RECOMMENDATIONS FROM A MEETING ON EBOLA VIRUS DISEASE OUTBREAK IN WEST-AFRICAN SUB-REGION AND POLICY IMPLICATIONS FOR GHANA

Organized by the Ghana Public Health Association

EXECUTIVE SUMMARY

The Ghana Public Health Association organized a scientific seminar to examine the Ebola Virus Disease (EVD) outbreak in the West-African sub-region and the policy implications for Ghana. The seminar was driven by the growing epidemic of EVD in the sub-region and the challenge this poses to the country. It is recognized that the condition poses a major public emergency with imminent negative implications for the health, social, economic and even religious lives of people in the country.

Taking cognizance of the nature of the virus, its epidemiology and the geographical location of Ghana, it will not be surprising, and almost inevitable, if the EVD is introduced into the country. The great test of our preparedness and response readiness is to be able to quickly contain its spread from the immediate contacts to others. The Government should therefore consider EVD as a national security threat and mobilise all the necessary logistic, funding and leadership support to deal with the situation. In spite of commendable initial efforts, the current level of readiness is inadequate to deal with any serious EVD outbreak in the country, and preparedness and response measures must be fast-tracked to the lower levels.

Context

1. Ebola Virus Disease (EVD) first appeared in 1976 in two simultaneous outbreaks in Sudan and the Democratic Republic of Congo (DRC). Since then, recurrent epidemics of the disease have occurred in Central and East Africa.

2. Since December 2013, there has been an explosive emergence of the EVD first in Guinea then spreading to involve Liberia, Sierra Leone, Nigeria and, Senegal. The epidemic remains a serious Public Health concern, fuelled in the community through human-to-human transmission, by close contact with the organs, blood, secretions, or other bodily fluids of infected people.

3. The WHO was officially informed of the outbreak in Guinea in March 2014 and declared the Ebola outbreak in West Africa a Public Health Emergency of International Concern (PHEIC) on 8th August 2014. As of 22nd September, 2014,

a day before the scientific session, there have been 5,843 reported cases and 2,803 deaths with an unprecedented number of the deaths among health professionals.

4. As of September 22, Ghana has reported 95 suspected cases of EVD from the ten regions, all of which have tested PCR negative at the Noguchi Memorial Institute for Medical Research (NMIMR).

5. Nonetheless, a number of intervention measures have been initiated in the country as part of preparedness and response plan for any eventuality.

6. It is under this context that the Ghana Public Health Association (GPHA) organized a public scientific session on Ebola Virus Disease and policy implications on 23 September 2014 to understand the nature of the disease, its potential threat to Ghana and discuss its public health implications to inform policy. GPHA is an apolitical, non-governmental professional association of all interested professionals who have a contribution to make to improve public health in Ghana.

Key Issues and Conclusions

The meeting acknowledged the tremendous effort in the country to put the nation in a state of readiness to address any possible outbreak. A number of issues were, however, identified which have to be addressed going forward:

1. There is intense traffic between Ghana, Nigeria, Guinea, Sierra Leone and Liberia with frequent air, land and sea border crossing. Unfortunately, the surveillance and screening system in place even at the 57 recognised points of entry to the country is not adequate. There are also numerous unapproved entry points and Ghanaian fishermen with relatives in Liberia, Guinea and Sierra Leone do return home regularly for festivals from the affected countries.

2. Though a number of activities have been initiated in the country, including public education on the disease, most of them are centred unfortunately at the national level and there is still a sense of inadequate technical capacity among health staff at the lower levels to adequately handle EVD should there be an outbreak at that level.

3. The level of preparedness among many sectors is woefully inadequate and apart from Ministries of Health and Education and one or two agencies, none of the other Ministries, Departments and Agencies (MDAs) have developed sector specific plans for EVD.

4. The logistic support system in terms of Personal Protective Equipment (PPE) and other basic items for infection control in the country, as well as funding for operational activities, are also inadequate.

5. It is noted with concern that a number of socio-cultural practices in the country, such as burial and funeral rites, are potential sources for the spread of EVD.

Recommendations

Government and Other Ministries, Departments and Agencies (MDAs)

1. Immediate steps should be taken to ensure that all border entry points to Ghana are properly secured and the appropriate surveillance and screening systems for the detection of EVD are put in place. 2. The Government, through the Chief of Staff, should ensure and enforce the development of sector specific preparedness and response plans by all MDAs for EVD and other epidemics. 3. District Assemblies should be made to take charge of Preparedness and Response plans and actions for EVD at the district level. 4. Ministry of Communication, the National Council for Civic Education (NCCE) and the media should be involved in a massive sustained public information, education and communication effort on EVD. The Toll-free numbers that have been secured should be widely publicised for the public to obtain information and report matters related to EVD. Religious leaders, as well as traditional leaders, must also be part of the process in their spheres of influence. 5. The menace of EVD is going to be with us for a long time. Therefore, an Emergency Fund for EVD and other such emergencies should be set up by Government. Funding should be mobilized from the corporate/commercial sector, religious entities and other stakeholders into the Fund. The fund should be used to support logistic and operational costs to execute preparedness plans in a sustainable manner. 6. A nationwide simulation exercise should be organized immediately, involving all stakeholders at all levels, to test our national preparedness and response readiness in the event of a suspected case of EVD anywhere in the country.

Ministry of Health and Ghana Health Service

1. Systems must be put in place quickly at all levels for early detection of suspected cases, reporting, specimen taking (if necessary), and transportation of specimen for laboratory confirmation. 2. Capacity of all relevant health workers at all levels, up to CHPS zone, should be built immediately through cascade training, on-job-training etc. on appropriate handling and management of suspected cases and specimens.

3. Algorithms, guidelines and protocols on patient handling, care and disposal should be developed and made available at all health facilities. 4. In view of the high rate of infection and death from EVD among health professionals, all health workers are to be made to follow strict Infection Control Procedures routinely when attending to patients and clients. The necessary PPEs must be provided in adequate numbers as a matter of course. 5. The provision of PPEs should be with adequate training on appropriate use (wearing and disposal). 6. The Director General of Ghana Health Service should ensure that managers of all health facilities comply with directive to establish functional holding, isolation or treatment rooms for EVD, as appropriate to their levels. 7. The three Treatment Centres under construction in Tema, Kumasi and Tamale must be completed sooner than later and made functional with trained personnel, equipment and logistics. 8. In the long term, a fully equipped and functional National Infection Control Hospital should be established in the country as a centre of excellence to manage such cases.

General Public

The menace posed by EVD in the country is a reality and the general public, as well as, traditional and religious leaders, are called upon to cooperate with health officials in the collective effort to deal with any eventuality.

Dr Amofah George General Secretary Ghana Public Health Association 0244322843

John Kingsley Krugu PRO Ghana Public Health Association 0205485387