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Context

This section provides an overview of the context and system factors in Ghana that may have played a role in the response to COVID-19 and the maintenance of essential health services. Context and systems factors are in place ahead of an infectious disease outbreak and cannot easily be changed during a response.

Exemplars in COVID-19 conceptual framework for assessing epidemic preparedness and response

Contextual factors

Although this research focuses primarily on the policy choices officials made during the early phases of the pandemic, a country’s ability to limit COVID-19 transmission and related mortality can also be attributed to contextual factors, including those below.

A country’s population demographics, such as age structure and population density, may contribute to pandemic outcomes, such as the number of cases and deaths (see figure below).

Pre-pandemic health context in Ghana, 2019

IHME, World Bank

The following underlying population-level health characteristics may have shaped Ghana’s experience in the early months of the COVID-19 pandemic:

Age structure

Ghana has a relatively young population. According to the Ghana Statistical Service, in 2021 around 57% of the population was younger than 25 years old.1Only about 3% were 65 or older.2

Elderly adults are significantly more likely to die from COVID-19 than younger adults and children.3 Countries around the world vary widely in their age structures: in some African countries, fewer than 2% of the population is 70 years or older, while in some European countries that share is more than 15%.4 Some research suggests that accounting for variation in age structure between countries may explain nearly 50% of the variation in COVID-19 mortality.5

 

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Chronic health conditions

Noncommunicable diseases such as stroke, ischemic heart disease, hypertension, diabetes mellitus, haemoglobinopathies including sickle cell disorders, chronic respiratory diseases (particularly asthma), were among the most significant causes of disease mortality in Ghana.6 In 2019, all-age cancer prevalence was 3.50%.7

Age standardized prevalence (%) of major non-communicable diseases in Ghana (2019)

IHME
A variety of chronic health conditions like high blood pressure, diabetes, and cardiovascular disease are associated with greater rates of mortality from COVID-19.3 HIV can make individuals susceptible to infectious diseases because of how it impacts the immune system. Similarly, cancer and cancer treatments like chemotherapy frequently disrupt the immune system, leaving individuals vulnerable to severe infection.8

 

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Smoking prevalence and ambient air pollution

Smoking prevalence in Ghana is relatively low: in 2016, less than 8% of men and only 0.3% of women reported smoking cigars or cigarettes.9 However, about 4 million people live in the Greater Accra Metropolitan Area, where air pollution is a serious concern—especially during the dry season when airborne dust joins anthropogenic pollutants in the air.10 In a 2021 ranking of 118 countries’ air quality, only 29 were worse than Ghana.11

Fine particulate matter, especially matter small enough to reach the deepest part of the lungs, causes chronic pulmonary injury and inflammation.3,12 Individuals exposed to these particles may be more likely to be infected with respiratory pathogens and to have more severe outcomes.13

According to the World Bank and the United Nations, Ghana is a lower-middle income country14 with one of the highest GDPs per capita in West Africa. Before the COVID-19 pandemic, its economy was growing: according to World Bank data the country’s GDP increased 6.5% in 2019.15 It was also diversifying. Traditional industries such as agriculture and mining thrived alongside developing sectors such as financial services, health care, and tourism.16

However, the COVID-19 pandemic—which brought temporary lockdowns in March 2020 and a sharp decline in the exports of commodities such as crude oil and cocoa17 —slowed this growth considerably, although temporarily.18 In 2020, Ghana’s GDP only grew 0.5%.19 The country’s poverty rate increased only slightly in the first year of the pandemic, from 25% in 2019 to 25.5.% in 2020, but nearly 75% of Ghanaian households reported a decrease in income that year.19,20

According to the World Bank, Ghana’s economic growth rebounded in 2021. That year, its GDP grew 5.4%.20 However, fiscal pressures remain. By 2022, the government’s foreign and domestic debt was very high (nearly 80% of GDP) and the cost of servicing that debt was rising, placing the country at high risk of default.21,22

 

