Siapha Kamara Chief of Party for People for Health (P4H) Project

The first confirmed cases and death to COVID-19 were recorded in Accra 12^th March, 2020, and 21^st March, 2020 respectively in Ghana[1]. Two months later, by 27^th May, 2020, the confirmed cases had jumped to 7,117 with 34 deaths, 2,317   recovered, and 4,766 active cases[2]. Initially confirmed cases were concentrated in Accra and Kumasi, Ghana’s most populous urban and commercial centers.  But, by 27^th May, 14 out of the 16 political administrative regions have recorded COVID-19 cases[3]. Even more disturbing, while majority of the confirmed   cases were imported in March and April, but this changed   in May.   Over 60% of the afflicted persons had not travelled outside Ghana.  Meanwhile testing for COVID-19 has risen to 203,383 making Ghana in May second only to South Africa’s 605,991. However, an important constant has been the low mortality rate of 0.5% which is far below the 3.1% average for African countries[4].  Hence, the question: what is Ghana doing right in fighting COVID-19?

The first thing that Ghana has gotten right is the leadership and management of COVID-19 by Mr. President.  There are 3 markers I  have used  to assess the quality of Ghana’s leadership in managing    COVID-19 and they are i) understanding of the magnitude  and  consequences of COVID-19,   ii)  development of a     coherent and doable   framework  with effective  strategies  to  combat  COVID-19   and  iii)  inspiring and empowering the citizenry to surmount  COVID-19. Without a doubt, the evidence of Ghana’s presidency performance on these benchmarks has been exceptional and enviable.  In the very first address to the nation, Mr. President declared a Whole of Ghana Approach, emphasizing that COVID-19   had yet no cure, more importantly, it remains oblivious to any physical boundary and social status in society.   The operational details of the Whole of Ghana Approach are elaborated in 9 Presidential COVID-19 addresses delivered in March, April, and May 2020. In these speeches, for example, Mr. President has stressed the investment that the government will make in the health sector and the national economy. Through increased investment, the government seeks to create an enabling environment that empowers Ghanaians and public health institutions to confidently battle COVID-19. More importantly, the operationalization of the Whole of Ghana Approach has successfully galvanized constituency-based groups,  i.e. political parties, faith-based groups, labor movement, and traditional authorities, to collaborate with the government to mobilize the 30 million Ghanaians to adopt the behavioral changes required to prevent the escalation of COVID-19 in the country.

Second, Ghana has the right overarching policy and strategy to combat COVID-19.   On 6th March 2020, while delivering the Independence Day Message, Mr. President admonished Ghanaians to adopt social distancing behaviors to prevent COVID-19 from tearing apart their lives. In all the COVID-19 addresses, Mr. President has underscored Ghana’s commitment to the adoption of the World Health Organization’s (WHO) recommended global best practices policies and strategies to prevent the spread of COVID-19.    Ghana was among the first countries in Africa to institute tracing, testing, isolation, and treatment (TTIT) exercise for COVID-19 cases. This was followed by the closure of land, sea, and air borders of Ghana in mid-March, 2020. The smart and selective utilization of social distancing tools such as the partial lockdown of Accra and Kumasi in March and April 2020, enabled the TTIT Teams to identify and neutralize hotspots from spreading the virus into other communities. Another significant element of Ghana’s strategy is the emphasis of Mr. President on using data and science to define and shape the COVID-19 prevention strategies. This has enabled Ghana’s COVID-19 strategies to remain aligned and responsive to the trajectory of the virus.

Third, social mobilization targeting constituency-based social groups is a significant strategic asset developed by the   Ghanaian government in the fight against COVID-19. They include: the two largest faith-based organizations(Christians and Moslems), organized labor ( Trade Union Congress-TUC), the medical community (Ghana Medical Association (GMA), traditional authorities ( National House of Chiefs), academia (Universities), creative industry (artist and painters), industry and commerce( Association of Ghana Industries (AGI), the youth of Ghana (National Union of Ghanaian Students), and the hospitality industry.  

Two key tools have been deployed by the presidency to educate and mobilize the leadership of these groups to get their members to comply with the COVID-19 prevention strategies. In this context, the Presidential addresses have undoubtedly been the most potent tool used by the government to effect social mobilization particularly in support of social distancing.  For instance, these groups are mentioned in all the presidential addresses and are often targeted with messages for their members. Engaging these powerful and respected social institutions has proven effective in rallying the vast majority of the citizenry to implement the government COVID-19 prevention strategies.

The second tool is the meetings at the Jubilee House, the seat of government, between the Presidency and leadership of these recognized social groups. Each of these meetings has involved the President himself chairing and leading the discussions. These meetings are opportunities for the presidency to provide details to specific decisions, actions, and to solicit their inputs into key aspects of Ghana’s COVID-19 strategies. Even more importantly, the face to face meetings are opportunities to nip in the bud any possible tension involving these groups with grassroots and organized following throughout the country. These social mobilization strategies are being taken to the communities by 278 district COVID-19 committees. The committees’ main mandate is to educate and mobilize the population to adhere to the government COVID-19 prevention protocols.

Fourth, the plan to invest in expanding as quickly as possible the health delivery infrastructure is right and timely. SEND budget advocacy work supported by USAID, UNICEF, International Budget Partnership (IBP) and World Bank has over the past decade consistently drawn governments attention, the present government in particular, for not prioritizing investment in the health sector, especially on infrastructure, equipment, essential commodities, and human resources. It came therefore as no surprise to us in SEND Ghana that the health services had limited infrastructural capacity to cope with the increased demand for specialized treatment centers that might arise should an escalation in COVID-19 cases occur. Hospitalization facilities for long term treatment for infectious diseases were in short supply.   At the outbreak of the COVID-19 in March, there were only two testing centers, both located in the southern zone, and none in the Northern half of the country. Also, in March there were few hospitals with limited facilities for quarantining and treating COVID-19 patients. Thankfully, Mr. President immediately owned up to the low investment in the health sector and promised to turn the situation around. For example, new testing and treatment centers have been opened in Tamale, Ho, and Accra. Certainly, the plan to build 88 additional hospitals will enhance the preparedness of Ghana’s health system not only to respond appropriately to any explosion in the COVID-19 cases but any future infectious diseases outbreak such as experienced with Ebola in 2015 in the region.

Fifth, the economic and social mitigation strategies are right and absolutely necessary.  Social distancing, the pivot, and driver of the COVID-19 prevention strategy globally is strongly advocated by Mr. President.  However, it has devastated informal economic activities, which are the main sources of livelihood for over 60% of the population in urban and rural communities. Open and densely populated markets are the driving forces in the informal economy. Markets across the country have been disrupted and, in many cases closed down.  The authorities have shut down markets because sellers and buyers are unable to observe social distancing during their business transactions.  Services, including the hospitality industry (hotels and restaurants) and small businesses (i.e. barbers, tailors, caters, and street hawkers) have lost their income to social distancing. International export and import businesses are grounded and no longer generating income.  Therefore, the COVID -19 mitigation programmes for water, electricity, and food for the vulnerable groups followed by the economic stimulus package, albeit with some implementation challenges, are contributing to sustaining the enabling environment to prevent the spreading of the virus in Ghana.  

However, as the next editorial will illustrate, there are areas where Ghana is not doing so well and if steps are not taken to improve on them, the COVID prevention strategies will deepen inequality and increase poverty among the   vulnerable Ghanaians who make up 23 .4% of the total population.

[1] https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Ghana

[2] https://www.worldometers.info/coronavirus/

[3] https://www.worldometers.info/coronavirus/