COVID-19: No reason for complacency – Update Volta Region

July 27, 2020 in Ghana, Partner by guenther_michels

COVID-19: NO REASON FOR COMPLACENCY – An Update on the situation in Ghana´s Volta-Region

Karsten Gareis, HITA, 15.7.2020 – with input from Jacob Ahiave / Grow Your Dream Foundation

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1 The current situation

In a recent report [1] Chatham House, an independent UK political think tank, summarised the general perception of how COVID-19 has affected the African continent: “Despite public health constraints, widespread infectious disease, and poor nutrition, COVID -19′s toll on Africa has so far been less than initially feared”. Except for South Africa, rates of infection and COVID-19 related deaths in Sub-Saharan Africa (SSA) have remained comparatively low, especially compared to the number of fatalities among non-white people in South America and elsewhere in the world. There is no reason for complacency yet, though, as “[...] the situation changes daily and significant uncertainties remain. [...] Resilience should not lead to complacency, which, in itself, would become a major risk.” [2]

The Ghana government response to the outbreak of COVID-19 has demonstrated strong commitment. It has been based on the country’s successful experience with fighting the West African Ebola epidemic (2013-2016) and benefits from emergency support from the World Bank amounting to $35 million to “help the country provide improved response systems” [3].

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On 15 March 2020, the government banned all public gatherings including conferences, workshops, funerals, festivals, political rallies, church activities and other related events to reduce the spread of COVID-19. Other measures have included disinfection of markets; special life insurance cover for the professionals at the frontline dealing with the pandemic; and the set-up of quarantine centres. Major efforts have been put into contact tracing and stepping up testing exercises in the country. Since 22 March, all the county’s borders have been closed. A lockdown was declared from 29 March to 20 April in two metropolitan regions in which most early cases of infections were reported (Accra and Kumasi). At around the same time all basic schools, senior high schools and universities, both public and private, closed. They remain so except for final year junior high, senior high and university students, for whom classes resumed on 15 June to allow them to conduct their respective exit examinations.

Wearing of masks in public places and social distancing was made compulsory nationwide in June. Punishment for violation of safety protocols is severe: For refusing to wear a face mask in public, the new legislation foresees a prison sentence of 4 to 10 years or a fine of GHS 12,000-60,000 (about € 2,000-10,000) or both[4] (!!). The legislation has been widely criticised as being out of proportion, as many poorer Ghanaians find it difficult even to afford a regular supply of face masks. Actual penalties imposed are less draconian. For example, the Ho Municipal Assembly has instituted a spot fine of GHS 20 against persons who are caught without face masks in public, which is enforced frequently.[5]

The efforts taken by the government and the national health system appear to have been effective in preventing a full-scale outbreak of the disease in the country. When looking at the total number of cases in relation to the population, Ghana’s rate is currently about one third of the rate for Germany, one fifth of South Africa, and less than one tenth of the USA and Brazil.[6] When the focus is on the number of COVID-19 related deaths as a proportion of the population, the Ghana’s figure is 25 times smaller than the German one. In early July, the number of active cases surpassed 5,000 for the first time, before falling again to 4,878. 129 deaths have been causally linked to COVID-19 so far – a very small number when compared, for instance, with the number of deaths due to tuberculosis (over 16,000 per year). [7]

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2 Worrying signs

These statistics do not, however, tell the full story. Because of the limited testing capacities in low- and medium-income countries, there is near certainty that deaths causally related to COVID-19 are substantially underreported in SSA when compared to higher income countries. Despite the ambitious approach to testing and tracing taken by its government, this is also true for Ghana. The number of tests (daily tests per 1 million people) in Ghana was 99 in early July, compared to 843 in Germany and 752 in South Africa. [8] The number of tests per confirmed case in Ghana is 5, roughly the same as in South Africa (4.4) but considerably less than in Germany (174). [9]

Compared to the low overall number of reported COVID-19 cases and deaths in Ghana, it is striking how many politicians have been infected by the virus. The list includes:

  • Minister of Health (recovered);
  • Chief Executive of the Sekondi-Takoradi Metropolitan Assembly (died);
  • CEO of the National Health Insurance Authority (NHIA) (recovered);
  • CEO of Forestry Commission and former General Secretary of the governing New Patriotic Party (died);
  • Deputy Minister for Trade and Industry (recovered);
  • Volta Regional Minister (recovered);
  • Senior Minister of the Republic of Ghana (in isolation);
  • Minister for Education (recovered).

In early July, the Ministry of Education went public with the information that 90% (!) of its staff tested positive for the Coronavirus. [10] At the time of writing, Ghana’s President Nana Akufo-Addo is still in self-imposed isolation on the advice of doctors after a person in his close circle tested positive for coronavirus, in spite of reportedly testing negative himself. [11]

Many of these cases are very recent, which suggests that claims that Ghana “reached the peak of its COVID-19 infections” already in early May, as publicly announced by the head of Public Health at the Ghana Health Service (GHS) and the government [12], are dubious. Party politics appear to play an important role in the way the government deals with the pandemic: the country will hold presidential and parliamentary elections in December 2020, in a vote that will be a very close contest between the ruling New Patriotic Party and the main opposition National Democratic Congress. Against this background, any official statements about the pandemic’s development in Ghana needs to be taken with a pinch of salt.

Apart from the uncertainty about the real extent of the spread of COVID-19 in Ghana, there are several other challenges that need to be addressed urgently. Ghana’s Minister of Health has listed some of these in a recent report to the WHO about Ghana’s experience with the pandemic [13]:

Propagation of fake news and myths

As discussed in our first report on COVID-19 and the current situation in Adaklu, a lot of damage is caused by the spread of fake news, misinformation and myths about the origin of the virus, its transmissibility and methods to prevent and treat an infection.

