From Ebola to Imbalance

30 April 2019

Co-authored with Joanne Liu


When Joanne was an emergency room physician in the Ste. Justine children’s hospital in Montreal, and a frequent volunteer with Doctors Without Borders (MSF, as it is known by its French initials), she enrolled in McGill University’s International Masters for Health Leadership (, founded by Henry. During the program, she decided to run for the international presidency of MSF. Several members of the class formed her campaign committee, and Joanne was elected in 2013.

Soon after, MSF was facing a looming crisis: an Ebola outbreak was spreading in villages in West Africa. MSF was on the ground there, and realized the potential severity: cases confirmed from locations kilometers apart, at the junction of three countries—Guinea, Liberia, and Sierra Leone—where the populations were mobile.

MSF shared its concerns with the U.N. agency, the World Health Organization (WHO), but to no avail. Meanwhile, MSF teams in the field were warning that the number of cases was growing, and that its own facilities were over capacity. By June of 2014, when one of its epidemiologists claimed that “the epidemic is out of control”, MSF realized that it has to pull the alarm, imperatively. The only tool it had was to speak up—issue an urgent wake-up call. Joanne arranged a meeting with Dr. Margaret Chan, Director-General of the WHO, to convince her to declare this a Public Health Emergency of International Concern (PHEIC)  With overwhelming evidence of the epidemic in West Africa, and growing hysteria from the Global North, mostly related to the evacuation of infected care-givers outside the region, Dr. Chan did so, on 8 August 2014.

Joanne was invited to brief the United Nations General Assembly in New York on 2 September 2014.  The Under General Secretary stated that only MSF could brief on the situation, not the usual UN agency, because MSF was one of the rare organizations deployed to care for Ebola patients.


For some years, Henry had been struggling with another concern, the imbalance that he believes is pervading much of today’s world, in favor of private sector forces over public sector needs and plural sector concerns. In 2015, he published a book about this, entitled Rebalancing Society:…radical renewal beyond left, right, and center. Since then, he has been pursuing possible solutions for redressing the balance.

Many people expect government to do so. After all, it is the ultimate authority, representing “the will of the people” in democratic societies. Unfortunately, many  governments are failing in some of their basic responsibilities. Thus, an increasing number of concerned people now expect business to fix society’s problem of imbalance.  But Henry questions this: can private sector forces fix a problem significantly of their own making? He looks, instead, to the plural sector to begin the process of radical renewal.

What is this plural sector? It comprises those associations, many of them rooted in communities, that are owned neither by the state nor by private investors. Some, such as cooperatives, are owned by members, while others are owned by no one. Think of all the foundations, clubs, religions, charities, many of the world’s renowned universities, and non-government organizations (NGOs), including Greenpeace, Amnesty International, and, of course, MSF.

Enter the NGOs

Why not carry the message of the MSF experience to this concern? From Ebola to imbalance. Acting together, prominent NGOs could draw attention to this crisis of imbalance, by issuing a wake-up call, to get plural sector communities and public sector authorities as well as responsible businesses in the private sector working together for balance. For example, what if a group of prominent NGOs published a compelling manifesto about what needs to be done to restore balance in society?

Who better than the NGOs on the ground, beyond the formal conferences in the fancy facilities—as was MSF, experiencing the consequences of Ebola firsthand? Do not the characteristics of many NGOs make them suitable for doing this, especially those not dependent on government or corporate funding? (MSF, for example, gets 94% of its funding from private donors.) Moreover, many NGOs have the capacity, and the legitimacy, to carry their messages far and wide. Their voices are global, yet they are organized locally, in communities that are networked around the world. And being committed to a cause, they can generate the altruism, the energy, the courage, and the flexibility necessary to act decisively.

Common Cause

But why would any NGO want to do this? Because while each has its own cause, together they have common cause: the imbalance that creates, or at least exacerbates, the very problems with which they have to deal. This imbalance is causing the degradation of our environments, which is the concern of Greenpeace, the demise of our democracies, which is addressed by Amnesty International , and the degradation of ourselves, which MSF faces most literally in war zones. Imbalance is the meta-issue behind many of the NGO’s own issues.

To do this, however, the NGOs will have to get their collective act together, which they can be reluctant to do.  Well, private sector businesses do this quite effectively—it is a major factor behind their power. (Compare the conferences of the World Economic Forum with those of the World Social Forum: one super-organized and highly-reported, the other disorderly and  obscure.)  Businesses may compete with each other in the marketplace, but when they want something broader, such as reduced taxes, they know how to work together, for example by using their chambers of commerce. Why not the NGOs?

Back to Balance

The centuries-old divide between right and left, namely private sector interests versus public sector controls, has obscured the pivotal role that the plural sector can play in dealing with major social problems. A stable society, like a stable stool, has to sit on three legs—public. private, and plural sectors—not two (public and private), let alone one (public communism, private capitalism, or community populism). This will happen only when the plural sector takes its place alongside those called private and public (hence this label plural sector, instead of “civil society” or “not-for-profits, etc.).

Nobody can expect any NGO to forgo its specific cause for common cause.  But the future of our progeny and our planet surely merits greater attention to common cause—from the NGOs and the rest of us. Together we face challenges from warming, weapons, and the skewed distribution of wealth. This is our looming crisis, vast and multi-faceted. Thanks to the vast and multi-faceted efforts that were eventually mobilized, Ebola was contained. Our imbalance needs to be.

© Henry Mintzberg and Joanne Liu 2019. Joanne is completing her second term as International President of Doctors Without Borders.