Challenge
The prolonged COVID-19 pandemic is exacerbating poverty, disparities, and social conditions in Ghana, disproportionately impacting the poor and vulnerable. Gross domestic product (GDP) growth is expected to have slowed to 1.1 percent in 2020, after averaging 7 percent per year from 2017 to 2019. Ghana’s labor market has also been hard hit by the pandemic, leading to job losses and lower incomes. In the first three months of the crisis, 77 percent of the population reported a decline in household incomes. The COVID-19 pandemic also threatened to disrupt the provision of essential health services due to barriers in the supply of, and demand for, services. If the disruptions in essential health and nutrition services had continued, including child immunizations, it is estimated that both maternal and child mortality in Ghana could have increased by 21 percent during 2021.
Approach
The project contributes to the safe reopening of socioeconomic activities, including schools. It applies a multisectoral approach, convening line ministries and technical agencies in various sectors, including decentralized government agencies to improve equity and reduce disparities. It aligns with other World Bank-supported projects in education, social protection and jobs, water and sanitation, and digital development, which are a part of the World Bank Group’s overall support for Ghana’s COVID-19 emergency response and resilient recovery. The project was among the first set of emergency support operations approved by the World Bank’s Board of Executive Directors on April 2, 2020 under the dedicated Fast-Track COVID-19 Facility. As the project has been implemented, its design has been adjusted to incorporate lessons learned. Lessons include using a decentralized approach and adjusting to the disruption in routine services.
Results
The key results include:
- The project contributes to the containment of the virus. As of March 4, 2021, 86,465 positive cases were reported, with a 93.6 percent recovery rate and 647 deaths — bringing the case fatality rate to 0.75 percent.
- The capacity of the laboratory system has been expanded through the use of streamlined digital solutions for timely case detection, diagnosis and reporting. Overall, a total of 925,611 tests have been performed. The number of laboratories was expanded from two to sixteen nationwide in less than a year.
- The capacity of the contact tracing system was strengthened, with 1,340 surveillance officers trained during the first three months of project execution.
- Case management capacity has been reinforced with the establishment of 21 treatment centers and 129 Intensive Care Unit (ICU) beds in 10 of the 16 regions. This includes the Greater Accra Region, which is the epicenter of COVID-19, as well as the border regions, such as the Western, Volta and Upper East regions.
- Timely support for the Inter-ministerial Coordination Committee enabled policymakers to develop policies and legislative instruments, as well as to enforce public health measures to contain the virus. When the first cases were detected on March 12, 2020, the Government responded with drastic restrictions on movements, starting with the strict border closures, the three-week partial lockdown in the two biggest cities (Accra and Kumasi), and the ban on public gatherings. The ban also included religious activities and funerals, which are at the center of Ghana’s rich and diverse culture and traditions. At the same time, Ghana was the first African nation to lift the lockdown on April 20, 2020 after the Government developed the capacity to analyze disease transmission. The Government has also adjusted self-quarantine protocols for asymptomatic patients according to the epidemiology, thus avoiding the overwhelming of health facilities.
- The project supports extensive, nationwide awareness campaigns delivered in sign language and local languages, including wide dissemination of the information, education, and communication materials, some of were also translated into Braille. The Government promptly launched a designated official website on COVID-19 three days after the first cases were detected. This helped to establish trusted communication channels for the media and the population. The Minister of Information and technical experts conducted daily and then semi-weekly briefs with a sign language on local TV and social media. Furthermore, the President has delivered periodic briefs in both English and local languages to inform citizens of social and public health measures on Sunday evenings. Call Centers and COVID-19 Information Centers were established in all 16 regions. Communication caravans also went around the country to disseminate information about preventive measures and where to seek care.
- As a result of these extensive awareness campaigns, a recent survey showed that 97 percent of respondents were aware of COVID-19. Indeed, 70 percent knew the symptoms, and 83 percent reported to have sufficient information about COVID-19.
- By December 2020, over 20,000 people with a disability had received psychosocial support, wheelchairs, and protective equipment to prevent the infection.
- The project also supports the continuity of essential health and nutrition service delivery and the reopening of socioeconomic activities, especially school reopening. Specifically, the project supported specific infection prevention and control measures at health facilities and schools.
World Bank Group Contribution
The World Bank provided US$232.5 million in International Development Association (IDA) financing. Additionally, Japan’s Trust Fund, the Policy and Human Resources Development Fund (PHRD), provided US$1 million.
Partners
As the lead of the Health Development Partners in 2020, the World Bank intensified its coordination among the development partners, including United Nations (UN) agencies, GAVI, the Global Fund to Fight Against Acquired Immune Deficiency Syndrome (AIDS), Tuberculosis and Malaria (the Global Fund), the United Kingdom’s Foreign and Commonwealth and Development Office (FCDO), the United States Agency for International Development (USAID), the United States Center for Disease Control and Prevention (CDC), the Japan International Cooperation Agency (JICA), and the European Union (EU). Weekly meetings dedicated to COVID-19 updates and a resource mapping tool facilitated dialogue with the Ministry of Health and the Ghana Health Service. The World Bank also enhanced its support using the Pandemic Emergency Financing Facility (PEF) of US$3.3 million. These resources were channeled through the United Nations Development Programme (UNDP), the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO).
Moving Forward
The first six-months of project implementation provided key lessons that were incorporated into the design of the first Additional Finance (AF). The AF is a response to emerging needs, promoting equal access to routine primary health care services. The project also plans to expand digital solutions. In the longer term, the World Bank plans to support the establishment of the Ghana Center for Disease Control. The second AF will continue to address this critical need, including the nationwide deployment of the COVID-19 vaccines.
Beneficiaries
This project reached all Ghanaian citizens through intensive communications and inclusive community engagement. The project provided psychosocial support, wheelchairs, and protective gear to over 20,000 persons with disabilities.