The African Centre for Health Policy Research and Analysis is health research, policy and public interest-based organization focused on helping the development of the health sector and systems for an effective health care delivery in Ghana and beyond. The Corona Virus pandemic is a global crisis affecting the world including our beloved country Ghana.
This paper takes a critical look at the pandemic in Ghana from the genesis of the virus elsewhere to the importation and confirmation, the measures and management of the pandemic (focusing on whether the measures and management have so far yielded the needed results) in Ghana. The presentation is going to be in four parts. These are
1. Medical and Scientific Perspective
2. The Management of the pandemic in Ghana so far
3. Executive restrictions and executive acts and
4. Conclusion and Recommendations
1.0 MEDICAL AND SCIENCE PERSPECTIVE
1.1 GENESIS OF OUTBREAK
As far back as December 27th, 2019, the Hubei Provincial Hospital in China reported to health officials that a novel coronavirus was detected, causing a disease known as SAR-COV2. It was reported that it had infected more than 180 individuals.
The government of the People Republic of China on the 7th of January 2020, reported to the World Health Organization (WHO) a confirmed novel corona virus. The virus demonstrated efficient human to human transmission leading to WHO declaring the outbreak a Public Health Emergency of International Concern (PHEIC). Based on this, the world health body requested all member states to strengthen their systems for enhanced preparedness to prevent importation, ensure early detection and appropriate response to the public health emergency. On January 31st 2020, WHO announced to the world that COVID 19 was upgraded to Global Health Emergency and on March 11th the world health body declared COVID-19 a Pandemic. Ghana was assessed in February and classified among 13 Priority-1 countries by WHO Africa region for being at risk based on flights and passenger volumes.
1.2 GOVERNMENT OF GHANA UNDERRATED COVID 19 RISKS
On January 31st 2020, WHO announced to the world that COVID 19 was upgraded to Global Health Emergency and entreating nations to prepare themselves to curb the spread. With this information at hand, our President and his team still went ahead with a planned 12 day tour of five European countries despite the risks, and this was at the expense of staying home to prepare the country towards implementing WHO recommendations (prevent importation, ensure early detection and appropriate response to any emergency). The tour took the president and his team to countries that had reported cases of COVID-19. Sadly however, upon return, the delegation refused to heed to the directives of ‘self-quarantine’, issued in the absence of the President by the Ghana Health Service. This gave room to other returnees to flout the directive leading to spread of the virus from Ghana’s index case.
1.3 NO NATIONAL STRATEGY IN GOVERNMENT’S APPROACH TO COVID-19
In challenging situations like that of Covid-19, one would expect government to provide Ghanaians with a clear strategy with possible scenarios on how it intends to manage the pandemic. A clear strategy brings about transparency and confidence for people to accept guidelines issued by government once they themselves analyze the situation using the strategy. As of today, no one has cited any strategy from government on COVID 19. The absence of a national strategy gives room for knee jerk reactions from government and that is what we are experiencing today. In fact, if we had a national strategy for COVID 19 in place, government probably wouldn’t have lifted a lockdown when the rate of community-spread was on the rise. Probably government would have made the restrictions stricter to limit movement as well as embark on rigorous contact tracing, testing and treatment.
1.4 UNDERRESOURCED HEALTH AND EMERGENCY SYSTEMS IN TACKLING COVID-19
At the close of February 2020, when Ghana was assessed using WHO Country Readiness Checklist as been a high risk country, funding was found to be a major challenge. The government of Ghana was required to make available GHC 35 million to get the country adequately positioned to confront the looming pandemic. Unfortunately, only a paltry sum of 2.8 million Ghana cedis was made available for this course. This amount was woefully inadequate to activate the needed systems in times of national medical emergencies as Covid-19. As it is said ‘a stitch in time saves 9’. If government had released the recommended 35 million GHC most of the resources we are lacking today or buying at throat cut prices (Personal and protective equipment-PPEs, Reagents, PCR machines etc) to manage COVID 19 cases would not have been an issue to the country. As a result of the government late reaction, today management of the pandemic is costing us billions of Ghana cedis than it would probably have been.
