Keywords

Introduction

Ethiopia, Africa’s second most populated country, announced its first confirmed COVID-19 on March 13, 2020. The pandemic hit the country at the time it was experiencing mixed socioeconomic fortunes. The country had an estimated population of 115 million people in 2019 (United Nations, 2019). Regarding geographical spread, the population is mainly rural, with only 21% urban dwellers. The sex composition of the population was even (Statista, 2020a).

Ethiopia’s two-digit growth figures in the last decade are unevenly distributed, making equity in economic gains a key concern. According to the World Bank database, the mean economic growth was 10.5% between 2012 and 2018, driven by agricultural growth, according to the National Bank of Ethiopia (NBE). However, the agriculture sector’s contribution to GDP growth has dwindled, with services taking the lead with a 40% share of GDP. The agricultural sector’s share was 33% in 2019 (NBE, 2019). This notwithstanding, the agriculture sector employed 67% of the population in 2019.Footnote 1 Despite the substantial share of agriculture to income and employment, the sector is vulnerable to climate change impacts with long spells of droughts (Deressa, 2007). Yet, the pandemic impact on the agricultural sector was minimal compared to industry and service sectors (Degye et al., 2020).

Ethiopia’s labour force participation rate was 79.6% in 2020. More men (85.8%) than women(73.56%) participated in the labour market in 2020 (ILO, 2020). With a 3% and 3.5% unemployment rate, women and youth were more likely to be unemployed (ILO, 2020). The pandemic measures that restricted mobility worsened the existing unemployment condition in the country with increased job losses in the early stages of the pandemic (Degye et al., 2020). However, the effect was unequally distributed across economic activities, geographic location, and social groups.

In 2015, 23.5% of Ethiopia population lived below the national poverty line. However, the global poverty headcount ratio is still significantly high. The population living on less than $5.5, $3.2, and $1.9 daily at international prices, respectively, were 90.7, 26.8, and 9.4% (World Bank, 2019). Although over 79% of the population working in the agricultural sector lives in rural areas, total undernourishment was 20.6% from 2016 to 2018 in Ethiopia, and the prevalence of wasting in children under age five was 10% and was the highest in Africa in 2018 (FAO et al., 2019). Child and maternal malnutrition is also high in Ethiopia; for example, 38% of children under five were stunted, 24% were underweight, and 22% of women aged 15–49 were thin with a BMI under 18.5 (WHO, 2016). It is important to note that since the agricultural sector is not insured, the coronavirus crisis is an additional bottleneck to agricultural-dependent countries like Ethiopia.

Ethiopia's health indicators show it was not ready for a pandemic, and this realisation determined its swift COVID-19 responses. The country falls below the continental average healthcare system with 0.8 midwives and nurses, 0.08 physicians, and 0.3 hospital beds in 2015—only 11.2% of its population access potable water. In terms of sanitation, 4.2% of rural people used at least one essential sanitation services in 2017. The study situates COVID-19 policies in Ethiopia’s political and socioeconomic performance to examine their equity and inclusiveness dimensions.

Methodology

The study employed a mixed method design that combined quantitative and qualitative data to examine the equity in Ethiopia's COVID-19 mitigation and policy responses. This case study was mainly desk research based on secondary sources from national institutions, including the Ethiopian Public Health Institute, Ministry of Health, Ministry of Education, Ministry of Water and Energy, Ministry of Labor and Social Affairs, Ministry of Technology and Innovation and Ministry of Women, Children and Youth, Ethiopia Central Statistical Agency, eight Regional Health Bureaus and two city administrations (or Addis Ababa and Dire Dawa cities). Due to security problems the Tigray region was not considered in the study. The study also relied on statistics from the WHO, John Hopkins University, and the Africa Centre for Disease Control. Primary data were collected through key informant interviews in institutions. The interviews were conducted via Zoom, telephone, and in-person. National and local policies, rules, and regulations were also analysed. The analysis also culled data from the World Bank’s three rounds of a telephone survey. The first-round survey was conducted between April 22 and May 13, 2020, and covered 3249 people. The second-round survey was conducted between May 14 and June 3, 2020, with 3 107 respondents. The third survey round was conducted between 4 and 26 June 2020 and had 3058 respondents.

