REPUBLIC OF GHANA MINISTRY OF HEALTH GHANA COVID-19 EMERGENCY PREPAREDNESS AND RESPONSE PROJECT ADDITIONAL FINANCING (P174839) STAKEHOLDER ENGAGEMENT PLAN (SEP) OCTOBER 2020 Contents LIST OF ACRONYMS 4 1.INTRODUCTION/PROJECT DESCRIPTION 5 2.PROJECT DESCRIPTION 6 Component 1: Emergency COVID-19 Response 6 Component 2: Strengthening Multi-sector, National Institutions and Platforms for Policy Development and Coordination of Prevention and Preparedness using One Health approach 8 Component 3: Community Engagement and Risk Communication (US$ 7.4 million equivalent) 8 Component 4: Implementation Management, Monitoring and Evaluation and Project Management 9 Rational for the Additional Financing 9 Objectives of the Stakeholder Engagement Plan (SEP) 12 3.STAKEHOLDER IDENTIFICATION AND ANALYSIS 13 Methodology 13 Affected parties 14 Other interested parties 15 Disadvantaged / vulnerable individuals or groups 16 4.STAKEHOLDER ENGAGEMENT PROGRAM 23 Summary of stakeholder engagement 23 Summary of project stakeholder needs and methods, tools and techniques for stakeholder engagement 23 Prevention of contagion risks in consultation processes 24 Stakeholder engagement plan 25 Future of the project 42 5.RESOURCES AND RESPONSIBILITIES FOR IMPLEMENTING STAKEHOLDER ENGAGEMENT ACTIVITIES 42 2 Resources 42 Responsibilities . 42 6.GRIEVANCE MECHANISM 43 Description of GRM 43 7.MONITORING AND REPORTING 44 ANNEX 1: KEY COMMUNICATION MESSAGES 45 ANNEX 2: PUBLIC EDUCATION AND MEDIA ENGAGEMENT PLAN 49 ANNEX 3: SOCIAL MEDIA PLAN 54 ANNEX 4: COMMUNITY ENGAGEMENT AND ANTI-STIGMA CAMPAIGN 56 3 List of Acronyms AF Additional Financing CBOs Community Based Organisations CIC Community Information Centres DFID Department for International Development FBOs Faith-based Organisations GHS Ghana Health Service HPD Health Promotion Division ISD Information Services Department MoH Ministry of Health MMDAs Metropolitan, Municipal and Districts Assemblies MoI Ministry of information NADMO National Disaster Management Organization NCCE National Commission on Civic Education NGOs Non-Governmental Organisations PPE Personal Protective Equipment RCCE Risk Communication and Community Engagement SBCC Social and Behaviour Change Communication UN United Nations UNICEF United Nations Children's Fund UNDP United Nations Development Programme USAID United States Agency for International Development WHO World Health Organization 4 1. Introduction/Project Description An outbreak of the coronavirus disease (COVID-19) caused by the 2019 novel coronavirus (SARS- CoV-2) has been spreading rapidly across the world since December 2019, following the diagnosis of the initial cases in Wuhan, Hubei Province, China. Since the beginning of March 2020, the number of cases outside China has increased thirteenfold and the number of affected countries has tripled. On March 11, 2020, the World Health Organization (WHO) declared a global pandemic as the coronavirus rapidly spreads across the world. Ghana recorded its first confirmed case of COVID-19 on 12th March 2020 and the number of cases have since risen to 44,205 with 42,777 recoveries and 276 deaths as of 30th August 2020. Over the coming months, the outbreak has the potential for greater loss of life, significant disruptions in global supply chains, lower commodity prices, and economic losses in both developed and developing countries. The COVID-19 outbreak is affecting supply chains and disrupting manufacturing operations around the world. Economic activity has fallen in the past eight months, especially in Ghana, and is expected to remain slow for months. The outbreak is taking place at a time when global economic activity is facing uncertainty and governments have limited policy space to act. The length and severity of impacts of the COVID-19 outbreak will depend on the projected length and location(s) of the outbreak, as well as on whether there are concerted, fast track response to support developing countries, where health systems are often weaker. With proactive containment measures, the loss of life and economic impact of the outbreak could be arrested. It is hence critical for the international community to work together on the underlying factors that are enabling the outbreak, on supporting policy responses, and on strengthening response capacity in developing countries - where health systems are weakest, and hence populations most vulnerable. The Government of Ghana, through the Ministry of Health (MOH), is currently implementing the Ghana COVID-19 Emergency Preparedness and Response Project (P173788) which was prepared under the global framework of the World Bank COVID-19 Response financed under the Fast Track COVID-19 Facility (FTCF), using the Multiphase Programmatic Approach (MPA). The Project Development Objective is to prevent, detect and respond to the threat posed by COVID-19 and strengthen national systems for public health preparedness in Ghana. The project has four main components, which are (i) Emergency COVID-19 Response; (ii) Strengthening Multi-sector, National Institutions and Platforms for Policy Development and Coordination of Prevention and Preparedness using One Health approach; (iii) Community Engagement and Risk Communication; and (iv) Implementation Management, Monitoring and Evaluation and Project Management. 5 2. Project Description The Ghana COVID-19 Emergency Preparedness and Response Project has been under implementation over the past 5 months. The Project components are described below. Component 1: Emergency COVID-19 Response Sub-Component 1.1: Case Detection, Confirmation, Contact Tracing, Recording and Reporting This sub-component would help (i) strengthen disease surveillance systems at points of entry (POEs), public health laboratories, and epidemiological capacity for early detection and confirmation of cases; (ii) combine detection of new cases with active contact tracing; (iii) support epidemiological investigation; (iv) strengthen risk assessment; and (v) provide on-time data and information for guiding decision-making and response and mitigation activities. The project will support surveillance systems strengthening for emerging infectious diseases by using a risk-based approach. The surveillance system comprises the following components (i) disease reporting system for the priority infectious diseases; (ii) laboratory investigation of priority pathogens; (iii) community event-based surveillance; and (iv) contact tracing, rumour surveillance and verification. Well-structured epidemiological studies and surveillance programs would be integrated with the disease control measures, which would be then adjusted and improved as new information becomes available. Strengthening animal and human disease surveillance and diagnostic capacity would be supported through the following activities: improving health information flow among relevant agencies and administrative levels; detection, reporting and follow-up of reported cases; public and community-based surveillance networks; routine serological surveys; and improving diagnostic laboratory capacity. Support would be provided to strengthen the network of the designated laboratories for COVID-19. With the existing Noguchi Memorial Institute for Medical Research (NMIMR) and the Kumasi Collaborative Centre for Research (KCCR) would investigate pathogens under the One Health approach and lead infectious diseases research and development in the country. Sub-Component 1.2: Containment, Isolation and Treatment An effective measure to prevent contracting a respiratory virus such as COVID-19 would be to limit, as much as possible, contact with the public. Therefore, the project would support the government for implementation of immediate term responses, i.e., classic “social distancing measures� such as school closings, escalating and de-escalating rationale, in compliance with the IHR. A number of holding, isolation, quarantine and treatment centres have been identified across the country. This sub-component supports the leasing, renting, establishment and refurbishing of designated facilities and centres to contain and treat infected cases in a timely manner. Support would be provided to ensure the operations of effective case containment and treatment with IPC measures to be enforced at all time with necessary equipment, commodities and basic infrastructure. Psychosocial and essential social support would be provided to those who are in isolation and quarantine centres with consideration of gender sensitivity and special care for people with disabilities and/or chronic conditions. Additional trained health workers would be deployed to the designated isolation/treatment centres for COVID-19 case 6 management, not to disrupt the general health services. It is important to clarify that the Bank will not support the enforcement of such measures when they involve actions by the police or the military, or otherwise that require the use of force. Financing would also be made available to develop guidelines on social distancing measures (e.g., in phases) to operationalize existing or new laws and regulations, support coordination among sectoral ministries and agencies, and support the MOH on the caring of health and other frontline personnel involved in pandemic control activities with IPC measures and psychosocial support when distressed. Compensation payments, life and health insurance for staff working in the frontlines of fighting the disease will be paid. Sub-Component 1.3: Social and Financial Support to Households Patients and their families needing support, especially those who are isolated or quarantined would be provided psychosocial counselling support, food-baskets and feeding during the isolation, quarantine and treatment period. Active social support would also be provided to reduce the impact of COVID-19 on the finances of directly affected to families. This will include cash transfers and support to access and use needed health services. To this end, financing would be provided for fee-waivers to access medical care and cash transfers to mitigate loss of household income due to job losses that may result from the closure of firms and enterprises, informal sector businesses, as well as government agencies, during the COVID-19 outbreak. The government would develop a COVID-19 Compensation Benefit Framework to roll out this sub- component within a month of this project becoming effective. Sub-Component 1.4: Health System Strengthening Human resource and institutional capacity are key to addressing the COVID-19 outbreak as well as to strengthen health systems to ensure the constant provision of general health services without disruption. This activity is related to training and capacity building for preparedness and response as well as service delivery guided by the different pillars and activities of the NAPHS and the UHC Roadmap. These include: (i) training of contact tracing coordination teams and networks at the national, regional and district levels; (ii) recruitment of technical experts and human resources for technical work and supportive supervision; (iii) training of district and sub-district level health workers and volunteers for surveillance and case management; (iv) training of laboratory personnel to build diagnostic capacity for COVID-19 at the subnational (regional/district) level; (v) orientation of POE staff for screening people entering the country at designated points of entry (airports, border crossings, etc.); (vi) capacity building for call/hotline centres; (vii) strengthening PHEM and community- and event-based surveillance for COVID-19; (vii) capacity building and orientation of national, regional and district Rapid Response Teams (RRTs), Doctors, Physician Assistants, staff of quarantine facilities, surveillance and point of entry teams across country and particularly in treatment centres at all border districts; and (viii) simulation exercises and scenarios conducted in facilities and communities marked as Demographic Surveillance Sites (DSS) sites and quarantine facility to ensure that facilities measure up to the required standards. 