The COVID-19 response in Addis Ababa (a personal reflection)

The COVID-19 response in Addis Ababa (a personal reflection)

Since the time that the first case was announced publicly mid-March 2020, the Government of Ethiopia (GoE) and the Addis Ababa City Administration had to deal with thousands of returnees from the Middle East and many African countries that decided to repatriate Ethiopians without legal residence permits (including Djibouti, Kenya, Sudan, Somalia, etc). Ethiopia has received forced returnees in the thousands (still growing) and have tested them all (at least all the known returnees) for COVID-19. Many of the positive cases identified until mid-May 2020 were from either these returnees or from those with travel history. However there is now a surge of positive cases for Addis Ababa-ns that have no travel history or contact with known positive cases; indicating a community transmission across the city.

Since the State of Emergency (SoE) was announced a few weeks ago, many individuals deemed non-essential for critical tasks of businesses, public and private institutions were told to stay home but with no reinforcement mechanism in place. While the government is struggling to secure resources from both domestic and external sources; the ball was dropped in the enforcement component. Many across Addis Ababa still go out to restaurants, cafés, and bars for leisure and do so during the day as well. Those that were relieved of mandatory office hours haven’t taken the advice of government or civil society groups to remain at home unless for crucial activities (buying supplies, hospitals/pharmacies, etc).

Since the regulation to have no more than four people in the same room came about, I have seen multiple occasions of non-compliance across the city. One can easily say COVID-19 has become a test for the functionality of the social contract between citizens and their government. The government’s authority is constantly tested by people who don’t feel accountable to its authority. While government seats on political power and authority, it does not command popular acceptance and recognition by the public of its authority to dictate norms and behavior to allow it to peacefully enforce regulation (even in a state of emergency). GoE’s legitimacy is measured every day. For better or for worse, right now, it is not paying up. About a week ago government started rounding up people in violation of provisions of the SoE. These were released on the same day after a ‘lesson’ and ‘warning’. This was intended for the public to learn, or so it seems, but much didn’t change. A few days ago government rounded up over 2,000 individuals failing to comply to the SoE regulations in public spaces and sentenced about 650 of them to up to three months in prison. While there are many factors at play here; including lack of awareness, absence of desire to learn and change; or outright lawlessness and ignorance; it could be indicative of what awaits us in the near future. It is one thing to write a regulation, it is another to enforce it. And in a city where you have millions depending on daily income to have ends met, and with estimated population of over 4 million inhabitants, people’s incentives to stay-in is non-existent.

Will Addis Ababa-ns have the real choice to stay in and let the wave pass? Or will survival command that they risk the public health to have daily subsistence needs met?

So what can the AA City Administration and the much bigger stakeholder, the Federal Government, do to have a safer Addis Ababa? We are used to hearing our mothers say to us “I am the one who knows the expenses of the family” and hide away a little every now and then for a rainy day. Mother’s accountability is to a higher power, or nature, if you will; since they knew about saving for a rainy day. More often than not, there came a time when that stash was needed to pay for an ill child or for expenses when regular income dried up. Should I hope that our government has something stashed up for a rainy day? Go ahead and laugh! If not, then the hundreds of millions in cash and in kind they have collected for this response, just over the last three months will do. This is where you hope your government knows what they are doing. They know how to streamline. They know how to enforce a lean government spending. They know how to coordinate from the highest level to the local woreda level of government. But deep inside, I know that is wishful thinking. I have seen that they are way behind on what they should have learned a long time ago. Obviously, this isn’t about individuals. This is about institutions. This is about a system of government that is agile. That adapts. That survives the biggest blow and bounces back. A government that is inherently resilient. Although every day I hear or see something that makes me question its capacity, I hope somehow it can pull together and lead the over 110 million citizens over the next months to either a “COVID-19 free” nation or a “COVID-19 under control” nation.

Here is a few ideas of how they can achieve that:

1 – Know what you have and what you lack in information and enforcement: look into the existing command and control structures. Not in the military or your law enforcement, please! Look into the system of command and control. You don’t need your military now. You need your Health Ministry and Public Health Institute to play a key role in spearheading government action. Are they looped in properly? Are they second guessed every time? Is the question if they are politically savvy or technically and professionally sound? It isn’t their job to think about jobs or income or the economy. But when you are living in a pandemic, you want their voice louder and everyone else adopting to their recommendations. This doesn’t mean they don’t get challenged, but not on the issue of the pandemic and for political reasons, simply because lives matter more than our political bickering. 

