The opposition National Democratic Congress(NDC) team on Covid-19 has proposed an aggressive nationwide testing program to enable the nation get a handle on the containment efforts of the pandemic.
According to the team, the ongoing Lockdown in the Greater Accra, and Kumasi triggered “mass evacuation of economic migrants from the hotspots, among who may be infected persons including asymptomatic carriers.”
In its proposal to the Information Minister on the situation, the team said:”This recommendation of a nationwide mass testing program must be paired with enforced quarantine of recent arrivals in the hinterland under the supervision of REGSEC or DISEC, and progressive health education of returnees, their families and their communities.”
Aspect of the proposal noted: “The limited success of the containment strategy employed prior to the announced lockdown portends difficult days ahead for the healthcare system. It is our considered opinion that a wave of incubating infections is likely to break within the next week, with serious consequences for the capacity and effectiveness of our healthcare system. This concern extends to the safety and sustainability of our healthcare workforce as well. 1.4. A catastrophic failure of the healthcare system – especially with regards to acute care – is imminent without the immediate deployment of logistical support and immediate financial aid to healthcare facilities. Our public providers, in their entirety, must be placed on a disaster preparedness footing, and private facilities must be given immediate support to adopt that posture as well”.
This comes on the heels of nine more recorded cases of the deadly COVID-19 on Thursday increasing the total case count to 204 from 195.
According to the GHS, since the last situational update, Ghana has confirmed nine additional COVID-19 cases, all from the Greater Accra region.
Four (4) of them have no history of travel nor contact with any confirmed case. Other four (4) have no travel history but are contacts of confirmed cases in Ghana, and one travelled to Ghana from Benin within the past 14 days.
As at 2nd April 2020, Ghana has recorded 204 cases COVID-19 with five (5) deaths. The number of regions reporting cases remains five (5) (Greater Accra, Ashanti, Northern, Upper West and Eastern).
The Greater Accra Region has most of the cases (183) followed by the Northern Region (10), Ashanti Region (9), Upper West Region (1) and Eastern Region (1).
Most of the cases are reported from routine and enhanced surveillance activities. Cases from travellers under mandatory quarantine remain 89.
Below are details of the proposal
1. Public Health Management Ghana’s current strategy appears to rely heavily on the efficiency of our testing and the effectiveness of our contact tracing protocols. It is clear that our efforts in both respects are limited. Given the porosity of our land borders, the risks posed by asymptomatic carriers in a low testing context, the basic reproduction number of the pandemic, and its low serial interval – we agree that the targeted lockdown of national hotspots is the best practice. However, there are several complementary imperatives that must accompany the lockdown, and we must be reflective of the implications of its modalities for the national effort:
1.1. The present approach – in particular the lead time built into its enforcement – is likely to prove counterproductive to the key technical objectives of reducing per capita average daily contacts over the lockdown period by two-thirds. The instances of public congestion at fuel stations, markets, malls and other key retail locations resulting from the 48-hour lead time may represent a sharp increase in per capita daily contacts concurrent with a sharp decrease in the average interval between those contacts. Both dynamics present optimal transmission conditions.
1.2. The lead time for the enforcement of the lockdown appears to have allowed for mass evacuation of economic migrants from the hotspots, among who may be infected persons including asymptomatic carriers. The risk of spread outside the lockdown perimeters, therefore, is concerning. We recommend, as a matter of urgency, the review of the testing strategy under consideration from one focused on contact tracing within the lockdown perimeters to a nationwide mass testing approach. The risk of outward spread has been exacerbated by the unintended consequences of the lead time, and it is essential to curtail that threat in its infancy. This recommendation of a nationwide mass testing program must be paired with enforced quarantine of recent arrivals in the hinterland under the supervision of REGSEC or DISEC, and progressive health education of returnees, their families and their communities.
1.3. The limited success of the containment strategy employed prior to the announced lockdown portends difficult days ahead for the healthcare system. It is our considered opinion that a wave of incubating infections is likely to break within the next week, with serious consequences for the capacity and effectiveness of our healthcare system. This concern extends to the safety and sustainability of our healthcare workforce as well.