Policy Responses to COVID-19 in Ethiopia

Despite severe economic constraints, Ethiopia took swift and bold measures in response to COVID-19 which relied on three foundations namely, solidarity and collaboration among stakeholders, coordination of resource mobilisation and the continuity of socioeconomic service delivery to the population Lia (2020). The Ethiopian government’s response evolved over the period depending on the threat at stake. However, its responses can be categorised into three broad areas: public health, social, and economic interventions.

The first public health measures hinged on restrictions on movement, which covered the closure of schools, borders, and public places. The government declared a five-month state of emergency (SoE) (Proc. 3/2020) on April 8, 2020, and an executive task force was established. An implementation guideline was developed to implement the protocols. It provided the federal government sweeping powers to limit individual rights in favour of public health and security. The SoE transferred the ultimate government decision-making power to the Cabinet. The regulation (Regulation 466/2020) prohibited religious, government, social, or political meetings in places of worship, public institutions, hotels, meeting halls, or any other place. The regulation also prohibited regional or federal officials from giving statements to members of the press about COVID-19 without first obtaining permission from the federal committee or sub-committees at the regional level. However, exceptions were made for professional commentary on COVID-19 laws, professional medical explanations, or daily press briefings by the Ministry of Health. The regulation also prohibited disseminating information about COVID-19 and related issues that would cause “terror and undue distress among the public”. The regulation requires public communication professionals and media outlets to ensure that information, analysis, or programmes on COVID-19 were “without exaggeration, appropriate and not prone to cause panic and terror among the public”.

The key informants said that declaring a state of emergency improved compliance with COVID-19 protocols such as wearing nose masks, social distancing, and other hygiene protocols. Unlike some countries in the region, Ethiopia did not undergo a full lockdown. Movement across regional states was permitted and humanitarian organisations, and cargos were permitted to operate without restrictions. The measures were scaled up gradually through an assessment of their impacts.

The government postponed the national election to May 2021, which was scheduled for August 2020. The House of Federation agreed on the rescheduling following extensive research and expert consultation. However, the Tigray region held a regional election by rejecting the parliament's decision.

Public Health and Social Measures

Public health and social measures were instituted to break the chain of transmission of the virus. The key strategies included awareness raising on the pandemic and preventive measures. As the health sector strategy of the country focused on prevention via primary healthcare provision, public awareness regarding the nature of COVID-19, its symptoms, transmission, and treatment was crucial. Goshu et al. (2020), who assessed the level of public awareness of COVID-19 mitigation measures, confirmed that knowledge of the pandemic was high in the country's rural and urban areas. For example, over 83% of rural people and 95% of urban households were knowledgeable about the basic COVID-19 hygiene protocols. Moreover, over 61% of rural and 77% of urban people knew masks or gloves could prevent infections.

The Ethiopian government received support from the WHO, Africa CDC, and Jac Ma Foundation to intensify contact tracing. Under the State of Emergency (Proclamation No 3/320), the government enforced social distancing, encouraging people to stay two metres from each other in all their essential activities. However, there were barriers to social distancing measures. For example, the limited number of sleeping rooms per household illustrates the difficulty of self-isolation. Also, limited access to electricity restricted access to COVID-19 prevention messages disseminated on various channels.

Education Measures

Following the first case confirmation on March 13, 2020, the government of Ethiopia officially announced the closure of schools, including Kindergarten to Higher Education, on March 16, 2020. The Ministry of Science and Higher Education (MoSHE) quickly shifted its focus to Virtual Learning Platforms (VLPs). The Ministry developed a concept note for the education sector's COVID-19 preparedness and response plan on April 3, 2020. The objective of the response plan was to ensure the continuity of learning at all levels while schools were closed. The strategies included using digital technology such as e-learning for secondary education and multi-media channels (e.g., radio and television) for primary schools. It was, however, evident that online learning was constrained by connectivity to the internet, access to electricity, skills in technology use, availability of devices (e.g., computers, radio, TV, laptops and mobile), monitoring of actual online learning, and poor quality of education. As a result, most private schools in urban localities found temporary solutions to continue teaching their students from a distance by uploading reading materials and assignments via Google Meet, Telegram, e-mail, and social media platforms.

Social Protection Measures

The government instituted social protection measures to protect vulnerable social groups such as the elderly, migrants, refugees, homeless children, adults, people with disabilities, and poor people. For example, the Ministry of Labour and Social Affairs (MoLSA) in partnership with private individuals provided transitory shelters for urban destitute street children in partnership with private donors. MoH, MoLSA, and donors first identified the vulnerable groups based on their age, gender, socioeconomic status, and marginalisation. They also designated medical care and food for disabled people.

