The Poor are Paying for the Whole Ghana Approach in the Fight Against COVID-19
/1. Ghana: West Africa’s Most COVID-19 Tested Country
The Whole Ghana Approach (WGA) of President Nana Akuffo Addo is definitely generating enviable results against the unrelenting COVID-19 pandemic that has ravaged 215 countries. As of 15th June, 2020, Ghana is the third most COVID-19 tested African country, the first being South Africa (1,121,958) and second Morocco (431,588)[1]. From 12th March, 2020 when the country recorded the first COVID-19 case to 15th June, 2020, it has conducted 254,331 tests. Of those tested, 11, 964 COVID-19 positive cases were recorded, of which 7, 652 are active.[2] Even more importantly, the total death (54) per 1 million of the population is 2%, putting Ghana among the lowest in the world.[3]
Furthermore, of the 16 Economic Community of West African States (ECOWAS) members, Ghana remains the top-most tested followed by Nigeria (92,924), Africa’s most populous country[4]. As shown in figure 2, Ghana’s 254,331 total COVID tests accounts for 45.4 % of all 560,074 tests done in the 15 West African countries put together. These high testing numbers are testimony to Ghana’s commitment to preventing COVID-19.
Through testing and contact tracing, the health system is enabled to control and prevent the spread of COVID-19. To strengthen contact tracing, on 11th April, 2020, the Ghanaian Vice President, who chairs the COVID-19 Monitoring Team, commissioned a homemade app that is being used to collect, process and make data quickly available to decision makers and implementers of COVID-19 programs. In the words of the Vice President: “data is our most powerful weapon in the fight against COVID-19. You cannot fight what you cannot see." [5] These tools are being complemented by two other prevention strategies: social distancing and handwashing with soap. Therefore, it should come as no surprise to anyone the Ghana’s Deputy Minister for Health announced on 7th May, 2020 that WHO shortlisted Ghana among the 6 countries globally with effective COVID-19 management[6] .
The operationalization of the Whole Ghana Approach (WGA) can be celebrated as a grand success. It has created an enabling social, economic, and political environment for the country’s health authority and scientific community to comply with WHO advice to members states to trace, test, isolate and treat (TTIT) those infested with the COVID-19.[7] Commendable as this might be, further interrogation of the WGA exposes the proverbial “devil in the details”: Ghana’s high testing achievements and the favorable recognition it is enjoying globally is occurring at great economic and social cost to its poor.
The poor make-up 23.4 % (7 million) of the estimated 30 million population. As I will argue, this increased burden on the poor is being perpetrated by the weak targeting mechanisms for the COVID-19 alleviation programmes (CAP) and inadequate relief package for the citizenry and vulnerable groups in particular. Even more unacceptable is that the extreme poor, who according to the Ghana Living Standard Survey 7 (GLSS-7) make up 8% (2.5 million) of the country’s population, were hardly reached by the relief package for water, electricity, and food during the partial lockdown of Accra and Kumasi in April, 2020. In what follows, I will examine the evidence on the significant role played by political leadership in driving the effectiveness of the WGA and its subsequent limits.
2. Effective political leadership in implementing Whole Ghana Approach to fighting COVID-19
Effective political leadership, as I understand it, is about inspiring, organizing and getting the citizenry to take measures or actions they might have otherwise not done to challenge prevailing social, economic or political conditions. In a middle-income country such as Ghana, effective political leadership also brings about reduction in the gap between the poor and rich. The importance of effective political leadership during consequential and upheaval moments in history cannot be overemphasized. COVID-19 is definitely one of those defining historical events of the 21st century and Ghana’s President and his WGA have demonstrated a performance worthy of being defined as good leadership.
In his very first address on 12th March, 2020 to the nation, the President emphasized the importance of the WGA, “this is about Ghana, and we should be in it together”, he urged the citizenry. The stress on unity and inclusiveness was followed by adoption of WHO recommended best practices for curbing the spreading of the COVID-19 in Ghana. Ghana was among the first countries in the West African Region to close its land, sea, and air borders, to impose social distancing measures, to quarantine and provide mandatory testing of all travelers, and to promote frequent handwashing with soap [8]. These initial measures were soon followed by partial lockdown for 3 weeks (30th March to 20 April, 2020) of Kumasi and Accra, the two most important political and commercial municipalities. Both cities account for 20% of the country’s population. Speaking during a virtual conference of the ECOWAS Extraordinary Summit on Coronavirus on 24th April, 2020, President Akufo-Addo explained the principles of the WGA to the fight against COVID-19 as : i) mobilization of social forces - religious, scientific, academic, political and civil society, ii) science and data are driving and shaping decisions and actions; and iii) opportunity to continue to push the Ghana Beyond Aid agenda[9] . He stressed to his fellow heads of government: “we are in a new territory, these are extraordinary times, and it requires a unique level of solidarity amongst ourselves to be able to find lasting solution”[10].
