Strategic response to COVID-19 in Ethiopia.

COVID-19, the novel coronavirus, has posed a major threat to low- and middle-income countries (LMICs) due to inadequate health infrastructure and human resources. Ethiopia, a low-income country with the second largest population in Africa, has coordinated a strategic response, leveraging existing infrastructure and health systems and mobilizing public health professionals and specialist expert physicians for a multifaceted, unified government approach and adaptive response. Resource limitations, particularly in critical care, have still posed challenges, but the public health and clinical interventions thus far have prevented the catastrophic toll that many predicted. As the pandemic continues, Ethiopia expects to use a triple care model integrated at all levels, consisting of COVID-19 care, isolation care for suspected cases, and essential health services, and urges intensified non-pharmaceutical interventions alongside equitable global vaccine distribution as the ultimate answers to pandemic control. This paper draws on existing data, national planning and guidelines, and expertise from health leadership to describe this response in hopes of providing an example of how future large-scale health challenges might be faced in LMICs, using Ethiopia's successes and challenges in facing the pandemic.

COVID-19, le nouveau coronavirus, a représenté une menace majeure pour les pays à revenu faible et intermédiaire (LMIC) en raison de l'insuffisance des infrastructures de santé et des ressources humaines. L'Éthiopie, un pays à faible revenu dont la population est la deuxième plus importante d'Afrique, a coordonné une réponse stratégique, en tirant parti des infrastructures et des systèmes de santé existants et en mobilisant des professionnels de la santé publique et des médecins experts spécialisés pour une approche gouvernementale unifiée à multiples facettes et une réponse adaptative. Les ressources limitées, notamment en matière de soins intensifs, ont encore posé des problèmes, mais les interventions cliniques et de santé publique menées jusqu'à présent ont permis d'éviter le bilan catastrophique que beaucoup prédisaient. Alors que la pandémie se poursuit, l'Éthiopie prévoit d'utiliser un modèle de soins triple intégré à tous les niveaux, composé de soins COVID-19, de soins d'isolement pour les cas suspects et de services de santé essentiels, et préconise l'intensification des interventions non pharmaceutiques parallèlement à une distribution équitable des vaccins à l'échelle mondiale comme réponses ultimes au contrôle de la pandémie. Cet article s'appuie sur les données existantes, la planification et les directives nationales, et l'expertise des responsables de la santé pour décrire cette réponse dans l'espoir de fournir un exemple de la manière dont les futurs défis sanitaires à grande échelle pourraient être relevés dans les LMIC, en utilisant les succès et les défis de l'Éthiopie face à la pandémie.

An evaluation of capacity and gaps in critical care services in Rwanda: A mixed methods approach

Background Low- and middle-income countries (LMICs) shoulder a disproportionately high burden of critical illness with limited healthcare infrastructure. However, despite increased attention on critical care capacity due to Covid-19, LMIC intensive care unit (ICU) capacity remains largely undescribed-especially in East Africa. We sought to characterize barriers to critical care capacity and delivery in Rwanda, hypothesizing that gaps in specialized personnel, training, and supervision ('human resources') would be perceived as more important limitations to high-quality ICU care compared to gaps in beds, medications, and diagnostics ('facilities, materials, equipment'). Methods We performed a cross-sectional survey of all hospitals with dedicated ICUs in Rwanda using a mixed-methods approach, adapting conceptual frameworks for health services evaluation in global disaster response and emergency medicine. Using World Health Organization (WHO)-developed benchmarks for facility-level surgery and trauma evaluations, we created a set of tools for ICU assessment. Questionnaires for physicians, nurses, trainee physicians, and hospital leadership were developed and pilot tested using REDCap software. Inventories of ICU and hospital capacity using an adapted WHO tool were undertaken at each site. Descriptive statistics including percentages, means, and standard deviations were performed. IRB approval was obtained though Columbia University Medical Center and the University of Rwanda. Results Four hospitals in Rwanda were identified with dedicated ICUs. Total ICU beds were 27 (5- 8), total annual ICU admissions were 1128. The majority (96%) of invited ICU medical staff completed the survey, including nurses (N=60), trainee physicians (N=29), and attending physicians (N=10). Complete inventories were obtained from all 4 hospitals. Respondents identified insufficient staffing (63%), equipment/bed shortages (40%), lack of training opportunities (36%), and inadequate supervision (23%) as key obstacles to providing high quality critical care. Both human resources (39%) and material resources (28%) were identified as key gaps. Inability to treat common critical illnesses was frequently reported. Inventories at the hospital level clearly identified resource constraints. Conclusions In this study, gaps in both material and human resources were perceived as limiting ICU care, in line with provider perceptions of inadequate care quality. Obstacles to change include material gaps, lack of training, and institutional barriers. Notably, health system leadership in Rwanda on multiple levels is aware of these gaps and challenges with specific plans to improve training, support, and availability of equipment and supplies. This study emphasizes the complex nature of LMIC critical care limitations, providing insight into addressing them institutionally.