TY - JOUR
T1 - Strengths, disconnects and lessons in local and central governance of the response to the first wave of COVID-19 in Ghana
AU - Wallace, Lauren J.
AU - Afun, Nana E.Enyimayew
AU - Ofosu, Anthony A.
AU - Aryeetey, Genevieve C.
AU - Arthur, Joshua
AU - Nonvignon, Justice
AU - Agyepong, Irene A.
N1 - Publisher Copyright:
© 2022 Ghana Medical Association. All Rights Reserved.
PY - 2022/9
Y1 - 2022/9
N2 - Objectives: To explore governance, coordination and implementation actors, structures and processes, facilitators, and barriers within local government and between central and local government in Ghana's COVID-19 response dur-ing the first wave of the outbreak. Design: Cross-sectional single case study. Data collection involved a desk review of media, policy and administrative documents and key informant in-depth interviews. Setting: Two municipalities in the Greater Accra region of Ghana Participants: Local government decentralised decision makers and officials of decentralised departments. Interventions: None. Main Outcome Measures: None Results: Coordination between the national and local government involved the provision of directives, guidelines, training, and resources. Most of the emergency response structures at the municipal level were functional except for some Public Health Emergency Management Committees. Inadequate resources challenged all aspects of the re-sponse. Coordination between local government and district health directorates in risk communication was poor. Dur-ing the distribution of relief items, a biased selection process and a lack of a bottom-up approach in planning and implementation were common and undermined the ability to target the most vulnerable beneficiaries. Conclusions: Adequate financing and equipping of frontline health facilities and workers for surveillance, laboratory and case management activities, transparent criteria to ensure effective targeting and monitoring of the distribution of relief items, and a stronger bottom-up approach to the planning and implementation of interventions need to be given high priority in any response to health security threats such as COVID-19.
AB - Objectives: To explore governance, coordination and implementation actors, structures and processes, facilitators, and barriers within local government and between central and local government in Ghana's COVID-19 response dur-ing the first wave of the outbreak. Design: Cross-sectional single case study. Data collection involved a desk review of media, policy and administrative documents and key informant in-depth interviews. Setting: Two municipalities in the Greater Accra region of Ghana Participants: Local government decentralised decision makers and officials of decentralised departments. Interventions: None. Main Outcome Measures: None Results: Coordination between the national and local government involved the provision of directives, guidelines, training, and resources. Most of the emergency response structures at the municipal level were functional except for some Public Health Emergency Management Committees. Inadequate resources challenged all aspects of the re-sponse. Coordination between local government and district health directorates in risk communication was poor. Dur-ing the distribution of relief items, a biased selection process and a lack of a bottom-up approach in planning and implementation were common and undermined the ability to target the most vulnerable beneficiaries. Conclusions: Adequate financing and equipping of frontline health facilities and workers for surveillance, laboratory and case management activities, transparent criteria to ensure effective targeting and monitoring of the distribution of relief items, and a stronger bottom-up approach to the planning and implementation of interventions need to be given high priority in any response to health security threats such as COVID-19.
KW - COVID-19
KW - Ghana
KW - Governance
KW - Health Security
UR - http://www.scopus.com/inward/record.url?scp=85141605831&partnerID=8YFLogxK
U2 - 10.4314/gmj.v56i3s.10
DO - 10.4314/gmj.v56i3s.10
M3 - Article
AN - SCOPUS:85141605831
SN - 0016-9560
VL - 56
SP - 85
EP - 95
JO - Ghana Medical Journal
JF - Ghana Medical Journal
IS - 3
ER -