7 Component 2: Strengthening Multi-sector, National Institutions and Platforms for Policy Development and Coordination of Prevention and Preparedness using One Health approach The main implementing agency of this Project will be MOH, working in collaboration with the Ghana Health Service (GHS), other ministries, departments and agencies. The project would support costs associated with project coordination. The country has set up an Inter-Ministerial Coordinating Committee (IMCC) and an Emergency Operations Centre (EOC) under GHS is operational. These bodies are the main coordinating points for the COVID-19 preparedness and response in Ghana. This component would also support implementation of the IHR as incorporated in National Action Plans for Health Security. Such support would include: (i) technical support for strengthening governance and updating policies and plans; (ii) support for institutional and organizational restructuring to respond to emergencies such as pandemic diseases; (iii) Operating Costs of the IMCC, EOC, quarantine centres and the Ghana Centre for Disease Control (CDC) including transport, communication support equipment and other administrative-related costs for coordination meetings and supportive supervision and monitoring; and (vi) contracts for private management of newly established infectious disease centres and medical villages. Support would be also provided to MOH with oversight from IMCC to develop standardized life insurance package, overtime and hazard payments, which are to be made for those directly involved in surveillance and case management. The component would support enhancing diseases information systems through development of a disease surveillance information system, as part of the disease control program. The aim is to provide better analytical capacity to Ghana; and to participate in global disease information sharing, complying with national obligations as members of OIE and WHO. A strengthened national system will contribute progressively towards better global and regional control. The information system and data management would be linked to rapid and standardized methods of routine analysis of surveillance data, which would demonstrate important changes in the health situation, and promptly supply this information to field personnel. Component 3: Community Engagement and Risk Communication (US$ 7.4 million equivalent) Risk Communication: The project will focus on risk communication and community engagement at the points of entry, engaging key decisions makers and stakeholders, community leadership and opinion leaders. The first level will be points of entry communication targeting travellers. Mass communication and social media will be key in bringing the message to individual households using various methods, including community van announcements for community sensitization. A series of executive briefings will be held for parliament and the media. The plan focuses on both the process and development of broadcast and communication support materials including billboards, printing of leaflets and pocket cards, epidemiological bulletins, TV documentaries and payment for broadcast of infomercials, civic education and faith-based organization engagements. Where needed, technical assistance will be procured, and technical 8 facilitator and expert commentator allowances paid for discussants on key media outlets. Community Engagement: Various approaches for community engagement including: (i) surveillance, home visits and contact tracing at the district, sub-district and community levels; (ii) risk communication through a well-established network of call centre, community health officers and community volunteers; and (iii) community mass communication and announcements and outreach services and sensitization through community announcement centres, sensitization, information sharing and counter misconceptions information sharing. Support provided under this sub-component would be supplementary to support from the GARID-CERC. Component 4: Implementation Management, Monitoring and Evaluation and Project Management Project Management: activities of the Project include: (a) providing support for the strengthening of public structures for the coordination and management of the Project, including central and local (decentralized) arrangements for the coordination of Project activities; (b) the carrying out of financial management and procurement requirements of the Project; (c) the recruitment of additional staff/consultants responsible for overall administration, procurement, and financial management under country specific projects; and (d) the financing of project coordination activities. Monitoring and Evaluation: The project activities include a monitoring and prospective evaluation framework for the project and for operations at the country and sub-regional or regional levels. For operations at the country and sub-regional or regional levels, the monitoring and prospective evaluation will provide a menu of options to be customized for each operation, together with performance benchmarks. The activities include: (a) monitoring and evaluating prevention and preparedness; (b) building capacity for clinical and public health research, including joint-learning across and within countries, and training in participatory monitoring and evaluation at all administrative levels, such as: (i) carrying out of evaluation workshops; (ii) the development of an action plan for monitoring and evaluation; and (iii) the replication of successful models; (c) monitoring and evaluation activities, such as supporting the Project Implementation Unit (PIU) in the monitoring of project implementation through, inter alia: (i) collection of data from line ministries and other implementation agencies; (ii) compilation of data into progress reports of project implementation; (iii) carrying out of surveys; and (iv) carrying out of annual expenditure reviews; and (d) carrying out of an impact evaluation on quantitative and qualitative aspects of the project interventions, including the collection of qualitative information through site-visit interviews, focus groups and respondent surveys. Rational for the Additional Financing The government on 12th October 2020 requested for Additional Financing of US$130 million to support the government to scale up response to COVID-19 given the fast-evolving nature of the pandemic, the high cost of inputs and the need to expand the scope of interventions. The 9 additional financing (AF) is expected to significantly ameliorate the deficits in the budgetary allocation to the health sector to fight the pandemic and save lives. The scope and the components envisaged under the AF are fully aligned with the Bank’s COVID -19 Fast Track Facility, and the parent project. The AF will scale up interventions including case finding, testing, and containment, and treatment; social support to vulnerable groups; provide and sustain essential primary healthcare and nutrition services; strengthen systems development for emergency preparedness and response and strategy for vaccine deployment; and effective communication and outreach to increase awareness and “vaccine literacy�. This includes the cost of refurbishment of facilities for isolation and treatment, personal protection equipment and the volume of contact tracing. These activities are expected to lead to a more targeted and efficient provision of necessary health services during the crisis. The table below shows the project components and the cost summary for previous, AF, and current totals. Table 1: Project components under the additional financing Component Amount P173788 Amount P174839 Project Total Emergency COVID-19 Response US$21.50 million US$107.36 million US$128.86 million Strengthening Multi-sector, National US$3.40 million US$9.54 million US$12.94 million Institutions and Platforms for Policy Development and Coordination of Prevention and Preparedness using One Health approach Community Engagement and Risk US$7.40 million US$1.90 million US$9.30 million Communication Implementation Management, US$2.70 million US$1.20 million US$3.90 million Monitoring and Evaluation and Project Management systems strengthening vaccine US$30.00 million US$30.00 million deployment Total US$35 million US$150 million US$185 million 2.5.1: Stakeholders Consulted as part of the AF Preparation process Stakeholder consultations were conducted as part of the preparation of the AF. this was to obtain feedback on the implementation of the parent project and to seek input into the AF activities. This is to ensure among others that feedback and concerns of stakeholders are addressed in the AF and the project interventions reach the most vulnerable in society. Feedback and input from stakeholders informed the design of the AF. Stakeholders consulted is provided in Table 2 below: Table 2. Stakeholders consulted as part of AF preparation No. Name of Institution 1 Ghana Society of the Physically Disabled 2 Coalition of NGOs in Health 10 3 The 4 major Political parties: New Patriotic Party (NPP), National Democratic Congress (NDC), Peoples National Congress (PNC) and Convention Peoples Party (CPP) 4 Queen Mothers Association of Ghana 5 Private Publishing Association of Ghana 6 Ministry of Education 7 Inter-Ministerial Coordinating Council – the Ministries of Finance, Health, Local Government, Gender, Children and Social Protection, Information, Transport, Interior and Defense, and Office of the President. 8 National Commission for Civic Education Health Agencies consulted: 9 Ghana Health Service 10 Tamale Teaching Hospital 11 Korle-Bu Teaching Hospital 12 Cape Coast Teaching Hospital 13 Ho Teaching Hospital 14 Komfo Anokye Teaching Hospital 15 Centre for Plant Medicine Research 16 Foods and Drug Authority 17 Pharmacy Council Ghana 18 Psychology Council 19 Nursing and Midwifery Council 20 Medical and Dental Council 21 Health Facilities Regulatory Agency 22 National Health Insurance Authority 23 Traditional Medicine Practice Council 24 Ghana College of Physicians and Surgeons 25 Allied Health Professions Council 26 Ghana College of Pharmacists 27 Mental Health Authority 28 Ghana College of Nurses & Midwives 29 Christian Health Association of Ghana 30 Ahmadiya Muslim Mission 31 Ghana Association of Quasi Government Health Institutions 32 National Blood Service 33 National Ambulance Service 34 Mortuary Services Agency 11 Objectives of the Stakeholder Engagement Plan (SEP) The overall objective of this SEP is to define a program for stakeholder engagement, including public information disclosure and consultation under the Ghana COVID-19 Emergency Preparedness and Response Project. The SEP outlines the ways in which the project team will communicate with stakeholders and includes a mechanism by which people can raise concerns, provide feedback, or make complaints about project and any activities related to the project. The involvement of the local population is essential to the success of the project in order to ensure smooth collaboration between project staff and local communities and to minimize and mitigate environmental and social risks related to the proposed project activities. In the context of infectious diseases, broad, culturally appropriate, and adapted awareness raising activities are particularly important to properly sensitize the communities to the risks related to infectious diseases. The specific objectives of the SEP are to ensure that Government is able to; i. Establish a systematic approach to stakeholder engagement that will help it identify stakeholders, build and maintain a constructive relationship with them, especially project affected parties; ii. Assess the level of stakeholder interest and support for the project and to enable stakeholders’ views to be taken into account in project design and environmental and social performance; iii. Promote and provide means for effective and inclusive engagement with project- affected parties throughout the project life cycle on issues that could potentially affect them; iv. Ensure that appropriate project information on environmental and social risks and impacts is disclosed to stakeholders in a timely, understandable, accessible, and appropriate manner and format; v. Provide project-affected parties with accessible, inclusive, and culturally sensitive means to raise issues and grievances, and allow the Government to respond to and manage such grievances effectively. 12 3. Stakeholder Identification and Analysis Project stakeholders are defined as individuals, groups or other entities who: (i) are impacted or likely to be impacted directly or indirectly, positively or adversely, by the Project (also known as ‘affected parties’); and (ii) may have an interest in the Project (‘interested parties’). They include individuals or groups whose interests may be affected by the Project and who have the potential to influence the Project outcomes in any way. Cooperation and negotiation with the stakeholders throughout the Project development often also require the identification of persons within the groups who act as legitimate representatives of their respective stakeholder group, i.e. the individuals who have been entrusted by their fellow group members with advocating the groups’ interests in the process of engagement with the Project. Community representatives may provide helpful insight into the local settings and act as main conduits for dissemination of the Project-related information and as a primary communication/liaison link between the Project and targeted communities and their established networks. Verification of stakeholder representatives (i.e. the process of confirming that they are legitimate and genuine advocates of the community they represent) remains an important task in establishing contact with the community stakeholders. Legitimacy of the community representatives can be verified by talking informally to a random sample of community members and heeding their views on who can be representing their interests in the most effective way. Methodology In order to meet best practice approaches, the project will apply the following principles for stakeholder engagement: • Openness and life-cycle approach: public consultations for the project(s) will be arranged during the whole life-cycle, carried out in an open manner, free of external manipulation, interference, coercion or intimidation; • Informed participation and feedback: information will be provided to and widely distributed among all stakeholders in an appropriate format; opportunities are provided for communicating stakeholders’ feedback, for analyzing and addressing comments and concerns; information will be provided to women and other vulnerable groups like old age persons, disabled, children etc. in a manner accessible to them to ensure their effective participation and feedback • Inclusiveness and sensitivity: stakeholder identification will be undertaken to support better communications and build effective relationships. The participation process for the projects is inclusive. All stakeholders at all times will be encouraged to be involved in the consultation process. Equal access to information will be provided to all stakeholders. Sensitivity to stakeholders’ needs is the key principle underlying the selection of engagement methods. Special attention will be given to vulnerable groups, in particular 13 women, youth, elderly, persons with disabilities and the cultural sensitivities of diverse ethnic groups. For the purposes of effective and tailored engagement, stakeholders of the proposed project(s) can be divided into the following core categories: • Affected Parties – persons, groups and other entities within the Project Area of Influence (PAI) that are directly influenced (actually or potentially) by the project and/or have been identified as most susceptible to change associated with the project, and who need to be closely engaged in identifying impacts and their significance, as well as in decision-making on mitigation and management measures; • Other Interested Parties – individuals/groups/entities that may not experience direct impacts from the Project but who consider or perceive their interests as being affected by the project and/or who could affect the project and the process of its implementation in some way; and • Vulnerable Groups – persons who may be disproportionately impacted or further disadvantaged by the project(s) as compared with any other groups due to their vulnerable status1, and that may require special engagement efforts to ensure their equal representation in the consultation and decision-making process associated with the project. Affected parties Affected Parties include local communities, community members and other parties that may be subject to direct impacts from the Project. Specifically, the following individuals and groups fall within this category: • Ministry of Health • Ghana Health Service • Metropolitan Municipal and District Assemblies • COVID-19 infected people • People under COVID-19 quarantine • Relatives of COVID-19 infected people • Relatives of people under COVID-19 quarantine • Neighbouring communities to laboratories, quarantine centres, and screening posts • Workers at construction sites of laboratories, clinics, quarantine centres and screening posts 1 Vulnerable status may stem from an individual’s or group’s race, national, ethnic or social origin, colour, gender, language, religion, political or other opinion, property, age, culture, literacy, sickness, physical or mental disability, poverty or economic disadvantage, and dependence on unique natural resources. 