1.5 GOVERNMENT DISREGARD TO MEDICAL AND SCIENTIFIC ADVICE.
As early as January 2020, WHO requested all member countries to do whatever they can to prevent importation of the virus into their respective countries. Several calls were made to government to shut our borders but to no avail. To make matters worse, the president himself decided to tour some European countries despite several cautions. Ghana as a country continued to receive flights from all over the world including affected countries until March 22nd by which time Ghana had recorded 23 COVID 19 cases with one death.
Government initial failure/refusal/neglect to follow medical advice to quarantine returnees to the country is what led to the fast spread of this disease. As the entire globe was issuing directives against mass gathering Ghana went ahead to celebrate the 63rd Independence Day in Kumasi with huge crowds in defiance of WHO recommendations. The Centre through a press release advised against the celebration but it was ignored.
Also calls on the National Identification Authority to halt its activities in the Eastern Region since it posed a threat to the people was equally ignored. The Government simply disregarded medical expert advice to prepare against importation of the virus.
1.6 LATE AND INEFFECTIVE BORDER CONTROLS AND MEASURES
Due to the disregard of medical and scientific advice of the risk of Covid-19, Government came in late with its directives to border closures and management. Many of the recorded cases were from the travels into the country by either land or airports. The poor border controls saw many illegal entries and exits even after the directives for closure. Border officials were not equipped with the needed tools and thus Immigration and Customs officers looked helpless as people move to and fro citing lack of protective equipment as their reason for not getting close to them.
1.7 PERSONEL TRAINING AND PROVISION OF PPE
Training of frontline workers and other health and non-health workers required to combat the pandemic was carried out very late when the pandemic had already engulfed our beloved country. Not until March 16 2020 the GHS had just trained just few workers within Accra and Kumasi. This put the country at serious risk for both care providers and the population at large.
A research the Center conducted in the five northern regions as late as March 23rd 2020 revealed that health facilities did not have the needed PPE to work. Training of personnel was yet to be done in some parts of the North and this resulted in the husband of the first case in Bolgatanga taking her wife home because frontline workers did not have the needed apparel to attend to her and the result of this are the numbers we see in Upper East Region.
We have heard the President make emphatic statements that thousands of personal and protective equipment have been distributed to facilities across the country yet, when you visit most hospitals, common facemask is still a challenge. With all this in the health sector which is directly responsible for managing the pandemic, the Electoral Commission whose mandate is not near this pandemic says they have all the needed personal and protective equipment for new voter’s registration. How is it possible to be committed to securing our lives and gives Personal and protective equipment to the Electoral body when the frontline worker lacks it?
1.8 TESTING SITES AND DATA MANAGEMENT
Government’s refusal to plan for the pandemic is also manifested in the number of coronavirus testing centers. Had government conducted a need assessment and developed a strategic plan in combating the pandemic a lot of money would have been saved, turn-around time for testing would have been reduced, those with positive results would have been isolated quickly and the spread would have been minimal. For example, samples taken from suspects outside Accra and Kumasi not until last week were transported to either of the two testing sites at a huge cost. Tamale for instance transported samples every day to Kumasi with an ambulance spending GHC 900 on fuel alone for each trip.
Data emanating from testing centers have also received some criticisms from the scientific community for accuracy. Our investigations revealed that some of the people engaged in taking sample lack the expertise. About 800 samples were reported not to be useful for testing at KCCR only after the figures were challenged. Autopsy performed at 37 Military Hospital on corpse who were earlier tested negative to COVID 19 subsequently resulted positive, casting doubts on the quality of sample taken or the testing process or confirming the allegations of pure manipulations of numbers. What has happened to the backlog of 18,000 samples? And what about the people who are waiting for their results from these sample?
Contact tracing has been found to be a challenge as there are many confirmed cases who do not really know the exact person who might have transmitted the virus to them. This means that, we might have more positive cases in the country than the actual figure but for mild clinical presentation of the disease.
