Bolstering Ghana’s health emergency readiness and response: A critical imperative to safeguarding social and child protection

The COVID-19 pandemic has afflicted global humanity at unprecedented levels and Ghana was not exempted. A recent analysis by Save the Children and UNICEF forecasted that “the economic fallout from the pandemic may push up to 24 million additional children living in Sub-Saharan African into poverty, from 250 million children living in poor households, to around 274million children by the end of 2020” (UNICEF and Save the Children, 2020).

The good news is that we are now back to normal life, however, a word of caution to Ghana and Africa is that “fundamentally, countries need to be better prepared. The fight against COVID-19 is certainly not over. Going forward, the need to leverage the lessons learned over the past two years, which have delivered clear guidance on the essential preventative work and knowledge management necessary for optimal preparedness and resilience in health emergencies. The pandemic is transitioning, acquiring episodic characteristics.

But with no way of predicting the likelihood of the emergence of a new, more deadly variant, WHO remains committed to assist Member States to focus on the
achievement of broadly resilient health care system” said Dr. Matshidiso Rebecca Moeti, Regional Director, WHO Regional Office for Africa.

The genesis of COVID-19 Pandemic in Ghana

Coronavirus has spread worldwide with 646,266,987 confirmed cases of COVID-19 resulting in more than 6,636,278 deaths reported to WHO as of 14 December 2022. Ghana confirmed its first case of COVID-19 on 12 March 2020 and had as at 14 December 2022 recorded 171,923 confirmed cases with 1,461 deaths reported to WHO (WHO, 2022). The first two cases of COVID-19 were reported on 12 March 2020. The cases were all imported but the disease quickly spread through the community and within a week of the first cases, the country confirmed cases in individuals with no links to foreign travel. The majority of the cases were in the two most populated cities of Accra and Kumasi.

Government of Ghana’s response to COVID-19

Immediate measures were instituted to detect, contain and prevent the spread of the disease which included a ban on all public gatherings, closures of schools, churches, mosques and other places of worship on 16 March 2020 and a ban on entry for travelers coming from a country with more than 200 confirmed COVID-19 cases within the previous 14 days. Then on 17 March 2022, a mandatory quarantine of all travelers that arrived in the country 48 hours prior to the closure of the country’s borders was instituted. Additionally, on 22 March 2022, a partial
lockdown of Accra including Kasoa in the Central Region and Kumasi on 30 March 2022 was implemented.

These and other critical measures were underpinned with education on the
disease and its transmission as well as preventive measures such as personal hygiene, including the washing of hands with soap under running water or alcohol-based hand sanitizers and wearing of face masks (GHS, 2020 and Kenu, E. et al, 2020). Notably, during the period of lockdown, an enhanced surveillance in the form of active case search and contact tracing strategies were activated to early detect, isolate and treat all confirmed cases. Although the lockdown was lifted after three weeks, post lockdown measures were enforced to control the spread of the infection.

These included personal hygiene measures, mandatory wearing of masks, ban on social gathering, social distancing, increasing number of testing sites and humanitarian support. However, grassroots engagements by Youth Rise International (YoRI) and its partners revealed that both the COVID-19 and the mitigations measures impacted negatively on the Ghanaian population disproportionally with the minority groups and those marginalized worst affected.

Marginalized, vulnerable and minority groups and COVID-19

Undeniably, the COVID-19 pandemic has placed a heavy toll on the human and economic development of many countries around the world including Ghana. However, grassroots and empirical evidence points to the facts that certain populations were more vulnerable to the negative social and economic effects of the COVID-19 pandemic due to underlying wealth inequalities, social discrimination, and social exclusion (UN, 2020). Mothers and children, prisoners, older adults, persons with disabilities, and individuals and families living in poverty were key groups who faced additional challenges in enduring the effects of the pandemic (OECD – COVID-19 and Africa, 2020). To reiterate, for the purposes of emphasis, there is existing research documenting the disproportionate and varying effects of the pandemic on vulnerable population and these impacts are categorized into primary impacts and secondary
impacts.

