Akwatia – The Christian Health Association of Ghana (CHAG) with funding support from UKaid, is commissioning COVID-19 High Dependency unit (HDU) at the St Dominic Hospital in Akwatia. The HDU has been established to enable District Hospitals and smaller facilities in the Eastern region manage very severe COVID-19 cases without sending them to National Treatment Centers. The centre is opened to referrals from all facilities in the Eastern region. The setting up of the HDU is part of a 2-year COVID-19 Response and Institutional Capacity Building (CRIB) project being implemented in 40 districts where CHAG facilities are district hospitals. The funding for the project came from the UKaid through the Foreign Commonwealth and Development Office (FCDO).
Background
At the dawn of the COVID 19 pandemic, the global community identified an all-inclusive partnership approach in dealing with the pandemic. Here in Ghana, the all-of-government and all-of-society response was identified as the most feasible pathway to containing the spread of the virus and mitigating the impact of the pandemic on our health system, lives and livelihoods.
Role of CHAG in National COVID Response
In March 2020 when the first case of COVID-19 was reported in Ghana, CHAG recognized its role and contributions in the National COVID-19 Response Actions. As the oldest and largest Non-State Actor in Health, and a reliable partner of the Ministry of Health with 30-40% share of the health sector, we embraced our responsibility to complement the government in all spheres of the COVID 19 management activities; risk communication, testing, case management, contact tracing amongst others.
In our case, ensuring equitable inclusion in the COVID-19 fight was necessary. So, in our preliminary assessment, we identified and prioritized the rural, remote and underserved areas in all the 16 Regions of the country as our intervention targets. We further adopted a comprehensive health system approach by way of managing the pandemic whilst ensuring the continuity of essential basic routine healthcare services.
As a matter of urgency, we needed development assistance for this grand plan. We sought tangible partnership support. Thankfully, the Foreign Commonwealth Development Office/UKAid answered us promptly. They provided the much needed financial and technical assistance to enable CHAG partner the Government in managing the COVID-19 pandemic effectively especially in 40 Districts and Municipalities where CHAG facilities serve as the functional District Referral Hospital.
Consequently, the CHAG COVID 19 Response and Institutional Capacity Building Project- The CRIB Project, was born to:
- Complement government’s response to COVID-19 pandemic
- Ensure the continuity of basic essential routine healthcare services in those 40 Districts and Municipalities
- Document and share lessons learnt on the COVID-19 with the wider health sector
Key Activities, Outputs and Successes:
With gratitude and sense of modesty, we are pleased to provide a brief update on progress and contributions made so far by the CRIB project in our National COVID Response in the areas of Testing, Contact Tracing, Case Management, Staff Capacity Building, amongst others
- Extending COVID-19 Testing:
- Six (6) Testing sites have been resourced adequately, accredited by HeFRA & FDA and are presently testing for COVID with PCR. Through FCDO’s funding support, the tests conducted in these six areas are free of charge. The test results from some of the testing sites are accepted at the airport for travel. And this allows travelers living outside the cities to test without having to spend a day or two in Accra.
- Thus far, a cumulative total of 21,158 (F-10,812: M-10,346) tests have been conducted in the 40 participating districts by both GHS & CHAG facilities (July 2020 – September 2021) with 6,404 (F-3,481: M- 2,923) positive cases (30.3%).
- Four thousand four hundred and nineteen (4,419), representing 20.9% of the total tests were conducted in six (6) CHAG facilities using PCR funded by FCDO under the CRIB project.
- All 40 CRIB District facilities are also conducting rapid diagnostic test with antigen testing.
- Contact Tracing:
Cumulatively, 14,247 contacts have been traced through the CRIB project (July 2020 to September 2021) out of which 7,521 (52.8%) were females while 6726 were males (47.2%). We are also actively supporting facilities and the DDHS in 40 districts for contact tracing.
In June and July 2021, our booster contact tracing support to 40 facilities and 40 District Health Administrations (GHS) saw a spike in the number of cases reported at the national level.
- Case Management
Several cases of COVID have been managed in the designated treatment centres in the CRIB districts. From July to September (2021) 697 very severe cases have been managed in the CRIB districts. In order to enhance case management, the Project set up 13 prefabricated isolation units in areas where there were no isolation units at all. In other places we have also refurbished 27 isolation units.
- Capacity Building for staff
The CRIB Project has trained 6,430 health care workers (GHS, CHAG, and Private) on Infection Prevention and Control, case management, contact tracing and triaging.
As part of our risk and behavioral change communications, many trained Community health workers have reached out to several homes in rural areas with essential and factual messages on COVID-19; and thereby helping rural communities to stay safe from COVID-19.
As of yesterday, 414 additional staff have been trained on Quality Improvement and Inventory management to ensure continuity of essential and basic health services particularly in rural areas
The High Dependency Unit Project
The commissioning of the HDU at the St Dominic Hospital in Akwatia marks the celebration of another milestone in the CRIB project.
It is estimated that about 6% of patients who get infected with COVID-19 will develop a severe form of the disease. From equity lens, whilst people in cities can have access to advanced case management centres, the same cannot be said at the district and sub-district levels. Referrals to these advanced case management centres in the cities leaves affected families with economic burden of transport, accommodation and feeding.
In addressing this gap, HDUs have been established to enable District Hospitals to manage very severe COVID-19 cases in rural areas without sending them to National Treatment Centers.
The HDU at Akwatia is one of three that have been established. The rest are in Bawku and Berekum to serve and provide buffer for case management in the Northern and Middle belts of our country.
Rationale for High Dependency Units
In enhancing our ongoing COVID 19 Response, and towards pandemic preparedness and readiness, CHAG recognize critical need for dedicated special Units in Hospitals for segregation purposes as well as for infection control.
Most importantly, we need a system that enhances better management of patients who can quickly deteriorate, particularly patients with multiple comorbidities and complications related to off-label treatments.
The Choice of St Dominic Hospital-Akwatia in the Eastern Region
- Eastern Region has been classified at the 3rd epicentre of the pandemic. The Region is strategically located as it borders 4 other Regions including the 1st, 2nd and 4th COVID 19 Epicentres. Hence, the St Dominic Hospital-Akwatia, here in the Eastern Region, remains pivotal in the national COVID response activities. Its proximity to Accra, Kumasi, Cape Coast makes it a special national asset in terms of serving as buffer for other adjoining regions in future outbreaks
- Therefore, having a functional HDU here in the Eastern Region is a welcome value addition and significant investment in strengthening our National COVID Response
- In the very near future, CHAG looks forward to replicating these critical lifesaving investments in strategic locations in our country.
Conclusion
The effective role of coordinated partnership in our national COVID-19 response actions cannot be overemphasized. The modest but impactful contributions of CHAG at the Community, District, Regional and National levels continue to complement government’s efforts at all times.
Amidst the growing pandemic fatigue, denial, non-compliance with preventive protocols, vaccine hesitancy and seeming loss of momentum in the COVID response actions; CHAG remains committed to harnessing our infrastructures in all the 16 Regions, trusted social spaces and credible assets in promoting fruitful partnerships towards strengthening our health system to be responsive, robust and resilient.
Thankfully, CHAG finds in FCDO, a worthy and reliable partner in our lifetime quest to promote access to lifesaving quality healthcare to everyone living in Ghana.
Health facilities in the Eastern region and particularly in the Denkyembour district are hereby informed that the St Dominic Hospital in Akwatia now has a functional COVID-19 High Dependency Unit to support the management of severe COVID cases in the Eastern region.
Thank you