This report generates lessons from the Ebola virus disease outbreak in the Mano River Union (MRU) states of Guinea, Liberia, and Sierra Leone, which have seen the worst devastation of this disease since it was first diagnosed in the Democratic Republic of Congo (DRC) in 1976. Among the key findings: The drastic reversal of the countries socioeconomic gains at the onset of the disease suggests that the three republics needed to improve governance and results, and that the international community should have provided more expedited attention and assistance. The main conclusions: Insufficient early warning and response systems in the three countries at the onset of the virus suggests monitoring and evaluation mechanisms were weak. Stronger accountability and partnerships were needed in those countries especially in the health sector for better services, and in other areas that relate to public health outcomes. Stronger statistical systems and planning and budgeting were also needed to better inform the three countries fiscal decisions and resource allocation. The key lessons: The key drivers of public health services are socioeconomic and environmental in nature such as good infrastructure; basic education; good hygiene practices; improved household income; and adequate energy supplies. These were largely insufficent in all three countries before the outbreak. There is also a need to improve the governance of the three countries health sectors. This includes increasing investment, transparency, and accountability in healthcare services and coordinating development actors, including donors and civil society organizations. Geopolitically, the disease could have been defeated earlier if some developed countries with historical ties to the subregion (Britain, France, and the United States, for example), had better coordinated their assistance. International organizations such as the WHO also needed considerable scaling up to coordinate the international health response. The main recommendations: Building of capacity is the most critical undertaking required. Specifcally, strengthening healthcare systems in the three countries, including establishing postgraduate medical training centers. Supporting epidemiological research and information dissemination in the MRU and beyond. Comprehensively assessing the capacity of these countries to respond to health and other emergencies.