Founding CEO of SEND West Africa and COP P4H , Siapha Kamara

This is a sequel to the editorial highlighting the strengths of Ghana’s approach to the prevention and mitigation of COVID-19. I assured our readers of this editorial pointing out the key things that are undermining the effectiveness of the fight against COVID-19 in Ghana. The failure by government to correct these six factors, will unfortunately only increase the devastation COVID-19 is causing to our lives and that of poor Ghanaians in particular.

First, civil society government partnership to promote good governance practices of accountability, transparency, equity, and participation in COVID-19 mitigation program virtually do not exist. A wide variety of constituency based social and political groups have been consulted by the Presidency about the COVID-19 prevention program of government. Surprisingly not even the Civil Society Coalition on the Sustainable Development Goal with 420 strong membership has been engaged by the presidency. Not involving CSOs, especially the research and advocacy organizations, runs contrary to the principles and advice of the International Monetary Fund   and World Bank, who are the main funders of Ghana’s COVID-19 program. The need for CSOs to supplement public financial management oversight institutions, for example, the Public Accounts Committee of Parliament and Auditor General Department, to prevent corruption and misapplication of COVID-19 funds cannot be overemphasized.

Second, targeting of the poor with COVID-19 Alleviation Program (CAP) has so far been weak. For instance, the payment of utility bills benefitted mainly those households accessing   water and electricity via the two public utility companies. The vast majority of Ghana’s vulnerable households are not serviced by either company. Successive Ghana Living Standard Surveys have emphasized that low income and poor Ghanaians relied on open sources for water and charcoal and firewood for energy. Similarly, none of the different economic stimulus interventions directly target Ghana’s poor. Big Ghanaian companies and their shareholders are being supported with GHC3 billion while owners of small, micro, and medium-sized enterprises are allocated GHC600 million. However, poor Ghanaians are small scale food crop farmers in rural areas while those in urban communities are petty traders, food vendors, hawkers or scavengers earning their livelihoods on a daily basis. These are informal economic activities disrupted by social distancing, including shift systems in the markets, yet, CAP does not provide alternative livelihood for their owners.  Ghana’s poor are presently 7 million out of the 30million population. This number is most likely to rise if government does not directly target the poor with productive and income-generating activities in post-COVID-19 Ghana.

Third, stigmatization and discrimination against those infected and cured followed by health workers and law enforcement personnel managing COVID-19 cases is rampant.  In Accra, on the Spintex road, a middle-class neighborhood, a 100-bedroom facility donated by a church to the health authority to be used as a COVID-19 isolation center was not allowed to open. The community protested against having COVID-19 isolation in their neighborhood. Not even the assurance that the facility could be used solely to host members of the community who get infected was convincing to the protesters. Also, in the Obuasi area, health workers were forced by a mob to relocate under armed protection an isolation center and its patients. The daughter of a recovered COVID-19 person in the Upper West was mocked and told to “get away” from the market by women who knew her family. An army officer at El-wak station was told by his friends “to keep away” when they learned he was providing security at a COVID -19 isolation center. Nurses have been refused services by Uber drivers once they get to know that their destination is a COVID-19 isolation or treatment center. Stigma and discrimination against persons living with HIV is one of the key reasons why the disease has persisted for the past 3 decades. It discourages people from being tested and disclosing their status. This, in turn, has made infected persons to unknowingly pass on the virus to closed relatives, friends, and workmates. Stigmatization and discrimination are threat to public health in Ghana and, therefore, the authorities need to institute harsh punitive measures to punish those involved.

The fourth thing that Ghana is doing poorly is the low availability of Personal Protective Equipment (PPE): gloves, face mask, gown, and booths, to workers at the lower level of the health delivery system ie Community Health Planning Service (CHPS), community health centers and district hospitals. These are the facilities where most Ghanaians access health services. For example, nursing staff at CHPS in the operational communities of P4H have restricted outreach visits to homes and communities because they do not have the required PPE for their work. Evidence so far shared by the Ghana Medical Association (GMA) and Ghana Nurses Association with the public confirm that majority of the health workers infected with the COVID-19 are working in peripheral facilities.  These health workers are easily infected not only because they do not have the appropriate PPE, but importantly, most of their patients are asymptomatic (ie carrier of the virus who have no sign of the disease). Ghana has entered the community transmission stage of the pandemic. The infection is occurring much easier and faster within the population. This, in turn, has increased the exposure and risk to doctors and nurses at CHPS, community health centers and district hospitals.      

Fifth, education and mobilization of the grassroots to adopt the required social behavioral changes to prevent and mitigate COVID-19 have been limited and urban-based. The popular public health adage” prevention is better than to cure” is most applicable to the COVID-19 crisis.  COVID-19 can best be nipped in its tracks through adherence to social distancing protocols and handwashing with soap by every individual. The rural communities where most Ghanaians live and where traditional beliefs and practices hold sway have been least affected by COVID-19 education and social mobilization interventions. It took civil society advocacy to get the government to step-up financial and material support to the National Commission for Civic Education (NCCE) and related bodies. Getting COVID-19 education to the remote and rural communities is one area where civil society and government partnership would make a big difference. The community transmission of COVID-19 makes education and social mobilization to adopt preventive measures especially social distancing and frequent washing of hands with soap extremely important.    

Sixth, weak compliance with and enforcement of COVID-19 preventive protocols especially social distancing and wearing of face mask. A significant number of the citizenry are aware of the different COVID-19 mitigation strategies but they are refusing to adhere to them. A key reason for the non-compliance is that law enforcement agencies, for example, the police, district assemblies, and traditional leaders are not punishing violators of COVID-19 mitigation strategies. The unwillingness of a large section of the population, especially the youth and diehard traditionalists, to adhere to preventive   protocol is definitely one of the forces fueling the community spreading of the COVID-19 in Ghana. It is to deter these miscreants that Mr. President’s 11^th address to the nation issued a directive empowering law enforcement agency to arrest, trial, and sentence those bridging the COVID-19 protocols.  

In conclusion, a civil society-government partnership is important for strengthening accountability and transparency in the implementation of the CAP and related COVID-19 mitigation programs.  Furthermore, government needs to step up measures to prosecute and punish those stigmatizing health workers and COVID-19 recovered persons as well as violators of the preventive   protocols,