Assessing the policy and institutional framework for multisectoral governance and accountability in emergency preparedness and response in Ethiopia.

Public health emergencies place sustained pressure on health systems, particularly where effective coordination across sectors and levels of governance is required. Although Ethiopia has established policy frameworks and coordination mechanisms aligned with global initiatives, evidence on how these arrangements function in practice remains limited. This study assessed multisector governance for public health emergency preparedness and response, focusing on accountability, coordination, institutional roles, and implementation. A sequential mixed-methods study was conducted in Ethiopia between July and September 2025. Quantitative data were collected through a cross-sectional survey of 74 stakeholders from institutions involved in emergency preparedness and response across the health, disaster risk management, agriculture, livestock, academic, and partner sectors. Governance was assessed across seven predefined domains using 5-point Likert-scale measures, with domain scores summarized using descriptive institutional maturity categories. Qualitative data from purposively selected key informants were analyzed thematically to contextualize and explain quantitative findings. The survey achieved a response rate of 92.5%. The overall perceived governance maturity score was 3.31, corresponding to the predefined functional category. Most governance domains were rated as functional, whereas policy framework implementation remained at the emerging level. Qualitative findings indicated that national guidelines and coordination platforms were widely recognized, but their implementation varied across administrative levels. Persistent challenges included role ambiguity, inconsistent coordination and reporting practices, weak feedback mechanisms, and uneven implementation of policy and legal frameworks, particularly at subnational levels, where governance frequently relied on adaptive and informal practices. Overall, Ethiopia has established a functional institutional foundation for multisector emergency governance; however, important policy-to-practice gaps remain. Strengthening operational guidance, coordination, accountability, and implementation across administrative levels will be essential to improve emergency preparedness and response.