In Ethiopia, the COVID-19 pandemic has forced us to think differently and adapt quickly to a new environment and a new reality. Much of our work culture here relies on in-person communication, rather than online, and there are challenges of connectivity. So, working from home is unusual in our context. The COVID-19 situation has pressured many of my colleagues and me to do so, and we are adapting.

I have been working as the Senior Gender Advisor for the USAID Transform: Primary Health Care project since 2017. In this role, I work with the project and its partners in the Ethiopian government to provide technical leadership in gender integration to prevent maternal and child deaths, strengthen primary healthcare service delivery, and support learning and capacity enhancement on how to improve gender integration across the project. I provide technical assistance directly to the Federal Ministry of Health and the Ministry of Women and Children Affairs. As I mentioned, much of this work has relied on in-person interactions that have now been disrupted.

In Addis Ababa, we are using online platforms to stay connected. My commute to the office is actually quite long, so I am able to use that extra time now to focus on my work and other activities, like catching up on reading. I am also getting the chance to interact with my children more and support them with their education. I am an optimist, and I see this change as an opportunity, but there are opportunity costs.

Gendered and Programmatic Challenges for the USAID Transform: Primary Health Care Project

One of those costs is a direct impact on our implementation of planned activities. We have had to cease many field-level activities and cancel capacity-enhancement training courses and awareness-raising workshops, for example. Our male engagement work has been paused indefinitely because of COVID-19. We were at a critical stage, about to start community-level dialogues, with the hope of scaling them up across Ethiopia. This intervention is important for Ethiopia, as well as USAID and the Ministry of Health, and all of our learning would have been important considerations for scale-up. We had come a long way—with a literature review, formative research, a curriculum design, and trained facilitators. It is really disappointing that we had to pause at this critical stage. We are looking at possibly restarting in October, but this work partially relies on pregnant couples, so we might need to recruit a new group of participants or adjust the curriculum at that point.

The occurrence of COVID-19 has really exacerbated existing problems. For women, the burden of unpaid care work in the home is becoming immense. In Ethiopia, we already have high but declining maternal mortality—one of the issues our project has been focused on changing—and we have seen a drop in visits to health facilities by young girls and pregnant women since March. This means women are not coming for antenatal care and other essential healthcare services. Some women are also giving birth at home instead of delivering at health facilities. And, we have heard reports of gender-based violence. The gender-based violence issue, whether intimate partner violence or early marriage—these situations are also exacerbated. There is no real evidence or data yet—it is all coming anecdotally. The Ministry of Health has recognized that COVID-19 is becoming a problem for family planning and other health services because clients are not coming to the facilities, and is taking actions to help address this challenge.

 I am an optimist, and I see this change as an opportunity, but there are opportunity costs.

Women are also at the forefront of the fight against COVID-19. Most healthcare workers in Ethiopia are women, working as nurses, midwives, and in other roles. This is connected to our project’s work—we are not able to continue communicating with and supporting these essential workers in the ways we did before.

There is also good news. The Transform: Primary Health Care project is working with other Transform projects and Ministry of Health structures across the regions and woredas1 to continue moving forward in many parts of our work, while helping increase awareness that facilities are open and essential services are available. We worked with the other Transform projects (more than 340 staff members across 11 thematic areas) to map activities and develop a 6- to 10-month plan in response to the changes COVID-19 has required us to make. Because we are not able to hold in-person training and capacity-enhancement events, we are looking at what we can do at systems and service delivery levels. We are focused on maintaining essential services for reproductive, maternal, neonatal, and child health, and advocating with the Ministry of Heath to include gender-based violence in clinical and prevention activities.

We have also started using a one-on-one mentorship approach, rather than large-group training, with health workers to continue building their skills and abilities in gender analysis and related action planning. This allows us to honor social and physical distancing requirements while moving our work forward. Our staff still interact with service delivery points for routine activities such as support for measles control and other disease outbreaks, and we plan to use those opportunities to conduct gender analysis mentorship and ensure gender-based violence prevention and response activities are integrated at the facility level. We are also advocating to include gender-based violence messaging in awareness raising about service availability; we want women and girls, especially, to know they can access these services.

These and other actions all depend on multiple factors and multiple actors that need to come together. When we come together, we have seen that we can take action even in a new reality. Take my role: I am focused on advocacy and technical assistance, rather than going to the facility level and advocating directly for essential services. Coordination and collaboration across the USAID Transform thematic areas is always important, but especially now as we come together with the government to coordinate how our work can continue, while supporting the country’s response to COVID-19.

Envisioning Programming Realities amid a Pandemic in Ethiopia

Personally and professionally, this new environment has forced us to think differently and adapt to a new reality. I am an optimist. I see this as an opportunity—for communicating in new ways and for new learning that is emerging. Work culture in the United States happens online, but this has not been the case in Ethiopia. COVID-19 has forced us to be online even with low connectivity. For example, we are seeing Zoom used at the government level, even by offices that were not communicating as directly before. This technology has also created access for people like me; if I want to engage in a Ministry of Heath webinar, I can register easily, whereas before these meetings happened in person and we did not always have the chance to participate. This is really exciting for us in terms of access.

 Our male engagement work has been paused indefinitely because of COVID-19. We were at a critical stage, about to start community-level dialogues, with the hope of scaling them up across Ethiopia.

On the service delivery side for Ethiopian communities, there is a lot of discussion happening about awareness and ways to bring services closer to people. Family planning and other services are already being provided close to where women are, at the health post level; options for an extended COVID-19 situation might need to include providing individuals with a larger supply of contraceptives or essential medicines. For antenatal care, we might see a shift to phone follow-ups rather than in person visits for less risky pregnancies, to reduce unnecessary trips. Mobile phone coverage is around 47 percent across rural Ethiopia, and women’s ownership and control of phones is a challenge. In the context of COVID-19, men will be important partners to help increase access to information. I see a potential for mobile technology to help a lot.

At the project level, replacing our capacity-enhancement approaches with one-on-one mentoring and coaching has been a big adaptation. And there is a regional platform for communication among regional gender officers that did not exist before. As I have said, I am an optimist. This is a new way of thinking that COVID-19 has produced in us, and I think these will be lasting changes.

How Is Your Program Responding at the Country Level?

If you are working on COVID-19 responses related to gender integration or gender-based violence prevention and response at the country level, please share your stories by commenting below, tweeting @EnCompass_World, or adding a note on EnCompass’ LinkedIn page or Facebook page.

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1Woreda is an administrative division in Ethiopia, equivalent to a district.