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COVID-19 Heroine: Minister Lia Tadesse

EJS Center / COVID-19 Response  / Spotlight a COVID-19 Heroine / COVID-19 Heroine: Minister Lia Tadesse

Minister Lia Tadesse

Minister Lia Tadesse is an obstetrician and gynecologist with extensive leadership experience in healthcare, academia, hospital management, and grant-funded programs. Prior to her appointment as Minister of Health of Ethiopia on 12 March 2020—just one day before the first case of COVID-19 was confirmed in Ethiopia—Minister Tadesse served as State Minister of Health from 2018 to 2020, leading Ethiopia’s national health programs under the Health Sector Transformation Strategy. From 2015 to 2018, she served as Program Director of the Center for International Reproductive Health Training at the University of Michigan, and from 2014 to 2015, she was Project Director of the United States Agency for International Development’s (USAID) Maternal and Child Survival Program in Ethiopia.

We spoke with Minister Tadesse for our “Spotlight a COVID-19 Heroine” series about what it was like stepping into her role as Minister of Health at such a uniquely challenging moment, how she has led her country’s COVID-19 response, and how her commitment to improving women’s health has helped shape her own career and leadership journey.

Read our interview with Minister Tadesse below.

 

Q: Can you tell us a bit about your career journey, and what motivated you to focus particularly on improving women’s health?  

Since childhood, I always wanted to be a physician, but it was during my time in medical school that I became really drawn to women’s health, especially in my fourth clinical year when I started my rotations in obstetrics and gynecology. I was trained at one of the universities in the southwestern part of Ethiopia, Jimma University, which served a huge catchment population. We saw many different patients—women who had suffered a great deal for a long time with delayed labor, obstructed labor, and other challenges. This experience showed me firsthand how medical interventions really save women’s lives, and it was extremely gratifying to be able to work in this area. Of course, there were also very sad moments when we were not able to save women, especially those coming from rural areas who received medical attention too late.

I continued my specialty in OB-GYN, but I think during that time I developed an interest in improving health systems and healthcare delivery. I think that was what drew me to take on leadership and administrative roles after I graduated as an OB-GYN. I spent a long time as hospital CEO and Vice Provost of St. Paul’s Hospital Millennium Medical College (SPHMMC), a teaching institution in Addis Ababa, and I progressively took on more administrative roles. I’ve now held positions at several non-governmental organizations, but my passion remains in improving healthcare systems, with a focus on reproductive, maternal, and child health. So, before stepping into my current role at the Ministry of Health, I served as State Minister of Health for some time.

Q: How has COVID-19 impacted women’s health in Ethiopia and across the continent?  

The COVID-19 pandemic has shown us many things, including the impact it has had on women. When you look at the data about the impact of COVID-19, and its death rates, the disease appears to be less severe for women. However, the indirect impact of COVID-19 has been really severe for women in terms of the economic, psychosocial, and other pandemic-related health issues.

As a country, the COVID-19 response measures that we have taken overall have not included enforcing a strict lockdown. We have tried to balance our response by taking the economic context of our country into consideration. But even with this in mind, we’ve seen the rate of unemployment increase during the pandemic, with higher rates of unemployment for women than for men. We’ve seen that when interventions like school closures happen, women are more likely to forgo their jobs to stay home and care for children and the sick.

In Ethiopia, as in other countries, women have faced additional challenges. We know that there has been an increase in gender-based violence. There’s also the challenge of accessibility to and disruption of public services due to COVID-19, including impaired access to services that are specific to women, such as antenatal care and delivery facilities. Collectively, the indirect impact of COVID-19 on women has been huge.

Q: Ethiopia’s first case of COVID-19 was confirmed on 13 March 2020, the day after your appointment as the Minister of Health. It must have been incredibly daunting to take up this post at such a time—what were some of the thoughts and feelings you had as you entered into this role? What motivated your decision to step up, in spite of the challenges that lay ahead? 

Yes, it was a very challenging moment. I had been serving as a State Minister before entering my current role, and, actually, for a few months before I became Minister of Health, I was the Acting Minister, so I was already leading the country’s COVID-19 preparedness and response efforts. Still,  taking on the full Ministerial role was quite different.

I remember in the evening of my first day as Minister, I got a call from the Director General of the Ethiopian Public Health Institute to say that we had our first confirmed COVID-19 case. It was a really shocking moment. However, when you are given such a challenging role in a difficult time, it’s also an opportunity to serve when you are needed most. I was encouraged by this thought, by the commitment of the team I had, and also by the support of the whole government, starting from our highest leadership. And there was a huge level of community solidarity in Ethiopia, in terms of working together with the Ministry of Health to support our COVID-19 response. So, there were many things that were encouraging, though it was a very challenging transition.

