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Ghana has developed a five-point National Health Strategy to contain COVID-19.
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Using Driver Diagrams to Map a National COVID-19 Response

By IHI Multimedia Team | Thursday, May 21, 2020

Using Driver Diagram

With a population of 30 million people and a predominantly public health care system, Ghana has been taking many measures via the Ministry of Health to curb the spread of COVID-19. As of May 18, 2020, Ghana had recorded 5,735 cumulative confirmed cases and 29 deaths

Ghana’s National Health Strategy to contain COVID-19 is a five-pronged approach focused on:   

  • Disease surveillance
  • Laboratory testing
  • Case management and infection prevention & control
  • Logistics management
  • Risk communication and social mobilization.

Mary Eyram Ashinyo, MD, Deputy Director of Quality Assurance for the Ghana Health Service, reflected on her country’s coronavirus response during a recent installment of the COVID-19 in Africa: Free IHI Call Series from IHI. Using an evolving driver diagram developed by IHI, Dr. Ashinyo explained how the primary drivers, if addressed, lead to positive outcomes in the fight against COVID-19.

ghana health services driver diagram

Figure 1 – Ghana Health Service driver diagram for coronavirus response

The driver diagram helps conceptualize the coordination of responses necessary to provide adequate support to address the unprecedented COVID-19 pandemic. When cross walking the driver diagram with the work Ghana is currently leading, there are many areas of overlap:

  • Psychological preparedness — The spread of the pandemic coincided with a spread of misinformation on the nature of the virus worldwide. Many people in Ghana thought the coronavirus wouldn’t reach Africa due to (now disproven) ideas about the virus not being able to survive in hot weather, and more. When the virus reached the country, strong leadership was needed to boost the morale of health care providers and change public perceptions of the virus. To help people, particularly health care providers, feel psychologically prepared, top leadership of the health system, including the Minister of Health and the Director General of the Ghana Health Service, made visible trips to see and inspecting treatment centers and other COVID-19 response arrangements. The government provided insurance packages and motivational packages for health care workers, as well as provided the needed capacity building and logistics required.
  • Skills and competency readiness — The Ministry of Health developed case management guidelines for Ghana. Previously, Ghana had been relying on available evidence from other countries, the WHO, and the international community. Luckily, Ghana possesses experience from assisting with other epidemics, like Ebola, to help coordinate the response.
  • Physical preparedness — Initially, there were issues surrounding availability of infrastructure to repurpose as designated COVID-19 treatment centers, as well as personal protective equipment and other supplies hospitals needed to keep workers safe. Donations by development partners such as the World Health Organization supported short-term interventions. In addition to partnership, Ghana authorized the local production of key materials such as face masks and hand sanitizers to allow for infrastructure to be created within communities to reduce the spread of the virus.
  • Communication through education — Strong risk communication and social mobilization was implemented to help contain the spread in Ghana. A national risk communication committee was set up that mapped out key cross-cutting stakeholders such as national and local governments, the Ghana Journalist Association, the Private Newspapers Association, Ghana radio, faith leaders, and more. The content of these communications was designed to be context appropriate including translating materials into eight languages and focused on preventative measures. Stakeholders were trained to thoroughly understand the content being disseminated through social media, radio, TV stations, billboards, etc. Political leaders including the President, celebrities, faith leaders, and community leaders leveraged their influence to give relevant updates nationwide.

While Ghana followed standard public health practices by implementing lockdowns and closing schools and public gatherings, it has not been a perfect process. The country experienced challenges in sustaining population awareness and making sure people picked up the right behaviors to contain the virus. The country reached a point where some people no longer cared about social distancing. People started to go to the beach and organize social gatherings. While this was unfortunate, it taught a major lesson: it is not enough to have the population awareness activities in the preparedness stage. Rather it needs to be sustained throughout all the stages of the response, and content must be continuously modified at every point when necessary.

  • Detection and mitigation strategies — Ghana initially identified 13 high-risk points of entry. At the airport, the country introduced a mandatory quarantine where over 1,000 people arriving from abroad at the airport were quarantined, tested, and monitored for 14 days. Out of those quarantined, more than 100 people tested positive.

Despite these interventions, the health system still faces challenges. Rapid expansion of hospital-based care for COVID-19 patients will prove crucial in containing the spread of the virus. Increased health infrastructure will ensure patients are monitored closely and are not discharged until they are tested for COVID-19.  

While there have been struggles across the country, there are many lessons to be learned from the coordinated interventions from Ghana. It has become important to continually monitor non-COVID-19 essential services, such as maternal and child mortality, and track them with simple indicators. It is also clear how necessary it is to invest in health care. Creating opportunities for private sector integration is crucial, to have the resources needed to support this work. Finally, centering patient safety remains key to the COVID-19 response.

Mary Eyram Ashinyo, MD, is Deputy Director, Quality Assurance for the Ghana Health Service.

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