3rd April 2020

On 11th March, 2020, the President of Ghana, Nana Akuffo Addo, declared “A Whole Ghana Approach” to the fight against COVID-19. This marked the first of his weekly press briefings to Ghanaian citizens, where, with a heavy heart, he confirmed their worst fears that the motherland was no longer COVID-19 free. Like leaders of over 148 countries, managing COVID-19 has undoubtedly become the most dreaded task of his political career. He appeared visibly tormented by the message given to him by officials of the Ministry of Health (MOH).  This usually smiling and self-assured 76-year-old President looked rather tense as he broke the dreaded news of the first positive COVID-19 case to a bewildered citizenry. His audience, who included yours truly, was absolutely startled; their worst nightmare had unfortunately become their new reality. To reassure the citizenry that their government was prepared, he announced that US$ 100 million would be devoted to the prevention of COVID-19 in Ghana.[1] While the  commitment of large amount from the national treasury to the fight against COVID-19 is a  welcome relief,  I argue that the need for government to implement the A Whole Ghana Approach in an accountable and transparent manner cannot be overemphasized.

source: https://ghc-ca.com/ghana-at-a-glance/location-maps/

Fear had already started creeping into the homes and hearts of Ghanaians when Mr. President, flanked by the visiting Prime Minister of the Republic of Trinidad and Tobago, the Honorable Dr. Keith Christopher Rowley (MP) , concluded the 63rd Independence Day Celebration (6th March) speech with these lines: “the subject that currently concerns the whole world is the novel Coronavirus. It is a medical crisis that is bringing in its wake death and economic difficulties, and is spreading fear and panic throughout the world”.[2] He noted that all three neighboring countries – Burkina Faso, Togo and Ivory Coast – had reported confirmed COVID-19 cases.

The presidential confirmation of the presence of the “World’s Most Wanted Public Health Enemy #1” on Ghanaian soil was received with swift responses from citizens. The pastors took to the pulpits and airwaves asking for divine intervention, while social media activists demanded immediate action to prevent the spread of the virus. Meanwhile, the rumor that it was a Norwegian diplomat who introduced COVID-19 into Ghana was a popular chat room discussion point. Many Ghanaians also believed the virus would never reach their beloved country as the epicenter of the crisis at the time, China, seemed very far away. The medical community led by the Ghana Health Service (GHS) assured the stunned population, that just as they had prevented the spread of Ebola into Ghana, they would successfully do so with COVID-19. In other words, Just listen and do as we say, the medical professionals reassured the country gripped by fear.[3]

There are however, three reasons why the fear of COVID-19 will not easily go away in Ghana. First and foremost, there is no cure for COVID-19, except to quarantine its victims and hope their immune system will rise up to the threat and surmount the virus. Secondly, the Ghanaian economy is highly dependent on the EU, UK, Canada, USA, and China for trade and development finance. It is these international partners who are so far among the hardest hit by the pandemic. No wonder the Minister of Finance in his first public statement on COVID-19 to Ghana’s parliament on 19th March, 2020, warned of an “economic meltdown” if the invisible enemy is not quickly nipped in the bud [4]. Third, Ghana’s health system is underfunded and ill-equipped. Primary level health care used by most Ghanaians remains poorly resourced and under-staffed.  Between 2015 to 2020, the MOH’s share of the national budget per annum has averaged at 8.1%.[5] This allocation is far short of the Abuja Declaration’s stipulations, which require African Union member countries to devote at least 15% of the national budget to the health sector [6]. Today, the health sector shockingly accounts for only 7.6% of Ghana’s government budget [7]. With this under-budgeting, it was no surprise that Ghanaian health officials estimated that the initial COVID-19 prevention cost was GHS 2.5 million (462,962 US$), while a World Health Organization (WHO) assessment in February, 2020 recommended GHS 35 million (6.5 million US$).

