COVID-19 has occupied a larger space in the history books of the world due to its highest morbidity and mortality recorded and with the unending challenge of finding a cure. With the declaration of the outbreak of coronavirus disease (COVID-19) by the World Health Organization (WHO) as a Public Health Emergency of International Concern (PHEIC) on the 30th of January 2020, every country was placed on ignition on protecting its borders to secure its citizens.
World figures of COVID-19 morbidities and mortalities keep rising every minute with current figures standing at 341,722 and 14,765 respectively (GHS/CDC/WHO, 24/3/20). Ghana has not been spared by the COVID-19 and currently has a morbidity of 24 and 2 mortalities. It was therefore imperative to embark on this survey when Ghana recorded its 9th case on the 19th of March 2020, to ascertain health facilities and health personnel preparedness to the call at hand.
A 6 day cross sectional survey was conducted across the entire country considering all the 16 regions with eligibility criteria being health care personnel. A total of 481 respondents were gathered. The study takes into consideration the preparation of the facilities and the personnel who also works in these various health facilities. The study began on the 19th of March 2020 at 5:30pm and ended on the 25th of same month at 5:30pm.
General knowledge on the COVID-19 was identified to be high from all the designation of health staff though contrary to the high knowledge 69.6% of the total 481respondents answered no to having attained any training during this pandemic, however, 23.5% agreeably answered that, they had attained training about the COVID-19 infection.
The study revealed that 65.9% of these respondents do not have hand sanitizers at their facilities. 85% of all the health care providers bemoaned the lack of Personal Protective Equipment overall suit which will be needed to handle suspected cases of COVID-19 and a 67.2% further added that there is no likelihood in the event of a COVID-19 case to get a PPE suit for protection of both health care personnel and patient.
So asking the ultimate question of how health personnel will rate their facility’s preparedness towards the COVID-19 pandemic on a scale of 0 to 10, 2 out of the 481respondents representing 0.4% rated their facilities to be fully prepared with a score of 10. However 70% of this figure responded that their facility were either not prepared at all on the zero score or not adequately prepared enough on a score of 1 to 5. The lack of preparedness could account for why on a scale of zero to 5, 51.1% of the respondents rated their fear of the COVID-19 to be 5.
91.3 % of the respondents were of the opinion that health workers need to be given remuneration and insurance in caring for patients during this pandemic. Most of the respondent displayed a poor knowledge with regards to available and known standing directive regarding transport of suspected case to designated centres, and similarly same was also the lack of available Standard Operating Procedures for health staff on the COVID-19 in the country.
It is therefore recommended that enough training be given to all health care professionals especially the frontline workers. Also more importantly is a recommendation made for PPE’s to be available at health facilities as well as other logistics like hand sanitizers, gloves and mask which will in effect boost the confidence level of the health workforce and furthermore to consider some remunerations and insurance for health care staff.
The world has been faced with its biggest battle after overriding the powers of Ebola virus disease (EVD) which within 2 years(2014-2016) claimed 11,310 lives from a total of 28,616 infected cases with majority being the West African countries within a span of 2 years (2014 – 2016), ( www.cdc.gov ). Tracing the source is Wuhan, a city in China being the epicenter where the outbreak began and later spreading like a wildfire across the entire globe. With over 200 countries affected across the globe, CONVID-19 has notoriously gained popularity assuming a threat to human existence. Scientific Researchers are aggressively seeking for a cure to end this pandemic.
According to the World Health Organization (WHO), situational report, the global statistics as at 18th March 2020 stood at 191,127 infected cases with 7,807 deaths from COVID-19. It is important to state clearly that data on morbidity and mortality keep changing and increasing every minute as other sources like www.worldometers.info had recorded 289,996 cases and 11,949 deaths (Retrieved 21/03/2020). There were initial believes that the virus could not thrive in the black man and even on the African soil but boundaries have been broken by this COVID-19 virus, spreading to several African countries. Ghana has had it fair share of this global pandemic recording 19 cases as at 20th of March, 2020 (Ghana health service.org). The increasing trend of cases in Ghana recorded within the span of 4days has called for questions about the country's preparedness towards this health crisis. How well are our health care professionals prepared with the necessary materials and logistics to combat this disease? This survey seeks therefore to project the country's health situation in respect to health facilities and health professionals’ preparedness towards this COVID-19 pandemic.
