2.1. Study area
The study was conducted in South Nations, Nationalities and People’s Region (SNNPR) before the declaration of the Sidama as an independent state. The region is one of the nine regional administrations and two city administrations make up the federal republic government of Ethiopia . The capital of the region, Hawassa, is located 275 KM south of Addis Ababa, on the main high way to Moyale –Kenya. SNNPR is administratively divided into 18 zones, one city administration and seven special woredas. The region is well known for its ethnic, cultural, linguistic and geographical diversities. It is thus, hosts for 56 ethnic diversities which is more than the three-fourth of the national diversities. Based on the population projection of 2007, the regional population is estimated to be 22 million [17, 18]. The region is one of the densely populated regions of the country.
In terms of health facilities and health services delivery the region is has covered 90 percent regarding the primary health services (health posts). There are 79 hospitals, 729 health centers and 3961 health posts. and 769 private pharmacies and drug shops and 2 diagnostic centers in the region.
Regarding the preparedness of the regional government to prevent and control COVID-19 pandemic, the region established and prepared 19 treatment centers, 02 test centers, 34 quarantine, 57 isolation centers. The region further organized 6 surveillance teams in different parts and, there are four RRT and 2 laboratories having 30 staff members .
2.2. Conceptual framework
The study was guided by the convergence model for the exploration of the patterns of the multisectoral approach. The 'Convergence' Model: Convergence can be characterized as the extent to which sectors, stakeholders, and administrative levels have been organized to work together with respect to a response across sectors for a certain issue. Convergence for responses across sectors can be understood along a continuum, from cooperation (least convergence with sectors all working on a single issue, but maintaining separate remits, activities, and plans) to integration (full convergence with sectors sharing structures, resources, and merged remits) .
Prevention and control of COVID-19 demand multifaceted efforts. Some of the actions are sector specific and others are cross-cutting. Therefore, the convergence model with varying level but closely managed multisectoral model is chosen.
2.3. Study Design
This study has employed a case study approach of the qualitative design. Case study is an in-depth empirical method, using multiple sources of evidence, that attempts to systematically investigate unfolding and development of a complex events within its context [23, 24].
2.3.1. Sampling and sampling frame
A purposive sampling technique was employed for this study with the potential of offering maximum flexibility to enroll the key informants with rich information . Bureaus, departments and offices at respective hierarchy with heightened probability of the disease impact and closely works with the health sectors were included in the study. Other organizations/ institutions such as non-governmental organizations and civic organizations were enrolled purposively in accordance to their level of involvement and previous acquaintances with the regional health bureau in one way or another.
President’s office/ chief administrator office, Bureaus of Health, Agriculture and Natural Resource Development, Water Energy and Irrigation Development, Women, Children and Youth Affairs, Urban and Housing Development, Transport and Road Development, Finance, Education, Labor and Social Affairs, Government Communication, Debub TV and Radio, Coalition of Religious institution, Civic Organization (Teacher’s Association) and The Ethiopian Red Cross Society, Debub Branch were involved in the study.
One third of the zones with larger population sizes and related high risk for the covid-19 exposure were enrolled for the data collection. Accordingly: Sidama, Gurage, Wolaita, Gedeo, Gamo and Hawassa City Administration were chosen.
At the zonal level also those departments with close concern and undertakings to COVID-19 prevention and control were included. These were: Office of the Administrator, Departments of Health, Education, Agriculture, Water, Sanitation and Energy, Women, Children and Youth Affairs, Labor and Social Affairs, Finance, Urban and Housing Development and Transportation and Road Development.
2.3.2. Data collection
The study has employed key informant interview and document review to collect information. Key informants enrolled based on their position in the organization and acquaintance to the overall institutional affairs and their level of involvement to the COVID-19 prevention and control. It was due to the requirement of the copious information for a given phenomenon .