MoLSA’s annual report showed that it supported 45,000 vulnerable people and out of these 24,003 were reunited with their families. About 21 136 Ethiopian returnees from various countries received support, including reintegration into their families and communities. MoLSA provided food, sanitation, and counselling support to 743,949 vulnerable people (e.g., old people, the disabled, the homeless, and prostitutes) across the country. Moreover, 1,285,134 urban and rural developmental safety net beneficiaries received a three-month advance payment. The Ethiopian Federation of National Associations of Persons with Disabilities mobilised 17 million Birr from development partners and provided food and sanitation assistance to 5000 people with disabilities. Ethiopia’s Productive Safety Net Program covers over eight million beneficiaries. Due to the pandemic, the public works requirement was waived, and thus all beneficiaries received unconditional transfers. At the onset of the pandemic, beneficiaries also received three months of payments in advance. Besides the PSNP, several smaller-scale initiatives, such as food banks, were launched to support the vulnerable (Abate et al., 2020).

Economic Policy Responses

The Government of Ethiopia has launched various economic measures, including tax exemption, cancellation of tax debts and property tax, employment tax reduction, injecting liquidity to private and government banks, loan rescheduling and additional loans to their businesses, various stimulus packages, and employment measures.

The cancellation of tax debts was among economic measures to sustain livelihood and businesses after the pandemic. Debts cancellation was one of some of the economic stimulus packages. A 10% reduction was given to firms that pay debt upfront. Regional governments also cancelled employment tax for four months.

The Central Bank of Ethiopia injected 15 billion Birr (or 0.45% of GDP) to private banks to allow banks to reschedule debt payments and interest reduction to firms without making a loss. The government also provided 33 billion in additional liquidity to the Commercial Bank of Ethiopia (Goshu et al., 2020). In addition, the government injected the liquidity of 1.5 billion Birr to farmers cooperatives to maintain the supply chain after the outbreak. Furthermore, the Development Bank of Ethiopia established a unique window to dispense micro and small-scale enterprises (MSES) loans quickly. In addition, the National Bank of Ethiopia provided additional liquidities to microfinance institutions to avail credit to borrowers. The government also supported microfinance institutions, farmers cooperatives, and some selected sectors. For instance, Ethiopian Airlines have had to implement new cost-cutting measures to secure its cash flow and revise its strategy from growth to survival.

The government also forbade public and private companies to lay off workers under a state of emergency. The Ethiopian tripartite constituents namely labour confederations, employers, and the government signed an agreement on the COVID-19 workplace response protocol on measures to be taken against the anticipated challenges of the pandemic on the economy and labour relations. The MoLSA protocol was consistent with ILO guidelines on crisis response and managing natural and artificial disasters. MOLSA monitored private employers and public enterprises and petitions of workers from 366 organisations by opposing layoffs, denial of wages and pay cuts and reinstated 12,004 workers.

One of the measures that made the Ethiopian approach unconventional was the focus on transporting food commodities. The transport ministry identified critical commodities and ensured uninterrupted agricultural commodity exchanges—farmer-to-farmer exchange, primary (farm gate), and secondary and tertiary agricultural commodity aggregation and distribution systems. In addition, efforts were put in place to ensure uninterrupted supplies of chemical fertilisers, improved seeds, pesticides, herbicides, and livestock medicine.

The Role of Non-state Actors in COVID-19 Intervention

The role of non-state actors such as the private sector, membership organisations, non-governmental organisations, and international organisations was significant in Ethiopia and as diverse as the sectors and the regions of the country in its forms, scope, and reach. The Ethiopian private sector remains adaptive in its response to the crisis. However, the engagement of the private sector goes beyond corporate social responsibility (CIPE, 2020). For example, following the government's request to contribute to the National COVID-19 Response Fund, the private sector contributed cash and in-kind to control the outbreak’s spread.

Some private businesses have also contributed to shifting their production line to COVID-19 intervention demand following the requests of MOE. The demand for certain products, such as hand sanitisers, face masks, personal protective equipment (PPE), and other goods, was urgently required. In addition, enterprises such as hotels and banks promoted and deployed online services. They also embarked on remote working arrangements and safety protocols at work.

