A public health emergency strikes close to home
The outbreak of Ebola Virus Disease in Guinea in March of this year, and its subsequent spread to Liberia and Sierra Leone, seemed to go largely unnoticed by much of the world for several months. In Ghana, however, the outbreak was being watched with concern from its earliest stages. While Ghana doesn’t share a border with any of the highly-affected countries, it enjoys robust travel and trade links with all three and acts as a major international travel hub for West Africa.
When the first case of Ebola was detected in Nigeria in late July, the risk that Ebola posed to Ghana was brought into sharp focus: the Nigerian index case had taken a flight from Liberia which stopped over in Ghana on route to Togo, where he changed planes and continued on to Lagos. Ghanaian health officials identified 11 passengers with contacts to the index patient who disembarked from the flight in Accra and successfully monitored 10 of them for the 21-day incubation period. All were negative.
By the time the World Health Organization (WHO) declared the Ebola outbreak a Public Health Emergency of International Concern under the International Health Regulations on August 8, the Government of Ghana and a range of national and international partners were already actively engaged in strengthening the country’s ability to detect, investigate and respond to potential cases of Ebola.
GIZ Ghana joins the response
Officials with the Ghana Revenue Authority hand over protective equipment to customs officers working at border crossings. © Ghana Revenue Authority
The Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), which is implementing programmes in Ghana on behalf of BMZ and others, has been a central part of these efforts. ‘Ebola is not only an issue for the three highly-affected countries, but for the 15 high-priority countries as well,’ says Dr Holger Till, the Deputy Country Director for GIZ Ghana. ‘Preparedness is absolutely key and everyone has to participate, whether you are a private company, a civil society organisation, or a development partner.’
The GIZ country office demonstrated early on that it was ready to contribute to Ebola preparedness on multiple fronts. Starting closest to home, it organised Ebola information sessions for its own employees, installed hand sanitizers and added protective gear to first aid kits in all its offices, and drew up a crisis plan in the event of a major outbreak in the country. Externally, it has worked creatively and flexibly to incorporate Ebola-related measures in its existing programmes and its work with partners. For example, Ebola information has been added to health sessions being conducted for farmers, and for students and teachers at vocational training institutions, through GIZ’s agriculture and sustainable economic development programmes respectively.
GIZ is also supporting activities outside its existing programming which contribute to the national Ebola preparedness plan, coordinated in country by the WHO. Examples include direct training measures for health personnel (e.g. doctors and laboratory technicians) at private hospitals and the construction of a prototype isolation and treatment center for infectious diseases in Takoradi in Western Region, which borders Côte d’Ivoire, in collaboration with Ghana Health Services.
In the coming months, it is envisaged that GIZ will work closely with the National Disaster Management Organisation (NADMO) to develop a telephone call centre for use in a potential Ebola outbreak – or in the context of other health emergencies.
Employee Wellbeing Programmes spring into action
For many years now, GIZ Ghana (on behalf of BMZ) has supported public and private sector partner organisations in Ghana in the establishment of Employee Wellbeing Programmes. While these initially focused narrowly on HIV, they have expanded over time to address a range of health and lifestyle issues, as well as social protection, for employees and their dependents.
These workplace structures have proven themselves to be a powerful asset in the current situation. In the face of the Ebola outbreak, the programmes provide a ready-made coordination mechanism for sharing information about Ebola with employees, their family members and the broader community. GIZ Ghana has invited human resource officers and focal persons from partners’ Employee Wellbeing Programmes to training sessions on Ebola. Afterwards, they are in the position to develop and lead organisational responses in their own institutions.
Ghana Revenue Authority: A frontline institution
One of the long-standing partners of German Development Cooperation in the area of Employee Wellbeing Programmes is the Ghana Revenue Authority (GRA), a public institution responsible for the administration of taxes and customs duties throughout the country. The Customs Division of GRA, whose main role is to prevent smuggling, has uniformed personnel stationed at Ghana’s 57 points of entry. In performing their routine duties, including luggage inspections, the customs officers have direct contact with arriving travelers. This puts them at the frontline of the country’s Ebola response.
Customs officers with the Ghana Revenue Authority are joined by immigration and port health officials at an Ebola sensitization session in August 2014. © Ghana Revenue Authority
As early as July of this year, representatives of GRA’s Employee Wellbeing Programme were alert to the risks facing their colleagues working on the borders – and to the positive role they could play in identifying arriving travelers who might be infected with Ebola. ‘Our people are helping to guard the frontiers of Ghana,’ explains Yusuf Quainoo, a National Focal Person for GRA’s Employee Wellbeing Programme. ‘Ebola hasn’t come to Ghana yet, but we must take precautions at the airport, at sea ports and at land crossings to ensure that our people are prepared for it.’
Over the course of August, with the support of GRA management, the Employee Wellbeing Programme organised and conducted full-day Ebola training sessions for teams of uniformed personnel at 12 of Ghana’s key entry points. Led by medical doctors and public health officials, the sessions provided GRA customs officers with basic information about Ebola, how it is transmitted, the measures which can be taken to prevent its spread, and what to do in cases where a traveler is suspected to have Ebola. GRA invited immigration officers, clearing agents and port health officials to join the sessions. ‘We are all working at the borders together,’ explains Yusuf Quainoo. ‘We see that cooperation is important.’
