The Coronavirus disease 2019 (COVID-19) pandemic, caused by the newly emergent coronavirus SARS-CoV-2, has hit Ghana with full blown community transmission to the shock of many policy makers. Effective measures to reduce the transmission of the virus require active support from the population.
Ghana’s COVID-19 response plan takes a comprehensive cross-sectoral approach, based on a systems thinking framework. It has contributed to the country’s attainment of a case fatality rate less than 0.5% as of June 2020. Implementing the response strategy has faced challenges similar to those of Ghana’s peers in the Sub-Saharan region. These include health system factors, such as weak data management infrastructure, poor coordination of interventions and shortage of logistics, but also community-level factors.
A key community-level challenge has been the poor compliance with prevention and control measures particularly physical distancing and wearing face masks. This non-compliance is particularly pronounced outside the epicentres of the Greater Accra and Greater Ashanti regions. Despite over twenty-four thousand confirmed cases, almost twenty thousand recoveries, over four thousand active cases and more than one hundred deaths as of 12 July 2020, at the initial stages of the response, most Ghanaians still did not believe in the existence of the virus and the threat it posed to their health. This reflects some weaknesses in the country’s communications strategy.
Firstly, updates on response parameters such as numbers of persons tested, confirmed cases and COVID-19 related deaths were inconsistent at the beginning of the response. While these were due to systems hiccups, communities perceived these inconsistencies as policy makers manipulating data. Secondly, Ghanaians did not see COVID-19 patients actively participating in the prevention and control campaigns during or after recovery, thus, citizens wondered whether these “patients” actually existed. Thirdly, policy makers did not maximize the opportunity to leverage prominent persons who had contracted the virus as ‘COVID-19 Champions’ to influence behavioural changes among communities. Subsequently, building community trust in the health systems and the social capital needed to ensure compliance with preventive measures appear to have failed due to these gaps. Social capital is embedded in social relationships between policy makers and communities and drives the latter to modify their behaviour for mutual benefit. Its major elements include social networks, civic engagement, norms of reciprocity and generalized trust as explained by Coleman and Fukuyama.
Prior to the COVID-19 pandemic, Ghanaian communities have had long-standing partnerships with health system policy makers and have influenced health systems strengthening through such relationships. An example is the famous “Community Score Card (CSC)”, an accountability tool implemented by Community Health Management Teams (CHMTs) in over one thousand communities to improve Infection Prevention and Control (IPC) as well as Water, Sanitation and Hygiene (WASH) systems in healthcare facilities. Using a tool that comprises a set of nine indicators, communities assess their health systems to identify and diagnose gaps, and introduce interventions to bridge these gaps.
One important feature of this community participation is their commitment to mobilize resources for implementing these interventions. Through these partnerships, communities have provided water resources to health facilities, provided hand hygiene facilities, constructed placenta pits and incinerators as well as constructed infrastructure for service delivery.
This demonstrated commitment could provide similar leverage to policy makers in this fight against the coronavirus pandemic. Policy makers need to become more aware of social capital in community partnerships and understand how this drives community compliance with public health behavioural change strategies. This is particularly important in this COVID-19 pandemic response which requires support from communities to break viral transmission.
About the Author:
Mary Eyram Ashinyo is a Physician Specialist – Public Health and a Health Policy Analysis Fellow. She is employed as Deputy Director Quality-Assurance at the Ghana Health Service of the Ministry of Health and a member of the country’s National COVID-19 response team.
Acknowledgement: This blog responds to a call by BMJ Global Health in conjunction with the Emerging Voices for Global Health on COVID-19 in Sub-Saharan Africa.
Competing interest: The author declares no competing interest.