This case study examines country-level primary health care (PHC) systems in Ethiopia in the context of the COVID-19 pandemic between March 2020 and March 2021. The case study is part of a collection of case studies providing criticaln insights into key PHC strengths, challenges and lessons learned using the Astana PHC framework, which considers integrated health services, multisectoral policy and action, and people and communities. Led by in-country research teams, the case studies update and extend the Primary Health Care Systems (PRIMASYS) case studies commissioned by the Alliance in 2015.

We assess the impact of Ethiopia’s flagship social protection program, the Productive Safety Net Program (PSNP) on the adverse impacts of the COVID-19 pandemic on food and nutrition security of households, mothers, and children. We use both pre-pandemic in-person household survey data and a post-pandemic phone survey. Two thirds of our respondents reported that their incomes had fallen after the pandemic began and almost half reported that their ability to satisfy their food needs had worsened. Employing a household fixed effects difference-in-difference approach, we find that the household food insecurity increased by 11.7 percentage points and the size of the food gap by 0.47 months in the aftermath of the onset of the pandemic. Participation in the PSNP offsets virtually all of this adverse change; the likelihood of becoming food insecure increased by only 2.4 percentage points for PSNP households and the duration of the food gap increased by only 0.13 months. The protective role of PSNP is greater for poorer households and those living in remote areas. Results are robust to definitions of PSNP participation, different estimators and how we account for the non-randomness of mobile phone ownership. PSNP households were less likely to reduce expenditures on health and education by 7.7 percentage points and were less likely to reduce expenditures on agricultural inputs by 13 percentage points. By contrast, mothers’ and children’s diets changed little, despite some changes in the composition of diets with consumption of animal source foods declining significantly.

This case study examines country-level primary health care (PHC) systems in Sudan in the context of the COVID-19 pandemic between March 2020 and July 2020. The case study is part of a collection of case studies providing critical insights into key PHC strengths, challenges and lessons learned using the Astana PHC framework, which considers integrated health services, multisectoral policy and action, and people and communities. Led by in-country research teams, the case studies update and extend the Primary Health Care Systems (PRIMASYS) case studies commissioned by the Alliance in 2015.

Ensuring that members of society are healthy and reaching their full potential requires the prevention of disease and injury; the promotion of health and well-being; the assurance of conditions in which people can be healthy; and the provision of timely, effective, and coordinated health care. Achieving substantial and lasting improvements in population health will require a concerted effort from all these entities, aligned with a common goal. The Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC) requested that the Institute of Medicine (IOM) examine the integration of primary care and public health. Primary Care and Public Health identifies the best examples of effective public health and primary care integration and the factors that promote and sustain these efforts, examines ways by which HRSA and CDC can use provisions of the Patient Protection and Affordable Care Act to promote the integration of primary care and public health, and discusses how HRSA-supported primary care systems and state and local public health departments can effectively integrate and coordinate to improve efforts directed at disease prevention. This report is essential for all health care centers and providers, state and local policy makers, educators, government agencies, and the public for learning how to integrate and improve population health.

This open access edited volume is a comparative effort to discern the short-term educational impact of the covid-19 pandemic on students, teachers and systems in Brazil, Chile, Finland, Japan, Mexico, Norway, Portugal, Russia, Singapore, Spain, South Africa, the United Kingdom and the United States. One of the first academic comparative studies of the educational impact of the pandemic, the book explains how the interruption of in person instruction and the variable efficacy of alternative forms of education caused learning loss and disengagement with learning, especially for disadvantaged students. Other direct and indirect impacts of the pandemic diminished the ability of families to support children and youth in their education. For students, as well as for teachers and school staff, these included the economic shocks experienced by families, in some cases leading to food insecurity and in many more causing stress and anxiety and impacting mental health. Opportunity to learn was also diminished by the shocks and trauma experienced by those with a close relative infected by the virus, and by the constrains on learning resulting from students having to learn at home, where the demands of schoolwork had to be negotiated with other family necessities, often sharing limited space. Furthermore, the prolonged stress caused by the uncertainty over the resolution of the pandemic and resulting from the knowledge that anyone could be infected and potentially lose their lives, created a traumatic context for many that undermined the necessary focus and dedication to schoolwork. These individual effects were reinforced by community effects, particularly for students and teachers living in communities where the multifaceted negative impacts resulting from the pandemic were pervasive. This is an open access book.

In early June 2020, we called by telephone a representative sample of nearly 600 households in Addis Ababa, Ethiopia to assess income changes and household food and nutrition security status during the COVID-19 pandemic (survey period covering May). This was the second administration of a COVID-19 related survey to these households, following an initial survey conducted in early May 2020 covering the situation of the survey households in April. More than two-third of the households indicated in the second survey that their incomes were lower than expected (up from 58 percent in April) and 45 percent reported that they are extremely stressed about the situation (up from 35 percent in April). Using a pre-pandemic wealth index, we find that less-wealthy households were considerably more likely to report income losses and high stress levels than were wealthier households. Compared to a period just before the pandemic (January and February 2020), indicators measuring food security have significantly worsened but have remained the same since April. During the pandemic, households are less and less frequently consuming relatively more expensive but nutritionally richer foods, such as fruit and dairy products. However, overall food security status in Addis Ababa is not yet alarming, possibly because many households have been able to use their savings to buffer food consumption. As the pandemic is still in an early stage in Ethiopia, it is likely that these savings will not last throughout the pandemic, calling for a rapid scale-up of existing support programs.

Immediately after the first confirmed case of COVID-19 in Ethiopia in March 2020, the Government of Ethiopia took several public health measures to prevent increased levels of infection These included closing all schools and restricting large gatherings and movements of people. Hand-washing and social distancing were the main prevention measures that government has communicated to the general public through various media platforms. Using the latest round of the Ethiopian Demographic and Health Survey, COVID-19 relevant indicators related to household access to communication platforms; access to water, sanitation, and hygiene (WASH); and characteristics of the home environment were assessed. The analysis shows that a sizeable proportion of the rural population does not have access to the media platforms used to publicize COVID-19 prevention measures. Moreover, without aggressive interventions, current levels of access to water and soap are suboptimal to adopt the hand-washing recommendations, particularly in rural areas. The low proportion of households with electricity, refrigeration, or internet connection and the relatively high prevalence of partner violence suggest that implementing the stay and work from home measures will be challenging. Public health measures that slow down the transmission of the virus should be continued and efforts to prevent transmission to rural areas should be prioritized. Communication platforms and messaging will need to be adapted to different local realities to make any COVID-19 containment recommendations operational. WASH-related support should be ramped-up, and addressing barriers to staying at home, such as the risk of partner violence, should be considered. The efforts needed to end the current pandemic in Ethiopia, as well as similar pandemics in the future, illuminates the serious challenges related to WASH and to the inequalities between rural and urban areas that need urgent attention.