Six out of 10 people in Ghana do not have health insurance and healthcare infrastructure tilts in favour of the haves and socially-privileged. There is one doctor to 10,000 people– two times more than the number recommended by the World Health Organisation.

A 2017 report revealed 79 districts hospitals with no doctors and 82 of the country’s most deprived districts without a hospital. The National Health Insurance Scheme– the country’s safety net for the poor to seek medical care- currently subscribed to by about 40 percent of Ghanaians, is now at breaking point, reeling under heavy debt. 

So how would the country’s marginalised cope with a COVID-19 epidemic?

Over 100,000 people live in the Old Fadama enclave. It is Ghana’s largest shanty town– home to thousands of head porters and doers of almost everything menial.

It’s a Sunday morning. A government ban on congregation of people more than 25 is still in force so a handful of members of the “True Life in Jesus Ministry” have come to pray.

“We are here to pray for the country,” says Kwadwo Agyei, the Pastor leading the service. “The way the coronavirus is going, only God can save us,” he tells me in broken English.

The room which has now been turned into the makeshift church where the congregation is praying used to be part of a hospital – the only one that existed in the Old Fadama community for many years. It was a private facility operated by a man people fondly called Dr Plange.

Dr Plange died in 2006. The hospital collapsed on his demise and with it, healthcare in this enclave.

“When Dr Plange was here, you didn’t need to travel. If you have a headache, you only walk a few meters from your house and you can see him here and you’ll be fine,” says Stephen Arku Savah, the Ewe Chief here and one the chiefs leading the 16 known ethnic groups in the slum.

Part of the structure is now a refuse dump. Its roofs are ripped off allowing water to seep into other parts to form puddles in other parts that used to hold shelves for drugs.

Government has consistently parried calls to pay attention to the people at Old Fadama. The State maintains they are living there illegally. And so there are no state services. No schools, no running water, and no hospitals for a community of 100,000 people.

Old Fadama may be the extreme case example of the condition of Ghana’s poor but they are not very far from what the reality is for nearly 25 percent of the country’s 30 million people who are poor.

“Deeper inequities are going to be exposed during this COVID-19 period because, over time, we haven’t invested in health infrastructure to reach all and provide the financing that is required,” says Dr Abena Asomaning Antwi, a Health Economist who has spent years studying the livelihoods of people in the Old Fadama enclave.  

West Legon, located close to Ghana’s premier university – the University of Ghana – is a plush, upmarket vicinity. Its serene lands and properties were snapped up by the country’s rich and well-connected years ago.

Today, you need an average of GH¢2,000 (roughly 350 USD and more than five times a daily minimum wage income earner gets paid a month), to rent a property monthly here. Driving through its paved and asphalted roads, this place looks like a different country from the thin shacks and crowded alleyways in Old Fadama.

In the heart of the area is the Medifem Multi-Specialist and Fertility Center – a well-equipped health facility with some of the most experienced health providers and state-of-the-art facilities providing healthcare that would rival what is provided in many middle-income nations. The services they provide here come at a price, way over what the average income earner in Ghana can afford.

“We have systems in place… ready to stop the spread of the infection (coronavirus),” says Dr Ampofo Koranteng, a Specialist Gynaecologist of 42 years standing, the man leading the hospital’s COVID-19 Emergency response.

From testing for people’s temperature right at the entrance, provision for handwashing and running water and a detailed travel history check of every single person walking into the facility for service, Medifem has a robust system that seeks to identify those likely to be at risk of coronavirus infection.

“There’s this difference between the poor and those who can afford. The poorly resourced, even to get to a hospital, you have to get into public transport and when you get there you have to queue for a long time. All of these [promote] the spread of the virus,” says Dr Koranteng.

Such high-end private health facilities like Medifem are few in Ghana. It could cost you up to GH¢500 (roughly 90 USD) on the average to get an appointment with a doctor in some of them depending on the condition you have. Since many of the slum dwellers in Old Fadama are daily wage earners with no security of income, that is money they cannot save even in an entire month.

That’s according to 50-year-old Israel Agbenu, who moved into the slum 10 years ago. He provides power to charge mobile phone batteries and sells water for a living. Out of this business, he caters for five children and his wife. Three years ago, he was diagnosed with diabetes. He has to see the doctor every week and make lifestyle changes like walking and exercising regularly. A year ago, he stopped going to see the doctor.   

“I have to travel every day. Take a car and spend so much. So I stopped. If I have to go through all of that to see a doctor then I’d stay here and die slowly,” he says.

Social distancing is an expensive privilege only a few can afford and with no healthcare available to the people in Old Fadama, a coronavirus outbreak here would spell doom, Mr. Agbenu fears. “There are no roads here and so if there’s someone who gets infected by the coronavirus, how would a car come here and pick them? 

People like Israel are at their wit's end, eking out a living in this slum. He would rather be here than die of hunger in his native Volta Region where he says there are very few jobs available.

“If you are a millionaire and you are living somewhere and all the money in Ghana is spent on building facilities for you and we have nothing, know that if coronavirus comes here, everyone would get some because people come from here and go everywhere,” says Arku Savah, the Ewe Chief in Old Fadama.

Covid-19 is spreading like wildfire and experts warn, it’s only a matter of when and not if, it would arrive here in Old Fadama. Everyone here knows that. What they do not know is if they, like Ghana’s privileged few, would ever be ready for it when it comes.

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Photography by Samuel Moore