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Ghana’s health system has substantial experience with outbreaks of contagious and epidemic disease. Cholera, which is spread via contaminated drinking water, is endemic. Health workers report cases every year, often in densely settled communities in the Greater Accra Region where drainage is poor, infrastructure for waste disposal is limited, and clean water can be hard to find.23 Large-scale cholera outbreaks took place in 1991, 1999, 2011, 2012, and 2014–2015.24,25 In that most recent outbreak, the worst yet, officials recorded nearly 29,000 cases and 243 deaths.26

Malaria remains the primary cause of outpatient visits and deaths in Ghana, particularly among children and pregnant women: in 2020, it represented 8% of outpatient cases and 21% of inpatient cases. The country’s National Malaria Control Programme is working to reduce malaria morbidity and mortality in Ghana across three main program areas: prevention (interventions include distributing insecticide-treated nets and intermittent preventive treatment for pregnant people), diagnosis and treatment, and surveillance.27 Data suggest that these interventions have been associated with decreasing indicators of malaria transmission in recent years.28 Malaria transmission has generally declined from 27.5% in 2011 to 14.1% in 2019.29

The northern parts of Ghana lie within the “meningitis belt” of sub-Saharan African, and the country has experienced recurrent outbreaks of that disease as well.30 For a few months at the end of 2015 and the beginning of 2016, an outbreak of bacterial meningitis sickened more than 1,000 people and killed 125.31 Bacterial meningitis can be diagnosed using molecular PCR testing, just as COVID-19 can; with the help of international partners such as the US Centers for Disease Control and Prevention, Ghana began to strengthen laboratory capacity during the 2015–2016 outbreak that it could use in future health emergencies.31,32

During the 2014–2016 West African Ebola virus disease outbreak, Ghanaian health officials acted quickly to reduce the risk of viral transmission into and within the country. Interventions included an interministerial committee chaired by the minister of health, which developed a national preparedness and response plan; Ebola treatment centers established by the Ghana Health Service, which also distributed PPE to health facilities; and point of entry screening for travelers.32 Official risk communication and community engagement campaigns placed ads with information on Ebola—including mode of spread, signs, symptoms, and prevention—in the Daily Graphic and the Ghanaian Times; made radio and television announcements; and trained media personnel and health authorities for multimedia broadcasts in local languages.33 They also distributed educational posters and brochures.

Ghana did not record any cases of Ebola virus disease during that outbreak, and these efforts gave authorities a blueprint for action in future health emergencies.

Researchers argue that these and other outbreaks of infectious disease pushed the Ghanaian health system to focus on crisis response and outbreak mitigation.34,35 This emphasis on emergency and pandemic preparedness helped accelerate Ghana’s initial COVID-19 response in March 2020, but it also may have undermined the delivery of routine health services including reproductive, maternal, neonatal, child, and adolescent health, and immunization services.36

System factors

Beyond policy interventions, other modifiable factors under the short-term control of countries and governments that can help shape countries’ pandemic outcomes include testing strategies, disease surveillance, laboratory capacities, contact-tracing programs, case management, mobility restrictions, and surge response coordination. In any analysis of a country’s COVID-19 preparedness and response, it is also important to consider preexisting system factors, such as the strength and structure of a country’s health care system and supply chains.

About 11% of Ghana’s GDP is dedicated to manufacturing. Most of this is heavy manufacturing, especially around Accra,36 but some local industries were able to pivot to manufacturing key supplies such as hand sanitizer, face masks, and reagents to sell to the government at affordable prices in the early months of the COVID-19 pandemic. There has been some subsequent investment in pharmaceutical manufacturing in Ghana.37,38

The drug stock room at the University of Ghana Medical Center in Accra, Ghana, on June 24, 2022. Credit: Nana Kofi Acquah.
The drug stock room at the University of Ghana Medical Center in Accra, Ghana, on June 24, 2022.
Credit: Nana Kofi Acquah. Copyright: © Gates Ventures, LLC.

 

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In 2001, African Union member states pledged to spend at least 15% of their budgets on the health sector each year.39 However, few have met this target. In 2019, Ghana spent just 3.4% of its GDP on health.40

 

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Despite these resource limitations, Ghana has established a national health insurance system, the National Health Insurance Scheme, and a multilevel public health care system, the Ghana Health Service. Both are regulated by the Ministry of Health.

