Experience of COVID-19 Response in Addis Ababa City Administration, Ethiopia: a mixed-methods implementation study

Background Urban centers in low- and middle-income countries faced substantial operational challenges during the COVID-19 pandemic. Addis Ababa, Ethiopia’s political and economic hub, implemented a comprehensive, multisectoral response coordinated through an Incident Management System (IMS) and Emergency Operations Center (EOC). Methods We conducted a mixed-methods implementation study synthesizing routine surveillance and programmatic data (March 2020–June 2023), policy and operational documents, and key informant interviews across surveillance, laboratory, logistics, case management, risk communication and community engagement (RCCE), and vaccination pillars. Quantitative indicators were descriptively analyzed; qualitative data were thematically analyzed and triangulated. This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Results Addis Ababa expanded surveillance and laboratory capacity through decentralization, scaled contact tracing, implemented home-based isolation and care, strengthened infection prevention and control, mobilized logistics and supply chains amid global shortages, and achieved high vaccination coverage through phased roll-out. Governance via IMS/EOC enabled coordination across eleven sub-cities and partners. Major challenges included supply chain disruptions, workforce fatigue, misinformation, and data integration constraints. Adaptive strategies—task force governance, community engagement via Family Health Teams, and evidence-informed decision-making—mitigated system strain. Conclusions A centralized IMS/EOC with decentralized implementation, strong RCCE, and flexible logistics were pivotal to sustaining urban pandemic response. Institutionalizing emergency management capacity and investing in data systems are critical for future preparedness.