when formal systems are weak. Effective informal institutions should help people reach and maintain bargains, minimizing violence. Can outside organizations engineer persistent institutional change? Will this strengthen property rights and investment? We experimentally evaluate a UN and civil society mass education campaign to promote alternative dispute resolution (ADR) practices and norms in rural Liberia, where violent land disputes are common. Prior work showed a drop in violence and unresolved disputes within one year. We return after three years to test for sustained impacts and mechanisms. Treated communities report large, persistent drops in violent disputes and a slight shift towards nonviolent norms. Treated residents also report larger farms, though overall effects on property rights and investment are mixed. Politically-connected residents report more secure property rights while those with fewer connections feel less secure. Sustained institutional engineering is feasible but politics shapes distributional outcomes.