With the global value chain disruption and a slowdown in international trade, many companies partially closed down their facilities. Some enterprises have decided to close their doors, sending staff on paid leave for an indefinite period. As aggregators of private sector interests and critical agencies of advocacy, Business Membership Organizations (BMOs) play an essential role in the fight against the COVID-19 pandemic. Business chambers and associations are taking on various roles in this regard. For more detailed roles of BMOs since the pandemic.

Many international and local NGOs have been involved in COVID-19 policy interventions in various ways. For example, HOPE, a US-based NGO, provided over 56,000 protective masks to Ethiopia and virtual training for healthcare workers on COVID-19. Another NGO closely working with the federal ministry of health in COVID-19 intervention is ‘Lifebox’, an NGO that has made two innovative contributions in Ethiopia namely N95 mask decontamination and medical equipment reuse and maintenance (Starr et al., 2020). Lifebox, Tegbareid Polytechnic College (PC), and Ethiopia COVID-19 Response Team (ECRT) consisting more than 1,800 professionals worked together in areas of patient monitoring systems. They also repaired existing medical devices in healthcare facilities in the country.

According to key informants, some regions and sectors have gotten relatively better support from NGOs, but others did not. Specifically, WHO and Africa CDC have contributed significantly to the Ethiopian health sector by donating COVID-19 lab testing equipment and providing Lab training. ILO supported BoLSA in awareness creation to manufacturing and textile industries in Hawassa and Mekelle, Refugee and hosting communities in Somalia and Tigray regions and Ethiopian migrant domestic workers in major destination countries in the Middle East. An Irish Emergency Alliance worked with Plan International to support the government in pandemic awareness creation. The World Bank, IMF, WFP, IOM, and UNICEF provided financial support, while the Jack Ma Foundation provided various health kits and PPE.

Inclusiveness of Policy Responses

Participants have contradicting views on the social inclusiveness of the policy measures in Ethiopia. MoLSA provided direct support to 45,000 street children, food, and sanitation support to 743,949 vulnerable people, 21 136 returnees to Ethiopia, and about 13,863 detainees to their homelands with the necessary logistics from abroad. BoLSA also provided counselling and support services to 29,654 people with various addictions and three-month advance payment support to 1,285,134 safety net beneficiaries, and food and hygiene support to 600,000 disabled people. However, reaching the needy was a big challenge due to resource capacity.

Regarding education sector strategies, delivery techniques used during school closures were not inclusive. The coverage of radio and TV instructions was not only limited but also interrupted by power cuts in small towns and rural areas. Access to the virtual learning platforms also depended on access to the technologies and gadgets which low-income families, households in rural areas, and disabled children in poor households do not always have. Student with vision impairment, and their parents reported that students could not take part in TV programmes involving practical activities. As a result, talking textbooks were provided to visually impaired students in the Tigray Region to address the problem of access to virtual learning materials. Participants in key informant interviews confirmed that due to the COVID-19 pandemic school closures, there was significant learning loss and huge inequalities against disadvantaged segments of the population. There were already pre-COVID-19 inequalities in access to quality education between children in urban and rural localities and children from various socioeconomic backgrounds. The primary purpose of the instruction methods designed during school closure was not to give access to students but to reduce anxieties and to send students who were not ignored back to school when the spread of the virus has reduced.

The pandemic also had health effects on non-pandemic patients. In some regions, home deliveries increased as expectant mothers could not easily access health facilities due to restriction mandates. The pandemic also decreased the number of people visiting hospitals for diagnosis. For example, diagnosis of malaria, measles, and other frequently occurring diseases decreased as resources were dedicated to the pandemic. The regional health Bureaus established the COVID-19 diagnosis team and other diseases team to address the inequity. Some regions deployed quarantine at home, but later experts noted that the strategy was not feasible for larger family size households, particularly the poor with insufficient room numbers. However, poor room households were transferred to public quarantines to address the challenge.

Economic Inclusiveness

In terms of economic inclusiveness, the economic policy measures were inclusive, according to the key informants. All economic sectors were targeted, but the policy emphasised airlines, industrial parks, health, education, and hospitality sectors. Interview participants argued that in collaboration with the transport sector, efforts were made to ensure that agricultural inputs were not disrupted and productivity was not affected. Menistu et al. (2020) explained that export-oriented firms were more likely to report receiving government support than domestic market-oriented firms. Goshu et al. (2020) found that agricultural operations were less adversely affected by the pandemic than non-agricultural businesses.

