2014.ISDS.Abstracts.Final.pdf


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ISDS 2014 Conference Abstracts

The Threat of Ebola Virus Disease: a Call to Integrate all 
Sectors in Surveillance Activities in Ghana

Dennis O. Laryea*1, Yaw Amoako1, Dan V. Armooh2, Emmanuel P. Abbeyquaye3 and 
Bernice N. Amartey3

1Public Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana; 2Health Allianz Clinic, Accra, Ghana; 337 Military Hospital Neghelli 
Barracks, Accra, Ghana

Objective
To describe Ghana’s disease surveillance system operation and the 

potential challenges in the light of the Ebola outbreak in West Africa

Introduction
Disease surveillance particularly surveillance for communicable 

diseases is essential in identifying cases and preventing the occurrence 
of an outbreak. Surveillance can also contribute to reducing the size 
of an outbreak. In order to achieve these, surveillance activities must 
include all possible sites for case detection. The lack of established 
mechanisms to provide feedback to the surveillance system at all 
such points can cause a failure of the surveillance system. These 
are extremely relevant particularly in the current outbreak of Ebola 
in some parts of the West African Sub Region. Ghana, like many 
countries has established surveillance systems for specific diseases. 
Currently, 44 diseases/public health events including Ebola are 
under surveillance as part of an Integrated Disease Surveillance and 
Response (IDSR) system. Although the Ministry of Health (MOH) 
exercises authority over issues of health, the operation of policies 
and practices on disease surveillance is by the Ghana Health Service 
(GHS), an agency of the MOH despite the existence of other agencies 
such as the teaching hospitals.

Methods
We examine Ghana’s health system in relation to communicable 

disease surveillance and identify possible challenges to the current 
system and suggest some ways to improve disease surveillance in 
Ghana in light of the current threat of Ebola and other emerging 
infectious diseases.

Results
Disease surveillance in Ghana is carried out by the Disease 

Surveillance Department of the GHS. Information on diseases is 
obtained mostly from health facilities under the GHS. Information 
on suspected or confirmed cases of diseases under surveillance are 
transmitted to the national headquarters of the GHS through the 
district and regional health directorates. Where required, specimens 
in addition to the appropriate notification forms are sent to designated 
Public Health Reference Laboratory for confirmation. Test results 
are transmitted via the same channels to the health facility involved. 
Although the system includes all facilities under the GHS, it does not 
explicitly involve non-GHS facilities. Surveillance practices including 
training of officers have also focussed on only GHS facilities.

Conclusions
Operating a surveillance system through a single agency, the GHS 

and its facilities with no clear guidelines for the integration of other 
parallel health service providers including private and other non-
GHS health facilities in the routine disease surveillance structure of 
Ghana is a source of concern. This is despite the IDSR guidelines 
identifying private hospitals and others such as veterinary services as 
sources of surveillance information. While active disease surveillance 

in non-GHS facilities has usually taken place during outbreaks when 
active case finding is undertaken, there is the need to ensure that these 
occur on a permanent basis to ensure that cases are not missed at the 
onset of an outbreak should the first cases of communicable disease 
outbreak report to a non-GHS facilitie. This is critical as a significant 
proportion of patients access health care in these non-GHS facilities 
following the introduction of the National Health Insurance Scheme 
(NHIS).

Ghana’s current practice of disease surveillance may potentially 
miss cases of public health importance. The surveillance system 
must move beyond the administrative structure of the Ghana Health 
Service and extend to include all potential sources of surveillance 
information. This will ensure that cases are detected and interventions 
promptly instituted to prevent or reduce the extent of outbreaks

Keywords
surveillance; health system; outbreak; Ghana

Acknowledgments

We acknowledge the contribution of staff of the Komfo Anokye Teaching 
Hospital, Kumasi, Ghana

References

Ghana Health Service, Facts and Figures 2010 [online] Available from 
http://www.moh-ghana.org/UploadFiles/Publications/GHS%20
Facts%20and%20Figures%202010_22APR2012.pdf accessed 5th 
September 2013

Ghana Health Service Technical Guidelines for Integrated Disease 
Surveillance and Response 2011 2nd Edition

*Dennis O. Laryea

E-mail: dlaryea@kathhsp.org    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * (1):e197, 201