Ethiopia’s unconventional COVID-19 response

To the surprise of many, African governments have responded swiftly and boldly to the COVID-19 crisis. Ethiopia’s unconventional approach, for example, reflects the country’s limited financial and human resources, as well as the low level of available international support. Despite these severe constraints, the results so far have been better than anyone expected.

From the start, Prime Minister Abiy Ahmed’s government understood that Ethiopia’s success in combating COVID-19 would depend not on the number of respirators it had, but on the public-health measures taken to contain the virus’s spread. His government also wanted to prevent serious damage to one of Africa’s fastest-growing economies, which expanded at a 10.5% average annual rate in 2004-18 but remains vulnerable. Safeguarding these gains, preventing job losses, and ensuring firms’ survival was critical.

So, instead of implementing a national lockdown like most other governments, including in Africa, Ethiopia initiated other essential measures in January, well ahead of most developed countries. The government then scaled up its response in mid-March, when the first COVID-19 case was reported in the country, and declared a state of emergency only on April 8. Moreover, it has encouraged production and other economic activities to continue during the crisis, thus considerably easing the pressure on vulnerable social groups and the informal sector.

The results so far are salutary, though we fear the worst may be yet to come. As of May 26, Ethiopia – with a population of 109 million – had reported only 701 cases and six deaths. That represents an infection rate of 0.8% among the tested population, 80% of whom are 24-44 years old.

The government’s rapid initial response was crucial. In January, it introduced strict passenger-screening protocols at Addis Ababa’s international airport, East Africa’s largest aviation hub. The Ministry of Health and local and regional governments jointly conducted house-to-house screenings of more than 11 million households containing 40 million people in the capital and provinces. And diagnostic testing was scaled up from zero in early March to over 5,000 tests per day by May, though it continues to be a major challenge.

Public awareness and education have been central to the government’s effort. The prime minister makes regular public announcements regarding COVID-19, while the health minister provides daily briefings. And, as part of a concerted media campaign to reach all citizens, state-owned telecoms monopoly Ethio Telecom uses cell-phone ring tones to remind people of the importance of hygiene measures such as hand washing, social distancing, and wearing facemasks. This platform has shown positive effects.

Furthermore, since February, the Ethiopian authorities have implemented a strict regime of rigorous contact tracing, isolation, compulsory quarantine, and treatment. The government converted public universities’ dormitories to increase the capacity of quarantine centers to over 50,000 beds, established additional isolation centers with a total of 15,000 beds, and set up treatment centers with a 5,000-bed capacity. It also introduced more comprehensive life insurance coverage to protect front-line health workers.

Whereas many advanced and emerging economies have introduced huge economic-stimulus and rescue plans, the Ethiopian government has been constrained by dwindling revenues and the need to reallocate budget expenditures to contain the pandemic. It cannot please everyone, and therefore has had to prioritize its modest resources.

The government’s COVID-19 economic-support package is based on the principle of shared costs and sacrifices. For example, the employers’ confederation, labor unions, and the government agreed on a tripartite protocol to prevent layoffs during the crisis. Government subsidies have enabled manufacturing exporters to benefit from zero-cost rail transport and lower export logistics costs. And the government’s new industrial-parks strategy envisages the establishment of manufacturing hubs to produce personal protective equipment for domestic and overseas markets.

Ethiopia continues to mobilize national resources and encourage voluntary activities to address the public-health emergency, with the government ensuring close coordination among federal agencies at all levels. And although the government’s pandemic response is a work in progress, its success so far illustrates what African countries can achieve despite tight resource constraints.

First and foremost, African governments must recognize that they are facing not only a public-health emergency, but also a multi-dimensional crisis with long-term implications. Standard policy prescriptions therefore will not work. Tackling the crisis requires not only local and national government responses that take each country’s unique context into account, but also unified regional and international action.

Second, the Ethiopian government has relied heavily on community mobilization and public-awareness campaigns, which have proved to be effective and cost-efficient. It has also relied on the country’s prevention-based primary public health-care infrastructure and the health extension system that was built up during the last two decades.

Third, the government ensured a coherent response by maximizing coordination among public agencies at different levels. It also engaged in dialogue with the private sector to find workable solutions when global brands and buyers abandoned their suppliers in developing countries.

Fourth, resource-constrained African countries cannot provide government and charitable support to all groups and firms. Governments must prioritize and target their limited resources at companies, and tie that support to performance criteria in order to incentivize vital social goals like employment retention. Learning what works and what does not in that regard has been a vital catalyst in Ethiopia’s response.

Finally, it is too early to judge the pandemic response mounted by Ethiopia and other African countries because governments still have to scale up their efforts to tackle the inevitable “surge” stage of the crisis. But one lesson is already clear: African governments’ COVID-19 strategies must reflect the local context, the evolving nature of the pandemic, binding resource constraints, and weak international collaboration.