Authors: Adwoa Twum and Marian Opoku-Agyeman
The Accelerator partnered with the Government of Ghana shortly after its’ first case of COVID-19 to strengthen and support the countries’ pandemic response efforts. Working closely with the President’s appointed Coordinator, the program supported local actors to create a COVID-19 response coordinating Secretariat to lead the effort. In Part 2 of this blog series, the implementation support team shares emerging lessons from the Secretariat’s approaches to engaging stakeholders and how these insights can be incorporated as part of future public health responses.
It's more than health
Ghana’s approach involved mitigating the pandemic effects across sectors through the multisectoral coordinating mechanisms (PHEMCs). Through these committees, several response activities were implemented. For example, PHEMCs coordinated the daily delivery of free food and other essentials to those in need in locked-down epicenters. Other social safety-net interventions were provided to cushion the economic impact and included several months of subsidized or free public utilities to the population.
The inter-ministerial task force, the COVID-19 Coordinator, and the PHEMCs at the various levels were part of the Government’s coordinated approach to managing the emergency across sectors and partners.
There's no one-sized solution
Countries differed widely in their approaches to containing the virus. While others had extensive lockdown periods, others eschewed lockdowns and focused on methods that could also safeguard the economic livelihood of some of the vulnerable members of the population. Even within countries, responses were tailored based on the severity of the cases within localities. In the early stages of the outbreak, Ghana’s response focused on locking down epicenters of spread and providing social services for those affected by the lockdowns. Regardless of what had been learned from the global evidence gathered for the response, the Secretariat and advisors had to contextualize the lessons to the country, considering Ghana’s local social and economic factors.
Leading from behind
The Secretariat relied heavily on collaborative approaches, targeted communication, consensus, and trust-building. This approach was critical as an entity working outside established Government structures to provide technical advice and coordinate inter-sectoral teams. The Secretariat was not at the forefront of the response efforts but worked behind the scenes to support government agencies and facilitate necessary processes.
Don't duplicate efforts; use existing structures
The role of the Coordinator was not a duplication of efforts but a centralized support system to facilitate effective coordination across sectors and partners. In setting up the office, they also sought not to duplicate existing structures but to complement and bolster structures and capacities with additional resources. The Coordinator worked within the structures at the ministries and their agencies, utilizing the expertise of the advisory cell members and support from development partners to target capacities and resources that were needed.
Draw expertise from outside
Outside expertise was brought in to reinforce existing capacities. This approach provided the Secretariat with a wide range of expertise from epidemiology to risk communications – from retired global scientists to active researchers/professors in the universities. The advisory cells gathered global and historical evidence to support government systems where frontline government agencies had limited bandwidth. These experts are actively involved in research and practice in their respective fields and were instrumental in providing input to the Secretariat. The Secretariat also worked closely with development partners who facilitated connections across their networks to share experiences.
The resurgence of the virus in 2021 in parts of Africa, including Ghana, where the effects had been comparatively milder, emphasizes the need for countries to maintain vigilance, boost capacities, and sustain local systems for effective surveillance and management of the pandemic. It is imperative to re-emphasize the need for a response that includes effective coordination across various sectors to mitigate the pandemic’s physical, mental health, and socio-economic impacts.
As a lower-middle-income country, there are key lessons to share with other lower-middle-income countries, especially given the backdrop of slow vaccine rollout campaigns, amidst catastrophic surges of COVID-19 in the region.
Ghana’s multisectoral approach to the pandemic efforts, bolstered by a central coordination secretariat outside of existing structures, could be a template that countries can utilize to tackle pressing challenges that require a multi-pronged solution. As an extension and a build-up, the Government of Ghana is in the preparatory phase of utilizing the COVID-19 coordinating Secretariat to establish a national center for disease control as the central agency for disease surveillance, prevention, and control.
In extracting from Ghana’s response approach – in situations where central coordinating mechanisms are not set up to respond to health emergencies – an interim mechanism such as the COVID-19 coordinating Secretariat could be a short-term initiative to coordinate a multisectoral response to an emergency. Specifically, in Ghana, immediate opportunities for using a central coordinating mechanism for a multisectoral response are presented in implementing the 2020 Health Policy and the UHC Roadmap.
The challenge here is to tackle the social determinants of health that present a looming danger as Ghana grapples with the double burden of managing infectious and non-communicable diseases. Existing high-level inter-sectoral mechanisms could be the fulcrum to ensure that government policies are implemented within a human/citizen development framework that touches on all sectors.
For example, cross-sectoral initiatives could deliver new road constructions that allow for safe interaction between motorists and pedestrians – or the intentional inclusion of recreational areas within residential and commercial real estate developments that promote physical and mental health activities. These activities could also lead to school educational curriculums that actively connect personal skills and economic development and the impacts on the physical environment. With a focus on tackling the social determinants of health and improving human development, the Ministry of Health could serve as the lead coordinating agency in the initial start-up phase of such a mechanism.
The most critical lesson thus far in this ongoing pandemic is the awareness that managing the COVID-19 outbreak and its effects have proven to be a marathon and not a sprint, as evidenced by the multi-wave COVID-19 surges that have afflicted various regions at different timelines. This pandemic has required a whole-of-government and whole-of-society approach and an eye on documenting lessons in preparation for future pandemics or other localized public health emergencies. Several pressing issues, such as climate change, increased air pollution and urbanization, global aging, and digital technologies, require collaborative multisectoral and multi-stakeholder action at different levels to mitigate their effects. Hopefully, COVID-19 has provided a template that countries can build on and apply broadly.