Even more worrying is that the country has limited infrastructural capacity for testing and supporting the treatment needs of COVID-19 patients. Ghana has only two testing centers, Noguchi Memorial Institute for Medical Research (NMIMR) and Kumasi Center for Collaborative Research (KCCR), equipped for running the COVID-19 test. Both are located in the south, none in the northern half of the country. With respect to treatment  facilities, this is how Dr. Franklin Asiedu-Bekoe, Head of the Disease Surveillance Unit of the Ghana Health Service (GHS), described the situation: “the two treatment centers is not enough for a population of 30 million whose daily interactions would create the perfect crucible for rapid spread from infected respiratory droplets.” [8] COVID-19 could not have come at a worse time for Ghanaians, 23% of whom are poor (i.e. living on less than US$1.25 per day). [9]  It is for these and other reasons that the MOH is advocating for partnerships with the private sector to help mobilize the needed resources to invest in the acquisition of equipment and the expansion of facilities for the testing and treatment for COVID-19 patients.

Since his first press briefing, A Whole Ghana Approach to COVID-19 has been elaborated by Mr. President in four subsequent (on 15, 19, 21 and 27 March, 2020) television and radio broadcasts to a worried citizenry. Key among the pillars of the President’s  approach are: restrict land borders, health screen all travelers at border points, no entrance into Ghana for travelers from countries with confirmed cases of more than 200, quarantine and test all suspected cases, mass education and mobilization emphasizing social distancing, close educational institutions, ban worship and religious gatherings, limit the number of people to attend funerals, and restrictions on movement of persons – lockdown – in the Greater Accra Metropolitan Area (GAMA) and the Greater Kumasi Metropolitan Area, and contiguous districts, for a period of two (2) weeks, subject to review. [10]

To strengthen the pillars of A Whole Ghana Approach, Ghana’s Parliament on 20th March, 2020 passed the “Imposition of Restriction Bill,” which empowers the presidency to curtail individual liberty in the national interest. [11] Of all the elements of the President’s approach, it is the Bill that has raised serious eyebrows of disapproval and worry. For example, the parliamentary opposition walked out when the vote on it was being taken. According to Ghana’s leading newspaper, The Daily Graphic, of 23rd March 2020:  

“Minority members of the committee expressed opposition against it on grounds that the legislation was too broad and not coronavirus specific, and could endow the president with unfettered powers, which could be used today and in the future to abuse the rights and freedom of the citizenry”

Two eminent legal scholars and social activists spoke out strongly against the Bill. The Executive Director of Center for Democratic Development- Ghana (CDD-Ghana), one of Ghana’s most influential political think tanks, Professor H. Kwasi Prempeh, described the bill as a “shoddy piece of work which will only be passed by a parliament that lacks balls.” Professor Kwaku Asare, a fellow of CDD-Ghana and also KPMG professor of Accounting at Fisher School of Accountancy, University of Florida, said the Bill was “disgraceful,” and urged Ghana’s parliament to “throw it away.” [12] Whether this Bill will contribute in a meaningful way to A Whole Ghana Approach or not, only time will tell, but its corrosive effects on human rights is definitely a source of deep concern within civil society. Even more importantly, by insisting on this Bill, Mr. President and his team have injected and provoked a needless controversy with the potential to degenerate into politicized public discussion of A Whole Ghana Approach to COVID-19.

Besides the Bill, the government is enjoying rare and unprecedented support from the parliamentary opposition. At the end of a national three-day fasting and prayer event, the President’s principal rival in the forthcoming November, 2020 election, former President John Mahama, is quoted by the Daily Graphic of 23rd March as urging his supporters to “rally behind the government to fight COVID-19.” [13]

