Stakeholders perspective of, and experience with contact tracing for COVID-19 in Ghana: A qualitative study among contact tracers, supervisors, and contacts

Abstract

Background Ghana confirmed the first two cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) infection on 12th March 2020. Following this, the government introduced routine and enhanced contact tracing to identify, quarantine, and test contacts for COVID-19. This study, therefore, intends to document the experiences of contact tracers, their supervisors, during COVID-19 containment in Ghana. Methods Purposive sampling was used to select twenty-seven (27) participants; sixteen contact tracers, six supervisors, and five contacts of COVID-19 cases for an in-depth interview using a topic guide. These interviews were conducted on a phone or face-to-face basis whilst maintaining physical distancing protocol. All these were recorded and transcribed verbatim. Then, QSR NVivo 12 was used to analyse the data thematically. Results Contact tracers were selected based on their professional background and surveillance experience with other infectious diseases. They were trained before the first confirmed cases of COVID-19 in the country and before deployment. Deployment of contact tracers was in pairs to monitor contacts daily through physical visits or over the phone. Their activities included educating contacts about the condition, filling the symptoms diary, and providing psychological support. Contacts for COVID-19 were identified through case investigation, and their monitoring is done once a day despite the twice-daily requirement. Wherever a case was confirmed, enhanced contact tracing within a 2km radius was done. Furthermore, it was reported that some contacts were not adhering to the self-quarantine. In addition to this, other challenges included; unstable provision of PPEs and remuneration, refusal of some contact to test, delays in receiving test results, and poor coordination of the whole process. Conclusions The study concludes that contact tracing was generally perceived to be helpful in COVID-19 containment in Ghana. However, adhering to self-quarantine protocol had many challenges for both contact tracers and the contacts. Improving coordination and quick release of test results to contacts is necessary for COVID-19 containment. Lastly, the supply of Personal Protection Equipment and motivation needs to be addressed to help position the country well for effective contact tracing.

Community-Level Experiences, Understandings, and Responses to COVID-19 in Low- and Middle-Income Countries: A Systematic Review of Qualitative and Ethnographic Studies

“…Reusing surgical masks in lieu of available PPE and shifting resource allocations from chronic disease management to acute COVID-19 treatment without sufficient capacity were complaints made by patients and providers alike, illustrative of larger structural deficiencies and challenges [63]. A lack of PPE, funding shortfalls, and poor public sector coordination were identified as negative stressors on contact tracers working in Ghana, constraining public health efforts to trace potentially exposed members of the public [61]. Further exacerbating material constraints were examples of policy discordance at multiple state levels, translating into confusion and difficulties in implementing health programs on the ground [73].…”

“…Several examples of adaptive and resilient governance were identified by researchers in India and Ghana [61,73]. Thematically, successful public health interventions relied on intersectoral collaboration, building upon previous epidemic and outbreak experiences and the established health policy infrastructure, with a focus on community-level engagement, including contact tracing, "social surveillance", and volunteerism.…”

“…Despite the obvious challenges, predictors of success relied heavily on a communal sense of responsibility, playing-field equality, and building social capital through cooperation. Self-governance and first-hand experience with witnessing positive outcomes, such as patient recovery or community successes in reducing incidences, were important in building social capital and contributed to widespread social cohesion [61,73].…”

Health Policy and the Fight Against COVID-19: A Narrative Review of Ghana’s Response

“…This training, among other things, included the procedures for comprehensive screening for cases and handling of suspected cases. Additional training was also provided to a selected group of health professionals on contact tracing, referral of suspected cases, and documentation using structured contact tracing forms [23,26]. Training of healthcare providers towards contact tracing and increasing health surveillance has been well documented across the world as a public health intervention strategy to identify early, manage, and prevent the spread of COVID-19 [27][28][29].…”

“…To boost Ghana's testing capacity, the Ghana Health Service directed all contacts of positive cases to be tested at no cost [26,37]. Samples were aggregated and tested in groups (pool testing) which made testing more efficient.…”