The survey seeks to identify if there are enough preparation made by health facilities and health personnel towards the outbreak of COVID-19 pandemic. The survey among others intends to sensitize the various health care staff and managers to put appropriate measures in place to safeguard the citizens of this country.
The survey further seeks to address the following:
- To elicit health facilities preparedness in facing the pandemic upon the entry of the CONVID-19 infection in Ghana.
- To ascertain knowledge level of health personnel across the country who are the frontline workers in this outbreak.
- To evaluate the availability of very essential materials and logistics needed by health facilities and health personnel to combat the CONVID-19 infection.
- To evaluate emergency response preparedness with respect to internal arrangements faceted for surveillance and case isolation.
The findings derived from this study is to add to the body of knowledge in academia, aid in policy direction, distribution of logistics and training of health staff to be better placed in the handling of the CORONA-19 infection.
The study aimed at acquiring a cross sectional view of the preparedness of health facilities and health personnel within the country towards COVID-19 pandemic.
Respondents for the survey were randomly invited to join the survey via a survey link which was shared on social media platforms from across the whole country. The survey questionnaire was restricted to only health platforms which included national platforms of various associations including nursing platforms, Physician Assistant platforms, District platforms etc.
The survey link which was sent on all these platforms lasted for a duration of six (6) days (19-25th of March) and was dedicated to conveniently gather responses from all health workers. Eligibility and inclusion criteria for the study were to be a health worker who would submit a completed survey form within the specified period. In all a total of 487 respondents were gathered.
1. BACKGROUND DATA
Table 1.1 Gender representation
2. Which region do you work?
Fig. 1.1 Regional Representation of respondents
3. Work designation of respondents
Table 1.2 Representation of Cadres of Health workers
The survey admitted all categories of health staff with the greatest number of respondents being Nurses with a 41.5%, followed by Physician Assistants with 28.7% and the least number 0.6% of respondents being Anaesthetics.
2. STAFF TRAINING AND PREPARATION
4. Staff who had had training on COVID-19 infection
Fig. 1.2 Representation on Training
Out of 487 respondents, 115 representing 24% had received training on COVID-19 pandemic whereas 69% has had no training at all on the COVID-19 pandemic. A 7% of the total number said they were yet to receive their training as at the time of the study.
5. Source of Information acquisition by Health personnel on COVID-19
Fig. 1.3 Health Workers sources of information for COVID-19.
Information is very paramount and communication during a pandemic situation is same because it gives direction to the people. It is evident that social media has occupied the greatest space in this global world and the survey revealed a 39.4% being the highest medium through which the health personnel were informed of COVID-19 infection followed by a 20.7% by browsing and the least medium being emails.
3. AVAILABILITY OF LOGISTICS AND SUPPLIES AT THE HEALTH FACILITIES
6. Available Hand Washing Materials
Table 1.3 Representation of available hand washing materials.
7. Availability of Hand Sanitizer 8. Facilities with available Face mask and gloves
Fig. 1.5 Represented facilities with available mask and gloves
Fig 1.4 Facilities with Hand Sanitizers
In a situation of a pandemic of this nature, infection prevention protocols must strongly be adhered to in order to protect the staff and patients as a whole so evaluating to see the availability of logistics which prevents infection transmission is highly recommendable. Hand washing materials were available in their percentages as depicted in table 1.3. The study revealed as shown in fig. 1.4 that only 34% of the 487 respondents had hand sanitizers available at their facilities and 66% of these had none at their facilities. On the other hand there were 51% of the respondents who said they had face mask and gloves at their facilities whereas the remaining 49% said no to having it as shown in fig. 1.5 .