The general sentiment of citizens is that the government should be given all the powers and space required to curb COVID-19 in its tracks. Indeed, the only opposition has come from fringe church groups in Kumasi (Ghana’s second most important city), who defied the ban on worship and were swiftly arrested. In fact, the very day the group was being taken to court, top Ghanaian church leaders were attending a breakfast meeting with the President and his officials at the Jubilee House, the seat of government in Accra. The Chief Iman, who leads the Islamic faith, also urged mosques and prayer leaders to respect and strictly adhere to the key pillars of the A Whole Ghana Agenda. [14] Amongst the traditional leaders who responded is the Asantehene, the King of the powerful Asante Kingdom, who was surprised “to see a number of schoolchildren who have been asked to stay at home to protect them from contracting the virus rather roaming the streets. In fact, the loads of traffic in Kumasi suggest to me that we have not grasped the full gravity of the crisis and are assuming we can continue to go about our business as usual. Our health service will be overrun, hundreds of our loved ones will die and our entire economy will collapse, and with other nations already on their knees, there will be no one to turn to bail us out.” [15]

Market Queen mothers, who are not known to accept any disruptions to their commercial activities without a fight, succumbed on 23th March. The Daily Graphic reported that 137 markets in the Greater Accra Region were shut down and sprayed by 1,300 sprayers with chemicals that are expected to kill all viruses and bacteria. This exercise will be replicated throughout all markets in Ghana. [16] However, if the spraying of markets is to have meaningful effects, one will hope that government has plans to not only repeat the exercise, but more importantly to sustain the education that is crucial to prevent the spread of COVID-19. Social distancing and handwashing with soap must be continuously emphasized to market women. Perhaps, the most significant social distancing action implemented by the government is the closure of all schools, which has mandated over 7.5 million students of all ages and grades to remain at home. As the distinguished Asantehene observed above, it seems these students were hurriedly sent home with little counselling about how to protect themselves and their communities against COVID-19.

Notwithstanding the high citizen compliance with Mr. President’s A Whole Ghana Approach, COVID-19 remains elusive and ever menacing. In less than three weeks, the confirmed cases have risen from 2 on 12th March, to 27 on 23rd March, and 195 on 1st April, 2020. There have been several important and dangerous trends.  First, until, March 20th, all confirmed cases were “imported,” i.e. people who returned from abroad and tested positive for COVID-19. This has, however, changed as three Ghanaians (1 man and 2 women) with no history of travel or relationship with anyone of recent travel history, tested positive. Secondly, Ghana registered its first three deaths between 21st and 23rd March, and by 1st April the number had risen to 5.  All 5 deaths have occurred in Kumasi, Accra, and Tema, Ghana’s busiest cities and the epicenters of COVID-19 cases in Ghana. Thirdly, Ghana has started quarantining travelers entering the country and testing them. This accounts for the steep rise in the number of confirmed cases shown by the graph below. For example, out of the 1030 quarantined cases, 185 completed the testing protocol and 25 proved positive of COVID-19 on 23rd March. According to GHS, 20 (74%) out of 27 confirmed cases on 23rd March were Ghanaians and 7 (23%) were nationals of France, Norway, China, and UK. It was therefore no surprise that Professor Abraham Annan, Director of NMIMR, is quoted on the front page of the Daily Graphic for 24th March: Halting COVID-19 spread: Noguchi urges lockdown, mass testing. [17]

                                         Source: Author’s, data from Ghana Health Service

Nearly two weeks after Mr. President made his speech to the nation, he and his top advisors were faced with perhaps the most important question political leaders the world over are currently confronting: To lockdown or not to lockdown?  The Ghanaian scientific, medical, and research community, who are the main sources of technical guidance of COVID-19 prevention policies and programs, was divided on this important question. According to The Ghana Medical Association (GMA) “… being fully conscious of the threat posed by this pandemic, the disturbing trend of community spread and the obvious inadequate capacity of the nation’s health system to deal with the increased numbers of COVID-19 infection especially in the severe to critical cases, call on His Excellency the President of the Republic of Ghana to declare a nationwide lockdown with the exception of essential services with immediate effect.” [18] Other experts, however, advocated for a measured and targeted lockdown. For example, a virologist with the Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Dr Michael Owusu argued as follows: [19]

“If you close the country down and you don’t have variables to measure the success of the closedown, then you can’t predict when to close down and how long to close down and what will be the end result of this. For me, the first is that you must know the exact burden of the disease at the community level. It is the community cases that sparks outbreak. So, once you understand the burden of the case, you can lock it down and whilst lockdown is ongoing, you still do mass testing, then the cases you record after the test will tell you the success of the lockdown”. 

