Author: Humanitarian Health Ethics Research Network

By Gojjam Limenih

Gojjam Limenih, is a senior lecturer and researcher of Public Health, The University of Gondar and an Advisory Council Member, Ministry of Science and Higher Education of Ethiopia (MoSHE). 

Ethiopia may not yet have witnessed the worst of this pandemic. In times of health crisis, such as the COVID-19 pandemic, we need our health systems to be working at their very best. This means that we need to trust our health system; health workers must have the equipment they need to do their job while protecting themselves and others, and healthcare must be accessible for all. Ethiopia’s health system and infrastructure is weak. The latest readiness assessments from the WHO indicate that there is extremely limited intensive care capacity for the treatment of severe COVID-19 cases if the surge comes[4]. The ability to treat severe forms of COVID-19 will depend on the availability of ventilators, electricity, and oxygen, all of which are scarce in Ethiopia. As the Ministry of Health reports, currently, there are only 600 ventilators for over 100 million people [1,2]. Even securing a supply of personal protective equipment (PPE), the first line of defence at the individual level, remains a major challenge.

Strategies and innovation in the face of the unprecedented    

The challenges our country faces in mitigating the spread of COVID-19 are enormous – however, there have been a range of proactive and coordinated efforts to respond to the pandemic. The government has been mobilizing different stakeholders and devising strategies to contain the virus through aggressive health measures and law enforcement. In order to reverse the rising numbers of infections, broader suppression measures were put in place, including closing schools and universities, prohibiting gatherings and promoting “social distancing” to the entire population. The current focus is reducing transmission of COVID-19 through individual and population-level measures, including personal hygiene, physical distancing, testing, isolating and tracking contacts and travel restrictions.

Ministry of Health (MOH) and National Public Health Institute (EPHI), provide regular updates (i.e. held press conferences) to inform the public. The Ministry is also working with a network of experts to coordinate regional surveillance efforts, diagnostics, clinical care and treatment, and other ways to identify, manage the disease and limit transmission. But hospitals are struggling to cope with COVID-19 as they face bed shortages, ICU equipment and testing facilities. To ease this pressure, shelter hospitals are ready and taken as a crucial step to isolate, treat, and triage patients with mild to moderate COVID-19. Hence, large, temporary hospitals are prepared by converting public venues, such as exhibition centres, into health-care facilities to isolate patients with mild to moderate symptoms of an infectious disease from their families and communities, while providing medical care, disease monitoring, food, shelter, and social activities. In Addis Ababa, Millennium Hall and other large avenues are ready for this purpose, which will help to isolate and treat more people who are infected. Many investors are lending their hotels to be prepared as quarantine centres and hospitals which will be crucial to contain the virus. 

Social cohesion and social gatherings are of great importance for Ethiopian society. Churches and Mosques are now closed to limit the spread of the virus. Instead, the government and religious authorities have worked together to launch a television program for all major religions to broadcast their spiritual education so that their followers can continue to observe their faith while staying at home. Nevertheless, the battle is real to keep people at home when the one thing that is so meaningful to most—their spiritual engagement— has been taken away by the pandemic. 

The arrival of the virus in Ethiopia has also given rise to local innovation. There are promising efforts to promote home-grown production of PPE to manage the spread of the virus. Factories in Addis Ababa and other manufacturing hubs have started producing alcohol-based cleaning solutions and hand sanitizer for distribution to high-risk areas. Textile factories are now focused on producing more face masks. Most of the universities are producing hand sanitizers and distributing them to the nearby communities. Researchers and students at Addis Ababa Technology University and manufacturers are working to assemble ventilators from locally sourced components. Notably, all these fast-moving efforts help to stay ahead of the virus long enough to put into place testing, contact tracing, and isolation, as well as temporary intensive care facilities. However, there is a need to better coordinate these scattered innovations towards the goal of greater long-term effectiveness and efficiency in fighting against COVID-19.

Recognizing limitations and uneven impacts

The present efforts to limit the spread of the virus are very encouraging. However, physical distancing and hand washing, globally adopted interventions to combat the spread of COVID-19, remain a major challenge in the context of overcrowding, poverty, and weak health-care systems.

The different measures in place are also urban-centric educational campaigns through media outlets that don’t consider the reality of rural society. It is only those with the privilege of access to radio and television that may hear about coronavirus risks, but not in great detail. Reaching out to the most vulnerable population in rural areas is vital. 75% percent of the Ethiopian people live in scattered rural villages. It requires special attention to prevent the spread before it gets to the villages. If it gets there, there may not be much room for intervention. Access to safe water and sanitation is low in Ethiopia, which inhibits people’s abilities to limit the infection. For now, the isolation of rural villages might shield them from the worst of COVID-19. But the absence of facilities and services makes the possibility of an outbreak in such areas particularly troubling. 

Another challenge for Ethiopia concerns the feasibility of the pandemic suppression strategies being applied. While Ethiopia didn’t decree a complete lockdown, forcing all but the most essential businesses to close down or operate online makes sense to control the spread. But such approaches will hit some people much harder than others. Self–isolation and staying at home mechanisms work very well to a certain extent if there is regular money coming in, but it doesn’t work as well when so many are living on the edge of poverty. Poverty maintains its deep grip. Many live on what they earn each day, and won’t eat if they can’t work. 

The pandemic has left many Ethiopians with the unenviable choice of either feeding their families or protecting them from COVID-19. The problem with approaches that do not take into account inequities is that these can end up limiting sustainable interventions. Evidently, more community engagement to develop culturally and contextually feasible health promotion activities is crucial in the fight against a disease such as COVID-19 and beyond. 

While infection control and mitigation strategies have uneven impacts across Ethiopian society, the COVID-19 pandemic is underlining the fragility of Ethiopia’s health system. Access to basic health services remains the exception rather than the norm. Access to health care is severely limited, especially in rural areas. The spread of COVID-19 in Ethiopia is as much the product of its fragile health system and social inequalities as it is about epidemic dynamics. 

The pandemic has created social panic, as contagious and dangerous as COVID-19 itself. As the sharp increase in infections is observed, worries ranging from the ability of strained healthcare systems to handle a severe outbreak, to the effect of the restrictions will have on those in the informal economy, play on people’s minds. Unless properly handled, the situation will create social unrest in the near future. COVID-19 is profoundly affecting people’s finances, with mental, physical and social health implications that will linger for years to come. As we anticipate the long-term social, economic and health effects of the pandemic, Ethiopia needs to address vulnerability and inequity to ensure communities rebound. 

The grand lesson? COVID-19 has presented the world with myriad opportunities for revising, rebuilding and renewing health systems. What we need now is a firm resolve and global action to rectify inequity. While it is hard to overhaul systems in the middle of a crisis, it is evident that health system strengthening in Ethiopia has to be a top priority. It is an unprecedented opportunity for the country to dig deeper into what really needs to be done, for the future health of Ethiopian society.

References

1. Ethiopian public health Institute COVID-19 daily update (EPHI), www.ephi.gov.et May 17 2020.
2. Ethiopian Ministry of Health COVID-19 daily update; www.moh.gov.et/ejcc/en, May 17 2020
3. Africa Joint Continental Strategy for COVID-19 outbreak: AU, Africa CDC, 2020 
4. WHO COVID-19, situational report, 1-3  www.who.int/emergencies/diseases/novel-coronavirus-may 8, 2020/situation-reports