8. Facilities with available Personal Protective Equipment (PPE’S)
Fig. 1.6 Representation of facilities with available PPE’s
From fig. 1.6 it can be realized that 415 (85%) of the respondents had no PPE’s at their facilities but 72 (15%) of them had available PPE’s within their facilities.
9. Likelihood to get a PPE to attend to a case now
A total of 67% of the respondents added that there is no likelihood that they will get personal protective equipment should they pick a case at their facility at the time of this study, whereas 23% believed that it was possible for them to get PPE’s but 10% of the total population were just simply uncertain.
10. Do you have an isolation point identified as temporal holding area for suspected cases of COVID-19?
Fig. 1.7 Facilities with available temporal holding point for isolation
54% out of the total 487 had no temporal holding point for isolation as against a 43% who had identified a temporal holding point for isolation. 3% however said they were uncertain about it as shown in fig. 1.7.
12. Rating of Health Facilities Preparedness by Health Personnel on a scale of 0-10
Fig. 1.8 Representation of facilities preparedness
It could be seen from fig. 1.8 a representation of preparedness of the health facilities for COVID-19, the survey registered the greatest number of respondents (87.3%) between the zero to 5 scale rating but rather saw a gradual decline in numbers as it approaches the upper limit of 10 with 0.4%.
4. WELFARE OF HEALTH PERSONNEL DURING PANDEMIC
13. What is your fear level as a health worker measured on a scale of 0 to 5 in this pandemic?
Fig. 1.9 Representation of Fear level measured among health workers
Fig. 1.9 reveals the fear margin being habited by health personnel who are at the forefront during this pandemic. 251 (51.5%) of the respondents hit the upper limit in expressing their fear whereas 89 (18.3%) of them rated 4. Fewer numbers however said they had no fear working during this period.
14. Where lies your fear in contracting COVID-19?
If fear level measured among health personnel was that high, then it was important to identify the point where fear was much associated with in contracting COVID-19. 303 out of 487 of the respondents answered that, their greatest fear lied at the facility followed by 17% who also feared they could contract it from their various work points. Moreover 14% also answered they would rather fear in contracting it in transport with 7% adding that they would be rather more careful in the community.
15. Should Health care providers be given an insurance or remuneration during this pandemic?
99% of the total 487 respondents agreed to health workers being given remunerations and insurance cover during this period of COVID-19 pandemic however there was a 1% presentation who disagreed.
16. What standing directive do you know concerning the transport of suspected case of COVID--19 to the designated managing centres?
Majority of the respondents answered no to knowing any available standing directive though distinctively an appreciable number could athirst that there were none available. A few of the varying answers claimed they would have called the National Ambulance to convey the suspected case but others responded they would keep the suspected patient in isolation call the Health directorate for further instructions.
17. Is your facility equipped to take samples of suspected cases for testing at the testing facilities?
Fig. 2.0 Representation of facilities equipped to take samples of suspected cases of COVID-19
Majority of the respondents 326 (66%) said their facility was not yet equipped to take samples of suspected case of COVID-19 to the testing centres, it is however not the same situation everywhere as 21% of them had their facilities equipped for testing. 13% of the total respondents of 487 said they had no idea whether their facility is able to do that.
18. Is there a triage team set up within your facility to keep surveillance of COVID-19 using the case definition?
This period of COVID-19 pandemic requires that health facilities keep strong surveillance to hand pick any suspected or probable case for isolation which is why it was necessary to inquire whether facilities had triage teams in place. The study revealed 50.9% of the respondents out of 487 had triage teams formed at their various facilities as compared to the 41.9% who said they had none in place. 7.2% however said they had no knowledge whether there is a triage team formed.
19. Do you have standing Standard Operating Procedures (SOP’s) for COVID-19 made available at your facility to guide your practice in this pandemic?
