The Impact of COVID-19 on the vulnerability of Ghana’s Health System: Personal reflections of a Regulator

Author: Evelyn A. Paintsil
Evelyn Aseawa Paintsil
It was all joyous entering into the New Year, the merry making, New Year outings, resolutions, new aspirations, and all to usher in the year 2020. There were a lot of plans to be accomplished in this New Year for almost everyone but out of the blue came a “life-changer” experience, which has put many plans on hold and left us with the fear of uncertainty. Thus, the confirmation of the novel corona virus 2019 (COVID-19).
In December 2019, the corona virus disease emerged in Wuhan, China, with several cases presenting pneumonia. By mid to late January 2020, the disease had spread to other parts of the world including Japan, Thailand, South Korea, Europe and the USA. By March 2020, about 213 countries had been affected by the virus leading to a declaration of a public health emergency by the World Health Organization. On the 12th March, 2020, Ghana recorded its first case of COVID-19 from two individuals returning to Ghana from Norway and Turkey.
COVID-19 has since remained a public health issue with great impact on all health systems globally including the most vulnerable ones such as that of Ghana’s health system. The partial lockdown in Ghana brought some socio-economic hardship on most employees and self-employed persons. The responsiveness of healthcare to the pandemic and increased accessibility has also been affected due to numerous factors such as inadequate health resources, anxiety amongst health workers, fear of contracting the disease, inconsistencies in information about COVID-19 and perspectives to the public.

COVID Changing Lives…
As a health regulator, COVID-19 has had an unfavorable impact on my personal life, my duties as a health regulator, and the organization. First, the presence of the disease in the country brought so much inconvenience in engaging with other staff at work, and increased client’s anonymity. Personally, the experience has led to a complete mental battle in the effort to go on with work as normally as possible to enable me achieve the maximum output. Then came the necessary partial lockdown of the city, where almost 90% of my colleagues in the facility had to stay home with only a few trying to handle work demands while adapting the working environment to cope with the management and prevention of the coronavirus.
For those reporting back at work, the reaction on the faces of family members when leaving home for work each day during the partial lockdown was enough to make them anxious. There is the constant reminder that a loved one may not return the same as they left home. The “strange” welcome gestures one receives when back from work only meant a total wash down in the bathroom before anything could be touched, or the start of a proper conversation. No more sitting down briefly to relax before undressing, no more welcome hugs, etc. Indeed, these are not ordinary times!!! Most health workers in the hospital setting now live outside the home, having no contact with family. Others have also contracted the disease in the course of the work, caring for patients infected with the virus and a lot more are suffering from the anxiety of catching the virus. These uncertainties and anxieties created amongst workers in the health sector overall affect the responsiveness of the health system.

My workplace (which is a regulatory body) had its own ordeals which have had a rippling effect on Ghana’s health system. Only a few people were allowed to work at a time following the social distancing rules but this has reduced work output and created a lot of pressure from manufacturers requiring their products to be approved. There has also been pressure from the government to accelerate the processing of certain products urgently required for the fight against COVID-19. The fast-tracking of products made work excessively tasking with mounting pressure on the few obliged to be at work. As this arrangement could not be sustained, the situation led to the adoption of new strategies after the partial lockdown to ease the pressure, increase work output, and to support the manufacturers depending on us to assess their products to support the preventive measure of the health system against the COVID-19.
Despite the ‘perks’ of the lockdown period that allowed some staff to stay at home and spend time with their families, taking a break from their daily busy schedules, have some quality time with their housemates or simply enjoy some restful time, there was always the nagging issue of compiling backlog of work for most workers. This created mixed feelings around the impact of the lockdown and other measures put in place by the organization to mitigate COVID-19.
Source: Global Health News Wire
Source: Global Health News Wire

Impact of Social Distancing on work relations…

The social distancing protocols are one of the core measures at work to mitigate COVID-19. They serve the purpose of reducing the spread of the virus and the unintended consequences of reducing workplace relationships for colleagues and staff. It is not possible to share a meal at lunch or hangout after a hard day’s work anymore. The absence of these social interactions is affecting the morale of workers which in turn has an impact on general productivity of staff, and their ability to make personal adjustments to the current situation.

The social distancing protocols also led to depopulation of the staff with the introduction of a shift system such that very few people were present at the office at a given time. The limited number of workforce meant few people are fully engaged with work leading to backlogs of products assessments, limited/delayed decision-meetings and selective follow-ups to reduce the number of meetings and contact activities. These further delayed product approval processes, halted surveillance inspections and inspections at manufacturing sites, which put the consumer more at risk in terms of quality and product safety.

