On March 12, 2020, Ghana recorded its first two imported cases of COVID-19 in the Greater Accra Region. All regions in Ghana have recorded cases of COVID-19, and response to the outbreak continues from the district level to the regional and national levels.

Anthony Appiah and Dr. Felicia Alemna, both of whom are resident epidemiologists with the Ghana Field Epidemiology and Laboratory Training Program (GFELTP) working in the Ga North and Ablekuma North districts of the Greater Accra Region, share firsthand their experiences as COVID-19 responders and how they have utilized their FELTP training to overcome challenges during the response.

Anthony Baffour Appiah, Resident Epidemiologist

The Ablekuma North Municipal Health Directorate (MHD) of the Ghana Health Service was notified of an imported COVID-19 case from the United Kingdom on March 29, 2020, and a team was formed to commence the investigation. One specific challenge during the investigation and community-enhanced surveillance for COVID-19 was data quality issues.

In the early stage of the COVID-19 outbreak in Ghana, an ArcGIS application (Collector for ArcGIS) was developed to collect household data and GPS coordinates of locations in the community where samples were taken. This application was developed as a stopgap measure as the nation rolled out Surveillance Outbreak Response Management and Analysis System (SORMAS) to all the regions. Teams at the district levels were expected to use this application whenever a sample is taken from households, filling the paper-based case investigation forms and generating unique numbers (epidemiological numbers) for each sample taken to the laboratory. During my visit to support the municipal health directorate, I found that field teams in the Ablekuma North district were not using the application to collect household information and GPS coordinates during the community surveillance. This led to difficulty in identification of households when laboratory results were released. Additionally, epidemiological numbers were wrongly generated and case investigation forms (paper-based) for samples incompletely filled.

To overcome these challenges, I organized training sessions for contact tracing teams with the support of the district. The training focused on strategies in contact tracing, sample collection procedures, generation of epidemiological numbers, and electronic data capture with the collector for ArcGIS and filling of the digitalized investigation forms. Practical sessions were organized on data capture with the collector for ArcGIS and web-based case investigation forms. Additionally, I provided timely supportive supervision on the field to address any challenges encountered by field teams.

Training and introduction of digitalized case investigation form in the Ablekuma North Municipality helped prevent incomplete filling of forms, assigning of wrong epidemiological numbers, and picking GPS coordinates of community samples taken. Timely supportive supervision of teams on the field helped address technical challenges and reduced errors in data capture. Our enhanced community surveillance increased case detection and early identification of cases in the municipality.

Dr. Felicia Alemna, Resident Epidemiologist

During the early stages of the coronavirus pandemic in Ghana, I was assigned to the National Incident Management Center at the Disease Control Department of the Ghana Health Service. Amongst other responsibilities, I was trained in professionally following up contacts of confirmed COVID-19 cases and relaying of results to negative contacts through making phone calls. At the end of March 2020, I was reassigned to the Ga North district to assist the directorate in surveillance activities. The Ga North district recorded its first confirmed case on 11 April 2020 with about 350 cases recorded by mid-September 2020.

The response to COVID-19 at the Ga North District Health Directorate (DHMT) was not without challenges. Notable among them was the delay in relaying COVID-19 results to tested contacts. This was due to inadequate personnel to call contacts who had taken the COVID-19 test to give feedback. As a result, people who had taken the COVID -19 test kept calling in or trouping into the Health Directorate for their results. This was quite a worrying phenomenon taking into consideration the risk of spread of the virus.

Together with the DHMT, I lead the organization of a training session for secretaries and administrative staff on how to professionally communicate COVID-19 laboratory results through phone calls. With this training, the district was able to give feedback to contacts that tested negative over the phone. Positive cases were handled by the disease control officer and the health information officer, who were also trained.