1.4. A catastrophic failure of the healthcare system – especially with regards to acute care – is imminent without the immediate deployment of logistical support and immediate financial aid to healthcare facilities. Our public providers, in their entirety, must be placed on a disaster preparedness footing, and private facilities must be given immediate support to adopt that posture as well. One key aspect of this is the immediate settlement of NHIA debt to providers, the suspension of capitated outpatient payments, and the inclusion of COVID-19 testing and treatment to the NHIS’ list of essential health benefits. These will provide demand-side incentives for proactive care-seeking behavior, and eliminate the risk of perverse incentives created by supply-side cost-sharing.
2. Information Management This is a crucial part of heightening awareness of the threat, enhancing public understanding of preventive measures, and improving preparedness for the weeks ahead. This will require the mobilization of the entire communication and information infrastructure of the state, and a collective focus on a single purpose. Critical stakeholders in the private sector will also need to be engaged so as to ensure that a consistent and contextually appropriate message reaches every corner of this country in a timely manner.
2.1. At present, messaging on COVID-19 appears to be targeted at a literacy level that precludes many millions of Ghanaians from the critical health information about the virus and its disease. That has manifested in a proliferation of false information and fake cures that are themselves a great risk to health. Of greater concern, the low permeability of the messaging into marginalized communities is occasioning a skewed risk perception that, ultimately, is limiting the degree of appropriate behavioral changes necessary to prevent infection.
2.2. The reach of the message appears to be limited by the inadequacy of state infrastructure around information dissemination. While there are purely logistical components to this obstacle, there also appear to be issues of contextual suitability of the messaging. Clear, concise translation of the key messages into every local language must be an immediate priority of the Ministry of Information.
2.3. With respect to the logistics of information dissemination, we believe that the mobilization of existing structures used by civil society organizations, political parties and religious groups for their own information dissemination purposes offers some immediate recourse. Many political parties, for example, already have vehicles mounted with loudspeakers in areas where state infrastructure is absent or lacking. These may be sourced through active engagement with the stakeholders for the purpose of ensuring deep penetration of the message into the hinterland areas.
2.4. To ensure consistency of outside efforts aimed at improving the reach of the key messages, the Ministry of Information must make available to any of the interested groups above clear messaging points developed in conjunction with community leaders in the respective target communities. These groups should have some flexibility in approach to allow them to leverage local trust in their brands and familiarity of their approach even as they deliver core messages about COVID-19. Religious organizations, especially denominational churches with national presences, have germane competencies that can also be leveraged to this cause.
2.5. It is crucial for the Ministry of Information and the Ghana Health Service to develop a proactive strategy for monitoring and refuting the false information on COVID-19 circulating on social and digital media. The rapid spread of fake remedies and hoaxes about susceptibility, among others, may themselves create a false sense of security that reduces vigilance in personal preventive measures. It is important to identify these messages and to be proactive in debunking and disproving them to ensure that the signal does not get drowned out by the noise.
2.6. The management of information related to the size of the outbreak itself, the details of the testing program, and the outcomes for patients must be consistent. This information is vital to reinforcing messages about the reality and risks of COVID-19 and to fill the information vacuum that supports the spread of inaccurate information. It is also important as a source of data for the academic and research communities, whose evaluation and analysis of the state of affairs and progress in this fight are crucial in aiding our collective preparedness for any germane crisis we might face in the future. That data should be structured in a user-friendly format and made available in a template common to researchers such as a downloadable online table.
3. Community Impact Mitigation The announced lockdown – and the broader economic impacts of COVID-19 – will have serious consequences for economically and socially vulnerable citizens. The financial and social limitations they face may limit their ability to adequately prepare for and survive a prolonged halt to our national life. This is in acknowledgement of the situation in our country with regards to housing, sanitation, food security and healthcare access, all of which follow the inequality gradient in our society. At this time, government has yet to table a comprehensive proposal to address the grave consequences that an economic slowdown or standstill would have for daily wage earners and other categories of vulnerable persons in Ghana. Anecdotal evidence from the first few days of the partial lockdown of hotspots suggests that there is great anxiety among these groups on the question of their sustenance and survival, which have the potential to evolve into serious social unrest if ignored.
