Judith Domadalo, a three-year-old girl was spotted lying on the bare floor at Tendoma community in the Wa West District of the Upper West Region, while receiving a drip from a nurse.

This suggests the urgent nature of her ill health.

That notwithstanding, Little Judith’s granny, Madam Kusia Liewaa, will make no mistake of sending her grandchild to the nearest health centre at Poyentanga for the fear of COVID-19.

“We heard there is a strange sickness that has no cure. We’re told to stay at home and not visit public places. That is why I’m scared to send my granddaughter to the health centre”, said the helpless old lady.

As I stand staring at visibly weak little Judith’s body lying and receiving the drip, I ask myself rhetorically, what would have been the fate of the little girl in few days, but for the timely intervention of the mobile health team?

For Mr Yuorido Kakariba, a patient who was being attended to by the nurses said he prefers to stay at home with sickness he is familiar with to going out and contracting what he referred to as a “strange disease”.

“We have lived with a lot of sicknesses, but no one told us not to go out, but with this disease, they said we should not go out because if we do, we are likely to get infected”, he said.

“All the time, we hear on the radio that nurses and doctors at the hospitals are getting infected – so we’re afraid of visiting our health centre because we’re not sure”, Mr Kakariba emphasized.

“If you get malaria there is medicine, but for coronavirus, we heard there is no medicine for it. So if you make a mistake and contract it, you are in trouble – that is why we don’t want to take chances”, he emphasized.

Madam Grace Bonye, the mother of a sick child said she did not send her child to the health centre because she was afraid of the risk of travelling in a public means and also using public facilities at the health centre.

‘We believe the disease is not in our village, we will only get it if we go to town and so we choose to stay at home and manage our sickness locally”, she said.

Madam Bonye said she was supposed to be sending her child for weighing and other immunization services but had to put all that on hold for fear of getting exposed to the deadly virus. These narratives are a microcosm of what is happening in other places in the region and probably in all rural areas across the country.

Mr Kareem Rashid Dalo, the Physician Assistant in charge of the Poyentanga Health Centre when contacted confirmed that the people were refusing to patronize the health centre because of the COVID-19 pandemic.

He said the situation, which was widespread in the area was a worry to them, adding that a lot of people were getting sick but had refused to visit the health centre.

This according to Mr Dalo was evident as the Out Patient Department (OPD) attendance had decreased drastically from 4,496 in half-year 2019 to more than 1,991 within the same period in 2020.

Mr Simon Asaman Awini, the Wa West District Nutrition Officer equally confirmed that COVID-19 had affected the health-seeking behaviour of the people in the district.

According to him, the district is the hub of malnutrition in the region; however, since the outbreak of COVID-19, they no longer receive cases of children suffering from severe acute malnutrition as they used to do.

The Upper West Region witnessed the outbreak of Cerebral Spinal Meningitis (CSM) in November 2019 claiming a total of 50 lives out of 357 cases.

Health Authorities in the region attributed it to the delay in reporting to health facilities due to the fear of COVID-19 and the stay at home protocol.

Stay home protocol

“Stay at home” is one of the World Health Organization’s (WHOs) recommended protocols aimed at stopping the spread of the virus.

In Ghana, this protocol among others has not only received both the Ghana Health Service (GHS) and President Akufo Addo’s endorsement but also well publicized by all segments of the media.

But how have rural dwellers interpreted this to mean? Well, for Kakariba and many others, COVID-19 is deadlier and managing other sicknesses at home without going out and getting infected by the virus is a preferred risk.

Dr Damien Punguyire, the Acting Upper West Regional Director of Health Services explained that education was for people to avoid public places due to the high risk involved.

He said the advice for the public to stay home and rather call to be attended to at home when experiencing symptoms of COVID-19 was also to minimize the risk at health facilities.

This, according to him, was misconstrued by the public, leading to a decline in OPD attendance countrywide resulting in underutilization of services.

“If you’re sick and you stay at home, you’re likely to die or risk developing lifelong complications that will be difficult to manage. So all are encouraged to visit the health facilities when feeling unwell”, said Dr Punguyire.

“We have put in a lot of safety measures at the facilities and I think they’re rather even safer than our market centres and other public places where a lot of people don’t wear nose masks to protect themselves and others”, he said.

Mobile clinic initiative

In responding to the challenge, Dr Punguyire said they directed health authorities at the district level to initiate outreach services to reach out to the people in their communities.

Implementing the directive at the Poyentanga Health Zone, Mr Dalo together with his colleagues initiated the outreach services through mobile clinics to enable them to respond to the situation.

“We now send our health staff to the communities to attend to sick people since they are refusing to come to the facility by themselves”, he said.

Mr Dalo added that the outreach team was recording a high number of attendance in the various communities than those who visited the facility itself daily.

Need to step up education and sensitisation

The stay at home protocol has been misconstrued by many including; rural dwellers, thereby, exposing the communication gap as far as public sensitization on COVID-19 is a concern.

There is, therefore, the need to step up education and sensitization especially in the rural communities to disabuse their minds of the misconception they have, regarding the COVID-19 protocols and the need to patronize the health facilities when sick to prevent needless deaths or lifelong complications.

COVID-19 Update in Ghana

Meanwhile, Ghana has confirmed 567 new cases bringing the total number of confirmed cases to a total of 39,642 according to the GHS website as of Thursday, August 6, 2020. There are 36,384 recoveries, 3,059 active cases and 199 deaths.

The Upper West Region has 88 confirmed cases, three deaths and currently no active case.

Recommendations

With the vision to make health care accessible to Ghanaians, in 2005, government, the Ministry of Health and the Ghana Health Services (GHS) collaboratively adopted the Community-Based Health Planning and Services (CHPS) as a national policy for the provision of primary health care services.

The CHPS initiative which is a scale-up of the Navrongo experiment, which was initiated and piloted in Northern Ghana over a decade ago, was aimed at removing the bottlenecks in physical and geographical access to health care delivery to deprived districts and communities in Ghana.

Proving to be an effective tool for primary health care delivery, there is, therefore, the urgent need for government to once again scale-up the CHPS initiative to cover every single community to make access to health care services more accessible to rural dwellers.

If every community were to have a CHPS compound, rural folks will not be afraid of accessing such a facility in their community in times of sickness even in this era of COVID-19.

Undoubtedly, the lives of little Judith and many others are being saved through these outreach services, hence the need to provide the necessary support in terms of fuel, medicines and other logistics to make the initiative more effective.

The health staff trekking on motorbikes to these communities needs to be motivated to enhance their commitment to the course of saving the lives of these rural dwellers in these difficult times.

Conclusion

Undoubtedly, COVID-19 has exposed the weak health systems in many developing nations including; Ghana.

Governments of these nations must begin to make giant investments in health infrastructure to improve on both access and quality healthcare delivery.

President Akufo Addo’s announcement of the government’s commitment to building 88 District Hospitals by the end of 2020 is a step in the right direction and deserves citizen’s support.

Access to quality health care is a right and geographical location should not be an obstacle in preventing people from enjoying that right.