The National Health Insurance Scheme, established in 2003, aims to bring basic health care services to everyone in Ghana. Health authorities at the national level regulate health insurers at the district level. They also set premiums and accredit providers. The scheme and its subsidiaries have a single benefit package and are funded by a value-added tax on goods and services, social security taxes from workers in the formal sector, and premiums paid by some Ghanaians.41 Everyone in Ghana is eligible for coverage, but not everyone has enrolled. As of 2014, the scheme covered some 40% of the population, and two-thirds were exempted from premium payments.42 According to the 2021 census, nearly 70% of the population was covered by the National Health Insurance Scheme or by private health insurance.43

Universal health care coverage index for Ghana health services

GBD 2019 Universal Health Coverage Collaborators

 

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The public health care delivery system, the Ghana Health Service, comprises three integrated levels of care covering preventive and promotive services, clinical care, and emergency services.

  • The primary level is a network of district, subdistrict, and community health facilities. District hospitals are the main referral facilities: each one serves some 100,000 to 200,000 people.44 Health centers and clinics at the subdistrict level serve about 20,000 people each. Community-based health planning and services zones serve rural communities. In 2020, there were 6,166 of these zones in Ghana.45
  • At the secondary level, regional hospitals run by general practitioners and specialists serve as referral centers for all district hospitals in each region.
  • The tertiary level is composed of teaching hospitals, which are semiautonomous national referral hospitals linked to universities: Komfo Anokye Teaching Hospital, Korle-Bu Teaching Hospital, Cape Coast Teaching Hospital, and Tamale Teaching Hospital. They provide specialized care and train future doctors.

These public facilities are complemented by private hospitals and clinics. In 2020, there were more than 9,200 health facilities (district and regional hospitals, teaching hospitals, polyclinics, clinics, community-based health planning and services, and maternity homes) in Ghana, up from 5,749 in 2016.46

Over the past two decades, Ghana’s Ministry of Health has introduced a variety of programs aimed at increasing the size of Ghana’s health workforce. These include auxiliary nursing programs; postgraduate specialist training colleges for doctors, pharmacists, nurses, and midwives; and financial incentives for health workers. In 2014, in collaboration with the global One Million Community Health Workers (CHWs) Campaign, Ghanaian health officials launched a national program aimed at training and deploying more than 31,000 paid CHWs throughout the country by 2023. As of July 2019, researchers counted approximately 26,000 program participants across the country.47 CHWs provide maternal and reproductive health services, neonatal and child health services, treatment of minor ailments, health education, and referrals, many at the household level. Community health volunteers support CHWs with service delivery and community mobilization, and they assist community members in their homes.

 

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Services provided by primary, secondary, and tertiary health facilities in Ghana

Amofah et al. (2020)

 

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Despite these interventions, health worker shortages remain. The density of doctors in Ghana is low compared with African and global averages (1.1 per 10,000 compared with 2.8 per 10,000 for Africa and 17.5 per 10,000 globally), although the density of nurses and midwives far exceeds the African average (27.1 per 10,000 for Ghana compared with 10.3 per 10,000 for Africa), and care providers are not equitably distributed across the country. Most doctors and nurses practice at regional and teaching hospitals, and very few qualified medical doctors practice in the poorest and most rural communities.

 

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Distribution of clinical staff in Ghana by region (2017)

MoH (2018)

Since 2002, Ghana has used the Integrated Disease Surveillance and Response (IDSR) strategy to detect, monitor, and report on high-priority diseases.48 IDSR is a way for countries to measure their implementation of World Health Organization (WHO) member states’ International Health Regulations (IHR) 2005,49 which balance the prevention of infectious and non-infectious diseases with the promotion of international travel and trade.50,51

Initially, Ghana’s IDSR goals focused on detecting, confirming, and responding to communicable diseases such as cholera and meningitis.52 More recently, they have expanded to include noncommunicable diseases such as hypertension and diabetes mellitus.53 According to a 2017 WHO report, the community-based surveillance component of IDSR in Ghana has grown weaker over time, but has contributed substantially to the detection of disease outbreaks, even in hard-to-reach areas, and the eradication of diseases such as Guinea worm disease.54