Political Inclusiveness

According to the participants, COVID-19 policies were inclusive because the government involved all political parties. Nevertheless, some parties, including Tigray Peoples Liberation Front (TPLF), refused to work with the ruling party for political reasons. For instance, parliament postponed the national election because of the outbreak. Other opposition parties hindered the government’s efforts to reduce the pandemic's spread. Most of those who opposed the intervention thought they had lost their power due to the current political reforms in the country. Therefore, they saw COVID-19 as a political agenda of the governing party. The political differences gradually reached a level of war between TPLF in Tigray and the federal government of Ethiopia. Despite these differences, however, the majority was cooperative in every aspect including compliance of pandemic protocols, resource mobilisation, and altruistic support for the vulnerable.

Equity Impact of COVID-19 Policy Responses

Compliance with COVID-19 protocols was high among the population. For instance, over 99% of men and women-headed households reported washing hands more often since the outbreak. In addition, over 96% of all households abstained from handshakes, while 86% avoided crowds and gatherings since the outbreak. Compliance was also high in the regions such as Addis Ababa and Dire Dawa (99%) and Amhara (92%).

Policy responses to the pandemic affected social groups differently. Although people with disabilities knew the outbreak and mitigation measures, they faced difficulties adhering to social distance measures. For example, visually impaired persons and wheelchair users in need of community assistance did not often get people to help them due to fear of infection. In addition, some visually impaired people felt isolated because of the protocols. For example, a visually impaired man lost hope in his community in Dire Dawa town because he felt isolated. As a result, he committed suicide by burning himself (Emirie et al., 2020).

Moreover, income constraints and disabilities differently affected compliance with the policy measures. For example, a physically disabled 19-year-old girl in Bahir Dar explained that she shared a toilet with others and was worried that if she got infected, she was sure her body would not cope. Moreover, disabled migrants live in very low-cost housing in Addis Ababa without private piped water and toilet and are therefore more exposed to the pandemic (Emirie et al., 2020). In general, compliance was high during the first stage of the pandemic and relaxed during the second stage.

Equity of Access to Necessities

The pandemic had deleterious effects on access to services, but this was differentiated by sex. More male-headed households were more likely to report that there were unable to buy medication during the first stage of the pandemic. During the second stage, it was the reverse, where more women reported they were unable to buy medication. The factors contributing to respondents’ inability to access necessities include shortages in shops, closure of markets, transportation challenges, restrictions on movement, increased prices, and a decline in regular income. The pandemic also caused rural–urban differences in access to necessities. For example, rural dwellers who could not buy medicine were 48%, while only 12% of urban people reported the same during the first stage of the pandemic. Similarly, 44% of the rural population compared to 17% of urban people surveyed were unable to buy sufficient ‘injera’, the local staple food (see Fig. 8.1). The results implied that although rural people are mainly in agricultural production, they were disproportionately affected with COVID-19 induced food insecurity.

Fig. 8.1
A stacked bar graph displays the percentage distribution across different crops. In Round 3 urban areas, the highest percentage, 22%, is for yes regarding medicine. In Round 3 rural areas, it's 23% for no regarding teff. In Round 2 urban areas, it's 20% for yes regarding medicine. In Round 2 rural areas, it's 35% for no regarding teff. In Round 1 urban areas, it's 20% for yes regarding medicine, and in Round 1 rural areas, it's 30% for no regarding medicine.

Access to basic necessities by location and crop. Note ‘yes’ for access while ‘no’ for do not have access in both periods

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Regarding regional disparities, respondents in the Somali region reported more difficulties accessing teff and wheat during the first and second rounds of the survey.

Equity in Education

School closures affected many school-going children, and over 47,000 schools were affected (MoE, 2020). The World Bank survey showed that out-of-school-age children did not engage in any learning during the period. The first-round survey showed that 65% of children in female-headed households and 68% in male-headed households were affected. Moreover, some children did not return to school when schools reopened.

The pandemic responses deepened the urban–rural education access inequity. In rural areas, 86% of out-of-school children did not engage in any learning during the pandemic. The figure for their urban counterparts was 57%. In addition, the second-round survey showed that rural children who stopped attending school after the pandemic were significantly higher than urban children who gave up school. Moreover, early marriage and child migration increased (Emirie et al., 2020).

