Challenges

Key challenges

At the conclusion of this study in December 2021, persistent challenges associated with Ghana’s COVID-19 response included:

Regional disparities in Ghana’s health system

Despite two decades of work to increase the number of health workers in Ghana and improve their training and retention, key personnel were still inequitably distributed across the country. Most doctors and nurses worked in regional teaching hospitals, and very few worked in disadvantaged or rural communities.¹ Likewise, health facilities and other infrastructure (such as intensive care beds) remained unevenly distributed.²

Limited testing and laboratory capacity

From March 2020 to December 2021, Ghana substantially increased the number of laboratory testing sites across the country.³ However, Ghana’s laboratory network still lacked key supplies such as reagents. It also lacked necessary investments in laboratory infrastructure, procurement, human-resources capacity-building (especially for biomedical scientists and virologists), and research using advanced techniques such as molecular sequencing.⁴

Fearful patients avoided health facilities

Between March 2020 and December 2021, the Ghanaian health system experienced unusually low levels of service utilization, which researchers attributed to patient and provider fear of contracting COVID-19 in health facilities. This was especially true early in 2020, before health facilities and health workers had sufficient PPE and PCR testing was scarce. In addition, key informants reported that stigma associated with COVID-19 infection prevented many infected people from disclosing their status. This stigma may have also kept patients from testing for and treating the pandemic pathogen.

Financial obstacles

Some key informants reported staying away from health facilities during the early months of the pandemic because they did not want to pay for COVID-19 tests or treatment. (This obstacle may have been exacerbated by widespread job instability during the same period.) Health care workers also lacked sufficient PPE, in part because the health system lacked the resources to pay for them, which prevented many from carrying out their duties comfortably and safely.⁴

Health worker burnout

In Ghana as elsewhere, the COVID-19 pandemic placed enormous physical and psychological strains on frontline health workers. Key informants reported that PPE shortages, inadequate psychological support, and a lack of financial or other incentives to stay on the job contributed to health worker burnout and made it difficult for them to feel safe and supported at work. In addition, key informants stated that health workers also experienced stigma associated with COVID-19—some communities reported widespread discrimination against health workers by people who feared they would spread the virus.