1.9 TREATMENT CENTRES
Earlier decision by government to use Korle Bu, Ridge and KATH as isolation centers for coronavirus patients was not well received by health experts citing challenges of preventing the spread of the disease to other patients in the regular hospital. Suggestions were made for government to rather make use of completed and both underutilized and abandoned hospitals like Legon Medical Center, Bank of Ghana Hospital and others. This was not taken by government until they had no choice. But ask, at whose cost? Obviously, at the cost of the safety of Ghanaians. If government had taken that advice early perhaps less health workers would have been infected and few having to observe quarantine due to contact with infected colleagues and patients.
1.10 PARTIAL LOCKDOWN
The way and manner government announced the partial lockdown was also an expression of how they underrated challenges faced by the vulnerable in society. They also failed to take valuable lessons from countries like Italy that implemented a partial lockdown and the resultant disaster that came with it. Between the time of the announcement to when the partial lockdown took effect, the gap gave opportunity for people to escape from the epicenters to virgin regions, thus contributing to the spread of the virus across the country. Equally problematic was the way government lifted the partial lock because no scientific reasons were given. Recommendation on easing the lockdown issued by WHO were not adhered to leaving the medical and scientific community in a state of shock as to what might have informed such a decision.
In summary, the Partial lockdown had some effect on the spread in general it could have been better if it was properly managed. Social interventions were marred with chaos and no respect for social distancing. People were still escaping from the lock down regions and spreading the disease.
2.0 EXTREME PARTISANSHIP IN THE MANAGEMENT OF COVID-19
2.1 POOR PUBLIC EDUCATION ON THE PANDEMIC
In pandemics like the one at hand, every single soul on this earth is at risk and therefore the need to provide the needed information to all using communication methods that best carry the information is important. This however is not the case in Ghana. Constitutionally mandated bodies responsible for public education such as National Commission for Civic Education (NCCE) and the Information Services Department (ISD) have been rendered useless by the extreme partisanship of the government.
Also, the government having taken over the work of these bodies, the government failed/neglected or refused to translate and educate the citizenry in the various languages. Sadly, the government has turned the platform that should be solely for education on the pandemic into political campaign platforms for petty propaganda. Instead of telling the citizenry about the preventive measures, they are busy on promises targeted at the next elections rather than the pandemic. For instance, how can a platform which should be solely for public education on the crisis at hand be given to the ministers of education to talk about successes in his ministry at this critical moment, the minister of agriculture to lie about prices of foodstuff? And even the president himself suddenly seeing the relevance of hospitals and making campaign promises to build more? The result of this is that majority of the masses still leave in disregard of the protocols of prevention due to ignorance.
Community radio stations that are major source of information to the rural folks have not been involve leaving the people to rely on other sources that sometime provide them with irrelevant and incorrect information.
2.2 FUNDING UTILIZATION AND TRANSPARENCY
Few days into the three weeks lockdown, government resorted to borrowing from the International Monetary Fund and the World Bank to fight the pandemic. Government also established COVID 19 Trust Found Board through the (Noble Coronavirus COVID-19 National Trust Fund Act, 2020 (Act 1013). Its mandate is to among others, raise money to complement the efforts of government to combat the pandemic and also design a programme for helping the vulnerable and the needy with the amounts of money realized.
It is however sad to note that the board has since not been transparent in its activities as there are no readily available information and regular public briefings by the board on their daily dealings. Till date Ghanaians don’t know how much has been realized by the Trust Fund, who are the donors and amounts donated and what is it been used for. We have so far been able to track donations into the fund amounting to Ghs39, 695,040. This excludes the $35 million IMF facility, $1 billion World Bank facility they secured, and the over $200 million National Stabilization fund.
The Center is however surprise that, after bagging over Seven Billion Ghana cedis hospital are still facing serious challenges with PPE the main gear for frontline workers.
3.0 THE EXECUTIVE RESTRICTIONS AND EXECUTIVE ACTS
3.1 THE IMPOSITIONS OF RESTRICTIONS ACT AND THE EXECUTIVE DIRECTIVES
Covid-19 is a global pandemic causing havoc all over the world over. In line with the global health body, the World health Organization’s directives and protocols on prevention, the President on March this year by an executive instrument, E.I 64, put in place some restrictions to help curb this pandemic in Ghana.