 

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WHO’s 2017 Joint External Evaluation of Ghana’s IHR core capacities found that the country had the laws and legislation it needed to conduct robust disease surveillance activities.55 It also found a robust immunization program for vaccine preventable diseases, a national laboratory system for human and animal health, and a mature Field Epidemiology Training Program. The country had a national public health emergency preparedness and response plan and strategy for risk assessment during outbreaks of contagious disease (all of these would be essential to the country’s response to the COVID-19 pandemic.) The evaluation recommended focusing on ensuring adequate funding for these tools and strengthening capacity for coordination, logistics, and early detection and response.

 

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Outbreak factors

Ghana confirmed its first case of COVID-19 on March 12, 2020, in a diplomatic worker who had recently returned from abroad.56 Between March 2020 and December 2021, the country experienced three major pandemic waves: June–August 2020, January–February 2021, and July–August 2021.57

As of December 31, 2021, the country had 142,986 confirmed COVID cases and 1,295 confirmed deaths.

Daily new confirmed COVID-19 deaths per million people in Ghana

Our World in Data

In March 2020, Ghanaian officials acted quickly to prevent the spread of COVID-19. They established a battery of preventive measures, including partial lockdowns in Accra and Kumasi, a ban on international travel, school closures, and a ban on all social gatherings. People were advised to avoid hospitals except in emergency situations and everyone entering a health facility was screened for COVID-19.58 To support and protect staff, conserve PPE, and reduce strain on the health system, the Ghana Medical Association suspended all elective procedures.

Daily new confirmed COVID-19 cases per million people in Ghana

Our World in Data

The relative importance of the drivers of outcomes of interest during an epidemic or pandemic will depend on the nature of the specific pathogen. In the case of the COVID-19 pandemic, the SARS-CoV-2 virus is characterized by respiratory transmission by both symptomatic and asymptomatic individuals. The virus disproportionately impacts older adults and those with compromised immune systems and comorbidities. Although vaccines and therapies to reduce severe disease and fatal outcomes from SARS-Cov-2 were developed relatively quickly, this is not always the case for other pathogens with epidemic and pandemic potential.

For more information, please see How Does COVID-19 Compare With Past Epidemics and Pandemics?

Global and regional factors

Geospatial distribution of cumulative confirmed cases of COVID-19 by regions in Ghana (March 2020 to December 2021)

University of Ghana School of Public Health, Ghana Health Services

Ghana borders Togo to the east, Burkina Faso to the north, Cote d’Ivoire to the west, and the Atlantic Ocean to the south.59 The population density at the national level has increased from 103 persons per square kilometer in 2010 to 129 persons per square kilometer in 2021.60

In Ghana, and more generally, high-density and low-income neighborhoods are more susceptible to infectious disease transmission, especially when they have developed quickly and without necessary infrastructure or have large or transient migrant populations.61 The geospatial distribution of COVID-19 cases by region in Ghana is illustrated in the figure above.

Ghana’s weather and climate were not a focus of this research, but more details and the relationship to the spread of infectious diseases can be found below.

 