The President’s humbleness in the fight against COVID-19 has been unquestionably outstanding and his effective leadership has won him the respect of other world leaders. Even more importantly, it is successfully marketing Ghana’s COVID-19 programs to the international health and development community. The WHO Director General, Dr. Tedros Adhanom Ghebreyesus, tweeted:
Undoubtedly, Ghana is reaping significant financial dividend for its bold, participatory and unifying approach to fighting COVID-19. In approving Ghana ‘s application to the International Monetary Fund (IMF) for support, its Deputy Managing Director pointed out: “the authorities have timely and proactively responded to contain the spread of the COVID-19 pandemic in Ghana”[11].
Overall Mr. President can be described as a high (i.e. good) performing political leader. This assessment is based on his : i) understanding of the magnitude and consequences of COVID-19, ii) development of a coherent and doable framework with effective strategies to combat COVID-19 and iii) inspiring and empowering the citizenry to surmount COVID-19.[12]
So far, the Ghanaian government has been successful in getting a sizeable number of Ghanaians to adopt different social and civic behavioral practices, albeit sometimes grudgingly, in all public spaces that were unthinkable a few months ago. Citizens, including party political activists, eschewed politics even with the election less than 6 months away, shut the doors of their churches and mosques, limited visits to families and friends, cut down the number of people attending burial ceremonies, and avoided shaking hands. Most big markets across Ghana have adopted a shift system to reduce overcrowding and promoted social distancing during transactions between buyers and sellers. However, in the 10th Presidential address of 31st May, places of worship were given permission to open their doors with restrictions on the numbers and length of services and senior classes in junior, senior, and university were permitted to return to write their final examinations. More importantly, the National Election Commission was told to resume preparation for the December election.
Despite Ghana’s good performance and the implementation of these globally acclaimed COVID-19 preventive measures by the government, the virus, which in March was only in Greater Accra and Ashanti Regions, has spread to all 16 political administrative regions of Ghana (as shown by the map to the right). The virus is now community-based, which is making the infection of persons to persons much easier, faster, and widespread. Alarmed by the spike in the number of confirmed cases in June, the President declared in the 11th address to the nation: “With the doctors and scientists telling us that the virus is transmitted from human contact, through talking, singing, coughing and sneezing, which results in sending droplets of the virus from one person to another wearing….. of masks is now mandatory…. The Police have been instructed to enforce this directive, which is the subject of an executive instrument”[13]. However, the implementation of WGA and the extent to which the government decisions are truly data driven, as the President repeatedly claims, is becoming increasingly untenable.
3. The limitations of the Whole Ghana Approach
The operationalization of the WGA has exposed weaknesses that if not addressed will limit Ghana’s ability to prevent and mitigate the corrosive impact of COVID-19 in the lives of its citizen, especially the poor and vulnerable. The decision to lift the partial lockdown of Accra and Kumasi on 20th April, was greeted with chorus of disapproval by independent experts.[14] In the words of a former head of the Ghana Health Services. “[L]looking at the science of this whole distribution of COVID-19, one will realize that it has moved from the center, Accra, towards the periphery…Even with our cases, there was still a lot of backlog in testing which we felt was not good enough [to warrant the lifting of the lockdown].”[15] Similarly, the former CEO of the Tamale Teaching Hospital and member of the National Democratic Congress (NDC) COVID-19 Team said, “And these contact traces are only primary contacts and because of the delay in some of the results that are coming from the primary contacts, the primary contacts have also contacted primary contacts, tertiary contacts and quaternary contacts. So, you just can’t test a few people and think that because your curve appears to be flattening you should lift the restrictions, I don’t think so”. Independent observers were also shocked on 31st May, when the President seems to justify the easing of the social distancing protocols with the following “The great majority of us continue to adhere to social distancing and enhanced hygiene protocols; we have as a result altered our way of life to accommodate these changes”. A columnist in the Daily Graphic reflected the minds of many independent observers in an opinion piece entitled “Is the President Really Happy with Us?” In the words of the columnist, “what the president said cannot be fact checked…. we may be dealing with different perception here.”