14 • People at COVID-19 risks (travellers, inhabitants of areas where cases have been identified, etc.) • Residents, business entities, and individual entrepreneurs in the area of the project that can benefit from the employment, training and business opportunities; • Public Health Workers • Health-care providers (e.g., National Health Service, hospitals, community health centres, pharmacies, etc.) • Municipal waste collection and disposal workers • Key policymakers (government ministries, agencies, departments that play a critical to COVID-19 response measures, especially health sector actors) • Traditional leaders, including chiefs and queen mothers • Community leaders and organizations Other interested parties The projects’ stakeholders also include parties other than the directly affected communities, including: • Parliament • Judiciary • Ministry of Finance • Ministry of Information • Traditional media (national and local) • Participants of social media • Ghana AIDS Commission • Africa CDC, WHO and other development partners who directly support COVID-19 response • Other relevant national government sectors (such as ministries, departments and agencies in education, water and sanitation, employment and labour, agriculture, inner city and zongo development, gender and social protection, social welfare, NADMO, transportation, interior, etc.) • Politicians • Other national and international health organizations (particularly those that support health sector such as WHO, UNICEF, UNDP, WHO, USAID, DFID). • Associational groups at both national, regional levels, such as the Ghana Medical Association, Pharmaceutical Council, Trades Union Congress, teachers’ unions, health workers unions, farmers associations, market women’s associations, etc. • Other local and international NGOs (who may have strong relationships within communities) • Businesses with international links 15 • Local government actors such as municipal and metropolitan district assemblies • Security Agencies/Personnel • Religious community- Faith-based organisations Academia • Airline and border control staff • Airlines and other international transport business • Civil Society Organizations • The public at large Disadvantaged / vulnerable individuals or groups The project activities may disproportionately affect disadvantaged or vulnerable individuals and groups who often do not have a voice to express their concerns or understand the risk and impacts of COVID-19 pandemic. The vulnerability may stem from person’s origin, gender, age, disability and health condition, economic deficiency and financial insecurity, disadvantaged status in the community (e.g., minorities or fringe groups), dependence on other individuals or natural resources, etc. Engagement with the vulnerable groups and individuals often requires the application of specific measures and assistance aimed at their facilitating their participation in the project-related decision making so that their awareness of and input to the overall process are commensurate to those of the other stakeholders. Within the Project, the vulnerable or disadvantaged groups include but not limited to the following: • Elderly • Illiterate people • People with disabilities • Homeless people • Women and girls particularly young women head potters (Kayayie) • People in Low Income/slum communities • Residents in remote or inaccessible areas • Patients with chronic diseases or pre-existing conditions • Female-headed households • Children, particularly from poor families The MoH/GHS and other relevant government agencies will engage vulnerable groups including disability organisations, women’s and other vulnerable groups throughout the project implementation through appropriate and culturally sensitive approaches outlined in Tables 3 and 4 below. Stakeholder Analysis Stakeholder analysis is an important requirement during the preparation and updating of the SEP as it helps in identifying the stakeholder groups that are likely to affect or be affected by the 16 project activities and sorting them according to their impact on the project and the impact the project activities on the different category of stakeholders. It also helps in shaping the design of stakeholder consultation activities by specifying the role(s) of each stakeholder group thereby helping in determining which stakeholders to engage and when. It is an ongoing process which may evolve as new stakeholders are introduced to the project. Table 3: Stakeholder Analysis Stakeholder Group(s) Role in project Interest Influence Affected Parties Ministry of Health and Government implementing agency High High Ghana Health Service Ministry of Information government communication and information High High dissemination on COVID-19 NCCE Public education and information dissemination on High Moderate COVID-19 Ministry of Sanitation Implementation of CERC component of the project, High Moderate and Water Resources provision of water and sanitation services including the provision of government subsidies on water to citizens Metropolitan Municipal Support in the implementation of project High Moderate and District Assemblies components in their councils Support dissemination of information on government COVID-19 response and updates • Collection and disposal of medical wastes • Enforcement of protocols for waste collection, disposal, and management COVID-19 infected Recipients of information on COVID-19 treatment ; High Low persons Cooperate and provide support to health authorities in surveillance and contact tracing Healthcare • Provision of care and support including required High High Workers/frontline information to COVID-19 patients workers (at national, • Adhere to all protocols in the treatment and regional and district management of COVID-19 levels) Persons at COVID-19 • Recipients of required information on COVID-19 High Low risks (travelers, including their risks levels and statuses and inhabitants of areas displaying responsible behaviour where cases have been • Adhere to COVID-19 protocols on social distancing identified, etc.) and other directives/advice Persons under COVID- • Recipients of required information on COVID-19 High Low 19 quarantine, • Cooperate and provide support to health including workers in authorities in surveillance and contact tracing the quarantine • Adhere to COVID-19 protocols on social distancing facilities and other directives/advice 17 Stakeholder Group(s) Role in project Interest Influence Patients in • Recipients of information on COVID-19 relevant to High Low holding and, treatment occupants of holding centers centers • Cooperate and provide support to health authorities in surveillance and contact tracing • Adhere to COVID-19 protocols on social distancing and other directives/advice Relatives of COVID-19 • Recipients of information about their infected Moderate Low infected persons family members • Cooperate and provide support to health authorities in surveillance and contact tracing • Adhere to COVID-19 protocols on social distancing and other directives/advice Relatives of persons • Recipients of information about their family Moderate Low under COVID-19 members under quarantine quarantine • Cooperate and provide support to health authorities in surveillance and contact tracing • Adhere to COVID-19 protocols on social distancing and other directives/advice Waste collection and • Collection and disposal of medical wastes Moderate Moderate disposal workers • Adhere to protocols for waste collection, disposal, and management Communities • Recipients of information about laboratories, High Moderate neighboring quarantine centers, and screening posts in their laboratories, neighborhood quarantine centers, and • Adherence to safety protocols screening posts Contractors • Recipients of information available contracts High Moderate • Information on E&S and other SOP at construction sites • Adhering to social distancing directives/advice Workers at • Recipients of information about the SOPs High Moderate construction sites of governing construction sites of laboratories, laboratories, quarantine centers and screening posts quarantine centers and • Adhering to social distancing directives/advice screening posts Community leaders, • Recipients of information on COVID-19 applicable to Moderate High religious leaders, their localities. traditional healer • Influencers /enforcers of social distancing and other measures at the community level. • Serve as social mobilizers to support fight against COVID-19 Operators of public • Recipients of information on COVID-19 applicable to Low Low transports the operations of public transport • Adhere to social distancing directives/advice Operators of the • Recipients of information on guidelines governing Low Low hospitality facilities the hospitality industry during COVID-19 18 Stakeholder Group(s) Role in project Interest Influence • Strict adherence to guidelines governing hospitality facilities. • Adhere to social distancing directives/advice Airline and border • Recipients of information on guidelines governing Low Low control staff border control and the airline industry during COVID-19 • Strict adherence to guidelines governing airline and border control staff. • Adhere to social distancing directives/advice Airlines and other • Recipients of information on guidelines governing Low Low international transport the airline industry during COVID-19 businesses • Strict adherence to guidelines governing airlines and other international transport businesses. • Adhere to social distancing directives/advice Persons affected by or • Recipients of information COVID-19 related SOPs Low Low otherwise involved in governing their job schedule project-supported • Adhere to social distancing directives/advice activities Public Healthcare • Recipients of information on SOP on handling High High workers in contact or COVID-19 related wastes handle COVID-19 • Strict adherence to guidelines on public health. related waste • Adhere to social distancing directives/advice Other Interested Parties Ministry of Finance • Disbursement of project funds High High Parliament • Promulgation of COVID-19 related laws Moderate Moderate and regulations • Support national policies and directives on COVID- 19 preparedness, prevention, and management Judiciary Adjudication of COVID-19 related litigations Moderate Moderate The Ministry of Gender Awareness creation and information dissemination Moderate Moderate and Social Protection on gender base violence and sexual exploitation and harassment) Security Maintain law and order in enforcing social distancing Moderate Moderate Agencies/Personnel directives Support in attending to emergency situations that may arise Other national & Support government’s efforts to curb COVID-19 Moderate Moderate International organizations engaged in COVID response Traditional/Religious Change agents in dissemination of COVID-19 moderate High Leaders information and social mobilization Civil society groups, Ensure accountability in the fight against COVID- Moderate Moderate and community 19 and public education organizations 19 Stakeholder Group(s) Role in project Interest Influence Businesses with Support government’s efforts to curb COVID-19 Moderate Moderate international links Traditional media Disseminate COVID-19 information to the general Moderate High (national and local) public Enforce adherence to social distancing directives/advice Users of social media Disseminate COVID-19 information to segments of Moderate Moderate the general public Telecommunication Disseminate COVID-19 information to the general Low Moderate companies public Other national and Support government’s efforts to curb COVID-19 High Moderate international health organizations The public at large • Recipients of information on the fight against Low Moderate COVID-19 • Adhere to social distancing directives/advice Vulnerable Groups Persons with • Recipients of information on the fight against High Low disabilities COVID-19 • Recipient of support to vulnerable people • Adhere to social distancing directives/advice Elderly persons • Recipients of information on the fight against Moderate Low COVID-19 • Recipient of support