Data collection instrument in the form of study guide question was developed against the study objectives by consulting literature and adopting from similar source including all necessary actions have been taken by collaborating partners. The study guide has encompassed all important dimensions related to the planning, intervention, monitoring and evaluation of the actions. The instrument was commented by professional team for its adequacy and completeness. Data collectors were recruited based on the professional background and previous qualitative data collection experiences. Accordingly, professionals at least with a first degree were involved. Orientation was provided for a day on how to competently collect data (note taking during the discussion). Almost all key informants from the selected institutions were participated in the interview. The participation depended on the level of saturation of information and the capability to capture thick information. Principal investigators have moderated the interview and the assistants took note and recorded the audio tape.
The most senior person in the organization was the preferred one for the interview; however, in the case of the absence of such a person, an immediate delegate based on the recommendation of the head of the institution was interviewed. It was done by the prior arrangement, once, the right person was designated, and communicated. The date and time for the interview was scheduled by discussing with the informant based on the convenience. On the interview day, the team was arrived 15 minutes before the interview time.
Necessary preparation was made to capture desired information. Just on time, courtesy greeting was offered and permission was requested to get in to the office. Once we got the welcoming confirmation into offer, we took chairs in the most convenient position. All instrument and audio materials were checked for the functionality before the commencement of the interview. The purpose of the study was briefly informed to the key informant and a letter of permission was given. Adequate time was given to read the support letter to the key informant and the team waited until he/she will formally allow conducting the interview. The interview was conducted by using an interview guide by giving adequate time to respond. Key informants prompted and proved to further elaborate the deep and thick information. The interview lasted for 40- 60 minutes on average. All the key informants’ interview sessions were conducted with the maximum care by maintaining the necessary COVID-19 prevention and control protocols.
When the interview ends, the team left the room by appreciating the informant for the time and information offered. And, notice was given when need arise, follow-up communication via phone would continue.
Secondary data were collected from document reviews. Policy related document, minutes of the meeting, decision based documents at various levels were consulted based on the checklist prepared for this purpose. Hard and soft copies of the document were gathered.
2.3.3. Data analysis
Data were analyzed using a content analysis of the qualitative data analysis method. The key informant interview audio taped material was transcribed verbatim in Amharic (the regional working language) and translated to English. Simultaneously, the hand written documents were organized into mature notes. Comparison and matching of the hand written summary note with the transcribed information was done. Ones all the hand written document and audio taped transcripts organized, descriptive coding was done. Following the coding, data, reduction by side noticing was done. After side noting, creating or identifying major themes, were taken place. The process has taken several consultations to the verbatim transcription and handwritten notes. Codes developed into themes and rearranging the several themes and intermarrying similar themes was done. Finally, interpretation of the themes, in line with the study objectives was conducted [27, 28]. Data from the document review were categorized according to the checklist; the availability of the desired documents, to what the implementing entities has organized and utilizes them. Findings were presented based on the major themes in line with the study objectives.
2.4 Ethical clearance
This study required the involvement of numerous stakeholders and institutions working in the region. As the result, the study needs to pass all the necessary steps related to the research ethics. The topic under the investigation is critical and concerns all human kinds. The stake was high. Therefore, ethical clearance was obtained from the Southern Nations and Nationalities and People’s Regional Health Bureau institutional ethics review board. Support letters from responsible authorities were obtained and submitted to the organizations/institutions/ individuals participating in the study. Informed written consent was obtained from the study participants before commencing the data collection ( the sample was annexed under the supplementary document # 3). The purpose of the study was communicated to the study participants. The benefits of the study were equally being shared. The rights of the study participants were maintained across the study period. All the methods were carried out in accordance with the relevant guideline and regulations witnessed by the ethical review board document annexed as a supplementary document #2. The finding of the study would be communicated to the authorities such as the Regional Health Bureau, Regional President’s Office, and other sectors collaborating in the fight against COVID-19 pandemics. The finding also will be published in scientific journals.
 ‘Woreda’ is an administrative hierarchy equivalent to district.