Furthermore, the WGA social mobilization strategy has so far excluded national civil society organizations (CSOs), especially those involved in research and advocacy promoting good governance practices of accountability, transparency, equity, and participation. The failure of the President to engage the civil society sector as he has done with other social groups has so far robbed the WGA of much needed critical citizen voices. Even more importantly, CSO expertise on accountability and transparency in the use of public financial resources is not being encouraged and mobilized to contribute to the WGA to the mitigation COVID-19. By not involving CSOs, the President has definitely undermined the credibility of the WGA and his commitment to ensure independent voice in the execution of COVID-19 programs. Not working with research and advocacy CSOs for example runs contrary to the policy advice and expectations of both the World Bank and IMF, the principal funders of Ghana’s COVID-19 response program,: “Governments should encourage engagement and dialogue with civil society organizations and citizens openly and transparently, especially when decisions related to the government’s response to the pandemic are involved”[16].
On top of the above weaknesses, the execution of WGA is having minimal impact on the lives of the poor. Even though the 11 Presidential Addresses to the nation emphasize the needs of the poor. Rather, the operationalization of the WGA has empowered salaried workers and upper classes Ghanaians with economic opportunities to fight COVID-19. Vulnerable Ghanaians with scarce financial and other productive assets have been shortchanged.
4. The Whole Ghana Approach has failed to properly target poor Ghanaians
Before the eruption of COVID-19, the Ghanaian economy was expected to grow and expand by between 6-7 % in 2020. It is now heading for a massive contraction in every sector, with the hospitality industry, which has for years led economic growth and expansion, being among the worst hit. Export agriculture, for example, cocoa, cashew nuts, shea butter, which accounts for 18.83%, stopped selling to the world[17]. In response to the economic devastation, the government in April announced three complementary measures: economic stimulus to cushion and restore the productive sector, relief support to households to make up for the loss in livelihood and income, and food for the poor and vulnerable groups in Accra and Kumasi due to the partial lockdown.[18]
To implement the economic stimulus support for businesses, government has established two different financing mechanisms: i) GH₵ 3 billion targeting large scale industries, belonging to the Association of Ghanaian Industries (AGI), especially those in the pharmaceutical, manufacturing , hospitality, services and agricultural sectors; and ii) GH₵600 million for micro, small and medium enterprises (MSME) [19]. How exactly Ghana’s poor will be reached by the economic stimulus funds, is yet too early to tell, but they are not the expected direct beneficiaries.
Unfortunately, our scrutiny of the three most touted relief packages: Bill payment for Water and Electricity and Food for the Needy revealed the proverbial “devil in the details”. First, let’s look at the payment of water bills for all Ghanaians for 3 months (April, May and June, 2020). GLSS 7 emphasizes that access to pipe-borne, safe and clean water, which is what the relief is intended to cover, is low in Ghana. Only 48.5 % of all households in Ghana are served with pipe-borne water. Worse still, in rural Ghana, as low as 23.2% of the households compared to 68% for urban households are connected to the pipe-borne water supply system. On top of the limited availability of pipe borne-water, water infrastructure in most poor urban neighbourhoods (e.g. Nima, Jamestown, etc.) and rural Ghana (e.g. Kete Krachi, Hohoe, etc.) is at a bare minimum. Consequently, 36.5 % of all households in Ghana use well water, with 50.9% in rural household against 36.4% urban households. Hardly do the poor households have a running pipe connected to their toilets, kitchen, bath room or water storage facility. Water is fetched and stored in small containers for the household members to use. In many poor communities where People for Health (P4H) is working, the Community-Based Health Planning and Services (CHPS) are not functioning because of a lack of water supply. Without water, CHPS are unable to perform the basic maternal and child health services, including supervised delivery. Besides, the extreme poor use only open water sources, and therefore do not pay any water bill. And, there are approximately 2.5 million Ghanaians GLSS7 classified as being extremely poor and this number is rising. Thus, support to households to pay for water bills will not reach many Ghanaians.
