By Maureen Simpson
In many communities across Ghana, access to health care is shaped by distance, terrain, and trust. Reaching a clinic isn’t always simple and, for some, care depends on whether the system can reach them instead. Even then, past experiences, misinformation, and unanswered questions influence whether people choose to seek out those services.
Between 2022 and 2024, Global Communities partnered with the Ghana Health Service (GHS) to close that gap, often referred to as “the last mile.” While COVID-19 vaccination efforts were the immediate focus, the work strengthened the primary health care system that communities rely on every day.
The Reality on the Ground
At the height of the pandemic, like many countries, Ghana’s health system was navigating multiple pressures at once. Vaccine distribution and uptake required more than supply. It meant accessing hard-to-reach places, keeping vaccines at safe temperatures from storage to delivery, and building confidence in the services being offered.
These were not new challenges, but COVID-19 made them hard to ignore. With a population of more than 31 million people and an average of just one hospital bed per 1,000 individuals, the country’s health workforce was under significant strain.
As these pressures grew, the government of Ghana worked with a range of stakeholders to expand capacity and reach. Through funding from the U.S. government, Global Communities became part of the effort to improve vaccination rollout in eight regions of the country.
“They were able to support this exercise at a time when we were climbing a mountain.”
Dr. Kwame Amponsah-Achiano, Programmes Manager, Ghana Health Service
From the outset, our approach was grounded in partnership. Rather than introducing new systems, we worked through existing structures and supported GHS with training and tools at national, regional, and district levels.
“There is no way you can build the capacity of a workforce without integrating their own structures,” said Emefa Baidoo, who led the COVID-19 project for Global Communities. “We were not trying to reinvent the wheel. We were just greasing the machine.”
how the work came together
Working with GHS, Global Communities supported training for more than 2.8 million health staff and volunteers on COVID-19 vaccination and community engagement. This investment strengthened the frontline workforce not only in technical skills but in how they connected with the people they serve. Nearly 7,000 received specialized training in risk communication, equipping them to listen, respond to concerns, and share accurate information in ways that resonated locally.
“Health care is about education,” Baidoo said. “No health program is successful if you can’t effectively communicate.”
Adama Musah (left) counsels a client at Tamale Reproductive and Child Health Center in northern Ghana. Photo by Bobby Neptune
Rather than relying on standardized approaches, messages were shared in local dialects, using words and expressions people recognized. Health teams partnered with community volunteers to adapt outreach to local contexts and ensure conversations around vaccination were accessible.
“Language builds trust,” Baidoo said. “They could identify with it.”
That trust was reinforced by those who carried the messages forward. Religious leaders, traditional authorities, and other respected community voices helped share information in everyday spaces, making it easier for people to ask questions and consider their options. Across eight regions, outreach included home visits, small group discussions, community gatherings, and local radio. One-on-one conversations during routine appointments proved especially effective, because clients could speak openly and be met with care.
“I get them to first have confidence in me, and then I can convince them to get vaccinated,” said Adama Musah, lead midwife at Tamala Reproductive and Child Health Center in northern Ghana.
Global Communities and the Ghana Health Service harnessed the influence of trusted community members like Adama (right) to reach high-risk populations such as pregnant women with information about COVID-19. Photo by Bobby Neptune
According to Adama, many pregnant women were initially fearful of the COVID-19 vaccine, despite facing higher health risks. During routine check-ups, she took time to answer questions, offer guidance, and talk through concerns in a way that felt personal.
“She spoke to me like she was my mother,” said Patience, a client who credited Adama for her decision to eventually get vaccinated. “She made me trust her.”
Over time, interactions like these helped address hesitancy and increase uptake across a wide range of people, including pregnant women, older adults, young people, and those with underlying health conditions. They also reinforced a broader principle: health services are more effective when they are shaped with communities, not just delivered to them.
WHAT IT TOOK TO GET THERE
Reaching people in more remote areas required more than communication. It depended on whether health teams had the tools and resources to get there in the first place.
In many parts of the country, distance and terrain made routine outreach difficult. Some communities could only be reached by boat. Others required long journeys by motorbike or on foot.
“It is difficult to send the nurses to the village,” said Saglabate Ambrose, a community volunteer in the Oti region. “We have a road, but it is unmotorable.”
Even where paths existed, access was not always straightforward. In some areas, health workers had to climb steep mountains to reach each household.
“You need a lot of energy to do that,” said Felix Kuleke, a community health nurse at Akpafu Mempeasem Health Center. “Sometimes, we get tired. We have to come back and rest before we proceed again.”
Through the COVID-19 project, Global Communities worked with GHS to address these barriers. Early support focused on making travel possible. This included fuel for motorbikes and vehicles as well as rented boats with life jackets for long trips across Volta Lake, a vast expanse of water that has long limited access for health teams.
By the end of the project, that support had expanded. Global Communities donated 30 motorbikes, four trucks, and a 20-foot boat dubbed the “Health Voyager,” making it possible for GHS to safely expand services to even the most isolated areas, including more than 200 islands.
At the boat’s commissioning ceremony, Dr. Patrick Kumah Aboagye, Director General of GHS, described the Health Voyager as “a monumental advancement in health care for the Oti region, ensuring no community is left behind.”
Support for field operations also helped teams travel more consistently. In some cases, they stayed in communities for several days, giving people time to ask questions, return for follow-up, and complete their vaccinations.
Other critical investments focused on how vaccines were stored and transported. Strengthening these systems helped ensure doses remained safe and effective as they moved from regional cold rooms to districts and communities. As a result, key services were no longer confined to fixed facilities, making it possible to reach people who had previously been missed.
TURNING INFORMATION INTO ACTION
Alongside efforts to expand vaccine access, Global Communities worked with GHS to strengthen how information was used to guide day-to-day decisions. District and regional teams, including more than 100 data officers, were trained and equipped with tools such as laptops and electronic tablets to support more consistent data collection and reporting.
With clearer and more timely information, teams could track coverage, identify gaps, and adjust their approach based on what they were seeing. This made it easier to follow up in areas with lower vaccination coverage and respond more quickly to emerging needs.
Health teams began to use data in their daily work to plan outreach more effectively and ensure services reached the people who needed them most. Regular data reviews helped maintain accuracy and consistency, giving teams confidence in the information available to them.
Between 2022 and 2024, across all eight regions, reporting remained both timely and reliable. Data accuracy was 100%, with no discrepancies between recorded and reported vaccination data.
WHAT CHANGED AND WHAT CONTINUES
By 2024, COVID-19 vaccination coverage had increased from 36.5% to 63.5% across supported areas. More than 4.3 million doses were administered, and over 1.8 million people were fully vaccinated.
But these were not temporary gains or the result of one-time investments.
Together with GHS, Global Communities helped strengthen systems that continue to support care beyond COVID-19. Today, vaccination has been integrated into routine services, and the same approaches now support maternal health, child immunization, and disease prevention.
“Any health activity can thrive using these structures, and we’ll get the desired result,” Baidoo said. “It’s not just addressing COVID-19. Whether it’s malaria, polio, cancer, or HIV, a stronger foundation is in place to handle future health challenges or whatever is the next priority.”
Cassie Vasiloff (USAID) contributed reporting to this story.