One issue that is emerging from COVID-19 management is the need to develop a model for Ghana’s response. Dr. Owusu Sekyere of the Kumasi Research Centre is one researcher who has made a strong case for Ghana to model a system for COVID-19 response. This raises the question of which model to follow.
Do we go for a ‘blueprint’ of handling a similar pandemic? Blueprints suggest that some lessons were documented which countries can draw lessons from.
The second option is called Soft System Modelling (SSM), which makes room for learning and replication. The world has experienced three major pandemics which have been well documented – The plague of 1720, the Cholera of 1820 and the Spanish Flu of 1920. The most recent case is COVID 19, which is eliciting country specific responses. In searching for a model, should Ghana go for the blueprints of previous pandemics? In the absence of any best practice for Africa to adopt, Ghana is for now resorting to home-grown solutions.
In modelling pandemics like COVID-19 the following questions might be considered:
- How is the context different?
- Was the problem the same or different; in what ways?
- Are the actors and stakeholders similar?
- What kinds of outcomes are sought?
Two key principles of modelling include:
- Identifying the problem
- Setting the Objectives of interventions
From the beginning, government outlined five objectives to combat the pandemic: to limit and stop importation of the virus; to contain its spread; to provide adequate care for the sick; to limit impacts of the virus on social and economic life; and to inspire the expansion of our domestic capability and deepen our self-reliance. These are in tandem with social protection principles. I am unsure whether these objectives are also useful for overall modelling of the national response.
So far, Ghana’s response to the pandemic has been hailed globally as among the most innovative; but have we documented our strategies as a blueprint for our future reference and for others? In any case, is the blueprint the best model for responding to a pandemic like COVID 19? Some policy experts have suggested using the Soft System Modelling (SSM). SSM is based on trying to reach an accommodation between different worldviews about how to undertake or improve a proposed action or intervention.
Unlike the ‘blueprint’, SSM is flexible and makes room for modifications, negotiation and lesson-learning. In modelling a response, it is unusual to find a situation in which there is genuine consensus between principal actors – government and its agencies and other stakeholder like the Ghana Medical Association, Ghana Psychological Association, Ghana Nurses and Midwifery Council etc. In response to such a crisis, it is necessary to try and accommodate conflicting views; and SSM can help by structuring debate.
In his eighth address on COVID-19, President Akufo-Addo indicated the significance of stakeholder engagement in management of the of virus: “I engaged a number of stakeholders to discuss the future of existing measures which have imposed restrictions on public gatherings, shut down our schools, and closed our borders. I met with the Chairperson and Members of the Council of State, the President and Members of the Standing Committee of the National House of Chiefs, representatives of organised labour – i.e. the leadership of the Trades Union Congress, leadership of the Christian Community, leadership of the Muslim Community, the President and Executive Committee of the Ghana Medical Association, representatives and leaders of the Media, and leadership of the National Union of Ghana Students (NUGS)”.
According to the president, the strong consensus that emerged from these and other consultations is that the existing measures must be maintained for now, “until we have a firm grip on movement of the virus”.
In the management of emergencies, creating space for stakeholder participation is necessary to learn their perspectives. In the 1990s, Johnson and Wilson developed a framework for joint agenda-setting, which is a process of negotiating that makes way for stakeholders to learn from each other, known as the 3As (assumptions, accountability and attributions).
In modelling emergency responses, debate and dialogue are more desirable forms of communications and more likely to lead to constructive and agreed action. When the president lifted the partial lockdown, some members of the Ghana Media Association argued that they had not been adequately consulted, which sent worrying signals of a breakdown in communications.
Communication is an essential part of modelling an emergency response; in fact, for the overall development process. As a result, learning to communicate effectively and thinking about some of the ramifications of policy could improve modelling and achievement of results. Modelling can be used creatively for thinking long-term about the future, and for developing different scenarios and thinking about the future. Models involve negotiation between the actors involved, the human dynamic or actions and particularly joint action; and requires skills in negotiating and brokering.
Action generally cannot take place without the involvement of other stakeholders. In many development interventions power relations will come into play as long the state and its agencies are involved. But this is the time for the state to open the space for discussion and joint action. On that score, government has done well by way of consultations with stakeholders. Going forward, government needs to create an action learning-space in the context of inter-ministerial, departments and agencies. This is aimed at building communicative action for shared knowledge and practices.
Modelling and World-views
Modelling is also influenced by the world-view of the institution or institutions leading management of the emergency. From my perspective, government’s response to the pandemic, thus far, is in tandem with the transformative worldview. A transformative worldview holds that policy responses to pandemics or emergencies need to be intertwined with the change agenda to confront social inequities or exclusions in the system. Specifically, the response should contain an action agenda for reform that may change lives of the population and strengthen the institutions – in this case, Ghana’s health systems.
Moreover, specific issues that speak to important social issues of the day need to be addressed; issues such as empowerment and equity, inclusion etc. Transformative world-views provide a voice for the voiceless and vulnerable, raising their consciousness or advancing an agenda for change to improve their lives. It becomes a united voice for reform and change.
This philosophical worldview focuses on the needs of groups and individuals in our society that may be marginalised or disenfranchised. In his eighth speech, President Akufo-Addo disclosed that the virus had revealed the unequal distribution of healthcare facilities, since the country over the years has focused infrastructural development in Accra and some of the big cities. “But, as we have seen, epidemics and pandemics, when they emerge, can spread to any part of our country.”
According to the president, there are eighty-eight (88) districts in our country without district hospitals; we have six (6) new regions without regional hospitals; we do not have 5 infectious disease control centres dotted across the country; and we do not have enough testing and isolation centres for diseases like COVD-19.
“We must urgently do something about this. That is why government has decided to undertake a major investment in our healthcare infrastructure, the largest in our history. We will this year begin constructing eighty-eight (88) hospitals in the districts without hospitals.”
One critical question is: was government’s decision to undertake such massive investments in the health system based on evidence? From the outset, President Akufo-Addo had hinted that crises always present the opportunities to correct situations, and that our health system would never be the same after COVID-19. As stated earlier, the aim of evidence-based policymaking is to produce policies which deal with problems and are forward-looking, rather than a response to short-term pressure that tackles symptoms and not cause.
Few would disagree that COVID-19 has exposed our health system and raised the urgent need for investment in the health system. Certainly, we have learnt and are still learning lessons from COVID-19. What matters is our response to the knowledge and learning we are gathering from the pandemic. On that score, the plans to construct 88 district hospitals, six new regional hospitals and three isolation hospitals for the three zones of Ghana appears to be an apt policy response; but government’s opponents think the planned intervention is overly ambitious and impossible.
In cases like the COVID response, government and the opposition need to speak with one voice. It is unfortunate that the opposition in Ghana often disagrees with any social intervention government initiates, no matter its benefit for the majority of people. The opposition is becoming too predictable in its stance against social interventions. One of the emerging trends in contemporary policy and development thinking is building greater degrees of cooperation between and among stakeholders.
Of course, in cooperation there is an expectation that parties will not behave opportunistically. The opposition is probably thinking that government’s decision to construct 88 district hospitals and six regional hospitals is motivated by the December 2020 elections. But the question remains, should government not take public action to remedy a public health situation caused by the pandemic? We understand that public action includes not only what is done by the state but also private sector contribution, with the state coordinating the response.
(***The writer is a Communications and Development Management Specialist, and a Social Justice Advocate. All views expressed in this article are my personal views and do not represent those of any organisation. (Email: [email protected]. Mobile: 0202642504 0243327586/0264327586)