Table 1

Key recommendations for strengthening Ghana’s COVID-19 response

Response domainIssues of concernKey recommendations
1Public health policies and implementation
  • Low testing rates, particularly, low community case finding and surveillance

  • Scarce epidemiological data on children

  • Limited availability of robust, nationwide, patient-level data

  • Healthcare workers’ risk, personal health and compensation

  • GHS to establish routine community surveillance for age groups, including (school) children

  • Maintain central patient registry for case reporting from public and private facilities

  • Use rapid antigen tests to screen for active cases, and antibody tests to assess for past infections in the community

  • PPE, salaries and benefits for healthcare workers should not be compromised; GoG to support responsible agencies while holding them accountable for lapses

  • Healthcare workers to receive subsidised or free care and treatment for COVID-19

2Vaccine distribution and uptake
  • Attaining adequate herd immunity to protect the general population

  • Misinformation on vaccines, including from prominent citizens

  • High vaccine hesitancy and low vaccine acceptance

  • Surveillance and hospital data on COVID-19 community hot spots and subpopulations at high risk of severe disease and death should be prioritised

  • Data on vaccine hesitancy in hot spots and among high-risk populations should be urgently collected and used to drive risk communication, vaccine advocacy

  • Misinformation and irresponsible statements by prominent individuals should be swiftly debunked on multiple platforms

3Clinical/health facility
  • High TAT for COVID-19 test results

  • High COVID-19 patient caseload

  • Limited hospital bed space

  • Ramp up public lab capacity to handle testing workload, and reduce delays. For example, revenue from mandatory airport testing can be used to support public labs

  • Institute a minimum TAT for COVID-19 tests as a quality measure for labs

  • Engage and compensate willing retired healthcare workers to ease patient caseload during second or subsequent waves

  • Construct more COVID-19-specific facilities (faster to complete); complete construction of district hospitals promised by GoG in 2020

4Children and schools
  • Basic IPC guidance for schools available, but inadequately disseminated/implemented

  • Detecting outbreaks, and guidance for closing/reopening schools in case of outbreaks not available

  • Children and teachers in resource-limited schools left relatively unprotected and exposed, as schools are open

  • GES to intensify dissemination of COVID-19 guidance

  • Updated guidance and follow-up for compliance to reinforce infection control

  • GHS to provide consistently age-disaggregated data that include information on paediatric COVID-19 cases and deaths

  • Community surveillance data to inform whether/how schools can stay open, and thresholds for closing and reopening

  • Prioritise teachers for vaccination

5Workplace protections
  • Lack of practical IPC guidance for the workplace

  • Stigma and fear of loss of income driving poor compliance with IPC

  • Poor examples set by political leaders in the workplace

  • GoG to provide adaptable guidance for workplace protection

  • Workplaces to provide options for telework/work from home where feasible

  • GoG to ensure that officials and institutions are in compliance with IPC measures; rule flouters should be reprimanded

6Media and public communication
  • Low public trust in political and health officials and agencies

  • Science journalism is often suboptimal; media has contributed to misinformation

  • COVID-19 risk and vaccine communication is poor

  • Engage, inform and update the public on strategies taken and progress on their implementation

  • Radio, TV, online and community fora with experts to conduct question and answer sessions with the public

  • Ministry of Information to co-develop and lead strategic communication blitz in partnership with private agencies and individual champions who have public trust

  • GES, Ghana Education Service; GHS, Ghana Health Service; GoG, Government of Ghana; IPC, Infection Prevention Control; PPE, personal protective equipment; TAT, turnaround time.