Responding to the Call

GHSC-PSM Supports Ghana's Fight Against COVID-19

Date

September 30, 2022

The Government of Ghana committed to vaccinating at least 20 million Ghanaians (87 percent of the population) by the end of 2021.

On February 24, 2021, Ghana became the first country to receive the first shipment of COVAX vaccines (600,000 doses). While this was great news, the logistics challenges of deployment became immediately apparent. The government’s mass distribution effort was hindered by a lack of vehicles that could maintain the cold temperatures required to preserve vaccine quality. These challenges were compounded by a shortage of health service providers overall, including those involved in logistics management. Furthermore, the need for oxygen commodities surged with the rising COVID-19 hospitalizations, often outpacing the available supply.

Recognizing that overcoming COVID-19 would require a monumental effort by local and international stakeholders, the Government of Ghana, through the Ministry of Health, reached out to U.S. Agency for International Development (USAID), among others, to assist in addressing these challenges.

COVID-19 Vaccines Global Access (COVAX) is a worldwide initiative aimed at equitable access to COVID-19 vaccines directed by the GAVI Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations, and the World Health Organization, alongside key delivery partner UNICEF.

A focus on logistics

The USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project, on behalf of USAID, engaged with the MOH and the Ghana Health Service (GHS) Expanded Program on Immunization (EPI) and identified four critical logistics needs for successful COVID-19 vaccination deployment where the project could assist:

Cold chain vehicles to transport vaccines from Accra to regional cold rooms across the country.
Temperature monitoring tools to monitor and maintain the integrity of the vaccine cold chain.
Capacity building in vaccine logistics management for health practitioners.
Ability to produce and manage safe and cost-effective oxygen locally for COVID-19 patients requiring critical care.

Vaccine logistics management: Leveraging GhiLMIS

COVID-19 vaccine availability is heavily dependent on sound logistics management. For proper logistics management, access to accurate and timely data is key. To that end, GHSC-PSM provided technical assistance to the EPI to integrate vaccine logistics into the Ghana Integrated Logistics Management Information System (GhiLMIS) - a web-based electronic platform that is designed to support inventory visibility, demand, supply and management of health commodities in Ghana’s public sector. GhiLMIS was launched in February 2020 by GHS with support from USAID and the Global Fund to Fight AIDS, tuberculosis, and malaria.

To expand system usage, GHSC-PSM is collaborating with GHS to train about 600 EPI officers and logistics personnel who are responsible for COVID-19 vaccine management by December 2022. Those trained will record all vaccine transactions using the GhiLMIS, hence allowing for end-to-end data visibility and logistics decision-making; whiles ensuring transparency and accountability in the management of COVID-19 vaccines.

GHSC-PSM also seconded a vaccine logistics officer to the EPI to provide direct technical assistance to improve the supply management of vaccines and support overall program implementation.

“So far, we’ve been able to train all national officers and regional officers from all 16 regions, the training is being conducted for all officers at the district and facility level. Now the GhiLMIS will become the single tool for stock management of vaccines within the GHS.” Kwaku Dwomor Ankrah, National Vaccine and Cold Chain Manager, EPI.

“Now, with the click of a button, we are able to know where vaccines are and where they are not, this is helping us to maintain adequate stocks throughout the country.” Kwame Amponsah-Achiano Program manager, EPI.

Transport

Ghana is a large country with poor road networks in most regions, especially in the North. With just one van equipped to transport cold chain commodities, EPI distributions to Ghana’s 16 regions often took three to four weeks. GHSC-PSM contracted a private third-party logistics (3PL) company to expand EPI’s cold chain transport capacity. This was no small feat since only one out of the many 3PL companies in Ghana had just two trucks that could meet the cold chain requirement. The addition of the 3PL trucks expanded transport capacity four-fold as each 3PL truck was twice the size of the EPI van.

With three trucks now in the mix, GHSC-PSM worked with EPI to develop an optimized schedule to expedite nationwide distribution based on the routes and terrain. Working in conjunction with the EPI cold van, the 3PL trucks begin their distribution routes from the airport to the EPI cold room in Accra and subsequently to all 16 regional cold rooms and distribution centers. Optimized routing and expanded transport services allowed EPI to speed up the distribution cycle by 75 percent, reducing the time it took for a round of nationwide distributions from four weeks to one.

Since February 2021, USAID has been supporting Ghana’s fight against COVID-19 with over 12.1 million doses of COVID-19 vaccines. On behalf of USAID, GHSC-PSM supported the transport and distribution of an additional 6.5 million doses of vaccines from central to regional level to protect over 17 million Ghanaians against COVID-19.