to vulnerable people • Adhere to social distancing directives/advice Children • Recipients of information on the fight against Low Low COVID-19 • Recipient of support to vulnerable people • Adhere to social distancing directives/advice Women / Kayayie/ • Recipients of information on the fight against High Low Female headed COVID-19 households/ Survivors • Recipient of support to vulnerable people of GBV/Intimate • Adhere to social distancing directives/advice partner abuse PLHIVs • Recipients of information on the fight against Moderate Low COVID-19 • Recipient of support to vulnerable people • Adhere to social distancing directives/advice Residents in slums or • Recipients of information on the fight against High Low low income/informal COVID-19 settlements • Adhere to social distancing directives/advice Residents in remote or • Recipients of information on the fight against Moderate Low inaccessible areas COVID-19 • Adhere to social distancing directives/advice 20 Stakeholder Group(s) Role in project Interest Influence The homeless • Recipients of information on the fight against Moderate Low COVID-19 • Recipient of support to vulnerable people • Adhere to social distancing directives/advice Patients with chronic • Recipients of information on the fight against High Low diseases or pre-existing COVID-19 conditions • Recipient of support to vulnerable people • Adhere to social distancing directives/advice The table below also identifies and assesses the needs of some disadvantaged or vulnerable individuals or groups to help determine suitable engagement strategies. Table 4: Characterization of Vulnerable Groups Preferred Stakeholder Key Language medium of Specific measure to (individual/group) Characteristics needs engagement/ mitigate these needs notification Persons with Braille, audio, Written disabilities Hearing sign language information, Accessible training impairment community venues, including use of (Hearing loss) announcement, sign-language focused group translators/ Visual meetings, TV, interpreters, braille impairment Radio etc. formats/ large prints (Low vision or blindness) Physical impairment (Mobility disabilities) Limitations Local language Verbal, Conduct engagement Women and girls; about the time as appropriate community activities at locations head potters of day or announcement, accessible to them in (Kayayie)/female location for focused group their communities; heads of public meetings, TV, The meeting not held households consultation; Radio etc. on market days or other additional evenings which may support and challenge their resources to participation, Use of enable them to gender-sensitive/ participate in appropriate language; consultations. meeting held in the local language; specific 21 Preferred Stakeholder Key Language medium of Specific measure to (individual/group) Characteristics needs engagement/ mitigate these needs notification meetings held for kayayies alone, etc. Limited voice, Local language Focus group Ensure access to Children low and English as meetings, use of COVID-19 information (particularly from representation, appropriate audio-visuals, and project benefits, poor families) lack of access to TV, Radio etc. prevention of child COVID-19 labour in project information communities where civil works will take place Homeless/displaced They are least Opportunities Verbal, Collaborate with other persons able to access for expression community relevant government traditional and as a form announcement, and non-governmental formal justice motivation to focus group institutions and other mechanisms for speak meetings, TV, groups/ association to any form of Radio etc. ensure that redress. They opportunities under the have limited project and other voice, low COVID-19 response representation measures are available and lack of to them access to information. They are more vulnerable to SEA and other forms of abuses. The elderly Physically weak Appropriate Verbal, Accessible venues and less mobile local language, community Translators/interpreters Visually simplified announcement, disadvantaged explanation TV, meetings (low vision) about the etc. COVID-19 pandemic and benefits of the project Patients with Use of English Verbal, Accessible formats of chronic diseases or or appropriate community venues pre-existing local language, announcement, translators/interpreters conditions simplified print and explanation electronic about the media, TV, 22 Preferred Stakeholder Key Language medium of Specific measure to (individual/group) Characteristics needs engagement/ mitigate these needs notification COVID-19 radio, meetings pandemic and etc. benefits of the project Residents in remote Limited voice Preferred Focus group Address special needs or inaccessible language meetings; to support them to areas; and illiterate Verbal, understand the community pandemic, project announcement, impacts and benefits. TV, radio etc. 4. Stakeholder Engagement Program Summary of stakeholder engagement Due to the emergency situation and the need to address issues related to COVID-19, no dedicated consultations beyond public authorities and health experts, including Africa CDC, were conducted during the project preparatory phases. However, during the implementation phase, the Ministry of Health, Ghana Health Service, Ministry of Information, National Commission on Civic Education, District Assemblies and other stakeholders have conducted several stakeholders’ consultations across the country as part of the SEP implementation. Summary of project stakeholder needs and methods, tools and techniques for stakeholder engagement The WHO “COVID-19 Strategic Preparedness and Response Plan OPERATIONAL PLANNING GUIDELINES TO SUPPORT COUNTRY PREPAREDNESS AND RESPONSE� (2020) outlines the following approach in Pillar 2 Risk Communication and Community Engagement, which will be the basis for the Project’s stakeholder engagement: It is critical to communicate to the public what is known about COVID‑19, what is unknown, what is being done, and actions to be taken on a regular basis. Preparedness and response activities should be conducted in a participatory, community-based way that are informed and continually optimized according to community feedback to detect and respond to concerns, rumours and misinformation. Changes in preparedness and response interventions would be announced and explained ahead of time and be developed based on community perspectives. Responsive, empathic, transparent and consistent messaging in local languages through trusted channels of communication, using community-based networks and key influencers and building capacity of local entities, is essential to establish authority and trust. 23 Safeguarding the legitimate, appropriate and proportionate use and processing of the potential large volumes of personal data, personal identifiable information and sensitive data likely to be collected and used in connection with the management of the COVID-19 outbreak and subsequent vaccination programs is considered a key social risk. The MoH/GHS has committed to adhere to the requirements of the Ghana Data Protection Act 2012 (Act 843). The SEP will use a variety of engagement techniques to build relationships with stakeholders, consult and gather information from them, as well as disseminate project information. It will also increase awareness and “vaccine literacy�, build trust, and reduce stigma around any COVID-19 vaccine for a larger target population. In selecting any consultation technique, a number of issues will be taken into consideration including stakeholders’ level of formal education, preferred channels of communication and cultural sensitivities in order to ensure that the purposes of each engagement will be achieved. Prevention of contagion risks in consultation processes A precautionary approach will be taken to the consultation process to prevent contagion, given the highly infectious nature of COVID-19. The public consultations shall be guided by the national protocols to prevent the spread of COVID-19, the World Bank guidance on Public Consultations and Stakeholder Engagement in World Bank-supported operations when there are constraints on conducting public meetings issued on 20 March, 2020 and updated guidance by the WHO to prevent the spread of COVID-19. Annexes 4-12 outline precautionary protocols for different settings which must be observed to mitigate the risks of transmission of the contagion during face-to-face consultations. These are measures which must be taken into consideration when selecting channels of communication, in light of the current COVID-19 situation, and they include: • Avoidance of public gatherings (taking into account national restrictions or advisories), including public hearings, workshops and community meetings; • If smaller meetings are permitted/advised, conduct consultations in small-group sessions, such as focus group meetings while observing social distancing protocols. If not permitted or advised, make all reasonable efforts to conduct meetings through online channels; • Diversify means of communication and rely more on social media and online channels. Where possible and appropriate, create dedicated online platforms and chatgroups appropriate for the purpose, based on the type and category of stakeholders; • Employ traditional channels of communications (TV, newspaper, radio, dedicated phone- lines, and mail) when stakeholders to do not have access to online channels or do not use them frequently. Traditional channels can also be highly effective in conveying relevant information to stakeholders, and allow them to provide their feedback and suggestions; • Where direct engagement with project affected people or beneficiaries is necessary, identify channels for direct communication with each affected household via a context specific combination of email messages, mail, online platforms, dedicated phone lines (112 or 311) with knowledgeable operators; 24 • Each of the proposed channels of engagement should clearly specify how feedback and suggestions can be provided by stakeholders. Stakeholder engagement plan The Stakeholder engagement plan has been integrated in the Risk Communication and Community Engagement Strategy. Further consultations will be done on ESIAs/ESMPs as and when such documents become relevant to be prepared. The PIU will ensure meaningful engagement and consultation and disclosure of project information to all stakeholders. The consultation activities are designed along with some key guiding principles, including the following: • Consultations must be widely publicised particularly among the project affected stakeholders/communities, preferably a week prior to any meeting or engagements; • Ensure non-technical information summary is accessible prior to any event to ensure that people are informed of the assessment and conclusions before scheduled meetings; • Location and timing of meetings must be designed to maximise stakeholder participation and availability; • Information presented must be clear, and non-technical, and presented in all appropriate local languages where necessary; • Engagements must be facilitated in ways that allow stakeholders to raise their views and concerns; • Issues raised must be addressed, at the meetings or at a later time. Precautionary approach will be taken to the consultation process to prevent contagion, given the highly infectious nature of COVID-19. The project will adapt to different requirements. While country-wide awareness campaigns will continue, specific communication around borders and international airports as well as quarantine centres and laboratories will have to be timed according to need and be adjusted to the specific local circumstance. Some techniques to be used for the engagement of different stakeholder groups have been summarized in the table 5 below: Table 5: Some Engagement techniques to be used for the Stakeholder engagement Engagement Description and use Audience Technique Official websites of MoH/GHS and the All stakeholders/general public Websites World Bank will be used to disseminate and disclose project documents intended for general readers and audience (e.g. ESMF, SEP, ESCP) 25 COVID-19 Education/awareness General public Print and electronic creation activities, awareness about Media project call centers, Grievance Redress Mechanism, and other outreach needs of the project etc. Distribution of This will be used to convey general General public printed public information on the Project and to materials: Project provide regular updates on its information leaflets, progress to local, regional and brochures, fact national stakeholders. sheets Stakeholder Discuss project activities, brainstorm MOH, GHS and other relevant meetings on implementation of subproject government agencies, Private sector activities, stakeholders to provide organizations in the health service input, recommendations and delivery, CSOs/NGOs in Health, disability strategies in subproject organization and other vulnerable implementation groups Community This will be used to disseminate pre- general public Information Centers prepared messages to communities, accompanied by additional information from communication teams. Public campaign & Traditional authorities, local general public social mobilization: influencers and opinion leaders will be leveraged to amplify the messages from the public education campaign. Legacy/Traditional Billboards, Poster and Sticker Stakeholders and the general public Mass Media Campaigns, as well as Radio and TV Engagements campaigns, documentaries, (Radio/TV adverts, informercials to disseminate COVID-19 billboards, information and to educate the public documentaries) on the pandemic Digital media Use of Online /social media to provide The general public and interested (Online, Social information on COVID-19 and update parties Media and other IT- on the project; use of Robocalls and based COVID-19 Call Centre to respond to Communications); questions, provide