Furthermore, the pandemic interventions had an unequal outcome on children's education across nine regional states in Ethiopia. Out of children in school before the pandemic, children engaged in learning activities after the outbreak was the highest in Tigray (61%) than in other regions except in Addis Ababa city administration (66%) in the first round. Other regions were within the range of 1% to 36% during the first round of the survey. In round two, the number increased in Tigray (77%), Addis Ababa (67%), and Dire Dawa (59%). The figures increased in subsequent periods in the other regions.

The pandemic generally affects school children from poorer and female-headed households and those in poor regions. Interventions to mitigate the disruptions in education (MoE, 2020) were more accessible to male-headed households and positively affected school children in those households. Most of the interventions increased the access of children in male-headed households to education compared to children in female-headed households. Children in female-headed households accessed lessons on mobile learning apps more in the first and second rounds of the survey. Similarly, urban school children accessed virtual learning platforms more than their rural counterparts.

Equity of Health Service Access

During the survey period, 17% and 18% of female and male-headed households reported needing medical attention. The figures increased to 23% for both household types in the second round. However, in the third round, it decreased to 18% and 20% for female and male-headed households, respectively. Regarding location, 19% of urban and 14% of rural households surveyed reported needing medical treatment. During the second round, the corresponding figures were 24% for urban and 22% for rural households. In the third round, 20% of urban and 18% of rural households surveyed needed medical treatment. The households reported they could not access medical care because of the pandemic. Figure 8.2 shows that while households in the upper and middle quintiles reported needing medical attention, the poor did not have access to medical care.

Fig. 8.2
A stacked bar graph represents the percentage distribution across location, social status, and sex. The highest percentage of yes responses in Round 1 is 40% in rural locations, for round 2 it is 32% in the poorest social status, and for round 3 it is also 32% in the poorest social status.

Medical care need by location, social status, and sex

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Regarding location, all respondents in the Somali region (100 per cent) had access to medical care, while Amhara (85%) had the least access. During the third round, however, Afar regions surveyed respondents had the highest (100%) access to medical care while Southern Ethiopia had the least 82%.

Urban youth in Ethiopia with disability faced difficulties accessing sexual and reproductive health services after the pandemic. Key informants explained that the outbreak interfered with essential health service delivery. Also, service delivery was affected by infections by health service workers. Some health service workers were deployed to attend to people in critical need of the services.

Employment Equity

Job losses were rampant during the pandemic period due to the closure of businesses and other factors. Job losses in urban areas attributed to business closure were significant compared to job losses in rural areas. The survey also showed that the pandemic-related business closure resulted in more job losses for the poor than for the rich (Fig. 8.3).

Fig. 8.3
A stacked bar graph represents the percentage distribution across gender, location, and social status. The highest percentage of yes responses in Round 3 is 45% in women gender, for round 2 it is 40% in the poorest social status, and for round 1 it is 50% in the rural location.

Business closure-related job losses

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It is important to note that due to government directives to employers not to lay off workers, job losses were experienced more in the informal sector. Nevertheless, some organisations continued to work in various modalities. For example, some universities provided education via online platforms, and some sectors continued working with utmost care and halted employment reduction.

Income Equity

The COVID-19 policy responses have impacted income and living costs. Women headed households who earned agricultural income had more income reduction in all three rounds of the survey. However, meanwhile, men encountered significantly more agricultural total income loss than women in all survey periods. Moreover, rural farm income was more affected than urban income in all periods except total income losses.

Farm income loss disparities also existed across regions. The total income loss of 79% was highest in the Harar region, followed by 71% in Addis Ababa in the first round. Most urbanised regions in Ethiopia faced high farm income losses because of the pandemic. The highest farm income reduction of 99% and 94% in the first and second rounds occurred in the Somali region.

In terms of wage employment, more men experienced a reduction than women. The pandemic reduced urban wage-employment income more than rural income. Private schoolteachers also experienced income losses more than their public counterparts. Regarding regional differences, 47% wage-employment income reduction was reported in the Somali region and 24% in the Dire Dawa region. With a 20% total income loss in the same period Somali region was more hit by the pandemic.

The pandemic also resulted in a total income decline in Ethiopia. More men than women had total income decline. For example, while men's incomes were reduced to 72%, that of women was 28% (Fig. 8.4). In addition, the total incomes of urban people saw more decline than that of their rural counterparts.