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Respiratory viruses spread more easily through thin, dry air (and consequently at higher elevations) than through humid air.62 In different climates, outdoor temperature ranges can lead to increased congregating in climate-controlled indoor settings that can increase viral transmission potential.3 All these factors may influence how rapidly COVID-19 spreads in different countries and at different times of the year.
As climate change worsens, the risk of infectious disease outbreaks has increased, with climatic conditions becoming increasingly fertile ground for pathogenic transmission.63 Research has shown that many infectious diseases are susceptible to climate variability, flooding, droughts, and the animal and human migratory impact of a changing climate, leading to a rise in vector-, food-, and water-borne illnesses.64
  1. 1
    Ghana Statistical Service. Ghana FactSheet. Accessed February 6, 2023. https://statsghana.gov.gh/ghfactsheet.php
  2. 2
    World Bank. Population ages 65 and above (% of total population) – Ghana [data set]. Accessed February 6, 2023. https://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS?locations=GH
  3. 3
    COVID-19 National Preparedness Collaborators. Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021. Lancet. 2022;399(10334):1489-1512. https://doi.org/10.1016/s0140-6736(22)00172-6
  4. 4
    Ritchie H, Roser M. Age structure. Our World in Data. Accessed February 6, 2023. https://ourworldindata.org/age-structure
  5. 5
    COVID-19 Forecasting Team. Variation in the COVID-19 infection-fatality ratio by age, time, and geography during the pre-vaccine era: A systematic analysis. Lancet. 399(10334):1469-1488. https://doi.org/10.1016/s0140-6736(21)02867-1
  6. 6
    World Health Organization (WHO). World Health Statistics 2021: Monitoring Health for the SDGs, Sustainable Development Goals. Geneva: WHO; 2021. Accessed February 6, 2023. https://www.who.int/data/gho/publications/world-health-statistics
  7. 7
    Institute for Health Metrics and Evaluation. GBD Compare. Accessed February 6, 2023. http://ihmeuw.org/5qoj
  8. 8
    Bollyky TJ, Tohme S, Kiernan S. Noncommunicable diseases kill slowly in normal times and quickly in COVID-19 times. Council on Foreign Relations. Last updated September 10, 2021. Accessed February 6, 2023. https://www.cfr.org/article/noncommunicable-diseases-kill-slowly-normal-times-and-quickly-covid-19-times
  9. 9
    Nketiah-Amponsah E, Afful-Mensah G, Ampaw S. Determinants of cigarette smoking and smoking intensity among adult males in Ghana. BMC Public Health. 2018;18(1):941. https://doi.org/10.1186/s12889-018-5872-0
  10. 10
    World Health Organization. Improving air quality in Accra, Ghana by integrating health into policymaking. 2021. Accessed February 6, 2023. https://www.who.int/about/accountability/results/who-results-report-2020-mtr/country-story/2021/ghana
  11. 11
    IQAir. Air quality in Ghana. Accessed February 6, 2023. https://www.iqair.com/us/ghana
  12. 12
    Patanavanich R, Glantz SA. Smoking is associated with COVID-19 progression: a meta-analysis. Nicotine Tob Res. 22(9):1653-1656. https://pubmed.ncbi.nlm.nih.gov/32399563/
  13. 13
    Wu X, Nethery RC, Sabath MB, Braun D, Dominici F. Air pollution and COVID-19 mortality in the United States: Strengths and limitations of an ecological regression analysis. Sci Adv. 2020;6(45):eabd4049. https://doi.org/10.1126/sciadv.abd4049
  14. 14
    Ghana Ministry of Finance. Ghana has not been down-graded as a low income country. Published April 14, 2021. Accessed February 6, 2023. https://mofep.gov.gh/press-release/2021-04-14/ghana-has-not-been-down-graded-as-a-low-income-country
  15. 15
    World Bank. GDP growth (annual %) – Ghana [data set]. Accessed February 6, 2023. https://data.worldbank.org/indicator/NY.GDP.MKTP.KD.ZG?end=2021&locations=GH&start=1961&view=chart
