Covid-19 and Decentralised Health Service Delivery in Ethiopia: The Case of Dejen Woreda and Debre Markos City Administration in the Amhara Region

Abstract

Decentralised health service delivery at the local level was affected by
the outbreak of the Covid-19 pandemic in Ethiopian federal system. This
study assesses the effects of the pandemic on decentralised health service
delivery in Dejen Woreda and Debre Markos City Administration in the
state of Amhara in Ethiopia, based on data collected using interviews,
documentary analysis and focus group discussions. The arrival of Covid-19
at the local level caused the interruption of medical follow-up among
patients, a shortage of resources and health professionals, and a decline
in the internal revenues of health centres. To prevent and control the
pandemic, a lockdown policy and a state of emergency were declared.
Task forces were established which collaborated with health offices and
engaged in the collection of resources in cash and in kind. The government
of the state of Amhara supported the Dejen Woreda Health Office by hiring
health professionals using its own budget. However, due to the prolonged
intervention of the regional government in the administrative autonomy
of the Woreda, a situation was created that made regionally hired
professionals unaccountable to the local health office. The article argues
that lifting the state of emergency was the only precondition for lifting the
intervention of regional government in the administrative autonomy of
local governments.