general Social media information on COVID-19, receive and (Facebook, Twitter, resolve complaints from the public. YouTube, Instagram). Bi-Weekly Press MoH/GHS and MOI to host press Stakeholders and the general public Briefings and briefings twice each week and on periodic Presidential assigned dates and times to update address to the the public on case counts, case nation management, updates and 26 developments on COVID-19. The twice weekly briefings will be carried live and translated in 13 key local languages and sign language. Periodic Presidential addresses to the nation on the situation and government responses; YouTube videos of Presidential address, bi-weekly press briefings, COVID 19 educational videos and animation in local languages to be used to disseminated information on the pandemic . Community/public To convey information on the project Stakeholders and the general public; meetings and activities, environmental and social CSOs, Disability Organizations, women meetings with risks and mitigation measures and and other vulnerable groups specialized groups regular updates on the pandemic and project measures under implementation, key project contacts and Hotlines, grievance redress procedures, Interactive Questions & Answers (Q&A) session with the general public Other Channels and Call Centre dedicated number (311) Project affected persons, and any other Tools will allow people to receive stakeholders and interested parties information and request assistance and guidance in the fight on COVID-19. Citizens Surveys Citizens survey will be conducted to Project beneficiaries and general public obtain feedback on the project activities from various groups of stakeholders and the general public Correspondence by Correspondences will be used to Government officials, NGOs, CSOs, phone/email/text distribute or share project CBOs, Development Partners, and WhatsApp information; invite people to Healthcare professionals and service messages/ written stakeholder meetings to receive and providers, the general public including letters provide feedback on enquires, PWDs complaints or grievances 4.5 Proposed strategy for information disclosure Stakeholder consultation and information disclosure will be an integral of the project implementation process which shall be consciously carried at every phase of the project implementation. The project implementation team shall ensure that each consultation process 27 is well planned and inclusive which must be documented and communicate feedback on all follow up issues, concerns, and actions emanating from the stakeholder consultation processes. The engagement and consultation will be carried out on an ongoing basis to reflect the nature of issues, impacts, and opportunities emanating from the implementation of the project. In terms of methodology, the SEP has been integrated in the broader RCCE Plan. The project will ensure that different activities and information disclosures are inclusive and culturally sensitive, thereby ensuring that the vulnerable groups outlined above will have the chance to participate in the Project benefits. Disclosure of Project information will be part of the project management cycle: (i) Preparation and Design Phase; (ii) Implementation Phase; (iii) Monitoring Phase; and (iv) Completion and Evaluation Phase. The strategy for information disclosure is presented in Table 6 below. 28 Table 6: Information Disclosure Project stage List of Method proposed Timetable/ Target Stakeholders Topic of Responsibility information to be Location consultation disclosed • Officials of the Ministry of Project Appraisal Official websites Prior to Health and Ghana Health Project WB, MOH/GHS, Document (PAD), approval and Service design, Preparation or ESMF, SEP, ESCP Once in 2 national daily implementatio • Development partners benefits and design phase newspapers n of project • World Bank Group impacts activities • Aaffected parties • National, Regional and district stakeholders Correspondences (Phone, SOP for SOP for Case Emails); Project MoH/GHS; Frontline health quarantine MoH/GHS Detection, Case duration workers; Inter-Ministerial facilities Confirmation, Formal and informal Coordinating Committee; Contact Tracing, meetings National, Regional and district Case Recording, stakeholders and Case Reporting SOP for quarantine facilities 29 Project stage List of Method proposed Timetable/ Target Stakeholders Topic of Responsibility information to be Location consultation disclosed Correspondences (Phone, Periodically as Ministry of Health Officials Solicit • MoH/GHS Project Strategies for Emails); the COVID-19 stakeholder implementation surveillance and • Ghana Health Service Officials inputs into situation and stage isolation of Formal and informal protocols • Security forces the suspected COVID- meetings evolves • Development partners surveillance 19 cases • CSOs/NGOs in health, private and sector healthcare service activities, providers Formal and informal Continuous • The General public • Seeking • MoH Information on meetings throughout • Ministries, Departments and views • GHS strategy project Agencies and • NCCE development for implementatio • Health institutions and allied opinions vaccine n, community workers of deployment; relevant engagement in • NGOs/CSOs communication local stakehol • Vulnerable groups and outreach languages, ders activities to • Development partners Radio and across increase • Private sector the Television awareness and country Discussions “vaccine literacy�. and Phone-in • Enable Programs stakehol ders to obtain informati on, speak freely to share their perceptio 30 Project stage List of Method proposed Timetable/ Target Stakeholders Topic of Responsibility information to be Location consultation disclosed n about the COVID- 19 vaccine and project related issues • Provide facts/info rmation to clarify concerns / address fears to increase awarene ss and “vaccine literacy • Build public trust and confiden ce • Resolve concerns 31 Project stage List of Method proposed Timetable/ Target Stakeholders Topic of Responsibility information to be Location consultation disclosed and grievance s as appropri ate Correspondences (Phone, Continuous • The General public • Seeking • MoH COVID risk, Emails); throughout • Transport operators views • Ministry of mitigation and project • Relatives of COVID-19 and Information behavioural Formal and informal implementatio infected persons opinions • GHS change meetings; Print and n, Radio and • Project affected persons of PAPs • NCCE communication electronic media/ • Enable Television • Relatives of persons under strategies infomercials/IE&C stakehol Discussion and COVID-19 quarantine materials ders to Phone-in • Vulnerable groups Programs obtain • Patients with chronic informati Use of diseases or pre-existing on, speak information conditions freely Van • Health Workers about COVID- 19 pandemi c and project related issues • Build public 32 Project stage List of Method proposed Timetable/ Target Stakeholders Topic of Responsibility information to be Location consultation disclosed trust and confiden ce • Resolve concerns and grievance s as appropri ate • • • • Disclosure of • Ministry of Health website • Disclose • The general E&S documents Official websites of IAs/ Websites of IAs • National news papers ESMF, public Newspaper publications/ • Call centres/codes for the ESMP, • Health publication on notice Once in 2 general public) RAP, SEP, Workers boards of health facilities national daily GRM and • Relatives of newspapers other COVID-19 • relevant infected • notice project boards of persons documen health • Relatives of tation. facilities persons • Project under informati COVID-19 on and quarantine progress updates; • Vulnerable groups • MMDAs 33 Project stage List of Method proposed Timetable/ Target Stakeholders Topic of Responsibility information to be Location consultation disclosed • Citizen’s Survey Project • General public • Phone • MoH perceptions duration • Health workers interview • GHS surveys on • Vulnerable groups s with government’s • CSOs the preparedness • Development partners general and response public, • Boarders and Port Authorities meetings with represen tatives of identifiab le groups, and radio call in at various regions and districts to gauge public perceptio ns about governm ent's prepared ness and response 34 Project stage List of Method proposed Timetable/ Target Stakeholders Topic of Responsibility information to be Location consultation disclosed • GRM • The General public • Dissemin • MoH dissemination Meetings, radio/tv Project • Relatives of COVID-19 ation of • Ministry of and awareness discussions, dedicated duration infected persons GR Information phone lines, jingles, • Relatives of persons under informati • NCCE engagement with Community COVID-19 quarantine on and community Information call • Vulnerable groups representatives, Centres centre • Health workers influencers numbers • MMDAs to mass audiences • The general public • Dissemin • MoH GBV risk Meetings, radio/tv Throughout • Women ation of • GHS mitigation discussions, jingles, project • Children informati messaging engagement with implementatio on to • Impacted communities community n/ Community mass • Persons with disability representatives, Information audiences • Health workers influencers Centres • Solicit • Contractors inputs • Vulnerable groups into strategy for mitigating GBV • Public Healthcare workers • Dissemin • MoH SOP for safe and Meetings, focus group Throughout • COVID-19 burial ation of • GHS dignified burial discussions, engagement project team/environmental officers informati • with community 35 Project stage List of Method proposed Timetable/ Target Stakeholders Topic of Responsibility information to be Location consultation disclosed representatives, implementatio • The general public on to influencers n • Traditional & Faith based mass leaders audiences • Vulnerable groups • Solicit inputs Environmental Protection Agency into guidelines for burring COVID-19 dead patients • Ministry of Health • Present • MoH/GHS Isolation and Correspondences (Phone, Project • Ghana Health Service staff Project quarantining Emails); Meetings, duration • Contractors informatio facility design engagement with • Environmental Protection n to community Community Agency stakehold Refurbishment/ representatives, Information ers Construction of influencers Centres • Allow Isolation/quaranti stakehold ne facilities ers to comment – opinions and views • Dissemina te technical 36 Project stage List of Method proposed Timetable/ Target Stakeholders Topic of Responsibility information to be Location consultation disclosed informatio n Record discussion s and decisions • Ministry of Health • Present • MoH/GHS Labor and Formal meetings/ Duration of • Ghana Health Service staff informatio working Correspondences (Phone, the subproject • Contractors n on conditions Emails); employee associated with s the construction contracts or rehabilitation • Display of facilities informatio n on notice boards, signposts, radio announce ment etc. • Encourage the use of GRM mechanis m to address issues on 37 Project stage List of Method proposed Timetable/ Target Stakeholders Topic of Responsibility information to be Location consultation disclosed labour and working conditions • Institutional completion National, • Ministry of Health Officials • Present • MoH Project Closure Lessons Learning reports Regional and • GHS officials at national, Project • GHS Sessions/ • Correspondences district level regional and district levels completio sustainability (Phone, Emails); stakeholders • World Bank Group n and engagement with • Security forces results stakeholders, • Health Workers informatio community • The general public n to a representatives, • Relatives of COVID-19 large influencers, infected persons group of • Public online surveys • Relatives of persons under stakehold • Focus group meetings COVID-19 quarantine ers, • Expert one-on-one especially • Impacted Communities, communit interviews • Vulnerable groups ies Formal meetings • Allow stakehold ers to provide their views and opinions • Distribute technical and non- 38 Project stage List of Method proposed Timetable/ Target Stakeholders Topic of Responsibility information to be Location consultation disclosed technical informatio n • Record discussion s, comments , questions. • Project Assets • Expert one-on-one • National, • Ministry of Health Officials • Present • MoH interviews Regional and • World Bank Group Project • GHS • Formal meetings district level • Health Workers informatio stakeholders n to a large group of stakehold ers, especially communit ies 39 Project stage List of Method proposed Timetable/ Target Stakeholders Topic of Responsibility information to be Location consultation disclosed • Allow stakehold ers to provide their views and opinions • Distribute technical and non- technical informatio n • Record discussion s, comments , questions. 