COVID-19 testing: A qualitative study exploring enablers and barriers in the Greater Accra Region, Ghana

Abstract

Introduction: Despite the rolling out of vaccines, the importance of extensive testing along with effective tracing and treatment is still crucial to slowing transmission of the COVID-19 virus. However, testing barriers can be significant impediments to effective COVID-19 response. This study explored enablers and barriers to COVID-19 testing in the Greater Accra region of Ghana. We envision lessons learned from this study could serve as a roadmap to strengthen the current response to COVID-19 and preparedness for future outbreaks, particularly in low- and middle-income countries. Methods: A qualitative design was undertaken to explore the phenomenon. Data collection methods included in-depth interviews with key informants with a purposively selected sample of 20 participants. Interviews were conducted using flexible semi-structured interview guides. Depending on the participant's position and involvement in COVID-19 testing, the guides were modified, and key elements were drawn from a tailored version of the WHO Health System Framework incorporating the Essential Public Health Functions (EPHF). The interview findings were augmented by reviewing published literature. Results: Better health governance and political leadership, community participation, multisectoral collaboration, effective resource management and information systems were key enablers of COVID-19 testing. Findings also revealed a strong political willingness to committing financial resources to enhance testing. The primary barriers to testing were mainly COVID-19 infodemic, inadequacy of material resources to meet growing health needs, and lack of opportunities to have equal and easy access to testing services. Further, although human resources were adequate, they were unevenly distributed across settings. Conclusion: To effectively be prepared for COVID-19 testing and respond to future outbreaks, the following are recommended: there should be improved political commitments to ensure even distribution of all resources across the country; financial supports should be provided for the poor to protect them from the financial burden of paying for expensive testing services; improving community participation should be encouraged to address socio-cultural barriers to testing hesitancy. However, multilateral cooperation with diverse stakeholders beyond the scope of health will be essential in facilitating pandemic responses such as scaling up testing strategies