The population’s worst fear was confirmed on 27th March: a lock down of Kumasi, Accra and Tema for a period of two weeks effective 30th March was announced. These three cities account for nearly 23 percent of Ghana’s population. [20] Possibly aware of the unpleasant message he was carrying to his fellow Ghanaians, Mr. President chose his time very carefully. At 11:15 PM sharp, before most people turned off their television/radio and took to their mattresses, he appeared to deliver his 4th COVID-19 address to the nation. A solemn national anthem interspersed by historical landmarks ushered the President to the podium dressed in a homemade long sleeve shirt.

His body language was evidently that of a frustrated and emotional President who wished that he did not have to lockdown the heartbeat of his country, Accra, the capital city. He emphasized that test results showed that 97 percent of the confirmed COVID-19 cases in Ghana were imported but the country had to take additional actions to strengthen the existing measures. The fact that nearly 7 million of his country men and women are poor was a center piece of his address.

“I am announcing tonight the establishment of a COVID-19 Fund, to be managed by an independent board of trustees, and chaired by former Chief Justice, Sophia Akuffo, to receive contributions and donations from the public to assist in the welfare of the needy and the vulnerable. I have directed the Controller and Accountant General to pay my next three months’ salary, i.e. April, May and June, into this Fund… The Minister for Finance has been directed by me to prepare, for approval by Parliament, a Coronavirus Alleviation Programme to address the disruption in economic activities, the hardship of our people, and to rescue and revitalize our industries. He will, then, immediately make available a minimum of one billion cedis (GH¢1 billion) to households and businesses, particularly small and medium scale enterprises. [21]

The lockdown for most urban poor Ghanaians meant immediate loss of livelihood including shelter. It was therefore not surprising that 76  Kayayeis (head porters in the big markets in Accra and Kumasi) “including  20 girls between the ages of 6 to 15 years, 21 babies and 35 women between the ages of 18 to 45 years” [22] on March 31st, less than 24 hours after the lockdown became operational, were arrested in transit  to their villages in Northern Ghana, the poorest part of Ghana. The one-day closure of the market and later the lockdown must have convinced the Kayayeis that darker and harder days lie ahead (learn more at this link). Arresting and returning the Kayayeis to Accra underscores the challenging and unpredictable times awaiting Ghana’s poor and the authorities responsible for enforcing the controversial COVID-19 Bill. 

Aside from the Kayayeis incident, the lockdown seems to be achieving one of its key objectives: increased testing for COVID-19. As evident by the graph above, with the number of tests risen, so too have confirmed cases increased. Encouragingly, GHS/MOH have also started reporting recovery. GHS Reports for 1st April indicated the following: 3 patients fully recovered, sent home and no longer being monitored; 49 discharged patients but kept under home surveillance and 138 patients are responding positively to treatment but still at the quarantine centers. Though the recovery numbers of patients are modest, they duly demonstrate that COVID-19 will indeed be conquered. 

In conclusion, within the past two weeks, Ghana, the once proud gateway to West Africa, has shut down in order to prevent COVID-19 from taking root in its communities.  The land and sea borders as well as the airports are closed to the travelling public except those bringing essential items to combat COVID-19. Accra, Kumasi, and Tema have descended from bustling, traffic jammed, and thriving small business driven urban centers into subdued and empty streets with hardly any hawkers. In the light of the experiences of the Kayayeis, the measures announced in the 4th Presidential address will strengthen A Whole of Ghana Approach only if they truly promote equitable COVID-19 burden sharing between the poor and the rest of Ghana. Equity can be achieved if the government establishes transparent and accountable implementation mechanisms and guidelines for the distribution of funds and execution of COVID-19 alleviation programs. Pro-poor programs in Ghana are replete with massive corruption by officials appointed by the government to run them.[23] Therefore, Ghanaian civil society should take an active interest and demand participation in the design, management, implementation, and monitoring of the funds to address the needs of vulnerable groups as well as the program for the rehabilitation of local industries.

