**1. Introduction**

Ebola Virus Disease (EVD) is recognized as one of the most fearful contagious diseases affecting mankind in recent times. The disease was first confirmed in 1976 in Zaire [now the Democratic republic of Congo (DRC)] near the Ebola River [1]. Following this, more than 25 outbreaks have been reported in the DRC, Gabon, Sudan, and Uganda with high mortality rates ranging between 25 and 90% [2, 3].

Towards the end of 2013, the West African Sub-region experienced the first case of the EVD in Guinea [4], which rapidly spread to Liberia and Sierra Leone with additional cases being reported in Mali, Nigeria and Senegal. This outbreak was quite significant regarding its unparalleled high morbidity and mortality rates; longevity and size; and how it increasingly became a global public health problem, resulting in the WHO declaring it as Public Health Emergency of International Concern [5]. By March 27, 2016, Sierra Leone reported the highest cases of 14, 124, followed by Liberia (10,675) and Guinea (3811) [6].

It is widely recognized that strong, well-funded and well-staffed health systems are fundamental prerequisites in the fight against diseases such as Ebola. However, the three most affected countries, Guinea, Liberia, and Sierra Leone, had suffered years of devastating civil wars that led to widespread poverty, weak infrastructure and a lack of health professionals, especially in rural areas. Consequently, the Ebola containment efforts were severely hampered by already weak and fragile health systems, including poor surveillance preparedness and weak governance systems [7–9].

Increasingly, a wide range of studies of international health security (IHS) governance and health systems' functioning have drawn attention to significant shortfalls in prevailing institutional arrangements to deal with such pandemics [10–12]. Typically, much of the criticism has fallen on the WHO as the lead organization responsible for global health governance [10, 13, 14]. Problems such as not responding promptly or in an ad hoc fashion; creating panic among affected populations; limited lessons learnt from previous pandemics; bureaucratic and political barriers that constrain the establishment of appropriate communication and organizational systems and structures for responding more effectively-have all been cited [15, 16]. Overall, there is a perception that IHS governance is characterized by dysfunction. As a result, proposals for moving the IHS agenda forward have called for significant reforms, including better resourcing of the WHO to counter future pandemics as well as consolidating the global health community's commitment and knowledge to promote and improve IHS both nationally and internationally [17–19].

Central to these discussions of how IHS and health systems should and could, be strengthened have included considerations to adopt more joined-up approaches that harness the role and strengths of civil society organizations (CSOs) [20, 21]. Such participation is often premised on the assumption that CSOs' grassroots linkages and close proximity to the communities most affected by specific health challenges gives them comparative advantage in providing effective and targeted interventions that reflect local contexts, needs and realities, which add to promoting democratic and accountable governance processes in global health [22]. To date however, how CSOs' engagement enables or constrains the search for effective organizational arrangements in the IHS and health systems strengthening agenda, is not well understood. Greater clarity on CSOs' contribution is needed to guide action.