According to UNICEF Ghana, the primary impacts of the pandemic on children are
classified as the direct effects on human health, i.e. on the morbidity and mortality of children and their caregivers. The secondary impacts on children are classified as those resulting from the indirect effects of health systems overload, economic fluctuations, government policies and lockdowns, social and behaviour changes, budgetary reallocations in child-relevant sectors, and
other disruptions to essential services for children, most visibly in education.

In this article, the focus is on three key vulnerable and minority groups: mothers and children, older adults and adults with disabilities and informal sector workers and poor population. Effects of COVID-19 on mothers and children: Mothers and children were by far the most commonly discussed vulnerable group during the COVID-19 pandemic. The main challenges faced by mothers and children were: 1) disruptions in education; 2) reduction in care seeking behaviour and access to health care; 3) sexual abuse and other forms of domestic violence;
and 4) food and economic insecurity.

Disruption in education: The nationwide school closures impacted the educational progress of more than nine million learners between pre-primary and secondary school levels. More than 1.6million children of primary school going age in some of the poorest and most deprived districts in Ghana also lost access to school meals. For many children from vulnerable groups, including children with disabilities, the prolonged school closures have put a premature end to their education (UNICEF Ghana, 2021).

Reduction in care seeking and access to health care: Nearly one million children below one year of age have been missing out on routine essential health services (UNICEF Ghana, 2021). Undeniably, the pandemic reduced the level of preventative health care seeking behaviours for women and children. In Ghana, Liberia and Sierra Leone, newspapers reported that some pregnant women were refused to attend antenatal care and feared giving birth at health facilities due to concerns of contracting the virus. There were cases were mothers were hesitant to bring their children to health facilities to receive vaccination for preventable diseases. The pandemic additionally inhibited access to family planning products or services.

Food and economic insecurity: COVID-19 pandemic exacerbated food and economic insecurity, particularly for children. “Prior to COVID-19, one-in-three children in Ghana already lived below the monetary poverty line, and two-in-three children were multidimensional poor.

Children staying at home and the re-prioritization of support services in key sectors have also compounded the various risks children face in critical periods of their development’’ (UNICEF Ghana, 2021).

Youth Rise International (YoRI) discovered from the grassroots communities that with the closing of schools during the pandemic, many children were left to fend for themselves or obligated by their family to contribute to the household finances. As a result, many children of low socio-economic backgrounds turned to the streets to sell items or to beg for money and food. More so, several others were forced into child labour and child trafficking across various sectors.

Even though there were radio and TV learning programs such as JOY Learning, the
food and economic insecurity hindered in-home learning for children as children spent more of their time selling on the streets or working instead of spending time to make use of those learning platforms.

Sexual abuse and other forms of domestic violence: All countries reported serious concerns about the effects of COVID-19 on domestic violence and sexual abuse for women and children. Through our grassroots engagement, Youth Rise International (YoRI) found out that the pandemic-related household income shocks, food insecurity, economic instability and social isolation increased children’s vulnerability to violence, child labour, and abuse. For instance,
between March and June 2020, the share of Ghanaian children exposed to physical
punishments in their households reportedly rose role from 18% to 26% according to a phone survey with households (UNICEF Ghana, 2021).

Effects of COVID-19 on older adults and adults with disabilities

It is undisputable fact that older adults and persons with disabilities are vulnerable groups. These two groups were more likely to require extra physical assistance and care throughout the pandemic. Sadly, they were worst affected by the COVID-19 and we discovered that the major effects on them were poverty, stigma, and lack of access to assistance for both populations.

Poverty, stigma and lack of access to assistance: Poverty was an additional vulnerability older adults faced during the pandemic as many of older adults and their family members were trapped at home due to the pandemic and unable to work. COVID-19 mitigation measures such as social distancing and the use of masks worsened the situation for those with disabilities, as finding additional physical assistance or support from aides was difficult during the pandemic. A disheartened anguish shared with Youth Rise International (YoRI) during our grassroots engagements by this minority group was that, they felt marginalized and socially-excluded because they were often not consulted during policymaking.

