The study used both qualitative and quantitative study methods. First, we (authors from the University of Ghana School of Public Health) reviewed desktop literature and documents and conducted in-depth interviews with key informants to identify exemplary cases of the effectiveness of Ghana’s approach to the COVID-19 pandemic between March 2020 and December 2021. We also documented all surveillance, diagnosis, treatment strategies, and treatment outcomes.
We then identified exemplary cases of the interventions implemented in Ghana to ensure the continuity of routine essential health services while containing the spread of the virus—in addition to mitigating the socioeconomic and gender inequalities associated with COVID-19 itself as well as the public health and social measures used to slow its spread.
To quantify the impact of COVID-19 on the provision of essential health services, we used an interrupted time series analytic approach with a seasonality-adjusted ordinary least squares regression model with Newey–West standard errors to adjust for autocorrelation in essential health services. We adapted the model from the COVID-19 International Modelling (CoMo) Consortium to simulate the spread of SARS-CoV-2 and quantified the effectiveness of different public health and social measures and vaccination programs on the spread of new cases of COVID-19 and deaths. The CoMo model is an age-structured compartmental susceptible-exposed-infected-recovered-susceptible model that stratifies symptoms, severity, treatment-seeking behavior, and access to general health care and emergency services.
The literature review focused on peer-reviewed and gray literature in English published after March 12, 2020, when Ghana recorded its first case. Primary research studies, modeling studies, guidelines, text and opinion papers, government orders and policies, case studies, media articles, and any relevant qualitative reports or quantitative data measuring the impact of the disruption of various aspects of human activities were all considered for inclusion in this review. The desk review extracted data from national and international websites and databases including the World Bank, World Health Organization, online media, Ghana Health Service, Ministry of Health, and Ghana Statistical Service.
We selected key informants with the assistance of staff from the Ghana Health Service and the Ministry of Health. We recruited individuals 18 years of age and older who previously tested positive for COVID-19 and recovered and frontline health workers who were actively involved in the management and maintenance of COVID-19 to share their experiences during the first two years of the pandemic. We conducted in-depth interviews with COVID-19 frontline health workers including nurses, medical doctors, disease control officers, pharmacists, laboratory technicians, and anesthetists. We also interviewed representatives from institutions that played a major role in formulating policies and implementing different pharmaceutical (vaccinations) and nonpharmaceutical COVID-19 interventions, including representatives from the Ministry of Health and the Ghana Health Service; officials and providers from established COVID-19 centers, other public and private health facilities, and research institutes; and the head of the COVID-19 Task Force.
We also interviewed representatives from other agencies that monitor the progress of key service delivery for malaria, tuberculosis, and HIV to learn how COVID-19 affects the delivery of those services and how challenges were mitigated.