49.7% of the total 487respondents have no Standard Operating Procedures (SOP’s) outlined for the management of COVID-19 at their facility. 32.4% out of this same number acknowledged that they have SOP’s within their facility but interestingly 17.9% of the health personnel said they were unaware of the presence of any SOP’s of COVID-19 within their facility
5. KNOWLEDGE LEVEL OF HEALTH WORKERS ON COVID-19
20. Knowledge on the mode of spread of COVID-19?
Fig. 2.1 Respondents knowledge of mode of spread of COVID-19
Knowledge measured on the mode of spread was found to be high as seen from fig. 2.1 of a total of 405 (83.2%) choosing droplets over other options provided however a 16% of the total figure of 487 believed COVID-19 is transmitted through airborne.
21. Is applying face mask one of the preventive measures of COVID-19 infection?
433 of the total 487 respondents answered that applying a face mask helps in the prevention of COVID-19 disease however 51 of these respondents disagreed and 3 of them said they had no idea.
22. What is the standard case definition for COVID-19 infection?
The standard case definition for COVID-19 infection include fever, cough with or without difficulty in breathing, runny nose and a history of contact with or from a COVID-19 case or zone respectively. More than half of the respondents were able to mention majority of the signs and symptoms of COVID-19 meeting the case definition however it was identified that, some health personnel had difficulty in naming all the required signs and symptoms that makes the case definition.
23. Is hand washing one of the preventive measures of COVID-19 infection?
A total number of 485 out of the 487 agreed that hand washing is one of the preventive measures of COVID-19 and among that only 2 disagreed.
24. Does touching the face increases your chance of getting infected with COVID-19?
Touching the face has been identified as one of the means by which one can be infected and of the total number who responded to the survey 98.4% of them were in agreement.
The study was meant to provide a snap short on preparedness of health facilities and health personnel with regards to the entry of COVID-19 disease into the country (Ghana). Even though there has been several developments pertaining to the spread of the disease and cases recorded, the study targeted bringing out clearly the health situation of our country Ghana towards COVID-19. A total of 487 respondents entered the survey through a survey link circulated on health platforms across the country within a period of 6 days.
The survey had the following specific objectives; to elicit health facilities preparedness in facing the pandemic upon the entry of the CONVID-19 infection in Ghana; to ascertain knowledge level of health personnel across the country who are the frontline workers in this outbreak; to evaluate the availability of very essential materials and logistics needed by health facilities and health personnel to combat the CONVID-19 infection and to evaluate emergency response preparedness with respect to internal arrangements faceted for surveillance and case isolation.
87.3% of the health workers on a scale of zero to 5, believed that their facilities were not prepared as at the time of the study whereas 12.7% rated their facilities preparedness above 6 to 10 and among the 487 respondents only 2 rated their facilities 10 points with respect to preparedness.
At the end of the survey it was revealed that the overall knowledge level of health personnel on COVID-19 was very high even though there were minimal clinical trainings organized for health staff.
On the assessment of available logistics for usage by health staff in combating COVID-19 disease, it was realized that there were averagely available hand washing materials likewise facial mask and gloves. A lot of health personnel 415 (85.2%) registered the lack of available PPE’s at their facilities, the absence of which makes it difficult to handle a suspected case of COVID-19.
On the issue of emergency preparedness by facilities, 50.9% of the respondents had triage teams set up and 42.9% of them responded that they had an isolation point set in readiness for COVID-19.
Based on the above findings the following recommendations are made for consideration by policy makers;
- To beef up supply of needed logistics to health facilities especially personal protective equipment (PPE;s).
- Staff training on COVID-19 by appropriate personnel should be intensified.
- Clear guidelines and directives should be given to health personnel to aid in proper handling of patients suspected of COVID-19
- Case management protocols should be developed by the Ghana Health Service and decentralized to health facilities for proper case management.
- www.cdc.org Ebola Virus Disease 2014-2016. Retrieved 18th March 2020.
- www.who.org World Health Organization Situational Report on CONVID-19, 2020. Retrieved 18th March 2020.
- www.worldometers.info Updates on CONVID-19 infection 2020. Retrieved 21st March 2020.
- www.ghanahealthservice.org COVID-19 update. Retrieved 24th March 2020.
CONDUCTED BY: SAMUEL WIAFE
[email protected] (0208910513)
(SENIOR PHYSICIAN ASSISTANT)