Fig. 8.4
A stacked bar graph illustrates the percentage distribution across different rounds. The highest percentage for the richest status is 20% in increased round 3. For gender men, it's 22% in increased round 2, while for gender women, it's 15% in loss of round 1. In rural locations, it's 22% in constant of round 1, and in urban locations, it's 30% in loss of round 2.

Total income losses by sex and social status

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Total income loss discrepancies occurred across regional states, with 94% total income reduction in the Somali region, 58% in Tigray, and 57% in the Oromia region in round one. The income losses were between 40 and 50% for all other regions. The income losses in the Somali region did not change in the third round. However, the status of income reduction in all other regions was still significant and ranged from 19 to 42%.

Food insecurity was also unevenly distributed. Twenty per cent of households surveyed ran out of food within 30 days of the pandemic, but food insecurity was more acute for female-headed households. On average, urban residents were more food insecure than rural households. While food insecurity affected the poor more than wealthier households. Ten per cent of wealthy households reported running out of food compared to 25% of their poorer counterparts. More female-headed and rural households reported that they had gone to bed without food than their male counterparts. In the first round, 57% of poor households and 36% of wealthier households reported going hungry.

Food security differences were also observed in regions with 64%, 40%, and 28%, respectively, in households in Somali, Afar, and Tigray regions having ran out of food in the last 30 days. The corresponding figure for other regions ranged between 8 and 24%. The figures, however, changed in the second and third rounds (see Fig. 8.5).

Fig. 8.5
A stacked bar graph depicts the percentage distribution across different rounds. The highest percentage for Round 1 no responses is 30% in Tigray, while for Round 1 yes responses, it's 25% in Somali. In Round 2, the highest percentage for no responses is 31% in B or G, and for yes responses, it's 3% in S N N P R. In Round 3, the highest percentage for no responses is 35% in Somali, and for yes responses, it's 3% in Amhara.

Food insecurity by region

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Distribution of Welfare Benefits and Corruption

The key informant interview participants had insufficient information regarding the incidence of corruption during the COVID-19 intervention. As some argue, a state of emergency with strict control by the security sector may reduce rent-seeking. However, an interviewee from MoH explained that in some areas, including the ministry, there were some unsuccessful attempts. In some areas, youth groups took yellow t-shirts from health bureaus and collected money for personal use. In SNNPR, although there was a strong involvement of volunteers and follow-up mechanisms, some minor rent-seeking behaviours were still noticed. In SNNPR, the state of the emergency proclamation halved the size of the passengers and doubled prices, but service providers doubled prices but did not halve the number of passengers.

An expert working for MoE also expected that massive resource mobilisation to fight the pandemic might increase rent-seeking and corruption incidences. However, the organisations encountered incidences of corruption because of a lack of attention and preoccupation with national security problems. Most key informant interview experts from regional bureaus asserted that they had not encountered any misbehaviour related to corruption and rent-seeking as people engaged in supporting the vulnerable with altruistic motives.

Structural Change and Innovativeness of Policy Responses

The policy response led to structural changes and innovation. For example, an report of MoE explained that students developed self-learning, decreased dependence, and spoon-feeding and confronted various challenges that led to more practical learning. The use of technologies like telegram, mobile apps for education, and online education increased but was accessible to those with resources. In some regions, teamwork, access to laboratory equipment, a multisectoral approach to address health challenges, and increased attention and support to health sectors by authorities were deployed. Moreover, the number of hospital beds and inputs of disinfectants increased contrary to pre-COVID-19 period. Authorities gave more attention to health sector by allocating sufficient budget. Universities research and other support collaborations with health centres and hospitals also increased. Virtual meetings such as Zoom meetings since the outbreak created an opportunity to discuss with the large population at a time, including higher government officials which reduced the costs of travelling and hall renting for meetings. However, internet and power cut problems constrained the deployment of the e-technologies for meetings.