Take the case of government paying half the electricity bill for the rich and middle classes and all for the poor. On the face of it, this looks fair, but close scrutiny of the data reveals the contrary. The GLSS 7 emphasised the unequal access of Ghanaians to the national power-grid being run by the Electricity Corporation of Ghana. Approximately 81.7 % of Ghana’s households are connected to the national power grid, which means that as high as 19.3 % of households are not on it. The Upper East, with 47.7%, and Greater Accra Region, with 93.7 % of households connected to the national power grid, are the lowest and highest regions with connectivity respectively in the country. Furthermore, the GLSS 7 is unequivocal that, a large proportion of the bottom poor households (53.9 % rural and 34.1% urban households) do not use electricity at all. These households are dependent on wood or charcoal for energy to cook or run their small-scale businesses, such as selling roasted yam. The extreme poor cannot even afford to purchase charcoal. This group hardly cook a meal but live by scavenging. They too are Ghanaians, but have been left uncared for by the government subsidy for only electricity powered consumers.
Targeting the poor with hot meals was discontinued immediately after the lockdown was lifted, without follow up measures put in place to empower them to adapt to the disruption in their livelihoods caused by COVID-19. Meanwhile, most salaried workers have some sort of savings which they are definitely utilizing to manage the insecurity and unpredictability caused by COVID-19. Also, those in the formal economy have skills and experiences that they will use to find work elsewhere or even become self -employed. The poor have no bank savings or employable skills and yet their informal economic activities are the hardest hit by the lockdown and social distancing required to prevent the spread of COVID-19. Cutting off the feeding support abruptly after the lockdown assumes wrongly that the informal economy is up and running, but that is incorrect. In fact, the informal economy is fast shrinking!
Market places, the heartbeat of the informal economy throughout urbanized Ghana have definitely experienced unprecedented disruptions including, spraying, closures, doing business in shifts and policing to ensure that social distancing is enforced. For example, in Kumasi, the central market, one of the largest and most influential in the country, traders are taking turns to come to the market to sell their goods. No seller is allowed to come to the market every day of the week. The Nima market in Accra has been closed down indefinitely without prior notice to traders. Certainly, these measures will improve the markets’ environment for social distancing, an essential tool for preventing the spread of COVID-19 in Ghana. However, reduction in the days of working in the markets is definitely impacting adversely on the livelihood activities of the poor. Their income has surely dropped, and this in turn is exacerbating the existing food and nutrition insecurity within their households. If the poor in urbanized Ghana ever needed direct feeding, that need is even greater now with the unpredictable economic environment engendered by COVID-19.
Furthermore, law enforcement on a few instances have been unkind to the poor and vulnerable. In Old Fadama, a poor neighbourhood along the Korle Lagoon, an estimated 1,000 poor people were evicted and their makeshift shacks taken down by armed officers, supervised by the authorities of Accra Metropolitan Authority (AMA). According to the city authority they had to evict the squatters because they were obstructing the flow of the lagoon, contributing to the flood each year in Accra. Moreover, AMA claimed the squatters were given adequate notice to relocate but have failed to do so. It is difficult to comprehend why the AMA, the seat of government, which should be mobilizing all the people of Accra including the poor to comply with social distancing protocol, brazenly threw about 1,000 helpless citizens into the streets. We are told the evictees even petitioned the presidency to no avail. In Ashaiman, one of Ghana’s poorest urban neighborhoods in Tema Municipality, a man was killed by a police officer who claimed it was accidental, but the Member of Parliament (MP) for the area suggested otherwise. The MP according to Ghana web was convinced it was rather the disproportionate use of force by the police officer enforcing the lockdown in Ashaiman.[20]
In Bolgatanga, the capital of Upper East Region, which has about 54.8 % of the population counted as being poor, 100 to 200 market women staged a peaceful demonstration against plans by the Municipal Assembly to relocate them to a more spacious market. Twenty-Seven (27) of the market women[21] were arrested for not complying with social distance guidelines. According to the police, they were compelled to beat some of the traders shown in the photo to the right and later arrested them because they “refused to take instructions, issued by the police”[22]. Thanks to the intervention of the Member of Parliament for Bolga, the 27 women were “granted bail for breaching the social gathering directive”.
Evidently, the mitigation programs of government to alleviate the economic suffering afflicted on all citizens by COVID-19 left out a sizable number of the poor and vulnerable Ghanaians. Ghana has sufficient demographic profile and poverty related data (ie GLSS Reports 1 to 7) prepared by Ghanaian institutions that could have been used to design a better targeted incentive package that speaks to and addresses the COVID-19 economic hardship on the poor. If the WGA is to be meaningful in the lives of the vulnerable Ghanaians, then future mitigation strategies should invest in, and expand on, existing social protection schemes, in particular: Livelihood Empowerment Against Poverty (LEAP), National Health Insurance Scheme (NHIS) and Ghana School Feeding Program (GSFP). In this context, the Government of Ghana should consider absorbing the cost for the poor and vulnerable of testing and treatment for COVID-19 related illness through the NHIS package.
