Turning Challenges into Opportunities: Lessons from Ethiopia’s COVID-19 Response for Strengthening Health Systems and Health Security

The COVID-19 outbreak, which emerged in late 2019, rapidly evolved into an unprecedented global public health crisis. An assessment of Ethiopia’s responses to the COVID-19 pandemic offers a unique learning experience for building stronger health systems and enhancing resilience against future health threats. This paper covers the major findings of a national study of the Government of Ethiopia’s COVID-19 response. The study followed a concurrent nested mixed methods design, combining quantitative and qualitative data collection at all levels of the health system. Primary data were collected from surveys of individuals involved in the COVID-19 pandemic response, health facility assessments, key informant interviews, and a review of COVID-19 response norms and standards. The study revealed that Ethiopia implemented a wide range of interventions across the WHO response pillars including multi-sectoral coordination and actions, partnerships with communities by engaging public figures, expanding molecular laboratory capacity, strengthening critical care facilities, and enhancing digitalization of health data. However, we detected a decline and a lack of institutionalization of COVID-19 practices, particularly in the areas of surveillance, laboratory testing, and case management. Our findings thus suggest that COVID-19 investments led to a strong response with robust implementation, but in the absence of a strong transition plan and limited capacity to apply the lessons learned, many of the COVID-19 response platforms were not effectively leveraged to strengthen the health system to address future responses.