 About the Author

Mr. Siapha Kamara is the founding Chief Executive Officer of SEND West Africa (www.sendwestafrica.org), which  has affiliates in Ghana, Liberia and Sierra Leone. He is currently the Chief of Party of the USAID funded People for Health Project, being implemented by a consortium led by SEND Ghana. His decades of social development activism include leading the SEND Sierra Leone community-based Ebola Responsive Program. This program mobilized thousands of rural women to actively participate in the transformation of the Kailahun District where Ebola started in 2014 from being the epicenter of the epidemic into Ebola free communities in 2016. Siapha also established the West Africa Against Ebola Campaign in Ghana which raised funds to support the education of Ebola orphans. He is head of the Editorial Team of the SEND West Africa COVID-19Update Online Publication, whose mission is to advocate increased learning and actions to mitigate the spread of the virus in West Africa. He can be contacted at Siapha.Kamara@sendwestafrica.org

Citations:

[1]  http://presidency.gov.gh/index.php/briefing-room/news-style-2/1533-100-million-provided-to-enhance-coronavirus-preparedness-and-response-plan-president-akufo-addo

[2]  http://presidency.gov.gh/index.php/briefing-room/speeches/1527-speech-by-president-nana-addo-dankwa-akufo-addo-at-the-63rd-independence-day-celebration

[3] http://ghanahealthservice.org/covid19/downloads/covid_19_first_confirmed_GH.pdf

[4] See The Ghanaian Times 19 March, 2020

[5]  Budget Statement and Economic Policy (2015 -2020)

[6] https://www.who.int/healthsystems/publications/Abuja10.pdf

[7] Budget Statement and Economic Policy – 2020

[8]  https://sciencespeaksblog.org/2020/02/28/covid-19-a-doctor-explores-preparedness-in-ghana/

[9]  Ghana Living Standard Survey (GLSS) 7 Report, 2017

[10]  Presidential address on 15, 19, 21 & 27 March: http://www.presidency.gov.gh/

[11] https://citinewsroom.com/2020/03/coronavirus-parliament-passes-imposition-of-restrictions-bill-2/

[12]  https://www.mynewsgh.com/only-a-parliament-without-balls-will-pass-shoddy-restriction-bill-cdds-h-k-prempeh-breaks-silence/

[13]  See Daily Graphic 23, March, 2020

[14] https://www.ghanaweb.com/GhanaHomePage/NewsArchive/Chief-Imam-urges-Muslims-to-adhere-to-govt-s-directive-896128

[15]   https://www.myjoyonline.com/news/national/adhere-to-coronavirus-prevention-directives-otumfuo-to-ghanaians/#

[16]  https://www.journalducameroun.com/en/accra-stands-still-for-market-fumigation-against-covid-19/

[17]  See Daily Graphic 24th  March, 2020

[18] https://www.businessghana.com/site/news/general/209193/GMA-reiterates-call-for-total-lockdown-of-Ghana-to-prevent-Coronavirus-spread

[19] https://www.primenewsghana.com/general-news/kccr-virologist-explains-why-gma-calls-for-lockdown-is-not-ideal.html

[20] https://www.macrotrends.net/cities/21107/accra/population and https://www.macrotrends.net/cities/21107/accra/population

[21]   http://www.presidency.gov.gh/index.php/briefing-room/speeches/1546-president-akufo-addo-addresses-nation-on-updates-to-ghana-s-enhanced-response-to-the-coronavirus-pandemic

[22]  https://www.modernghana.com/news/992868/covid-19-ama-gives-stranded-kayayes-food-shelter.htm

[23]  Manasseh Azure  Awuni, The Fourth  John Mahama : Reign, Rejection and Rebound,  2020.

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