5. Conclusion
In less than 90 days, the Government of Ghana has operationalized the WGA mechanism to prevent COVID-19. The emphasis is on promoting TTIT, social distancing, and handwashing with soap to fight and prevent COVID-19. Carrying out these strategies has resulted in Ghana becoming one of the most COVID-19 tested counties in Africa and the highest in the West African Region. The country’s political leadership has been outstanding in mobilizing the social, religious, and professional groups to support the WGA to mitigate COVID-19. This has contributed to the government’s ability to secure large-scale external funding to invest in the fight against COVID-19. Overall, the President is ranked as a high performing political leader in the fight against COVID-19. However, because of the weak targeting of the poor with relief measures, if not adequately addressed, inequality will definitely worsen in post-COVID-19 Ghana. The failure of the President to engage and encourage the participation of CSOs in the implementation of COVID-19 mitigation programmes undermines the creditability of the WAG. Even more importantly, the non-involvement of CSOs, especially the research and advocacy organization, raises doubts about the government’s commitment to enhanced accountability and transparency in the use of domestic and external financial resources mobilized to fund COVID-19 programmes,
***
Note: Part 1 on the Whole of Ghana Approach to fighting COVID-19 can be found here: https://www.africaproactive.com/blog/covid-19-a-whole-ghana-approach
Mr. Siapha Kamara is the founding Chief Executive Officer of SEND West Africa (www.sendwestafrica.org), which has affiliates in Ghana, Liberia and Sierra Leone. He is currently the Chief of Party of the USAID funded People for Health Project, being implemented by a consortium led by SEND Ghana. His decades of social development activism include leading the SEND Sierra Leone community-based Ebola Responsive Program. This program mobilized thousands of rural women to actively participate in the transformation of the Kailahun District where Ebola started in 2014 from being the epicenter of the epidemic into Ebola free communities in 2016. Siapha also established the West Africa Against Ebola Campaign in Ghana which raised funds to support the education of Ebola orphans. He is head of the Editorial Team of the SEND West Africa COVID-19Update Online Publication, whose mission is to advocate increased learning and actions to mitigate the spread of the virus in West Africa. He can be contacted at siapha.Kamara@sendwestafrica.org.
[1] https://www.worldometers.info/coronavirus/#countries
[2] https://www.worldometers.info/coronavirus/#countries
[3] www.worldmeters.info.coronavirus
[4] www.worldmeters.info.coronavirus
[5] https://www.ghanaweb.com/GhanaHomePage/NewsArchive/Ghana
[6] https://www.abcnewsgh.com/who-shortlists-ghana-among-6-countries-globally-with-effective-covid-19-management/
[7] https://www.weforum.org/agenda/2020/03/coronavirus-covid-19-testing-disease/
[8] See: Ghanaian Times,2nd May, 2020
[9] See Ghanaian Times, 24th May, 2020
[10] See Ghanaian Times, 24, May, 2020
[11] See: www. Imf.org/en/news/articles/2020/04/13/pr 20153-ghana-imf-exective-apporves
[12] [12] Assessment criteria: 1 low performer (fair), 2: high performer ( good/ satisfactory) 3: very high performer ( very good )
[13] 11th Presidential COVID-19 Address to the nation on 15th June, 20209
[14] https://imaniafrica.org/2020/04/26/data-meet-politics-a-covid-19-love-story-from-accra-bright-simons/
[15] ttps://thevaultzmag.com/index.php/vaultz-daily-brief/lifting-of-partial-lockdown-is-a-disappointment-prof-badu-akos
[16] See, Advancing Accountability for special Emergency to Address COVID-19
[17] https:// www.mofep.gov.gh/sites/default/files /news/MOF-statement -to parliament -20200330.pd
[18] https://www.mofep.gov.gh/sites/default/files/news/MoF-Statement-to-Parliament_20200330.pd
[19] i) April, 2020 , Covid-19 Presidential Address to the Nation #8; ii) https://www.graphic.com.gh/news/general-news/president-akufo-addo-launches-stimulus-package-today.html
[20] The murder of the Ashaiman worker Eric Ofotsu
[21] 14th May, Ghanaian Times
[22] https://citinewsroom.com/2020/05/bolga-traders-beaten-arrested-for-protesting-relocation-to-spacious-market/