The study set out to compare the pandemic responses of two nations whose prior crisis experience could hardly have been more different. South Africa entered the pandemic carrying what public health experts describe as a quadruple burden of disease: a high prevalence of HIV, a substantial tuberculosis epidemic, rising rates of non-communicable diseases, and persistent violence and injury. Sierra Leone, by contrast, had recently emerged from the devastating 2014–2016 West African Ebola outbreak, an experience that had already forced its health authorities to confront an epidemic with limited infrastructure. The researchers wanted to know how these contrasting starting points shaped the leadership capacities each country could draw upon when SARS-CoV-2 arrived.

Methodologically, the study took the form of a qualitative comparative case study conducted during 2024 and 2025. The authors carried out semi-structured interviews with purposefully sampled senior decision-makers and policymakers in both countries — the people who had been in the room when critical pandemic choices were made. To give the analysis structure, they anchored it in two complementary frameworks: the World Health Organization’s COVID-19 Strategic Preparedness and Response Plan monitoring and evaluation framework, and a conceptual framework describing the dimensions of resilience management. Interview data were then analysed using a framework-based thematic approach, explicitly organised around three core capacities that resilience theorists distinguish: adaptive, absorptive and transformative capacity.

These three capacities form the technical backbone of the study. Absorptive capacity refers to a system’s ability to withstand a shock and continue functioning — to keep hospitals open, supply chains running and staff at their posts while the crisis rages. Adaptive capacity describes the ability to adjust strategies, policies and practices in response to changing conditions, pivoting when the original plan no longer fits reality. Transformative capacity, the most demanding of the three, involves changing the fundamental structures of the system so that it emerges from the crisis fundamentally stronger. The researchers used this triad as a diagnostic lens, asking which capacities each country’s leadership displayed, which were missing, and how the capacities interacted — or failed to interact.

The analysis generated nine themes in total, of which the authors report four as most significant: coordination and navigation of authority, mobilising health resources, communication during the crisis, and resource mobilisation through multisectoral partnerships. From these themes, two distinct strategic profiles emerged. Sierra Leone’s response drew heavily on adaptive and absorptive capacity, leveraging the institutional muscle memory built during the Ebola epidemic. South Africa’s response likewise showed strong adaptive capacity, visible in rapid policy pivots, but it ran into absorptive constraints — most notably difficulties with coordination and with public trust — that limited how much shock the system could actually absorb.

One of the sharpest comparative lessons concerns the decentralisation of decision-making. In South Africa, decentralised structures proved effective, allowing provinces and local authorities to tailor interventions to their own epidemiological situations. In Sierra Leone, the same principle appeared in a more fragmented form: authority was dispersed, but the connective tissue needed to coordinate dispersed actors was weaker, producing fragmentation rather than flexibility. The finding underscores a subtle but important point for preparedness planners — decentralisation is not inherently good or bad; its value depends on whether the surrounding coordination mechanisms are strong enough to hold the system together.

Trust emerged as the second major differentiator, and in an unexpected direction. Sierra Leone’s post-Ebola context had cultivated comparatively stronger trust in epidemic response institutions, a legacy of communities and health workers having lived through a previous outbreak together. South Africa, despite its far larger health budget and more elaborate institutional apparatus, faced coordination and trust issues that eroded the effectiveness of its response. The lesson is uncomfortable for wealthier nations: material resources cannot substitute for the social capital that allows public health directives to be believed, followed and sustained under pressure.

The third comparative lesson involved the continuity of essential services — the capacity to keep delivering HIV treatment, routine immunisation, maternal care and other non-COVID services while the pandemic consumed attention and resources. Here the study found that both countries fell short, but through different mechanisms. In each case, the pandemic disrupted the ordinary business of the health system, and in each case leadership struggled to protect routine services from the gravitational pull of the emergency. That shared weakness, the authors suggest, points to a structural blind spot in pandemic planning everywhere: plans focus on fighting the incoming threat while assuming the rest of the system can coast, an assumption that repeatedly proves false.

