ABSTRACT
Introduction/ Background: The COVID-19 pandemic has brought multifaceted impact including on health systems. In Ethiopia limited data is available how the response to the pandemic is shaping at sub-national level. This study explored the response to COVID-19 at subnational level and its impact on essential health services. Methods: We conducted a qualitative study using key informant interviews. A total of 59 health leaders across Ethiopia's 10 regions and 2 administrative cities were purposively selected. Data were collected using a semi-structured interview guide in October 2020. Transcripts were coded, categorized and thematic analysis was conducted. Twenty-four experts with graduate level training conducted the interviews and supervised the data collection. The respondents included regional and zonal managers, directors and health workers at primary health facilities. Results: Local government took the lead in responding to COVID-19 by organizing multisectoral committees. Health officials organized incident management teams. The management reassigned the health workforce to COVID-19 surveillance and case management and took other measures. Training was prioritized for members of rapid response teams, laboratory technicians, clinicians assigned to treatment centers and health extension workers. Personal protective equipment was difficult to obtain at the beginning of the pandemic. Rapid response teams conducted case investigation, contact tracing, and sample collection. Essential health services declined in the first few months of the pandemic, affecting maternal and child health, HIV/AIDS, and tuberculosis services. Impact: There is a need to learn from the multisectoral actions that were effective at beginning of the SARS-COV-2 pandemic. it also underscores multisectoral actions are critical for minimizing the impact of pandemics such as COVID-19. In addition, investing to build resilient health systems at grassroots is a priority issue. Conclusion: Multisectoral support was intensive at beginning and helped in directing human, material, and financial resources toward the response. But the intensity of the response faded away and essential services suffered in the first few months of the pandemic.