A backpack containing simple but essential medicines and supplies is all Antoinette Nuselie Segla, principal community health nurse, needs to embark on a health outreach in Fadama, a populous community in the north of Ghana’s capital, Accra.

Segla and her team of three other nurses attend to more than 50 caregivers and their children during clinic days at the compound of the Chief Imam of Fadama. That was until the onset of the COVID-19 pandemic. Fear of contracting the virus has kept people away from seeking health services.

“When they (community) heard about COVID-19, they refused to come and we were also a bit scared initially because we didn’t have proper personal protective equipment to work with, no buckets to wash our hands and few chairs to ensure proper physical distancing,” Segla explains.

The pandemic has affected immunization services. In April the Ghana Expanded Programme on Immunization suspended yellow fever preventive mass vaccination campaign. Community health outreach, which constitutes about 45% of the country’s immunization strategy, was also disrupted.

When the three-week partial lockdown of the capital Accra was lifted, Segla and her team decided to resume services. By holding smaller but frequent clinics, phoning parents whose children missed vaccination and by scheduling home visits where necessary, the team has ensured children in their community are immunized.

“Ours is preventive healthcare, so if they are not coming because of COVID-19, we have to go to them. It is the nature of our work, and that is what we have signed up for and we are committed to doing it,” Segla says. On average the team visits roughly 20 households in a day and attends to around five children per family.

In Ghana, immunizations have contributed to a reduction in neonatal, infant and under-five mortality rates. Measles, for instance, drastically dropped from over 23 000 cases in 2000 to just 34 in 2018, while neonatal tetanus has been eliminated in the country since 2011. Ghana has also not reported any cases of wild polio since 2008 due to routine immunization and polio vaccination campaigns.

“Availing my child for vaccination is the best I can do to protect him and that is why I welcome the nurses into my home,” says Aboagyewaa Osei, a mother of a three-year-old baby. “They come wearing masks and gloves so there is no cause for alarm.”

For Osei, allowing the nurses to do their job amid COVID-19 is her way of showing gratitude for the risk they are taking to provide essential services to children. 

The country has so far seen a 10% drop in immunization coverage, says Dr Kwame Amponsa-Achiano, manager of the Extended Programme on Immunization of the Ghana Health Service.

In the first quarter of 2020, around 21 000 children missed the second dose of the measles-rubella vaccine and over 50 000 missed yellow fever vaccination. If the trend continues due to the COVID-19 pandemic, Ghana will have about 200,000 unvaccinated children by December 2020, according to projections by the World Health Organization (WHO) in Ghana.

WHO in Ghana supports the country’s Expanded Programme on Immunization with guidelines on safely carrying out immunization during the COVID-19 pandemic.

The guideline comprises reproductive, maternal, newborn, child and adolescent health and focuses on the essential services which must be delivered in all facilities. It outlines measures health workers should take in order to prevent the spread of the pandemic.

Fred Osei Sarpong, technical officer in charge of immunizations at the WHO Ghana, says the guideline also summarizes the basic protective equipment that must be made available at all vaccination sessions.

“Direct support has also been provided to regions to enable the sustainability of immunization services in the context of COVID-19,” he adds.

Sarpong says constant monitoring helps identify facilities, districts and regions which have been hard hit by the pandemic so that appropriate action is taken. This, he says, is very important as a build-up of unvaccinated children could lead to outbreaks of vaccine-preventable diseases. “The impact of vaccine-preventable disease outbreaks may even be more damaging than COVID-19 especially to children who would otherwise have been vaccinated.”

“We have not halted routine immunization because of COVID-19,” Dr Amponsa-Achiano explains. “We are doing it in line with COVID-19 measures and WHO guideline and it is gradually picking up.”

He says other regions such as Bono, Bono East, North East and Northern have all been able to vaccinate more children through community outreach and other strategies such as those used by Segla and her team.

“We want to get back to our campaigns by August because the more we wait the worse it will become,” says Dr Amponsa-Achiano.