Primary health care is the foundation of efficient, equitable, and resilient health systems globally. The lessons from the West Africa Ebola outbreak response in 2014/15 shows that primary health system is the first line of defense against pandemics that amplifies the urgency of building the resilience of the health system. This study examined the resilience of the primary health care system (Health Centers and Health Extension Program) containing COVID-19 pandemics and maintaining maternal and child health care and analyzed the gaps and opportunities of response strategies to build a resilient primary healthcare system in Addis Ababa.

Basing on the resilient health systems framework (that are characterized by awareness, diversity, self-regulation, integration, and adaptability), we assessed the resilience of 10 selected high-volume health centers, one health center in each of the 10 sub-cities. Data were obtained from interviews with health center directors, and staff who are working at MNCH services units, urban health extension professionals; and from direct observations of the facility environment to assess the capacity of the facility in responding to the pandemic and maintaining routine MNCH services during July 2020. Facilities’ situational awareness, diverse capacity, integration with stakeholders, combating the pandemic and maintaining core functions, and learning and adaptive capacities were explored.  Furthermore, a retrospective 12-months data including data on MNCH services were collected from surveyed health centers to understand the service utilization.

Our results demonstrate that the primary health care system including the community health system is playing a critical role in ensuring the continuity of essential health services despite the challenges posed by the pandemic that would lessen the burden of secondary and tertiary level facilities. Generally, they had good capacity to maintain routine maternal and child health care services as well as respond to COVID-19, however, their learning and adaptive capacity as well as capacity to contain and isolate health threats while delivering core health services were suboptimal. Further strengthening of the resilience of the primary health care would be critical to contain further crisis and alleviate the stress of the entire health system. Furthermore, innovative and strategic issues to further harness the community health system has been done to respond to COVID-19 and maintain routine services and harness the resilience dividend. Such types of strategically coordinated activities are needed to further build the resilience of the primary health care to meet Ethiopian sustainable development goals and universal health coverage.