COVID-19 also affected the responsiveness of most organisations within the health system, as far as facility activities were concerned. Staff now find it difficult to interact with clients, touch their documents and samples, and are always in haste to finish up with them despite having facemasks on. Thus, the overall output, from human relationships to providing quality healthcare is affected. Due to fear of contracting the disease from clients, staff adapted a crude way of ensuring the virus outlive its viability on surfaces by leaving client documents unattended to and not keeping them at the right places on time. This led to low turnaround time and some documents going missing. Some clients had to be called to re-submit certain documents creating new trust and efficiency problems.

You can imagine the client’s reaction and level of confidence in the facility at this point! To curb this situation, staff were provided with free hand sanitizers and PPEs to ensure maximum protection and to assure staff of their safety. Staff were also trained online on the various modes of transmission and areas that staff are at most risk of exposure to infection. Posters with inscriptions such as “Please don’t touch the desk” were posted on surfaces at various offices to reduce human contact as much as possible.

Strategies to Keep Going

In order to keep up with work, give approvals for qualified products and to ensure the effectiveness of work activities to support the health system, the management team at my facility adopted certain strategies;

  • Shift System: A shift system was adopted to enable staff work onsite for a week and stay home for two weeks. This was done in such a way that, about half or one-third of a department reports to work for a week and the others report the next week, with three shifts of three weekly rotations. Other departments also took day and night shifts where some members report in the morning from 8am to 12noon and the others take over from 1pm to 7pm. The essence of this is to minimize contact and mitigate the impact of COVID-19 on the organization in case a staff member is infected.
  • Working from Home: The staff that are not present at the office work from home within the off-site period. Thus, staff members will be doing assessments and joining meetings electronically and call in on mobile phones for assistance and clarification.
  • “Always Available Staff”: Another strategy is selected staff were made to come to work regularly who were not part of the shift system. These are critical staff that require to serve as “referees” for those working from home and those on the shift system. They are usually those in supervisory and management positions with decision making power and influence over the process of regulation overall.

Policy Loopholes

This is where I give a deep sigh…! Although staff agreed that the policies/strategies adopted were going to help clear backlogs, there is general displeasure about the inconvenience of these policies. To begin with, most staff do not own their personal cars, therefore they use the public transport to travel to work, especially those for whom the staff bus does not travel to their area of residence. Also, staff were asked to work from home without any provision for internet, laptops or call units. Working from home meant joining electronic meetings, sending out work done through emails and other electronic mediums. Moreover, work files couldn’t be accessed from home and so staff are really limited working in the house. There was also the difficulty of full concentration when working from home especially for people who do not have the necessary environmental conditions required for effective work at home. These weaknesses affected the full implementation of strategies and the struggle to achieve maximum output. It is evident that the structures required to mitigate the COVID-19 may not be always easy considering the individual condition and resources to support the remote working arrangements.

Despite all these, it is important that some measures are also put in place to protect the organization, its workers and clients. For this reason, some long-term arrangements such as digitalization of client applications to enable us receive online applications and work remotely with access to files and other resources is important. Staff’s ability to access files outside the work premises will ease their frustrations and enable them work remotely easily. Some remuneration to support the internet cost of staff must also be a priority as well as improvements in transporting workers to facilitate safety to and from work.

References

UN, 20202 Socio-economic and health impact of COVID 19 on sex and gender based violence Accessed at: https://ghana.un.org/en/43329-socio-economic-and-health-impact-covid-19-sexual-and-gender-based-violence-sgbv-ghana

Cambridge Africa (2020) COVID-19 and Psychological wellbeing of frontline workers in Ghana Accessed on: https://www.cambridge-africa.cam.ac.uk/cambridge-africa-updates/covid-19-and-psychological-wellbeing-of-frontline-workers-in-ghana/

About the Author:

Evelyn P
Evelyn Aseawa Paintsil holds a B. Pharm (Pharmacy) from Kwame Nkrumah University of Science and Technology and currently pursuing a Master’s Degree in Public Health from the Ghana Institute of Management and Public Administration (GIMPA). She has over four years’ experience in Community Pharmacy Practice, has worked as a Pharmaceutical Quality Control Consultant and currently working as a Regulatory Pharmacist.

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The Centre for Health Systems and Policy Research (CHESPOR) at GIMPA:
This Blog Series is compiled and edited by Dr. Gina Teddy, Coordinator as the Centre for Health Systems and Policy Research (CHESPOR). It is part of a Special COVID-19 Edition to explore issues of health systems vulnerabilities and resilience compiled by the Centre for Health Systems and Policy Research (CHESPOR). The COVID-19 Edition is a series from the GIMPA MPH 2019/2020 Cohort working as frontline workers in various sectors of the health system to enable them share their experiences and perspectives on the impact of COVID-19 Pandemic on Ghana’s Health System. However, the views expressed herein are those of the author and do not necessarily reflect those of CHESPOR or the Ghana Institute of Management and Public Administration (GIMPA)

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