Taken together, the findings lead to the study’s central conclusion: resilience in a pandemic depends on the strategic integration of complementary capacities rather than on the isolated presence of any one of them, or on the volume of available resources. A system with superb adaptive capacity but weak absorptive foundations — South Africa’s profile in this comparison — can pivot brilliantly yet still crack under sustained load. A system with strong absorptive and adaptive reflexes but limited transformative reach — closer to Sierra Leone’s profile — can weather a storm without fundamentally upgrading itself for the next one. Leadership, in this framing, is the integrative function that binds the three capacities into a coherent whole, deciding when to absorb, when to adapt and when to transform.

The authors draw a pointed implication for future pandemic preparedness: context-specific factors should be prioritised over generic templates. The WHO strategic preparedness framework provided a useful scaffold for the analysis, but the study’s deepest insights came from the particular histories, institutions and social fabrics of the two countries — South Africa’s quadruple disease burden and federal-style decentralisation, Sierra Leone’s Ebola scar tissue and hard-won community trust. As governments and global agencies stockpile vaccines and draft the next generation of preparedness plans, this comparison from two very different African health systems offers a sobering reminder that the decisive variable in the next crisis may not be what is in the warehouse, but whether leaders can weave absorption, adaptation and transformation into a single, trusted strategy.

Subject of Research: Comparative health leadership and resilience during the COVID-19 pandemic in South Africa and Sierra Leone

Article Title: Leading through the storm: a qualitative comparative case study of leadership during the COVID-19 pandemic in South Africa and Sierra Leone

Article References: Zembe, J., Senkubuge, F., Modisenyane, M., Wurie, H. R., Kanu, H. Y., & Barrie, A. (2026). Leading through the storm: a qualitative comparative case study of leadership during the COVID-19 pandemic in South Africa and Sierra Leone. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15712-7

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15712-7

Keywords: COVID-19, health leadership, health system resilience, South Africa, Sierra Leone, pandemic preparedness, adaptive capacity, absorptive capacity, transformative capacity, health policy, qualitative research, decentralisation

The study, conducted by Yijia Jing of Fudan University’s Institute for Global Public Policy, Wenxue Fan of the Henan Academy of Social Sciences, and Ping Zhang of Fudan University’s School of International Relations and Public Affairs, addresses a phenomenon that is increasingly global in scope. Around the world, the rise of what political scientists call Mega Local Jurisdictions—provinces, states, and metropolitan regions whose populations and economies rival those of mid-sized nations—has strained national intergovernmental systems everywhere. These enormous subnational units generate the vitality, administrative competence, and policy innovation that national economies depend on, yet their sheer scale gives them the leverage to demand concessions, resist directives, and widen regional inequalities. Governments must simultaneously encourage their initiative and restrain their autonomy, a tension that no federal or unitary constitution fully resolves.

China offers arguably the most extreme laboratory for studying this dilemma. Its provincial-level jurisdictions are demographically and economically comparable to large countries: Guangdong alone has a population exceeding that of most European nations, and a handful of coastal provinces generate the bulk of national GDP and exports. After 1978, the reform era deliberately devolved fiscal authority, economic decision-making, and policy experimentation to the provinces, unleashing the competitive growth machine that transformed the Chinese economy. Yet China remains a unitary one-party state in which provincial leaders serve at the pleasure of the centre, creating an unusual combination of deep economic decentralisation and persistent political centralisation. The researchers argue that this combination is not an inconsistency to be explained away but the operating principle of the system itself.

To test that argument, the team analysed provincial economic and leadership data spanning 1978 to 2021, drawing on national statistical yearbooks, fiscal records, marketisation indices compiled by the National Economic Research Institute, and detailed records of provincial leadership appointments and careers. The analysis compared mega provinces—the largest jurisdictions by population, economic output, and strategic significance—with smaller provinces across two dimensions: the degree of central empowerment they received and the intensity of central control they experienced. The data allowed the researchers to track how fiscal arrangements, policy privileges, and personnel decisions differed systematically between the two groups over the entire reform period.