Temperature Monitoring

Proper storage and handling are critical to maintaining vaccine integrity. Ghana can reach average outside temperatures of 43 degrees Celsius, so things can heat up quickly. Most COVID-19 vaccines require cold chain conditions (2 to 8 degrees Celsius) to keep them from degrading, while others can require as much as minus 60 to minus 90 degrees Celsius. Exposure to temperatures above the recommended ranges can reduce vaccine potency resulting in limited protection.

GHSC-PSM installed smart temperature monitors in the EPI cold van and 3PL trucks. A display on the truck dashboard makes drivers aware of any temperature excursions - information that logistics officers can also access remotely. These logistics officers maintain constant communication with drivers during transit to advise on mitigation measures should challenges arise. In the unlikely event of a temperature excursion, the drivers liaise with logistics officers to identify the closest health facility with proper refrigeration where vaccines could be offloaded and stored until the vehicle temperature challenges are resolved.

“We initially had some difficulty transporting the vaccines from the airport to the national cold room and from the national cold room to all the regional cold rooms. We reached out and GHSC-PSM came in handy to support us with additional cold van to transport our vaccines. They’ve also installed temperature monitoring devices in the vehicles; which is helping us to maintain the temperature of the vaccines during transit. It is something we’ve never had before, so we are really grateful.” Kwame Amponsah-Achiano Program manager, EPI.

Cold van loading COVID-19 vaccines from the national cold room to be delivered to the Northern region cold room. Photo credit: Mary Ekeh GHSC-PSM

Availability activates stakeholders

Availability of COVID-19 vaccines in the districts activates a multitude of stakeholders such as health facility staff who retrieve their COVID-19 commodities from the district health directorates, chiefs, opinion leaders, and religious leaders who organize community mobilization campaigns; and community health workers who visit homes and set up vaccination points at high traffic locations such as churches and mosques to bring services closer to the people they serve. GHSC-PSM and EPI are also joining forces to educate and mobilize the community to participate in the campaigns, in addition to conducting site monitoring and supervisory visits to ensure effective use of GhiLMIS for vaccine management and accountability.

As a result of the combined effort, about 62 percent of the population had received at least one dose of the vaccine with about 27 percent fully vaccinated as of September 2022.

“We always get vaccines when we get to the directorate, there hasn’t been a shortage of vaccines since we started.” Joyce Dankwa, Community Health Nurse, Ashanti Mampong Municipal Hospital.

Joyce Dankwa, vaccinating a client during a community outreach exercise. Photo credit: GHSC-PSM

Agartha Agyemang, a resident of Ashanti Mampong receives her 4th dose of COVID-19 vaccination during a community outreach campaign. Photo credit: GHSC-PSM

H.E. Stephanie S. Sullivan, U.S. Ambassador to Ghana, inspecting 02 plant at the GIDC Accra. Photo credit: GHSC-PSM

Localizing oxygen supply for rapid deployment

Supplemental oxygen (O2) is a lifesaving treatment for critically ill COVID-19 patients hence rapid availability is essential. Prior to COVID-19, the health sector in Ghana did not have enough oxygen cylinders at health facilities and those that were available provided medical oxygen at about 10 liters per minute to manage respiratory conditions. However, with the onset of COVID-19, health care providers realized that patients who had difficulty in breathing as a result of COVID-19 complications required oxygen with higher pressure i.e., at least 30 liters per minute to be able to manage their condition. The system could not cope with the flow rate needed to manage COVID-19.

This situation was further complicated by the surge in cases – due in large part to the Delta variant (B.1.617.2) and hospitalizations, coupled with the lack of skilled health care providers to manage critical cases. Health facilities were relying heavily on the private sector to provide expensive oxygen; which also resulted in huge financial burden to the sector. The MOH called on USAID and its implementing partners for support to be able to produce sustainable, cost effective and quality medical oxygen to manage COVID-19 and other related diseases.

To that end, GHSC-PSM worked with GHS, Jhpiego, and the Ministry of Health to procure, deliver and install four Pressure Swing Adsorption (PSA) oxygen generating plants for the government of Ghana, in addition to 28 high-flow, high-pressure oxygen concentrators at four sites: the Ghana Infectious Disease Centre Accra, Cape Coast Municipal Hospital, Kumasi South Hospital and Tamale West Hospital. These sites were selected to ensure regional equity and accessibility to all critical care centers across the nation. Each of the four PSA plants has the capacity to produce 250 liters of oxygen per minute, enough to manage approximately 25 severely ill patients per day.

GHSC-PSM monitored pre-installation and provided non-clinical training and technical assistance to 45 technical staff from the facilities on usage of the PSA plants. The project continues to work with GHS to continuously monitor the function and usage of the equipment at the sites. The oxygen support system is enabling Ghana to provide life-saving care for COVID-19 patients, and contributing to the relatively low COVID-19 death toll in the country which is 1,459 deaths out of 168,116 reported cases, representing 0.9 percent as of August 2022.

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