  16. 16
    US Department of Commerce, International Trade Administration. Ghana – country commercial guide. Published July 22, 2022. Accessed February 6, 2023. https://www.trade.gov/country-commercial-guides/ghana-market-overview
  17. 17
    van Huellen S, Asante-Poku NA. How commodity exporting countries like Ghana have been hit by COVID-19. The Conversation. March 14, 2021. Accessed February 6, 2023. https://theconversation.com/how-commodity-exporting-countries-like-ghana-have-been-hit-by-covid-19-155799
  18. 18
    World Bank. The World Bank in Ghana. Accessed February 6, 2023. https://www.worldbank.org/en/country/ghana/overview
  19. 19
    World Bank. GDP growth (annual %) – Ghana [data set]. Accessed February 6, 2023. https://data.worldbank.org/indicator/NY.GDP.MKTP.KD.ZG?locations=GH
  20. 20
    World Bank. World Bank Poverty and Equity Brief: Ghana. October 2022. Accessed February 6, 2023. https://databankfiles.worldbank.org/public/ddpext_download/poverty/987B9C90-CB9F-4D93-AE8C-750588BF00QA/current/Global_POVEQ_GHA.pdf
  21. 21
    Inveen C, Strohecker K. Default ‘a real possibility’ for Ghana, Fitch senior director says.” Reuters. September 21, 2022. Accessed February 6, 2023. https://www.reuters.com/world/africa/default-a-real-possibility-ghana-fitch-senior-director-says-2022-09-21/
  22. 22
    World Bank classifies Ghana as high debt distressed country. Ghanaian Times. October 6, 2022. Accessed February 6, 2023. https://allafrica.com/stories/202210070151.html
  23. 23
    Ofori-Adjei D, Koram K. Of cholera and Ebola virus disease in Ghana. Ghana Med J. 2014;48(3):120. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4335441/
  24. 24
    United Nations Children’s Fund. Ghana—Cholera Factsheet. https://web.archive.org/web/20221014111728/https://www.plateformecholera.info/index.php/cholera-in-wca/cholera-factsheet/221-unicef-factsheet-ghana
  25. 25
    Ohene-Adjei K, Kenu E, Bandoh DA, et al. Epidemiological link of a major cholera outbreak in Greater Accra region of Ghana, 2014. BMC Public Health. 2017;17(801):1-10. https://doi.org/10.1186/s12889-017-4803-9
  26. 26
    Mireku-Gyimah N, Apanga PA, Awoonor-Williams JK. Cyclical cholera outbreaks in Ghana: filth, not myth. Infect Dis Poverty. 2018;7(1):51. https://doi.org/10.1186/s40249-018-0436-1
  27. 27
    Country Coordinating Mechanism Ghana. National Malaria Control Programme. Accessed February 6, 2023. https://www.ccmghana.net/index.php/2018-2020/malaria/national-malaria-control-programme
  28. 28
    Coleman S, Dadzie SK, Seyoum A. et al. A reduction in malaria transmission intensity in Northern Ghana after 7 years of indoor residual spraying. Malar J. 2017;16(1):324. https://doi.org/10.1186/s12936-017-1971-0
  29. 29
    World malaria report 2021. Geneva: World Health Organization; 2021.
  30. 30
    Kwarteng A, Amuasi J, Annan A, et al. Current meningitis outbreak in Ghana: historical perspectives and the importance of diagnostics. Acta Trop. 2017;169:51-56. https://doi.org/10.1016/j.actatropica.2017.01.014
  31. 31
    US Centers for Disease Control and Prevention. Ghana: quick laboratory action helped control a meningitis outbreak. Last updated April 16, 2016. Accessed February 6, 2023. https://www.cdc.gov/globalhealth/security/stories/ghana-lab-meningitis-outbreak.html
  32. 32
    Adongo PB, Tabong PTN, Asampong E, et al. Preparing towards preventing and containing an Ebola virus disease outbreak: what socio-cultural practices may affect containment efforts in Ghana? PLoS Negl Trop Dis. 2016;10(7):e0004852. https://journals.plos.org/plosntds/article/figure?id=10.1371/journal.pntd.0004852.g003
  33. 33