Eric Boakye, another National Focal Person for the Employee Wellbeing Programme, observed that the participants left the sessions with a much clearer understanding of the Ebola threat and their role in identifying potential cases. ‘They now have the information they need to protect themselves,’ says Boakye, ‘and they realise that they have an active role to play in the country’s Ebola response.’
The Commissioner for Customs at the Ghana Revenue Authority (right) hands over protective equipment to GRA customs officers at a visit to a border crossing in November 2014. © Ghana Revenue Authority.
In light of Ebola’s potential impacts on its core operations, the management of the Ghana Revenue Authority has activated the company’s Business Continuity Plan, which was developed in 2011 with support from GIZ via the German Pandemic Preparedness Initiative. (A Business Continuity Plan outlines a set of measures which can be taken to minimise disruptions to an institution’s key operations in the event of emergencies ranging from national disasters to power outages and disease outbreaks.) GRA has distributed information about Ebola to its employees through the company newsletter, leaflets, fact sheets, posters and an eHealth text messaging platform which was developed with support from GCNet, a private sector partner of GIZ. It has also ordered reinforced hygiene measures throughout its offices and provided Personal Protective Equipment (PPEs) to GRA offices at border points.
In recent months, heightened attention to the risk of Ebola has had an unexpected consequence: it has made GRA employees more aware of other health threats, like cholera, whose spread can be limited by basic preventive measures, such as regular handwashing. ‘It’s not only Ebola that can affect our staff,’ notes Yusuf Quainoo. ‘As an Employee Wellbeing Programme we’ve raised awareness about Ebola, and people are using this information to look at other issues as well.’
Complete, accurate and easy-to-understand information about Ebola
As the outbreak deepened in West Africa and the first cases appeared in Europe and North America, Ebola received widespread coverage in the Ghanaian media and became a common topic of conversation. As in other countries, popular fear of the disease, whose fatality rate in some circumstances can be as high as 90%, led to rumours, misinformation and alarm.
At the sensitisation sessions conducted with GRA border personnel, for example, many in attendance did not understand the significance of regular handwashing with soap and running water, assuming that hand sanitizers were sufficient to kill the Ebola virus (not all are). It was also not well understood that Ebola can be transmitted through objects or surfaces which have been contaminated with bodily fluids from an infected person.
In order to bring together in one place basic information about Ebola that is scientifically accurate, comprehensive, and easy to understand, GIZ Ghana supported the development of an Ebola Virus Disease toolbox. Divided into two sections – one for the public, and one for health care workers – the toolbox contains detailed information about the disease, the chronology of Ghana’s response to the outbreak, the signs and symptoms of infection, and what to do in the instance of a suspected case. It also contains links to dozens of flyers, fact sheets and posters which can be used to spread awareness of Ebola in workplaces and other institutions.
Ghana’s Minister of Health launched the toolkit at a national stakeholder meeting in early November. Six hundred copies were distributed to private sector companies countrywide.
An experienced partner in pandemic preparedness
While some elements of Ghana’s national Ebola preparedness plan are experiencing delays, Ghana is generally well prepared for the potential arrival of Ebola, according to Holger Till. In the absence of a confirmed case, however, there is always a risk of complacency and it is important that preparedness activities continue until the outbreak is under control. Indeed, advanced planning is the key to preparedness: this was one of the core principles of the German Pandemic Preparedness Initiative, an innovative bilateral assistance programme implemented by GIZ on behalf of the German Federal Ministry of Economic Cooperation and Development between 2009 and 2013. The programme provided rapid and flexible technical support to partner countries, including Ghana, to strengthen their pandemic readiness in line with the International Health Regulations.
GIZ’s experience with the Pandemic Preparedness Initiative, as well as its ongoing efforts in support of Ebola preparedness in Ghana, underscore the value of using existing coordination mechanisms as platforms for sharing information and organising activities in response to emerging health threats. Employee Wellbeing Programmes, for example, have demonstrated that they are an excellent basis for this type of work. Not everything has to be started from scratch; existing structures and networks can be rapidly redirected to great effect.
The experience from Ghana also reminds us that it is important to think beyond the health sector. Although health is not a focus area for German Development Cooperation in Ghana, GIZ Ghana has found multiple ways to support the national response by working creatively and realigning funds within existing frameworks. GIZ has activated its considerable networks – which span private sector companies, public institutions and civil society organisations – and used its convening capacities to bring together dozens of important Ghanaian stakeholders in support of the national response. The risks of an Ebola outbreak in Ghana have been taken seriously and the considerable expertise of German Development Cooperation has been brought to bear in a strategic manner.
Also of interest
In January 2015 the London School of Hygiene and Tropical Medicine is offering a free two-week online course on the science behind the Ebola outbreak.
For more information, visit http://www.lshtm.ac.uk/study/freeonlinecourses/ebola/index.html