For instance, they were deprived of effectively benefitting from the special initiatives that governments took to fight COVID-19 especially those in rural and hard-to-reach population.

Effect of COVID-19 on informal sector workers and poor populations

Informal sector workers including beggars, farmers, market sellers and the low-income families were recognized as vulnerable group hard hit with COVID-19 pandemic. The effects on this population were: 1) worsening food insecurity and inability to sell products.

Worsening food insecurity: As a result of COVID-19, many low-income families experienced worsened food insecurity. Most of their effects on food security were caused by local lockdowns and other Government directives. We encountered cases where families reduced their daily meals from three per day to one per day to save food and several of them reported that they were beginning to starve.

Inability to sell products: COVID-19 affected the ability of persons to sell their produce and other products. Lockdowns forced thousands of petty traders and owners of small and medium scale enterprises (MMSEs) to close down their shops or recorded poor sales, thereby impacting negatively on their economic livelihoods. Also, social distancing measures caused farmers to
suffer from a lack of manpower to grow and sell their produce. Youth Rise International (YoRI) through our engagement with smallholder farmers became worried at how these farmers faced several issues in selling their produce including drops in purchasing price and hikes in transportation cost and market closures. Consequently, a large amount of produce perished causing tremendous losses in profits for smallholder farmers.

Inclusive and sustainable epidemic preparedness plan and response

A desktop review conducted by Youth Rise International (YoRI) revealed that in later part of 2020, Ghana prepared an Emergency Preparedness and Response Plan (EPRP) with the overall objective to:

slow and stop transmission, prevent outbreaks and delay spread

provide optimized care for all patients

to minimize the impact of the pandemic on health systems, social services and economic activity (MOH, 2020).

We would like to believe that the success achieved by the Government of Ghana in radically addressing the COVID-19 pandemic was partly due to having in place a solid EPRP. Undeniably, the Government did well and Youth Rise International (YoRI) appreciates such a great achievement by reducing the loss of human lives and the ravaging impact of The COVID-19 pandemic on health.

Drawing the curtains down, it is important to note that the grassroots communities we engaged shared in the sentiment that the COVID-19 pandemic caught the world, Africa and for that matter Ghana unawares. So understandably, most of the measures put in place were ad hoc and emergency-driven. However, their questions to us and the government are:

What lessons have we learned as a country to effectively manage emerging or future epidemics and health crises?

What are we doing to prevents the devastating impacts of the previous and future
pandemics on the welfare, safety and livelihoods of the vulnerable, marginalized and minority groups in Ghana?

Youth Rise International (YoRI) used the questions as a starting point to engage them for deeper conversations to pick their plausible ideas, suggestions and inputs. To this end, our grassroots communities made the following recommendations for the Government of Ghana through Ministry of Health:

Ghana should transition or absorb COVID-19 surveillance and response into
national health systems by prioritizing two things: set up a Health Emergency
Fund and draw lessons from the ad hoc EPRP to re-design a national strategic
EPRP at least for the next 5-10years.

That way, Ghana would be acting proactively and will be well equipped to mitigate the impacts of future pandemics or health crises on the vulnerable, marginalized and minority groups.

In addition to the emergency relief, Ghana should strengthen the existing social
protection systems especially expanding the Livelihood Empowerment Against
Poverty (LEAP) and prioritizing child-sensitive spending.

Since emerging evidence from the current pandemic and grassroots evidence
demonstrate that health crises can perpetrates socio-economic vulnerabilities,
therefore, poverty-alleviating initiatives should be part of pandemic response and EPRP.

The challenge of healthcare inaccessibility mostly affected mothers, children and persons with disability. Therefore, safeguarding children’s and women’s rights should be an essential component of the emergency response and EPRP.