Q: As Minister of Health, you have coordinated Ethiopia’s National Ministerial Committee’s efforts to make COVID-19 a top political leadership priority. You also established a scientific advisory council, the National COVID-19 Advisory Committee, to assist the cross-ministerial task force in reviewing publications, conducting studies, and guiding interventions. Can you tell us more about this? What have been the greatest successes of the task force and scientific advisory council to date?

I think that being able to quickly establish the National COVID-19 Advisory Committee has been one of the strongest pillars of our response. Prior to establishing the committee, we had been informally engaging with experts who were providing us with advice, but we recognized the need to have more coordinated support and advisory groups. Professional associations were also discussing how they could be more helpful in supporting the government’s COVID-19 response. Those discussions led to the formation of the National COVID-19 Advisory Committee, composed of different heads across multiple professional associations within the country, all of whom have experience in crisis management and the prevention and treatment of infectious diseases.

The National COVID-19 Advisory Committee was able to help our decision making and our approach to our response by continuously reviewing scientific evidence and providing us with advice. We had to continuously review and revise our approach every few weeks because new information about the disease would become available, and the advisory committee’s role has been really critical in giving us that expert, up-to-date advice. They also are able to answer questions that we send to them directly, so they work very closely with us.

Beyond that, the advisory committee has also done a lot on the ground. For example, within the committee, there were several sub-teams tasked with addressing different issues: the psychosocial sub-teams organized themselves and visited quarantine facilities to provide patients with support. Other sub-teams were helping with resource mobilization, going beyond the provision of expert advisory support. We’re now discussing how to institutionalize this committee so it can continue to grow—not just in light of COVID-19, but with regard to other health care system issues, because it has really shown us how strong partnerships have a stronger impact.

Q: In response to the pandemic’s spread in Ethiopia, you established multiple isolation treatment centers, including a COVID-19 treatment center in one of the country’s main venues, Addis Ababa’s Millennium Hall, with 1,500 beds. Can you tell us more about this effort? How were you able to quickly mobilize to establish these treatment centers? 

Initially one of our areas of focus was ensuring that we had enough facilities that could care for our COVID-19 patients, particularly within Addis Ababa, which was expected to be Ethiopia’s pandemic epicenter, given its large population and the traffic it receives via its international airport. While facilities were being set up in regions across the country, we had to ensure that we had enough centers within Addis Ababa.

The first treatment center we implemented was in fact a hospital which we evacuated all other services from in order to dedicate it entirely to COVID-19 treatment. But we realized we needed to move quickly and at scale, so we started to establish makeshift centers. We soon considered Addis Ababa’s Millennium Hall, which is the largest meeting hall we have in Ethiopia, as a potential COVID-19 treatment center. We submitted a request to the Ministerial National Committee, chaired by our Prime Minister, to turn the Millennium Hall into a makeshift hospital, and our request was accepted.

Having access to the space was critical, but a lot of work went into transforming Millennium Hall into a makeshift hospital. We assigned one of Addis Ababa’s hospitals, St. Paul’s Hospital Millennium Medical College, to take the lead in organizing those efforts. Partitions and ventilation systems had to be installed, and the hall had to be equipped with the necessary equipment, including beds—we ended up fitting in 1,500 beds. Through partners and stakeholders working together, we were able to materialize our goal in a very short period of time. In less than six weeks, we were able to fully turn the hall into a functional hospital that continues to be in use treating patients today. We’ve also done similar things converting facilities like youth centers, universities, and other facilities within universities to make them into makeshift COVID-19 treatment and isolation centers.

Q: Ethiopia has made rapid progress in its COVID-19 testing efforts, with the establishment of 60 testing centers nationwide, and 1.7 million tests conducted to-date. What elements were key to successfully creating a network of viable test centers nationwide, and to carrying out such a high volume of tests? 

One of the biggest strengths in our country’s COVID-19 response was the lab capacity building that we did. At first, many labs that were performing COVID-19 tests in Ethiopia were then sending these test samples to South Africa to be analyzed. We implemented Ethiopia’s first lab in early February and have since expanded to more than 60 labs nationwide. These labs have been really instrumental in our response, allowing for 1.7 million tests to be done so far.

What helped us move quickly towards setting up these labs was the fact that many of our public health labs, regional laboratories, and research labs at universities had previously established testing labs for influenza, HIV, and other diseases. We were able to collectively work to convert these into COVID-19 testing labs, collaborating with different partners from public health institutes, who provided the necessary technical support and training to lab workers. We also mobilized resources through donations, and through our Prime Minister’s strong commitment to distribute testing kits from other countries. Recently, we have jointly established a COVID-19 test manufacturing facility in-country. So, the rapid progress and establishing of widespread testing has been one of the key pillars in the Ministry’s COVID-19 response.