3.1. It is essential, in our view, that a meaningful safety net be put in place to mitigate these risks as these Ghanaians should not be doubly punished by the ill and the cure. All proposals should aim to tap into strategic national reserves of manpower and resources, and they should seek to harness the core competencies of local government, social welfare agencies, and community based organizations in their execution.
3.2. Strategies for community impact mitigation are recommended as the topmost priority in the face of the public response to the lead time of the partial lockdown of hotspots. The aforementioned risk of outward spread may occasion the phasing out of exemptions within the respective perimeters if the technical objectives of the lockdown are to be achieved. At the extreme, adverse implications of the present strategy may occasion the imposition of a nationwide lockdown. The poorest communities and most vulnerable households must be provided with a practical means of sustenance in such an eventuality lest a declaration of an enhanced lockdown materialize itself as a starvation order.
3.3. The reports of dramatic price hikes must be addressed as an immediate step to protecting the poor from an extremely regressive public policy outcome, which may be accomplished by standardizing prices of essential goods. Alternatively, a supply-side solution may be found in the strategic deployment of reserves maintained by the National Buffer Stocks Corporation (NBSC) to induce lower costs through price competition. The maintenance of such retail outlets may be delegated to local government under the supervision of DISEC and REGSEC. The NBSC’s reserves may also be employed for a direct nutrition assistance program to the most vulnerable communities and households nationwide to guarantee their food security. IV. Safeguarding the Economy The outbreak of COVID-19 in Ghana presents the greatest risk to our economic stability that we have faced to date. The impact of the pandemic on the global economy was already wreaking havoc on our economic outlook well before the first cases were confirmed. Government must now formulate a plan to address the unprecedented risk our economy faces and to support the fight against the virus, to mitigate its impacts on trade and enterprise, and to preserve human health and dignity at this difficult time. A reasonable, sustainable funding plan is essential to accomplish these goals.
4.1. The government’s current proposal to appropriate $590 million from the Heritage Fund as part of this funding plan is a non-starter. That money is an investment in the future of this country, and it cannot be touched at any cost.
4.2. This is especially true when government has not fully explored other sources of funding and alternate proposals for resourcing the fight against COVID-19. The deprioritization of nonessential spending is a first step in this respect, and that remains to be seen in the proposals presented to Parliament by the Honorable Minister of Finance.
4.3. We propose a repurposing of part of the USD 3 billion proceeds from the most recent Eurobond sale to immediately finance the urgent actions that must be taken in the coming days to protect Ghanaian citizens, our households and our economy. The prior intention to utilize the same for restructuring energy sector debt is not a priority at this time, and must be shelved under the circumstances to allow for a rapid deployment of resources to fight the COVID-19 menace. The Minority in Parliament is prepared to engage in this respect, and can provide an expenditure proposal upon request.
4.4. The spending plan laid out by the Honorable Minister of Finance has an overt focus on mitigating the economic impacts on enterprises in the travel and tourism sector. It is silent on any potential contingencies for the broader economy, especially for the small- and medium-scale enterprises that form the bulwark of economic activity in Ghana. The income loss faced by such enterprises has considerable consequences on overall economic activity, and the risk of their large scale collapse in the event of an extended lockdown is not adequately addressed.
4.5. The specific strategy employed in this partial lockdown may occasion certain unintended consequences both within the designated areas and without. These externalities are likely to compel a more intensive lockdown protocol, including the phasing out of exemptions targeted at food access. The logistical operation necessary to execute a large scale nutrition assistance program, for example, does not appear to be articulated in government’s proposals. This and other such progressive social interventions will be necessary contingencies as the situation unfolds, and government must have the foresight and flexibility to respond rapidly with financial