SEND Ghana: Setting the standard for Ghana’s COVID-19 social accountability

COVID-19 has left a generation scarred in its wake. From the lingering economic effects, such as the disruptions to supply chains across the world to the apprehension whenever an unmasked person sneezes, especially, in an enclosed space, the impact is undeniable.

Ghana’s response to COVID-19 was heralded globally for being swift and comprehensive, and in many ways, it was. Restrictions on movement in the earliest days, which were characterized by gross uncertainty, the mandatory wearing of masks in public spaces and support for business were all enforced fairly well.

These measures, in part, kept the total number of positive cases to approximately 171,000 – 0.54 percent of the population, using the 2021 Housing and Population Census – and a mortality rate of 0.85 percent (1,460). This compares favourably, for instance, with the 4.03 million cases recorded among South Africa’s 60 million, where, unfortunately, 102,000 persons died from the illness as of August 2022.

Vaccines injection

The most important component of the fight against the virus is undoubtedly the vaccines, which one study found that between December 2020, and December 2021, saved an additional 14.4 to 19.8 million deaths in 185 countries.

Acutely aware that successful deployment could, among other things, improve the mental and emotional well-being of the citizenry, decrease morbidity and mortality, and minimize disruptions to social and economic functions, managers of the pandemic response developed a National Deployment and Vaccination Plan (NDVP).

This was executed by applying the World Health Organization’s (WHO) Strategic Advisory Group of Experts on Immunization (SAGE’s) framework for the allocation and prioritization of vaccination.

Under this framework, the government had to ensure the provision of cold chain equipment (CCEs) across health centres in the country. In addition, vaccination safety protocols, such as infection prevention and waste disposal were adhered to, even as vaccines were administered in phases; targeting the most vulnerable and the most exposed. 

On this front, Ghana was again at the fore of its peers, when in February 2021, it made history by becoming the recipient of the first batch of AstraZeneca/Oxford vaccines under the COVID-19 Vaccines Global Access (COVAX) facility.

The initiative bore fruit as the nation has recorded a modest vaccination rate despite instances of hesitancy, mostly spurred by conspiracy theories. Official data indicates that some 14.9 million doses of the vaccines have been administered, meaning, 65 percent of eligible persons have had at least one shot, with 27.6 percent, being fully vaccinated.

SEND Ghana leading social accountability

Considering the far-reaching impact of COVID-19, and how indispensable vaccines are to curbing its spread, there is a need for objective, data-driven monitoring and accountability to ensure satisfactory delivery.  SEND Ghana has applied a social accountability framework to ensure this.

With funding support from the Partnership for Transparency Fund (PTF), SEND Ghana through a survey “monitored the compliance for Ghana’s NDVP and citizens’ COVID-19 vaccination experience, with the view to promote equity, transparency and accountability of the COVID-19 NDVP and to inform future vaccination service delivery.” The study surveyed more than 1,000 citizens, health workers and teachers in 25 vaccination centres across eight districts in urban and peri-urban areas equally chosen from Accra and Kumasi, which were characterized by high incidents of COVID-19.

This was done to ascertain the level of uptake, thoughts and experiences around vaccination on the part of the target group and assess the distribution of cold chain equipment (CCEs) and vaccine logistics, among similar themes. An apparent theme of the exercise was the desire of the majority of respondents (52 percent) to get vaccinated with the goal of protecting not only themselves but persons with whom they come on in regular, close contact.

Logistics are required for the successful implementation of any mass inoculation drive and the survey discovered that the distribution of CCEs was “somewhat fair.” The available refrigerator models were considered “quite adequate” and their distribution across health centres in the districts “equitable.”

Gaps with other models, cold boxes and vaccine carriers drew calls for “the Ministry of Health and the Ghana Health Service to adopt steps to increase the availability of vaccine logistics across districts within the country.” This comes to suggest that government needs to adopt necessary measures to ensure the supply of required capacity and the number of CCE and related accessories in districts with gaps.

SEND Ghana: Setting the standard for Ghana’s COVID-19 social accountability

The health facilities, it noted, observed strict adherence to safety and hygiene protocols, a phenomenon largely attributed to the operators’ deeper understanding of the risks, coupled with, in some instances, first-hand experience of the horrors of being infected. Most vaccination facilities offered discrete waiting spaces for vaccine recipients to rest and be monitored for any immediate negative effects. Hand hygiene amenities like alcohol-based sanitizers were also readily available.

Teachers and health professionals were given priority by the NDVP for the immunization exercise because of their susceptibility to contracting the virus. Despite this high vaccination rate, 1 in 10 medical professionals and 13.5 percent of teachers who had not received the immunizations stated concerns about side effects, a lack of knowledge about the safety and adverse effects of the vaccines, and doubts about their efficacy as justifications.

On account of the above, SEND recommended that the Ghana Health Service organize NDVP refresher training for its employees. Inasmuch as monitoring results indicate compliance was generally good, such a move would improve the NDVP guideline compliance rate. Health Directorates are encouraged to sustain the vaccine promotion efforts/campaigns to contribute to the attainment of the country’s herd immunity target with an emphasis on assuaging concerns over possible side effects and safety, which featured prominently. 

Furthermore, building on the concern of respondents for the well-being of their close associates, it was recommended that the COVID-19 vaccination communication messages “should focus on the protection of family members and friends from the disease and possible deaths and less on mandates restricting access to services and employment reasons.” Ultimately, the GHS was urged to commend its staff for exhibiting top-rate professionalism during the vaccination exercise.

Going forward

Whilst it might seem that there is no imminent danger of a full-blown resurgence of the pandemic, there remains the possibility of mutation. Already, two subvariants of the omicron’s BA.5 strand – BQ.1 and BQ.1.1 – which emerged recently have both been described as  “dangerous” and  “qualities or characteristics that could evade some of the existing interventions,” according to a top US health official, as reported by its media.

Furthermore, the adoption of these recommendations would prove useful in the event of the outbreak of other illnesses. The threat of Ebola, Lassa fever, Marburg, and other severe respiratory diseases hangs over local healthcare systems almost in perpetuity. With the possible socioeconomic disruptions that a resurgence of COVID-19 or a similar pandemic would pose, the guidance provided in SEND GHANA and PTF’s survey must be implemented as a matter of urgency.

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