Q: Since March, you have been providing regular updates to the public via social media and by holding live Q&A sessions. Could you tell us a bit more about these communication efforts? What messages have been the most critical for you to deliver? 

Risk communication has been another big pillar in our response, and we started this very early on. Our risk communication efforts have not been limited to those working in the Ministry of Health—they have also involved a lot of engagement with the media, reaching out to members of the artist community to help spread the message, and others. We made sure that the content of our messaging was in line with official health guidelines, but delivered in an engaging way, and that took a very strong collective effort.

As the Minister of Health, working alongside the Ethiopian Public Health Institute (EPHI), my duty was to ensure that we kept the public informed about what was happening—what we’re seeing in terms of numbers of cases and the challenges that we’re facing. Similarly, it was our duty to ensure that people were informed about up-to-date prevention measures, so that they could be better-equipped to stop the spread of the disease themselves.

At one point we also held some question-and-answer sessions, during which we invited members of the public to pose us their questions. By holding these sessions our goal was to make sure that communities knew what was happening, and that they had the necessary information to protect their own health.

We believe that our communication efforts have helped people to take ownership and responsibility of protecting their own health and the health of those around them by increasing their awareness and understanding of COVID-19.

Q: Looking ahead at the potential long-term impacts of COVID-19 on women’s health—in Ethiopia and globally—what measures do you think will be most important to prioritize in the months and years ahead? 

There are lots of learnings to take away from our COVID-19 response—we’re actually in the process of conducting a review of what went well and what didn’t go well, and which areas we need to continue to build on.

The foundational issue is that we must continue building a strong primary healthcare system that is capable of responding to any epidemic, while simultaneously maintaining and continuing to offer essential services to the community. We have to make sure our primary healthcare systems are strong at all levels, because they are the pillars of our community-level responses. Currently, as part of our response efforts, we’ve been utilizing Ethiopia’s Health Extension Program to conduct door-to-door visits in communities, to make sure that households are informed, and to detect any cases of COVID-19 or any other chronic illness.

Part of building on our strong primary healthcare system includes continuing to build and strengthen our lab systems, because these are critical in responding to epidemics. And we must also look at vulnerable populations and consider how to shield them, making sure we address the needs of vulnerable communities in challenging times. We need to have a system in place that allows us to reach those communities immediately. These are some of the ways that we can continue to build a resilient healthcare system that can then efficiently and effectively care for women, children, and other vulnerable communities going forward.

Q: Within your first few months as Health Minister, you were faced with leading a national response to an unprecedented global health crisis. What did you do to stay focused, motivated, and energized throughout this hugely challenging time? 

Overall, when I think about the work that I do, I’m also thinking about how I can help provide a solution to a challenge. I think my main motivation is that I go to work every day knowing that what I’m doing will solve a problem or an issue—not just at a larger level but at an individual level.

One of the things I do to make sure that my team and I are energized is to have regularly scheduled communications with all core team members, so they know that they are being supported and that we are working collectively towards a common goal. This regular team communication also keeps up the spirit of working together, not just within our teams but in our work with various other sectors of government, and with other partners. Really engaging with them all has been encouraging, and in the work that we do, it’s also a way of making sure that things on the ground are running well.

The support I have from my family also energizes and motivates me. My husband really supports my work and he’s a leadership coach and trainer, so I have my own personal coach! But he doesn’t just support me professionally—it’s really challenging when you have such a demanding role and also have a family. We have three children who are still young, so my husband helps manage the family and supports me at home and as a mother, and that is really encouraging for me. And, finally, I feel that I’m here for a reason, and I also pray—so these are all things that really energize me.

Q: What advice do you have for other African women who have public leadership aspirations, in public health, and beyond?

Public health is a very challenging field in many ways, but it also provides a huge opportunity to positively affect and impact the lives and livelihoods of so many people in different communities. Having been a clinician, I know how much I loved the day-to-day interactions I had with my patients, and I loved seeing the impacts of my interventions on my patients—getting to see the fruits of your labor on a daily basis is really inspiring. One of the challenges I faced when I started to shift into a leadership role was that I stopped seeing many of the immediate effects of my work. The interventions I am now involved in are at a different scale, but we see progress in terms of policies, strategies, and building strong healthcare systems.

I believe that more women should be encouraged to pursue roles in public health. Women have certain qualities that allow us to meaningfully contribute to positive developments in health care. Maybe this is due to our natural inclinations and strengths, but also, as women, as mothers, we have caring qualities that are very helpful when considering how to develop and improve upon health systems.

Though it’s a challenging sector, I encourage women to follow their public health aspirations. And to those of us already working in public health, we need to continue to work collectively together, but we must also be willing to look outside to different sectors, as this collaboration and these partnerships will help move us forward towards creating even more impactful health systems.