40 4.6 Strategy to incorporate the views of vulnerable groups Stakeholder consultations with vulnerable groups were conducted as part of the preparation of the AF. The disability organisation and women traditional leaders including the Queen mothers Association of Ghana were consulted to obtain their feedback on the implementation of the parent project and to seek input into the AF Project to ensure that the project interventions reach the most vulnerable in society. Feedback and input from these stakeholders informed the design of the AF (e.g. Sub-Component 1.3: Social Support to Vulnerable Groups). Vulnerable groups will continue to be targeted through representative organizations, including women, people with disabilities, children, the elderly, illiterate people, homeless people, PLHIVs, the elderly, persons with underlining conditions, etc. At any phase of project implementation, additional vulnerable groups may be identified and engaged appropriately, and the SEP/RCCE will be revised periodically to reflect newly identified stakeholder or vulnerable groups. In cases where vulnerable status may lead to people’s reluctance or physical incapacity to participate in large - scale community meetings, the project will hold separate small group discussions with them at an easily accessible venue. Some strategies to be adopted to reach out to these groups include: • Identify leaders and organisations of vulnerable and marginalized groups to reach-out to these groups; • Through the existing industry associations, maintain a database of marginalized groups e.g. disability organisations, Ghana Federation of Disability Organisations and National Council for Persons with Disabilities; • Leverage existing protocol of Ghana Health Service for engaging marginalize groups to identify and engage them; • Engage community leaders, CSOs and NGOs working with vulnerable groups • Organize face-to-face focus group discussions with these populations as and when appropriate • Use local languages, translators, and interpreters, as and when appropriate. When appropriate, feedback obtained from vulnerable groups will be used to alter arrangements at isolation and quarantine canters as well as the messaging and approach for behavioural change for communication. The awareness-raising and stakeholder engagement with vulnerable groups will take into account their particular sensitivities, concerns, and cultural sensitivities, to ensure their full understanding of project activities and benefits. The project will encourage community sensitization by using disability organisations in Ghana as champions to deliver messages to identifiable disability groups and other vulnerable groups in the various communities. Also, posters in accessible format including braille format, sign language interpreters, drama, radio talk and TV shows, songs in local languages with specific message for persons with disabilities will also be developed. The project will inherently benefit vulnerable groups by deliberately increasing and improving their access to opportunities available to them in the fight against COVID-19. 41 Future of the project Stakeholders will be kept informed as the project develops, including reporting on project environmental and social performance and implementation of the stakeholder engagement plan and grievance mechanism. This will be important for the wider public, but equally and even more so for suspected and/or identified COVID-19 cases as well as their relatives. 5. Resources and Responsibilities for implementing stakeholder engagement activities Resources The Ministry of Health will oversee stakeholder engagement activities. The SEP is funded under Component 3: Community Engagement and Risk Communication of the project which has a total budget of US$ 9.30 million equivalent. Management functions and responsibilities Implementation arrangements for the SEP: The Ministry of Health through Ghana Health Service will lead and provide oversight on the implementation of the stakeholder engagement plan. The project management unit under the Ghana Health Service will have the primary responsibility to coordinate the implementation of the SEP with other implementation agencies. The MoH/GHS have appointed E&S staff to oversee implementation of environmental and social framework elements of the project including the SEP. The Officers will coordinate with other departments and agencies involved in the implementation of the project to ensure that the SEP activities are integrated in the RCCE strategy and implemented as required. They will monitor the SEP in accordance with the requirements of the legal agreement, including the Environmental and Social Commitment Plan (ESCP). Table 7: Summary of key Institutions/Focal Persons and their Responsibilities Institutions/ Focal persons/ Unit Responsibilities ▪ Oversight responsibility for entire project Ministry of Health implementation ▪ Responsible for managing the overall operation risks on the project ▪ Provide overall Coordination for SEP Project Implementation Unit implementation ▪ Facilitate implementation of SEP Environmental and Social Safeguards ▪ Incorporate SEP guidelines in contractors’ Specialists agreement 42 ▪ Organize and conduct national and sub- national training ▪ Develop manuals and modules for capacity building and awareness creation ▪ Facilitate monitoring and coordinate monitoring activities on SEP implementation ▪ Develop and ensure effective implementation of GRM ▪ Liaise with relevant institutions on environmental and social issues 6. Grievance Mechanism The main objective of a Grievance Redress Mechanism (GRM) is to assist to resolve complaints and grievances in a timely, effective and efficient manner that satisfies all parties involved. Specifically, it provides a transparent and credible process for fair, effective and lasting outcomes. It also builds trust and cooperation as an integral component of broader community consultation that facilitates corrective actions. Specifically, the GRM: ▪ Provides affected people, interested parties and the public with avenues for making a complaint or resolving any dispute that may arise during the course of the implementation of projects; ▪ Ensures that appropriate and mutually acceptable redress actions are identified and implemented to the satisfaction of complainants; and ▪ Avoids the need to resort to judicial proceedings. Description of GRM Grievances redress mechanisms have been established at the district, regional and national levels to handle complaints at the respective health facility by the Grievance Office and at the national level by MoH, including via dedicated hotlines established. The GRM includes the following steps: Step 0: Grievance discussed with the respective health facility Step 1: Grievance raised with the District Chief Executive and District Health Promotion Teams; Step 2: Regional Director of Health Services; Step 3: Appeal to the Director General of the Ghana Health Service and the Health Facilities Regulatory Agency of the Ministry of Health. 43 Once all possible redress has been proposed and if the complainant is still not satisfied then they should be advised of their right to legal recourse. In the instance of the COVID-19 emergency, the GRM will be available for use by all project stakeholders including those directly and indirectly impacted, positively or negatively, allowing them to submit questions, concerns/complaints, comments, suggestions and obtain resolution or feedback. Existing grievance procedures would be used to encourage reporting of co-workers if they show outward symptoms, such as ongoing and severe coughing with fever, and do not voluntarily submit to testing. The responsibility for the coordination of the GRM shall rest with the Focal Person of SEP/RCCE implementation and the coordinators of the COVID-19 Call Centres (Hotlines 112 or 311) of the Ministry of Health and Ghana Health Centres and District Health Promotion Centres. Complaints could be registered through face-to-face interactions, calls, text messages, email or voice mail etc. Once they receive complaints from complainants, they will be responsible for logging all complaints. In addition, they will also ensure that grievances are addressed and propose appropriate measures to avoid or minimize adverse impacts of the interventions in order to build trust and maintain rapport by providing affected persons and the wider public with adequate information on the project and its GRM procedures, as well as communicating outcomes with complainants; and regularly provide a report on GRM results to the MoH/GHS and the World Bank. 7. Monitoring and Reporting The SEP will be periodically revised and updated as necessary in the course of project implementation in order to ensure that the information presented herein is consistent and is the most recent, and that the identified methods of engagement remain appropriate and effective in relation to the project context and specific phases of the development. Any major changes to the project related activities and to its schedule will be duly reflected in the SEP. The project will maintain Stakeholder Engagement Log that chronicles all stakeholder engagements undertaken or planned. The Engagement Log includes location and dates of meetings, workshops, and a description of the project-affected parties and other stakeholders consulted. The project will also develop an evaluation form to assess the effectiveness of every formal engagement process. The evaluation questions will be designed as appropriate for the relevant audience. Quarterly summaries and internal reports on public grievances, enquiries and related incidents, together with the status of implementation of associated corrective/preventative actions will be collated by responsible staff and referred to the senior management of the project. It may also include for instance, how the project implementation agency responded to the concerns raised, how these responses were conveyed back to those consulted, details of outstanding issues and any planned follow up. The quarterly summaries will provide a mechanism for assessing both the number and the nature of complaints and requests for information, along with the Project’s ability to address those in a timely and effective manner. Information on public engagement 44 activities undertaken by the Project during the year may be conveyed to the stakeholders through various means including publication of a standalone annual report on project’s interaction with the stakeholders and other planned communication channels of the project. ANNEX 1: Some Key Communication Messages (Source: Ghana’s COVID-19 Risk Communication & Community Engagement Strategy, 2020) Messages on COVID-19 will be framed and designed to address the following: What COVID-19 is • COVID-19 is a disease caused by a new strain of coronavirus. First detected in Wuhan, China, the virus is new and linked to the same family of viruses that cause Severe Acute Respiratory Syndrome (SARS) and some types of common cold. Symptoms of COVID-19 • Symptoms vary in different people but generally most people who catch the virus experience, fever, coughing and shortness of breath. Others report loss of appetite and sense of smell. • However, it has been discovered that many infected people may show only mild symptoms or be ‘asymptomatic’, meaning they show no symptoms at all. • While most people recover from COVID-19 in more severe cases, the virus can cause pneumonia or breathing difficulties and lead to death. Who is most at risk? • Anyone, irrespective of age, ethnicity, race, education and socio-economic status can catch the disease. • However, some people are more at risk than others and when infected can be more severely ill. The at-risk group includes older people, and people with pre-existing medical conditions, such as diabetes, hypertension and heart disease. How infection occurs and spreads • COVID-19 is a very infectious disease and is spreading very quickly around the world. You can be infected through direct contact with respiratory droplets of an infected person through coughing, sneezing, talking and singing. • The COVID-19 virus can also survive on surfaces for several hours so you can be infected if you touch contaminated surfaces and then touch your eyes, nose or mouth. New 45 evidence suggests however that this may be low risk compared to other ways the disease spreads, but public bathrooms and common areas are still considered high risk. • Emerging information suggests gatherings in enclosed spaces like workplaces, religious places, restaurants, parties/weddings, conferences, cinema halls, gyms, theatres, etc. are very risk Prevention of the spread of COVID-19 • A number of public health measures can prevent infection and the spread of COVID-19. These safety measures include: • Washing hands for more than 20 seconds under running water as frequently as possible kills the virus if on your hand. • Using hand sanitizers when handwashing is not immediately possible is also effective in killing the virus if on your hand. • Covering your mouth and nose when coughing and sneezing with, handkerchief, tissue or bended elbow to prevent spreading droplets. • Disposing of used tissue immediately • Using masks to cover your face in public places. Mask wearing is now mandatory and carries a fine or imprisonment (refer to appendix 8). • Maintaining physical distance of two meters in public (refer to appendix 9). • Avoiding touching surfaces and objects in public places or using a sanitizer or washing your hands immediately after touching. • If you think a surface may be infected, clean it with simple disinfectant to kill the virus and protect yourself and others. • Avoid staying in enclosed places where there are others for more than an hour if possible; it is better to be outside than indoors with people. What to do if infected or showing suspected symptoms • Stay at home if you feel unwell and showing any of the symptoms of the coronavirus such as fever, coughing or sneezing and contact a medical professional for help. • Self-isolate by avoiding physical contact with anymore, including those you live with. • If your cough is getting worse and you are having difficulty breathing, seek medical attention immediately. • Quarantine for at least 14 days. Availability of medicines or therapies that can prevent or cure COVID-19 • There is no one ‘magic’ cure or available vaccine for COVID-19, yet. However, some western, traditional or home remedies may provide comfort and alleviate symptoms of COVID19. 