    World Health Organization. WHO Ghana Ebola viral disease (EVD) preparedness and response activities. Published June 25, 2014. Accessed February 6, 2023. https://www.afro.who.int/news/who-ghana-ebola-viral-disease-evd-preparedness-and-response-activities-25-june-2014
  34. 34
    Atuire CA, Rutazibwa OU. An African reading of the COVID-19 pandemic and the stakes of decolonization. Published July 29, 2021. Accessed February 7, 2023. https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization
  35. 35
    Mensah D, Asampong R, Amuna P, Ayanore MA. COVID-19 effects on national health system response to a local epidemic: the case of cerebrospinal meningitis outbreak in Ghana. Pan Afr Med J. 2020;35(suppl 2):20. https://doi.org/10.11604/pamj.supp.2020.35.2.23031
  36. 36
    World Bank. Manufacturing, value added (% of GDP) – Ghana [data set]. Accessed February 6, 2023. https://data.worldbank.org/indicator/NV.IND.MANF.ZS?locations=GH
  37. 37
    Ghana to build pharmaceutical manufacturing hub to promote local production. HealthCare Africa. April 21, 2021. Accessed February 6, 2023. https://www.healthcareafrica.info/ghana-to-build-pharmaceutical-manufacturing-hub-to-promote-local-production/
  38. 38
    Ghana to become hub of pharmaceutical production in SSA —Fitch Solutions. Med Aditus. May 11, 2021. Accessed February 6, 2023. https://medaditus.org/news-articles/ghana-to-become-hub-of-pharmaceutical-production-in-ssa-fitch-solutions/
  39. 39
    Gatome-Munyua A, Olalere N. Public financing for health in Africa: 15% of an elephant is not 15% of a chicken. Africa Renewal. October 13, 2020. Accessed February 6, 2023. https://www.un.org/africarenewal/magazine/october-2020/public-financing-health-africa-when-15-elephant-not-15-chicken
  40. 40
    World Bank. Current health expenditure (% of GDP) – Ghana [data set]. Accessed February 6, 2023. https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=GH
  41. 41
    Blanchet NJ, Fink G, Osei-Akoto I. The effect of Ghana’s National Health Insurance Scheme on health care utilisation. Ghana Med J. 2012;46(2):76-84. https://pubmed.ncbi.nlm.nih.gov/22942455/
  42. 42
    Wang H, Otoo N, Dsane-Selby L. Ghana National Health Insurance Scheme: Improving Financial Sustainability based on Expenditure Review. Washington, DC: World Bank Group; 2017. Accessed February 6, 2023. https://openknowledge.worldbank.org/bitstream/handle/10986/27658/9781464811173.pdf
  43. 43
    US Department of Commerce, International Trade Administration. Ghana healthcare insurance. Published February 28, 2022. Accessed February 6, 2023. https://www.trade.gov/market-intelligence/ghana-healthcare-insurance
  44. 44
    Asamani JA, Chebere M, Barton P, D’Almeida S, Odame E, Oppong R. Forecast of healthcare facilities and health workforce requirements for the public sector in Ghana, 2016–2026. Int J Health Policy Manag. 2018;7(11):1040-1052. https://doi.org/10.15171/ijhpm.2018.64
  45. 45
    Ghana Ministry of Health (MOH). Ghana Health Sector: 2021 Programme of Work. Accra, Ghana: MOH; 2021. Accessed February 6, 2023. https://www.moh.gov.gh/wp-content/uploads/2021/08/Ministry-of-Health-2021-APOW-6-July-2021-very-final-v2-1.pdf
  46. 46
    Ghana Ministry of Health (MOH). Ghana COVID-19 Emergency Preparedness and Response Project & Additional Financing. Accra, Ghana: MOH; 2020. Accessed February 6, 2023. https://www.moh.gov.gh/wp-content/uploads/2016/02/FINAL-COVID-19-ESMF.pdf
  47. 47
    Schwarz D, Kim JH, Ratcliffe H, et al. The status of Ghanaian community health workers’ supervision and service delivery: descriptive analyses from the 2017 Performance Monitoring and Accountability 2020 survey. Gates Open Res. 2019;3:1468. https://doi.org/10.12688/gatesopenres.12979.3
  48. 48
    Adokiya MN, Awoonor-Williams JK, Beiersmann C, et al. The integrated disease surveillance and response system in northern Ghana: challenges to the core and support functions. BMC Health Serv Res. 2015;15:288. https://doi.org/10.1186/s12913-015-0960-7