The findings are striking. Contrary to the intuition that China’s largest provinces would enjoy the greatest freedom, the study found that central empowerment and central control over mega provinces were both stronger than for other provinces, in economic and political arenas alike. The centre gave its biggest jurisdictions more economic incentives—greater fiscal discretion, more policy experimentation rights, and stronger development privileges—precisely because their performance carried outsized weight in national growth. But it simultaneously applied more political control, tightening oversight of their leadership teams and ensuring that the officials who ran them were closely monitored and reliably aligned. Power and leash, in other words, grew together rather than trading off.

Within that pattern, the study identified a structural compromise at the heart of how mega provinces are governed: their leaders receive more economic room to operate but accept more political discipline in exchange. Provincial officials in the largest jurisdictions were subject to sharper performance expectations and closer personnel scrutiny than their counterparts elsewhere, reflecting the well-documented role of promotion tournaments and cadre evaluation in aligning local incentives with national goals. This trade-off, the authors argue, is what converts potential regional rivals into reliable engines of national development. The centre’s strategy is therefore not simply to decentralise or centralise, but to calibrate the two instruments against each other, adjusting economic incentives and political constraints in tandem as conditions change.

That calibration, the researchers contend, is what makes the governance “delicate” rather than merely mixed. The balance between empowering and controlling the mega provinces is dynamic and multifaceted, shifting across policy domains and historical periods. During the high-growth decades, economic decentralisation deepened as the centre rewarded provincial performance; as disparities widened and the risks of localism grew, political centralisation tightened to preserve conformity and shared development. The interweaving of the two ensures that neither the vitality of the largest jurisdictions nor the coherence of the national system is sacrificed to the other. The analogy to cooking small fish captures the required precision: excessive stirring breaks the fish, but neglect burns it, and the skilful cook knows how little handling suffices.

The study’s implications extend well beyond China. Mega local jurisdictions are now a worldwide trend, from India’s large states and Brazil’s state governments to the megacity regions of Latin America, Europe, and Southeast Asia, and every national system faces the same dual pressure of affording vitality and ensuring equity. China’s experience suggests that the conventional dichotomy between decentralised and centralised governance is too crude for these cases. Effective management of very large jurisdictions may require deliberately interlocking the two logics—granting economic autonomy in proportion to political accountability—rather than oscillating between devolution and recentralisation. The Chinese model, the authors caution, is shaped by its distinctive institutional context and cannot be transplanted wholesale, but the underlying principle of calibrated, mutually reinforcing instruments offers a comparative benchmark for other multi-level systems.

The research was supported by major grants from the National Natural Science Foundation of China, and its empirical foundation—covering the full arc of reform from Deng Xiaoping’s early experiments to the recentralising turn of the past decade—provides one of the most systematic quantitative portraits yet of how the world’s largest unitary state manages its most powerful subnational units. As mega-regions continue to grow everywhere and national governments grapple with the balance between regional dynamism and national cohesion, the Chinese finding that control and empowerment rise together offers a provocative answer to one of comparative governance’s oldest questions. In the art of governing big countries, it appears, the delicate touch matters more than the firm grip or the free hand—and knowing exactly how much of each to apply is what separates a working system from a broken one.

Subject of Research: Central-local governance of mega local jurisdictions in China, examining how decentralisation and centralisation are interwoven to balance provincial vitality with national control.

Article Title: Governing a big country is like cooking small fish: exploring delicate governance of mega local jurisdictions in China

Article References: Jing, Y., Fan, W., & Zhang, P. (2026). Governing a big country is like cooking small fish: exploring delicate governance of mega local jurisdictions in China. Global Public Policy and Governance, 6(1), 23-42. https://doi.org/10.1007/s43508-026-00143-1

Image Credits: AI Generated

DOI: 10.1007/s43508-026-00143-1

Keywords: Mega Local Jurisdictions, China, decentralisation, centralisation, intergovernmental relations, delicate governance, provincial governance, fiscal decentralization, central-provincial relations, public policy, governance, Governing