46 • Doctors advise that boosting the immune system by eating the right foods, for example, can also help quicker recovery from the disease. Those with severe symptoms are treated with appropriate medications that address symptoms. • Unfortunately, there are many fake cures and remedies on the Ghanaian market that can harm your help so beware and check with the Ghana Standards Board to determine if a remedy is certified or not. Case count and management • Daily updates on progress and containment of COVID-19, including number of cumulative infections, number of people who have recovered, number of deaths • Cases should be broken down into regions and districts to show community spread • Infographics can help illustrate messages on case count and management. Addressing Uncertainty The coronavirus is a new virus and scientists are still discovering new things each day. It is important to accurately communicate scientific uncertainty and be very upfront about what is not known about the disease. Update facts as new information emerges and explain why measures could be revised (for example there is increasingly stronger evidence of the efficacy of mask wearing compared to earlier on in the disease when WHO recommended masks only for people who had been infected). Addressing stigma • Stigma is fuelled fundamentally by fear and lack of knowledge. Knowing what COVID-19 is and how to prevent infection can help understanding. • COVID-19 can infect and cause sickness in anybody regardless of gender, race, ethnicity, age, education or socio-economic status. • Similar to other diseases we live with, such as malaria, most people recover; someone who has completed quarantine does not pose a risk of infection to other people • Do not shun or tease anyone about being sick; remember that the virus doesn’t follow geographical boundaries or ethnicities. Addressing Disinformation, rumours and misinformation • Myths and misconceptions on how to prevent infection or cure COVID-19 that must be addressed. For example, drinking alcohol, chlorine, seawater or spraying them all over your body will not kill viruses that have already entered your body and are extremely harmful. 47 • Foods like garlic, ginger, etc. are healthy but there is no evidence that eating them will protect you from COVID19. • Steam inhalation with neem and other cold ointments (such as Robb) can help alleviate symptoms but there is no evidence they prevent or cure the disease. • Rumours and misinformation about spread, prominent people contracting the disease Stay-At-Home Measures • To control the transmission of COVID-19 many countries introduced measures aimed at restricting the movement of people, broadly termed stay-at-home measures. • Lockdowns, curfews (which restrict movement at certain times of the day) and quarantines (which restrict movement of individuals) are examples of mandatory measures aimed at controlling disease spread that involves restrictions on normal social and economic life. • Lockdowns can vary in degree from total movement restrictions to restrictions for particular communities or locations. Most lockdowns make exceptions only for essential services to operate. What Government is doing to address the COVID-19 threat • Empowering people with information through intense public education and community engagement so they can take the right precautionary measures. • Tracing, testing and treating people who are infected • Increasing testing facilities in the country • Creating isolation centres in communities across the country where those who cannot self-isolate at home can go to avoid infecting others within their household and compound. • Designating special COVID-19 hospital and health facilities around the country to focus special attention on treating infected and ill patients. • Directing stay at home or lockdown measures when and where necessary. • Putting in place workplace and school protocols to guide people on how to behave to avoid being infected or infecting others and getting help if they contract the disease (see appendix 10). • Putting measures in place to mitigate economic hardship on especially the vulnerable and businesses and to keep the economy going. • Enacting legislation to support mitigation measures and protect public safety. 48 ANNEX 2: Public Education and Media Engagement Plan (Source: Ghana’s COVID-19 Risk Communication & Community Engagement Strategy, 2020) Context During health crises people must be well informed so they know what individual preventive measures to take to avoid infection and the spread of disease. In today’s world professional media and digital technologies play a crucial role in the flow of information. Public education though the media and other digitally-driven platforms of communication is therefore crucial in ensuring people get timely accurate and useful information on COVID-19. The Ministry of Information is the main implementer of the Ghana government’s public education and media plan and is working in conjunction with other state institutions, primarily the Ministry of Health, Ghana Health Service (GHS), the Health Promotion Division (HPD) of GHS and the National Commission on Civic Education (NCCE) to educate and provide helpful information to the public to inform their decisions regarding COVID-19. The media is the key partner in the Government’s public education plan because it is cost efficient and has nationwide reach. Ghana has a vibrant media landscape with multiple outlets and an ever-increasing plethora of newspapers, magazines, radio, television, online and social media. As of December 2019, the National Communications Authority (NCA) had given authorization for to 513 FM stations out of which 399 were on air and 140 television stations of which 96 were on air. Thirty-one of the radio stations are classified as public, 5 as foreign, 21 as campus, 75 as community and 381 as commercial, according to NCA statistics, with a regional breakdown of on air stations as follows: Ashanti 57, Bono 34, Bono East 25, Ahafo 6, Central 32, Eastern 32, Greater Accra 51, Northern 23, Savannah 7, North East 2, Upper East 18, Upper West 18, Volta 28, Oti 7, Western 42 and Western North 17 (NCA Quarterly Statistical Bulletin, Vol. 4 Issue 4, December 2019). In addition to this wide array of broadcast media, there are more than 1,000 active print media registered with the National Media Commission (NMC), including at least 10 regular daily newspapers. In addition to online and social media platforms these legacy platforms are available for news and information dissemination on COVID-19. Objectives of Plan To formulate and implement strategies to educate and inform the general public, most at risk groups and communities on the Novel Coronavirus in order to create awareness on the COVID- 19 disease, what preventive measures and proactive actions to take to avoid infection, and the resources available to them, including where to get healthcare. Audiences • General Public • At Risk Groups 49 • Local Communities • Healthcare workers • All state institutions • All professional bodies, unions and associational groups, etc. Key Stakeholders • Ghana Broadcasting Corporation national, regional and rural radio and televisions Commercial radio stations • Community radio stations • Campus radio stations • Free-on-air television stations • Ghana News Agency (GNA) • State-owned newspapers • Selected privately-owned newspapers • Ghana Independent Broadcasters Association (GIBA) • Ghana Journalists Association (GJA) • Ghana Community Radio Network • Private Newspaper Publishers Association of Ghana (PRINPAG) • Advertising Association of Ghana (AAG) • National Media Commission (NMC) • Institute of Public Relations (IPR), Ghana • National Film Authority • Traditional authorities and opinion leaders • Local influencers • Metropolitan and District assemblies Communication Goals The aim of the public education and media plan is to engage legacy and social media actors and use other specialized communication (e.g. mobile vans, robocall) platforms to raise awareness on COVID-19 and bring about social and behavioural change in communities and on the individual level to mitigate the spread and impact of the disease. Communication Strategies The Ministry of Information has designed a five-strand communication strategy to complement the community engagement and social mobilisation strategy aimed at outreach in local communities. The public education and media engagement strategy components are: Public Education and Social Mobilization; Legacy/Traditional Media (e.g. newspapers radio, television) Engagements; Use of Online and Social Media; Biweekly Press Briefings and Government Communication. 50 Public education campaign & social mobilization: This will involve the use of ISD Vans popularly known as Aban cene to broadcast pre -prepared messages on COVID-19 throughout communities with the priority being communities least served by FM radio. District Information Officers (DIOs) and cinema van commentators will also run commentary on COVID-19 to educate the public in all 260 districts in the country. In areas where mobile vans are unavailable, the district assemblies and other decentralised Institutions will provide vans for the use of public education teams. In addition, Community Information Centres will be used in a similar manner to disseminate pre- prepared messages to communities, accompanied by additional information from communication teams. The support of traditional authorities, local influencers and opinion leaders will also be leveraged to amplify the messages from the public education campaign. • Legacy/Traditional Media Engagements: Billboards, infomercials and the buying of media airtime both on TV and radio will be used to disseminate COVID-19 information and to educate the public. Journalists will also be encouraged and supported to cover covid-19 related events and issues and to do produce compelling stories, including giving voice to personal testimonies of frontline workers and COVID-19 recovered patients. COVID-19 spokespersons will also be available to grant media interviews. In addition, the media will be engaged to do special programmes on COVID-19. The capacity of journalists will also be built to enhance their understanding of the virus and how to report accurately on it. • Online, Social Media and other IT-based Communications: In addition to using social media and other available online sources (including websites of key government institutions) to communicate on COVID-19, specialized IT sources such as robocalls and a COVID-19 Call Centre will be set up to respond to questions, provide general information on covid-10. • Bi-Weekly Press Briefings at MoI: Twice each week on assigned dates and times the Ministry will host a press briefing where case counts, case management, updates and developments on COVID-19 will be given. Various stakeholders and industry players, including GHS officials will be brought together to give information to citizens on a regular basis. The bi-weekly briefings will be carried live and translated in 13 key local languages. YouTube videos will also be made available • Government Communication: A well-informed group of spokespersons and health experts will be deployed to various TV and radio stations to educate the public. In addition, there will be periodic Presidential addresses to the nation on the situation and government responses which will be carried live and disseminated widely in social media as well. Channels and Tools 51 Public Education will be done using broadcast vans, field announcements, community information centres (CICs), etc. primarily by the Information Services Department (ISD) in cooperation with health officials, HPD and NCCE to carry COVID-related messages across the entire country. There will be Poster and Sticker Campaigns, as well as Radio and TV campaigns. YouTube videos of Presidential addresses and bi-weekly press briefings will be produced and made widely available in addition to educational videos and animation in local languages. A widely advertised Call Centre dedicated number (311) will allow people to receive information and request assistance and guidance in the fight on COVID-19. Messages All messaging on COVID-19 will be clear, consistent, concrete, and repeated frequently to help people understand and remember what to do or not to do. Information targeted at the public will use plain language in explaining the science behind the disease and familiar words to help people understand. As much as possible cultural symbols people can relate to such as the manner of dress, familiar foods and community settings will be incorporated in messages and local analogies drawn to help people relate better to new concepts. Foreign idioms, references and images of other races should not be used in health messages intended for target audiences in Ghana. All messages will be customized and translated from English into relevant local languages to suit specific target audiences. There are different types of approaches used in health communication to attract attention and compel action from audiences, including fear, humour, rationale/factual and emotional appeals. Messages can also have positive appeals, such as asking people to do something positive like washing their hands frequently, or negative appeals, such as discouraging people from engaging in certain behaviours (e.g. “do not shake hands�). Depending on the intent of the message and the target audience, communication on COVID-19 will use a combination of these message appeals. For example, a message such as, “the coronavirus spreads easily so do not share cups and eating utensils with others,� contains both a rationale and a negative appeal. Key messages will be crafted to create awareness and motivate social and behavioural change, to provide updates and new information and to address basic issues such as: • Understanding of what the coronavirus and COVID-19 and its symptoms • Who is most at risk? • How infection occurs and spreads and how to prevent spread • What to do if infected or showing suspected symptoms and availability of medicines or therapies that can prevent or cure the disease • Number of cases, recoveries, deaths and management of cases 52 • Uncertainty of aspects of the disease • The problem of stigmatization and how to stop it • The challenge of disinformation, misinformation and rumours and need to check facts • What Government is doing to address the COVID-19 threat • Information on progress of the disease and new developments • The fact that the disease may be with us for a long time. • The shared responsibility of everyone in the fight against the disease Media Monitoring and Evaluation The media monitoring unit of the ISD will monitor news and information on COVID-19. In addition, there will be documentation and dissemination of success stories of the Ghana COVID-19 Emergency Preparedness and Response Project. 