Experiences and lessons from structural interventions against COVID-19 in Addis Ababa, Ethiopia.

Introduction: Fighting pandemics like COVID-19 requires implementing successful structural and behavioral interventions that attempt to change the social and political environments to increase adherence to preventive behavior among community members. However, studying structural interventions implemented during pandemics and their challenges remains to be uncharted territory in developing implemented countries. Objectives: Given this, we documented the experiences of implementing such interventions in Ethiopia with the aim of drawing lessons for future efforts to fight similar outbreaks in resource limited and low-income settings. Methods: We conducted a qualitative study between September and October 2021. Data were collected through face to face and telephone interviews from purposefully selected stakeholders from government and private sectors engaged in social interventions to prevent COVID-19. The systematization and the analysis of the data were conducted with MAXQDA 2020 software. Results: Ethiopia implemented structural and social interventions to respond to the COVID-19 pandemic. This included: developing national policy and guidelines, mainstreaming COVID-19 interventions to local organizations, implementing capacity development programs, and developing strategies to engage the community, through traditional institutions, in intervention activities. In addition, a mass communication approach was used to deliver risk messages. This yielded a promising result in slowing down the spread of COVID-19 in the capital of Ethiopia-Addis Ababa. On the other hand, competing interests, misconceptions, capacity constraints among professionals and organizations, limited capacity to enforce legislation and lack of motivation for change from the community side affected the implementation and the outcomes of interventions. Conclusion: Going forward, these challenges need to be taken into consideration when designing and implementing structural interventions to contain disease outbreaks effectively. The study highlighted that attempts to withstand pandemic in low- and middle-income settings shall successfully utilize local resources, act swiftly when pandemics outbreak and adjust themselves to the dynamic challenges and limitations of structural interventions.