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CeDHA fellows have a virtual round-table discussion and share their thoughts on Covid-19 in Ghana.

Moderator: Ghana's official figures currently (05-05-2020) stand at 3,019 cases with 303 recoveries and a death toll of 18. 137,924 samples have been tested. Protocols in place to fight the pandemic include ban on social gatherings, partial lock-downs, disinfection of schools and markets, and the mandatory wearing of face masks in public.

Moderator: Let’s start with the covid-19 curve - have we flattened it? Some people say we are peaking - have we? Where on the curve are we?

AAB: The curve has not yet been flattened. The question as to where we are on the curve, the data that is coming out suggests to me that we are climbing – transmission of the virus seem to be increasing because the case count is rising astronomically. I must also add that we do not have enough detailed data to be able to make a definitive statement on whether we are close to flattening the curve. There are many parameters that we need to know to be able to definitely talk about flattening of the curve.

ABA: We cannot tell for now since the rate of reportage is not consistent. We should at least be able to generate daily figures, without backlog before a reliable trend can be established.

POA: We just do not know, do we? The way the information on infected cases is presented – the backlogs and the fact that we get updates every two or three days – it is very difficult to tell where we are.

Moderator: What are the implications of current situation for inequality - economic/health/education etc.?

AAB: While COVID-19 affects everybody in society, its effects are particularly detrimental to specific social groups, such as the poor and most vulnerable, older persons with underlying health conditions, such as for instance, persons with diabetes, asthma and other related conditions. When the day is done, the economic costs will be staggering. And, the mental and psycho-social well-being of the population will be greatly affected. To ameliorate the economic and social cost of the pandemic will require targeting the disadvantaged and poor and providing them with social safety nets and stimulus packages to businesses, especially small scale businesses.

ABA: Clearly, some segments of society would be disadvantaged on all fronts. Targeting of the disadvantaged should be effectively done.

POA: I expect economic inequalities would increase especially in the areas that saw the partial lockdown Accra and Kumasi. Two main reasons for this. First, the lockdown disrupted economic activity but the poor were more likely to be affected. Majority of the middle and upper class who work in the formal sector would have been more successful at moving the economic activities online or working from home. The same cannot be said of the poor, most of whom are in the informal sector. Secondly, the so-called social interventions will probably benefit the middle and upper classes more than the poor. The rich will be saving more from the absorption of water bills on account of probably consuming more water. With the electricity tariff intervention, anyone who consuming more than twice the lifeline will be benefiting more than the lifeline consumers. Overall, I expect economic inequality will increase because of the Covid-19 and the interventions.

Moderator: We read news reports of people flouting the laws such as holding parties, fleeing from quarantine etc. What are some the factors hindering compliance to directives?

AAB: Factors hindering compliance include lack of adequate knowledge about the infectivity levels of the virus, indiscipline, poverty, and inadequate enforcement of the directives. In addition, a lot of people still do not believe that the disease is real, so there is the usual attitude of the Ghanaian – ‘the man must eat’ mantra.

ABA: Stigmatisation which tends to discourage voluntary testing, downplaying of virus by authorities and weak enforcement.

POA: A combination of factors. First, it appears the actual planning and implementation seem to lag behind the announcements. We needed to have increased the availability of masks and sanitizers before the lockdown was removed. Secondly, it appears the education has not gone well in some sections of society. Some many people do not seem to appreciate the seriousness of Covid-19 and cannot seem to be bordered to follow the directives. Perhaps, at the early stages, we should have descended heavily on people who were non-compliant. But then again, when you do not have enough face masks, it is difficult to punish people for not wearing them.

Moderator: Thoughts on the Accra/Tema/Kumasi lockdown - ended too soon or not soon enough?

AAB: Given that the case counts in Accra and Kumasi were still rising at the time the lockdown was lifted, it would seem to me that we rushed in lifting the lockdown -- it would have been better to continue with the lockdown in those two cities a little bit longer to observe the situation further. Of course, while it is important to weigh-in the economic and social ramifications of lockdown on especially the poor and marginalized, the health risks (costs) of this pandemic are rather too high to trade for anything. In fact, it would require monitoring the situation and introducing selective lockdown based on emerging pockets or clusters of hotspots so as to take aggressive testing and isolating those infected and put on treatment. So, I will not advocate for total nationwide lockdown but rather selective lockdown.

ABA: It should have been escalated to nationwide lockdown. Especially since some cases in other regions have been traced to Accra and Kumasi.

POA: I actually think the timing was just about right. At the very outset, I thought the lockdown could last no more than 4 weeks because of the economic impact. The extent of the suffering among the lower class could be extended for a long period. The measures put in place to cushion the poor were not enough and towards the end of the last week of the lockdown, you could tell that people were getting restless.

Moderator: What are your views on government’s 1-year plan to invest in health infrastructure - build hospitals, infectious disease control centres, growth in pharmaceutical industry etc.?

AAB: It is always a good idea to continue to improve our health infrastructure which is currently inadequate and fragile. However, attention must also be paid to resourcing the existing facilities and completing other health facilities that have been initiated but currently abandoned. Another important area of investment is to resource the national health insurance scheme and put in measures to efficiently improve it management, while at the same time improving the country’s public health response systems. Now, the response systems seem ad hoc, and lack the deployment of critical public health experts such as epidemiologists, data scientists, and other public health experts. Finally, the information (data) management needs serious improvement.

ABA: On building more hospitals- doubtful and misdirected. Existing hospitals and health centres should first be adequately resourced. Infectious disease control centres may be useful if geared towards boosting research and not just testing. Pharmaceutical industries will be a good move. In order to bring all this to fruition, an enabling environment should be created.

POA: Given the gaps in health infrastructure and inequities in the distribution of the existing facilities, a decision to build more facilities is a good decision. However, I prefer we take a systems approach so that we strengthen the entire health system not just building structures. One major weaknesses in the health system exposed by the Covid-19 pandemic is the shortage of essential drugs and supplies. Taking a system approach will allow us to holistically address the existing weaknesses in our health system from infrastructure to human resource to financing and medicines and supplies.

Panel members

Ayaga Bawah (AAB)

Arhizah Blay-Abiti (ABA)

Patrick Opoku Asuming (POA)

Pearl Kyei (Moderator)