Breaching of social distancing rules

Despite the harsh punishment of violations of the COVID-19 protocols implemented by the government, anecdotal evidence suggests that social distancing rules are systemically breached in some communities and under some circumstances.

Unfortunately, the nationwide process of voter registration, which is currently ongoing in preparation of the December elections, is causing large numbers of people to assemble in groups at registration posts. Despite calls to postpone the compilation of a new voters’ register, Ghana’s Electoral Commission insisted on the need for a completely new register rather than an update of the existing one (which is from 2012). [14] The Electoral Commission has promised to make sure that COVID-19 protocols are upheld at all registration posts, but many observers have issued doubts. A group of healthcare practitioners formally complained to the Electoral Commission that “public conducting a mass voter registration exercise as the country battles the Covid-19 pandemic will result in more deaths from the disease [...] as the exercise will promote the gathering of people in a manner that will inadvertently undermine the principles of social distancing and therefore facilitate the community spread of the disease”. [15]

Evidence from Ho indeed suggests that the voter registration exercise is compromising the safety of the population, as social distancing is proving impossible due to the large number of voters seeking to register – see the photos below, taken on 10 July.

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Another decision by the government also risks leading to violations of the social distancing protocol. In June, final year junior high, senior high and university students, where asked to return to their classes to allow them to take their exit examinations. While President Akufo-Addo urged teachers to “conduct their lessons under strict social distancing”, the actual situation in the schools and universities often makes it all but impossible. We received reports from our partner schools in Ho, according to which dozens of students currently share a single dormitory room, and campuses are simply not large enough to allow children to keep at distance from each other. The fact that rainy season started in April, forcing everybody to spend indoors for many hours during the day, does not help matters. It does not come as a surprise, then, that both Mawuli and Mawuko Girls’ Senior High Schools in Ho recorded cases of children infected with the virus on July 13th. [16]

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‘The Denial syndrome’ of asymptomatic COVID-19 cases

In contrast to other transmissible diseases, cases of infection with COVID-19 are often asymptomatic, i.e. a large share of infected persons do not experience any symptoms themselves. Many Ghanaians are unwilling to accept the real possibility that a person can be a carrier for the infection without experiencing any symptoms whatsoever – increasing the likelihood that they will spread the virus due to careless behaviour such as insufficient social distancing.

Stigmatisation of recovered patients

Stigmatisation of patients who have recovered from COVID-19 represents a significant mental health risk to those affected. Moreover, fear of stigmatisation (and of being isolated in central facilities) can make individuals with symptoms that may be related to COVID-19, such as coughing or sneezing, try to hide their condition rather than seek medical attention.

Suspension of public health activities and under-utilisation of health services

Some public health activities such as vaccination campaigns are at risk of being suspended because of the COVID-19 response taking up most resources. Target groups of vaccinations are also harder to reach because of fears of being infected when participating in the campaign, which typically requires a visit to a health facility such as a CHPS compound.

In Ghana, attendance at maternal and child health services has dropped by 50% nationwide since the outbreak of COVID-19, according to estimates by Prof. Fred Binka, a leading epidemiologist at the University of Health and Allied Sciences in Hohoe.[17]

Ghana has planned to distribute insecticide-treated bed nets as a means of malaria prevention in 2020, as it does every three years in the context of a WHO-coordinated mass campaign to hand out bed nets to their population. The campaign has for now been suspended. Any delay is likely to result directly into increases in deaths due to malaria.[18]

The current practice of isolating persons who are believed may be infected with the Coronavirus makes matters worse. We received reports that in Adaklu and the city of Ho (which is situated close to Adaklu and provides the District’s population with advanced health services) individuals who visit a doctor because of symptoms that could be caused by COVID-19, or who for other reasons are thought to have been infected, are typically not allowed to return home, but are isolated for 14 days in a building on the premises of the Kpetoe Health Centre. The HITA team visited the facility in spring 2019, when we handed over several hospital beds as well as IT equipment donated by HITA supporters back in Germany. The photo above, which we shot during our visit, shows the building currently being used for the isolation station. Naturally, many people will avoid visiting a health facility if they risk being quarantined in this way without proof that they are COVID-19 infected.

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3 Next steps

HITA is currently in the process of discussing with collaborators in the Volta Region how we can help ensure an adequate response to COVID-19. Our main partners in this are two departments of the University of Health and Allied Sciences (UHAS), namely the School of Nursing and Midwifery (SONAM) located in Ho and the School of Public Health (SPH) located in Hohoe. We are also in continuous contact with Togbe Lablulu in Adaklu-Waya and with the Grow Your Life Foundation team that supports the communities of Adaklu through awareness raising activities, with a focus on giving women a stronger role in rural society.

Together with these stakeholders we have drafted a plan for an intervention to investigate COVID-19 related opinions, perceptions and behaviours of the rural population with an emphasis on the practical challenges people face in adhering to COVID-19 protocols (e.g. social distancing, protective clothing, hygiene, self-isolation) and in accessing health services at times of the pandemic. Based on the findings, we plan to develop training measures targeting community health nurses, who are in an ideal position to educate and directly support people in rural communities about how best to deal with the risks and hardships caused by the pandemic. As befits HITA’s belief in the power of information and communication technology to boost development in low-resource environments, our planned intervention will make full use of, in particular, mobile telephony and smartphones in order to implement inexpensive solutions tailored to the needs of Ghana’s rural population.


[2]     ibidem

[6]     Ghana (10 July, 2020): 756; Germany: 2365; South Africa: 4019; UK: 4237; Brazil: 8260. Source: https://ourworldindata.org/grapher/total-confirmed-cases-of-covid-19-per-million-people?tab=table