Conclusion and Recommendation

The Ethiopian government implemented a step-by-step COVID-19 response plan considering the country's economic and social conditions. The country declared five months state of emergency and implemented a partial lockdown. The policy intervention maintained the balance between reducing the health effect of COVID-19 and its economic impact. The government emphasised preventive measures while maintaining some economic activities in the industry, service, and agriculture to satisfy the economic needs and prevent its devastating impact. The integrated role of the government, NGOs (local and international), the private sector, CBOs, and the community was significant in the intervention, particularly in awareness creation, resource mobilisation, and supporting the vulnerable. As a result, the overall effect of COVID-19 in Ethiopia is relatively low compared to other countries worldwide. However, the poor health system and inadequate preventive facilities (such as PPE and treatment equipment, among others); inadequate social services (e.g., water and sanitation), political turmoil and conflict, dependency on the informal economy, high unemployment rate, debt distress, high inflation rate, and low level of domestic resource mobilisation were the challenges in the fight against COVID-19. The equity impact was also significant in terms of income, employment, food security, and reaching the disabled, socially marginalised groups and others living with other chronic diseases. The equity difference was significantly based on age, gender, income status, and geographic location. It is fair to conclude that COVID-19 in Ethiopia was not only a curse but also an opportunity to improve health infrastructure and promote technological innovation in the health, education, and economic sectors. It is also an opportunity to prepare for future similar health crises.

The Ethiopian case shows that the government and non-state actors participated in the implementation of public and social, economic, and governance lockdown policy responses to reduce the spread of COVID-19. Unlike some countries in the region, the lockdown in Ethiopia was partial with selected restrictions. A prevention-focused health sector strategy also guided the overall intervention effort, and the government tried to balance a health crises and its socioeconomic fallouts.

The federal and regional governments adopted significant economic policy responses, including liquidity injection, to allow banks to reduce interest rates and extended debt payment mandates. About leadership and governance, various committees were established to make proactive non-routine decisions to address the challenges of the pandemic. However, resource allocations to control the pandemic competed for limited health facilities and health workers available to provide essential health services. Although the state-enforced social distancing through the state of emergency, shortage of rooms to quarantine and water for hand washing in some parts of the country and power and internet cuts to work from home were among the challenges that hindered the implementation.

Although the government and non-government actors supported vulnerable social groups, the inclusiveness of policy measures was questioned. School closure was implemented while the virtual platform and other modalities used to continue education were affected by various setbacks and resulted in huge inequity. Lessons taught using TV and radio programmes and online excluded the poor and the disabled more. Children in big cities benefited from the interventions than their rural counterparts. Also, innovations practised reducing physical contacts discriminated against the disabled. Home quarantines were impossible for the poor that lacked sufficient rooms. The emphasis on the pandemic compromised essential health services and decreased the number of patients visiting hospitals and maternal care.

Moreover, the lockdowns increased women's domestic violence, sexual assault, early marriage, and school dropout rates. The lockdown measures disproportionately impacted the informal income, aviation, and entertainment sectors. Efforts to reduce the transmission of the outbreak concentrated in urban areas, and in effect, protective measures were less practised in the countryside.

The case analysis demonstrated that Ethiopia’s policy responses had equity impacts. Policy responses to the pandemic unequally affected the vulnerable social groups in Ethiopia. The partial lockdowns in Ethiopia affected urban food and medicine access more than rural ones and resulted in regional variations but were not gendered. The outbreak responses also led to differences in rural–urban, income class, and regional education access. Urban people in need of medical treatment were not only more significant. However, they had more access to medical treatment than rural people in all survey periods after the pandemic. The rich have had more need for medical treatment and accessed the medical treatment more than the poor. Despite the regional inequities across regions, people needing medical treatment and who had accessed it after the pandemic was significant.

The outbreak resulted in more job losses for men, as the survey has shown. Business closures affected the poor and urban jobs more significantly. Informal sector jobs were more affected than formal sector jobs. During the three survey periods, policy responses affected total agricultural and waged employment income losses for men more than women.

The policy responses significantly impacted food security in Ethiopia. Female-headed households were more food insecure than men, and the poor were more food insecure than the rich. However, a significant proportion of the rich were food insecure. Rural people were more food insecure, but there were still instances of urban people being more food insecure than rural people.

Recommendations

  • Given the differential impacts of the pandemic and its policy responses on diverse groups, the government must make efforts to reach targeted groups with specific interventions. Proper targeting can be achieved with structural changes in the economy and deployment of innovative tools.

  • The government must strengthen and institutionalise existing social protection programmes in rural and urban areas to reach large-scale vulnerable groups such as the elderly, disabled, women, and children so that they will be protected from future health and socioeconomic shocks.

  • There is the need for an expansion in education, health, and water and sanitation infrastructure in rural and poor urban neighbourhoods to enhance access for the poor.