53 ANNEX 3: Social media plan (Source: Ghana’s COVID-19 Risk Communication & Community Engagement Strategy, 2020) Social media is a powerful tool for disseminating information and engaging audiences and increasingly people are going to online and social media sources for health information. Reports indicate high social media use in Ghana with more than 19.53 million mobile users, 10 million internet users, and 5.6 million active social media (Graphic, Feb 18, 2018). Tracking and using health marketing tactics to reach social media audiences with COVID-19 information may be time consuming, therefore media firms could be contracted to push and track COVID-19 information on social media. Platforms for Communicating In addition to relevant government websites, COVID-19 information will be communicated through commonly used social media platforms in Ghana namely: WhatsApp, Facebook, Twitter and Instagram, YouTube and Pinterest. Creating and Maintaining a social media presence • Most government institutions at the national, regional and district levels already have websites; also, many have social media accounts, especially Facebook and Twitter. However, these are not updated regularly. • It is important to improve the visibility and reach of websites and social media platforms by enhancing the look and making it more active. • Websites and social media accounts of all relevant COVID-19 information implementing entities, including the Ministry of Health, Ghana Health Service, Health Promotion Division of the GHS, Ministry of Information and NCCE, should be updated daily with relevant information on case counts and management and other COVID-19-related information. • Social media allows for interactivity with users. Communicators will keep audiences engaged by posting regularly, responding to their messages and comments and creating interactive content. Social media Content • Content of social media will be tailored to suit different audiences taking into account the preferred platform of different demographic groups. • COVID-19 related information will be tailored to suit different social media platforms (e.g. videos for YouTube; infographics and short messages for WhatsApp; shorter messages averaging 40 characters and no more than 280 characters for Twitter; longer information and write-ups for Facebook and websites, and pictures and images for Instagram). • Daily updates on case counts, accompanied by infographics will be provided 54 • Messages on good practices and preventative measures will be reinforced. • Tweets from official sources will be inserted into online conversations to sustain interest and tweets of partners posting about COVID-19 re-tweeted • Voice of COVID-19 frontline workers and patients will be incorporated • Particular attention will be given to visual appeal of posts by using infographics, graphs, Graphics Interchange Format (GIFS), photos and audio-visual clips, etc. to capture and sustain interest. Infographics help to simplify information and can be used to tell better stories and create a fast but lasting impact. • Links to other relevant information and useful resources will be provided • Posts will be made to address fake news, rumours, misinformation and disinformation on COVID-19. • Information on where to go to for help will be provided • Stories on people who have recovered and are champions of anti-stigma • Information on what government is doing to address COVID-19 Tracking social media Engagements for feedback and action • Interactions on social media will be tracked through metrics such as: Likes, Follows, Shares, Comments, Retweets, and Click-throughs. • Website traffic will also be tracked over a set period to monitor the number of views and the kinds of information people access. • Social media will also be used to monitor, gather and respond to rumours and myths in relation to COVID-19 and surveillance. 55 ANNEX 4: Community Engagement and Anti-stigma campaign (Source: Ghana’s COVID-19 Risk Communication & Community Engagement Strategy, 2020) Context Communities are made up of groups of people who have common characteristics and defined by their geographic location, ethnicity, occupation or shared interest and other common bonds, or other demographic factors such as age and gender. Community engagement provides opportunities for different communities of people, including under-represented and excluded groups from being informed and participating in public decision-making to achieve a common purpose. The Health Promotion Division of the Ghana Health Service will lead the institutional communication engagement and anti-stigma campaign on COVID-19 and will train COVID teams and institutional staff across the country. Community engagement will be driven by the National Risk Communication Team of the Ghana Health Service in collaboration with other stakeholders from the health sector, Ministry of Information as well as NCCE. Objectives of Plan The Community and anti-stigma campaign plan will guide how groups and communities at all levels of the country – national, regional, district, sub-district – will be mobilized and engaged on COVID-19 through a number of face-to-face, media and communication platforms. The community engagement activities outlined in the plan complement other public education and media engagement activities which are aimed at supporting government’s response to the COVID-19 pandemic Communication goals • To engage groups and local communities on what to do to avoid infection, stop the spread of and prevent stigma relating to COVID-19 in their communities. • To provide information on healthcare for COVID-19, adopting healthy behaviours and other mitigation measures available to reduce the impact of the disease. Audiences • The General Public • Residents in ‘hot spots’ of the disease • Most at risk groups (e.g. people living with HIV/AIDS) • Vulnerable groups such as people living with disability and homeless people • Port staff at all points of entry (Immigration, CEPs, and Port Health staff) • Tourism Industry people • Traditional authorities and opinion leaders • Faith based organisations 56 • Non-governmental organisations (NGOs) • Civil Society groups • Schools, etc. • Professional organisations, unions, associations • Businesses/Private sector • Ghana Road Transport Union (GPRTU) and other transport owners • Market women (and men), traders, shop owners and street vendors • Women’s groups Strategies The broad strategies in the community engagement and anti-stigma campaign involve coordination activities, development and dissemination of SBCC materials, training and capacity building, engagement with groups and within communities, and anti-stigma interventions. Coordination Activities: • Risk Communication & Social Mobilization Technical Working Group meets to outline and activate risk communication response plan and work with a variety of international and national partners including: MoH, GHS- Public Relations Unit, HPD, NADMO, Veterinary Services Department, ISD, School Health Education Promotion (SHEP) unit, Red Cross, WHO, UNICEF, USAID FAO etc. • HPD works with other government ministries, departments and agencies to develop of guidelines and protocols targeted at specific audiences • Risk communication plan outlined and activated • Regular meetings held to review progress in implementation of response plan • A permanent information centre established at the health promotion division with trained personnel to manage the call centre and other call centres to respond to COVID - 19 related cases and other health matters Development and dissemination of SBCC and other communication materials: • Development and production of SBCC material on COVID- 19, including content for legacy and social media • Dissemination of SBCC materials on 2019-COVID-19 at approved entry points, hotels, health facilities, schools, religious worship centers, workplaces, public places, etc. • Zonal dissemination of emergency preparedness and response plan for risk communication to regional Health Promotion Officers and partners • Improved sharing of appropriate information and messages • Development of content to address rumours and emerging issues • Development of risk communication data visualization dashboard on COVID-19 57 • Development of real time survey and analytic tool COVID-19 risk communication impact assessment Training and capacity building programmes for: • Health staff in risk communication in all 16 regions, • Regional Risk Communication Teams (5 per region) • spokespersons • GHS-Public Relation Unit, Health promotion Division, Public Health Division USAID • health personals to manage teleconsultation center • Regional Information Officers of Information Service Department • Regional Health Promotion Officers • Regional DHPOs (on interpersonal communication) • Journalists Engagement with Groups and Within Communities • Community engagement activities rolled out in different communities in the country, with a priority on hot spots. Risk communication activities will be undertaken in sub-districts and CHPS zones for at least 12 months (using CIC, House to House, churches, mosques, schools etc. • Regional Ministers, MMDA’s in collaboration with Regional Health Directors to step up community engagement activities in all 16 regions on preventative measures, personal hygiene, wearing of masks campaign, social distancing disinfection of markets, schools and offices, stigma and assisting in setting up isolation • Orientation, Sensitisation and Engagement Activities on COVID-19 with a number of groups to educate and inform, discuss their roles, and seek support in the implementation of interventions, including: ➢ Port staff at all points of entry (Immigration, CEPs, Port Health staff) on COVID-19 ➢ Ghana Hoteliers Association on COVID-19 and their roles ➢ Leadership of Ghana Prisons Service for education on the preventive and control measures ➢ Leadership of the Ghana Federation of Disability for education on the preventive and control measures ➢ Interpreters and leadership of the Ghana Association for the marginalized ➢ Leadership of People living with HIV for education on preventive and control measures ➢ Faith-based organization ➢ NGOs and Civil Society ➢ Ghana National Association for the Deaf ➢ Chief Editors and Producers of selected media houses on 2019- COVID-19 ➢ Political parties 58 ➢ Parliamentarians ➢ Ghana Medical Association, Pharmaceutical Society & Allied Health Associations (to advocate for support in surveillance) ➢ Engagement of fisherfolks and opinion leaders in the fishing areas ➢ Engagements with traditional leaders to support community engagement ➢ Engagements on living with the virus Anti-stigma interventions • Assisting in setting up isolation • Community sensitization on anti-stigma • Using recovered patients in press briefing, in communities as COVID-19 ambassadors • Using psychologists to help address stigma • Stigma educational messages for Information services departments, staff and health promotion officers • Stigma educational messages for the public • Radio and television discussions on stigma • Stigma addressed in press briefings • Presidential speech to contain anti-stigma messages • High profile personalities infected encouraged to openly declare positive status to fight COVID-19 related stigma • NCCE-organised training on stigma in districts Channels, Platforms and tools • A variety of communication platforms, channels and tools will be used to support the activities indicated above including: • Radio and Television • Social media • Mobile vans • Public announcements and education in churches, schools and mosques, community events • Public service announcements and advertisements in traditional and social media • Rumours and Information surveillance in social media, print, and broadcast media • Pull ups • Fact Sheets • Letters to Editors and FBOs • Synopsis and discussion guide • National guidelines on social distancing, masking and various workplace protocols • Media briefings • Radio and television discussion show, including in local languages • Daily release of updates on COVID-19 59 • Drama on COVID- 19 for kids Messages: Key messages will aim at creating awareness and motivating social and behavioural change, to provide. Messages will also elicit the support of community leaders and influencers and provide updates and new information to address basic issues such as: • Understanding of what the coronavirus and COVID-19 and its symptoms • Who is most at risk? • How infection occurs and spreads and how to prevent spread • What to do if infected or showing suspected symptoms and availability of medicines or therapies that can prevent or cure the disease • Number of cases, recoveries, deaths and management of cases • Uncertainty of aspects of the disease • The problem of stigmatization and how to stop it • The challenge of disinformation, misinformation and rumours and need to check facts • What Government is doing to address the COVID-19 threat • Information on progress of the disease and new developments • The fact that the disease may be with us for a long time. • The shared responsibility of everyone in the fight against the disease Monitoring and Evaluation • Rapid assessment to assess impact of interventions to be conducted • Media monitoring and feedback activities to be undertaken • Evaluation of impact of risk communication interventions to be undertaken 60