2 – Know what you have and preposition what you need: this is where Disaster Risk Management follows the lead from the health experts. And that whole of government action tracks. As disaster management and response professionals, you want them to tell you what is needed, when, where, in what quantity, and run an emergency operation center that has real power and authority over emergency operations and management of responses. The highest body of government, in our case the Ministerial Committee overseeing COVID-19 response convened by the Prime Minster, should follow suit. Otherwise, you risk having frustrated professionals who are powerless. When we see tons of food and cash provided as aid for COVID-19 affected people, as much as it shows me the national solidarity, it also worries me because we are giving it to a city government that has largely failed to do the basics. Addis Ababa City Administration in my view has constantly failed to meet a bare minimum standard of quality service in many aspects of municipality management and development. Leave alone collecting resources for and spearheading a massive disaster relief program, they barely manage their own budget lines annually. Case in point...too many to list, but one minor one with massive relevance to COVID-19 response. Capacity in the area of SoE provisions regulation/enforcement for the city largely falls on the city administration. Look at how they have failed to implement. No reason for excuse will suffice. Their inability to implement laws is why as I write this. Just across my street in this “residential neighborhood”, there is a bar open and is serving alcohol to individuals that are sitting lip-on-lip. There is no social distancing! For all the resources that has been collected, a database and a pre-positioning plan need to be put in place and communicated with local citizens groups, not party affiliate youth or women groups. This isn’t a time to slack or score political points. This is a time to hold institutions and their leaders to account per their responsibilities. I imagine half of this city’s population can’t survive more than two days without fending for themselves. Which mean basic food items and supplies need to be provided! Unfortunately the systemic infrastructure is non-existent.

3 – Drive the message home: you might think this is all done and everyone is aware. Think again. This isn’t a nation of people that hear when told once. Or twice. Unfortunate. But the reality is human behavior is not such that you hear and comply the first time. This isn’t just in Ethiopia. This is human nature (except for may be the Scandinavians). So continue to drive the message home. Make it everyone’s business. Make it everyone’s problem. Public servants and law enforcement with citizen groups and volunteers need to continually communicate with the public. Everyone needs to know. Those who are multiple offenders need to pay the penalty. Why is there not a system of accountability for people not complying? Why isn’t there a fine? Why isn’t there a system of neighborhood watch? When people leave their neighborhoods why do they leave without masks and with no purpose? “Just a walk” isn’t a good enough excuse anymore.

4 – Pray for the best but prepare for the worst: I am not sure if anyone that has gone into an ICU ever survived in Ethiopia. Yes, people have recovered but not after going over the edge. If this is indicative in any way to anything, it is about 0.9 person for every 100 tested and confirmed cases dies (about 1 of every hundred). We are at about 700 cases and 6 death. According to the current numbers for the tested, about 87 thousand, we have 0.8% positive cases. But this may be misleading. A large number of the tests are with travel history. And it is only in the last week or so that we started seeing a rise in number of community transmissions. And this is where it begun for many countries. So don’t relax just yet. We are in just the beginning days of the pandemic for Ethiopia. Remember even with these numbers, it isn’t all rosy for a city of 4 million. If we take 5% of tested and confirmed case (200,000) then we are looking at over 2,000 death and this is the most conservative estimate. And this is just in Addis Ababa with the best case scenario. The worst case scenario will be an overwhelmed health care system and entire chunks of the city overrun by the disease. This would mean tens of thousands of deaths.

5 – a time for solidarity and learning: is someone writing these lessons? This is a question that one of my colleagues used to ask frequently when so much “meat” was discussed in meetings. We should be learning from this. We don’t learn from it once it has passed. We learn from it, improve, adapt and revamp responses and control efforts as we go through it. Be it on our health care, in our coordination, in our information management, in our disaster response, in our safety-net programs; this is where so much learning needs to happen. There should be a dedicated team of experts from all sectors set up at the highest levels of institutions and government making sure that we are recording and learning from this process, from where the gaps are, and ensuring that key decision makers are informed and change is implemented as we address the challenges of the pandemic. Sometimes it is easier to redo the whole system now, when there is incentive for everyone involved. For all you experts out there, if you thought the appointed government officials were difficult to convince to do something meaningful for their citizens and constituency, this is the time to test your idea, bring data and reason behind it and get it approved. These are times to stand together for better services and care for our people, for our neighbor, and for our country. You are needed. Wherever you are, whoever you are, whatever you do you are now needed. If not for anything but to #stayhome #helpyourneighbour! See you on the other side.

The quality of your life depends on the quality of your plans!