Generally speaking, the restrictions are much needed to help the fight even though in our case it was done without any emphasis of our peculiar circumstances. There could have been more thoughtful with specificities to our context. Nonetheless, little they say is always better than none.
More worrying is the disregard of these restrictions by the government and some of its institutions who should be leading the way in observing the protocols for our collective safety. The Electoral commission which is not an exempt institution under the E.I 64 disregarded the directives and a court order to organize meetings of numbers more than the 25 persons allowed. If the executive (government) is not in support of such disrespect to the rule of law by the Electoral Commission, why are they not arresting and prosecuting the Electoral commission officers who organized the meeting as they have done to some church, community leaders and individuals?
Also, just a couple of days ago, the police and military provided support for an installation of a Chief at Akropong in the Eastern Region of Ghana in clear disregard to the restrictions. Did the police and military give approval to this without regards to the powers that be? Have the organizers been arrested and arraigned before court or those involved are above the law? Or is it the case of giving different strokes to different folks? Fellow Ghanaians, is the law applied as and when it suits the government? This is most unfortunate to say the least.
Ghanaians must wake up to the global realties of this pandemic and resist all attempts by this government’s political ambition as against their safety, health and welfare. We are yet to see true commitment to the welfare and interest of Ghanaians by the government than parochial partisan pursuit even in this pandemic. Words are nothing but mere fanciful expressions which is better understood by actions.
The African Centre for Health Policy Research and Analysis concludes that, the Government of Ghana’s measures and management of the pandemic has been haphazard, not properly planned and thought out, not guided by any strategy and not based on medical science. The Centre notes sadly that despite medical and scientific advice for early precautions and measures to stop the importation and spread of this deadly virus, the government of Ghana and the managers of our health system failed to take the necessary precautions and hence the virus pandemic in Ghana.
Further, the Centre states that the management of the pandemic in Ghana has been extremely partisan and lacks direction and coordination. There are very few testing centres in the country, thus only few samples are tested which also take so long for the results to be made known. There is also a general complaint across the country of lack of preventive and protective equipment in health facilities, exposing many more persons to the badly managed virus. The pandemic and the safety of the citizenry doesn’t seem a priority from the way it is been handled.
Lastly, the Centre notes further that; Government’s handling of public education and sensitization about the preventive measures has been very poor. The messages churned out during these press meetings are rather more of petty campaign promises than that targeting at the pandemic. The constitutionally mandated bodies like the National Commission for Civic Education and Information Services Department who could have done this education better and in all local languages have regrettably been sidelined.
1. The Centre calls on government, the Ministry of Health and the Ghana Health Service to as a matter of urgency put in place a National Strategy in tackling the pandemic in Ghana. It is not too late as the pandemic keeping raging on in Ghana. A National Strategy is needed urgently to help the country refocus and prioritize the fight of this pandemic.
2. The government must prioritize the fight against the pandemic by opening up many testing centres across the country. This will help in testing many persons, help reduce the time for getting the results from the current delays so that positive persons can be quickly isolated and managed for the safety of Ghanaians.
3. Educating Ghanaians particularly in the rural areas must be given special attention. The National Commission for Civic Education, the Information Services Department which is in every region must be resourced immediately to disseminate the needed information to help the fight and demystify their wrong believes about the pandemic.
4. All hospitals and health facilities must be resourced and equipped with the needed tools as they are the first point of contact with unhealthy persons. This must be done with the needed urgency in this pandemic.
5. The Centre calls on the Novel Corona Virus National Trust Fund to make available to the public the amount of money mobilized so far and how they intend to proceed with the use of those monies in helping curb this pandemic. Transparency is key to earning public confidence in the Fund set up. Regular press briefings will be important in this respect.
6. The Centre call on the government to at all times act on medical and scientific expert advice in relation to this pandemic. Medical and science advice will help in the targeting of the lockdown and the reviews thereof.
7. The Center call on all law enforcement agencies to enforce the IMPOSITIONS OF RESTRICTIONS ACT AND THE EXECUTIVE DIRECTIVES without fear or favour.
DR THOMAS WINSUM ANABAH