  49. 49
    World Health Organization (WHO). International Health Regulations (2005). 3rd ed. Geneva: WHO; 2016. Accessed February 8, 2023. https://www.who.int/publications/i/item/9789241580496
  50. 50
    Kasolo F, Yoti Z, Bakyaita N, et al. IDSR as a platform for implementing IHR in African countries. Biosecur Bioterror. 2013;11:163-169. https://doi.org/10.1089/bsp.2013.0032
  51. 51
    Masiira B, Nakiire L, Kihembo C, et al. Evaluation of integrated disease surveillance and response (IDSR) core and support functions after the revitalisation of IDSR in Uganda from 2012 to 2016. BMC Public Health. 2019;19(1):46. https://doi.org/10.1186/s12889-018-6336-2
  52. 52
    Ghana Ministry of Health (MOH). Technical Guidelines for Integrated Disease Surveillance and Response in Ghana. Accra, Ghana: MOH; 2002. Accessed February 6, 2023. https://www.moh.gov.gh/wp-content/uploads/2016/02/Integrated-Disease-Surveillance-and-Response-Ghana-Guidelines.pdf
  53. 53
    Ghana Ministry of Health (MOH). Technical Guidelines Integrated Disease Surveillance & Response Ghana. 2nd ed. Accessed February 6, 2023. https://www.moh.gov.gh/manuals-guidelines/
  54. 54
    World Health Organization (WHO). Primary Health Care Systems (Primasys): Comprehensive Case Study From Ghana. Geneva: WHO; 2017. Accessed February 6, 2023. https://apps.who.int/iris/handle/10665/341169
  55. 55
    World Health Organization (WHO). Joint External Evaluation of IHR Core Capacities of the Republic of Ghana: Mission Report, 6-10 February 2017. Geneva: WHO; 2017. Accessed February 6, 2023. https://apps.who.int/iris/handle/10665/255578
  56. 56
    Ghana: Ministry of Health confirms first case of COVID-19 March 13. Crisis24. March 12, 2020. Accessed February 6, 2023. https://crisis24.garda.com/alerts/2020/03/ghana-ministry-of-health-confirms-first-case-of-covid-19-march-13
  57. 57
    Bandoh DA, Odikro M, Frimpong JA, Malm KL, Asiedu-Bekoe F, Kenu E . Strategies adopted by Ghana during first and second waves of COVID-19 in Ghana. J Interv Epidemiol Public Health. 2022;5(1):3. https://www.afenet-journal.net/content/series/5/1/3/full/
  58. 58
    Lee IK, Wang CC, Lin MC, Kung CT, Lan KC, Lee CT. Effective strategies to prevent coronavirus disease-2019 (COVID-19) outbreak in hospital. J Hosp Infect. 105(1):102-103. https://doi.org/10.1016/j.jhin.2020.02.022
  59. 59
    Saleh K. The Health Sector in Ghana: A Comprehensive Assessment. Washington, DC: World Bank; 2013. Accessed May 10, 2023. https://openknowledge.worldbank.org/server/api/core/bitstreams/fc5c79f7-d6ce-56b3-ae51-66856b200b5f/content
  60. 60
    Ghana Statistical Service (GSS). 2021 Population and Housing Census Press Release on Provisional Results. Accra, Ghana: GSS; 2021. Accessed May 10, 2023. https://statsghana.gov.gh/gssmain/fileUpload/pressrelease/2021%20PHC%20Provisional%20Results%20Press%20Release.pdf
  61. 61
    Owusu-Ansah FE, Tagbor H, Togbe MA. Access to health in city slum dwellers: The case of Sodom and Gomorrah in Accra, Ghana. Afr J Prim Health Care Fam Med. 2016;8(1):e1-7. https://doi.org/10.4102/phcfm.v8i1.822
  62. 62
    Khan AJ, Hussain H, Omer SB, et al. High incidence of childhood pneumonia at high altitudes in Pakistan: a longitudinal cohort study. Bull World Health Organ. 2009;87(3):193-199. https://doi.org/10.2471/blt.07.048264
  63. 63
    Mora C, McKenzie T, Gaw IM, et al. Over half of known human pathogenic diseases can be aggravated by climate change. Nat Clim Chang. 2022;12(9):869-875. https://doi.org/10.1038/s41558-022-01426-1
  64. 64
    The Lancet Microbe. Climate change: fires, floods, and infectious diseases. Lancet Microbe. 2021;2(9):e415. https://doi.org/10.1016/s2666-5247(21)00220-2
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