Communication Strategies in Relation to COVID-19 in South Africa and Ghana: A Systematic Review

Abstract

COVID-19 is a novel severe acute respiratory syndrome coronavirus 2 (SAR–CoV-2) spread from person to person through infected air droplets of saliva and discharged from sneezes and coughs. This study seeks to contribute to knowledge and understanding of how coronavirus outbreaks could be addressed by examining communication and media strategies used by governments and public health institutions in South Africa and Ghana during the coronavirus pandemic. The study systematically analysed published data on COVID-19 in South Africa and Ghana from 2019 to 2020 to identify recurring themes to discuss issues regarding communication strategies in response to the outbreak. This study found various inadequacies and challenges to communication and media strategies to address the spread of COVID-19. The governments and public health institutions in South Africa and Ghana used multiple mass media channels to communicate different messages and create awareness about COVID-19. This article recommends the improvement of communication and media engagements between governments and health stakeholders in South Africa and Ghana to increase public awareness of the risks, threats and outcomes of COVID-19. The media in South Africa and Ghana must conduct fact finding of information about coronavirus from official sources in government and health institutions before dissemination to the public to minimise fake news, misinformation and disinformation. The governments and health institutions must not rely solely on traditional mass media strategies but also integrate indigenous communication strategies for engagements to address the challenges of mass media to increase public awareness about COVID-19 in South Africa and Ghana.

Keywords

COVID-19 health communication communication strategies media South Africa Ghana

Introduction

COVID-19, also known as coronavirus, is a novel severe acute respiratory syndrome coronavirus 2 (SAR-CoV-2) disease that started to infect humans in December 2019 through contact with infected wild animals in China (Li et al., 2020). COVID-19 spread from person to person through infected air droplets of saliva and discharged from sneezes and coughs (Harapan et al., 2020). The coronavirus is transmitted when people come into contact with surfaces and hands contaminated by the virus, and touch their mouths, eyes or noses. COVID-19 has non-particular flu-like symptoms: fever, dry cough, diarrhoea, tiredness, headaches and pains (Singhal, 2020; Walker & Adukwu, 2020). Therefore, COVID-19 could be misdiagnosed as other illnesses such as typhoid fever and malaria which are common to African countries. COVID-19 has a relatively high mortality because of the multidimensional dysfunction of the human immune system by the virus (Harapan et al., 2020; Zhai et al., 2020).

Since the first COVID-19 case in Wuhan, many outbreaks have been reported worldwide (Li et al., 2020). As of 18 March 2023, there were over 682,403,916 laboratory-confirmed cases and 6,818,879 deaths globally (www.worldometers.info/coronavirus). COVID-19 is most prevalent in the United States, India, Brazil and Europe. However, Africa is not immune to the effects of the coronavirus. Africa recorded its first COVID-19 case in February 2020 in Egypt, which continued to increase and result in many deaths and negative social, economic and political consequences (Gyasi, 2020). As of 18 March 2023, there were more than 12,804,066 laboratory confirmed COVID-19 cases and 258,622 deaths in Africa (www.worldometers.info/coronavirus). South Africa is the epicentre of COVID-19 in Africa (Garba et al., 2020), with over 4,069,578 cases and 102,595 deaths as of 18 March 2023 (www.worldometers.info/coronavirus). Refer to Table 1 below for detailed Covid-19 cases in African countries. Ghana has one of the highest coronavirus cases in West Africa with over 171,288 cases and 1,462 deaths as of 18 March 2023 (www.worldometers.info/coronavirus).

Table 1.

Number of COVID-19 Cases/Deaths in the 2019–2023 Outbreak in Africa as of 18 March 2023.

	Country	Total Cases Confirmed	Total Deaths	Country	Total Cases Confirmed	Total Deaths
Worst affected African countries	South Africa	4,069,578	102,595	Burundi	53,661	38
	Morocco	1,272,526	16,296	Seychelles	50,937	172
	Tunisia	1,151,333	29,345	Gabon	48,981	306
	Egypt	515,792	24,613	Mauritius	41,796	1,043
	Libya	507,201	6,437	Mayotte	42,004	188
	Ethiopia	500,245	7,572	Tanzania	42,927	846
	Reunion	486,588	921	Togo	39,416	290
Rest of the countries in Africa	Kenya	342,943	5,688	Guinea	38,267	467
	Zambia	343,376	4,057	Lesotho	34,790	723
	Botswana	329,769	2,801	Mali	33,074	743
	Algeria	271,543	6,881	Benin	27,999	163
	Nigeria	266,641	3,155	Somalia	27,324	1,361
	Zimbabwe	264,391	5,672	Congo	25,375	386
	Mozambique	233,214	2,242	Burkina Faso	22,056	396
	Ghana	171,288	1,462	South Sudan	18,368	138
	Namibia	171,208	4,090	Equatorial Guinea	17,229	183
	Uganda	170,558	3,630	Djibouti	15,690	189
	Rwanda	133,194	1,468	Central Africa Republic	15,368	113
	Cameroon	124,605	1,966	Gambia	12,598	372
	Angola	105,298	1,933	Eritrea	10,189	103
	Democratic Republic of Congo	95,815	1,464	Niger	9,931	312
	Senegal	88,933	1,971	Comoros	9,048	161
	Malawi	88,707	2,686	Guinea-Bissau	8,960	176
	Ivory Coast	88,291	834	Liberia	8,090	295
	Eswatini	74,323	1,425	Sierra Leone	7,760	126
	Madagascar	67,941	1,423	Chad	7,682	194
	Sudan	63,853	5,023	Sao Tome and Principe	6,296	77
	Mauritania	63,668	997	Saint Helena	2,166	–
	Cabo Verde	63,252	413	Western Sahara	10	1
Total number of Coronavirus and fatalities					12,804,066	258,622

Source: Adapted from www.worldometers.info/coronavirus 2023.

The travel restrictions, social distancing, self-isolation, stigmatisation and prejudices halted economies and business activities that created global recession (Brennen et al., 2020; Nicola et al., 2020; Roberto & Johnson, 2020). There were international, national and local unrests in the outbreak of COVID-19 that challenged global health organisations including the World Health Organization and governments because of the devastating effects (Sohrabi et al., 2020). The coronavirus was an unprecedented crisis in Africa, where governments, health institutions and civil society organisations warned citizens to take measures to curb spread and fatalities (Bonful et al., 2020).

The weak health systems, lack of vaccine or treatment, insufficient knowledge about the disease and inadequate healthcare professionals in Africa challenged the management of the coronavirus (Mukandavire et al., 2020). Inadequate medical facilities, ventilators, personal protective equipment especially face masks, as well as cultural beliefs and practices also challenged efforts to address the COVID-19 pandemic (Afulani et al., 2020; Roberto & Johnson, 2020). Governments, authorities and public health institutions use several measures including surveillance, screening, contact tracing, quarantine or patient isolation and care, monitoring, border and movement control to curb the spread and fatalities in pandemics (Reddy et al., 2020; Zhao et al., 2020). Some of the measures used to address COVID-19 in Africa were ad hoc and culturally insensitive to local populations (Adom, 2020; Walker & Adukwu, 2020).

Despite the inadequacy, healthcare providers and professionals were willing to assist COVID-19 patients, however, the emergency and sensitivity of the outbreak overwhelmed their support, which led to slow communication, mistrust and distrust between health workers, patients and families during the outbreak (Brennen et al., 2020). Lack of information about occurrences in quarantine and isolation centres, limited access to healthcare and medical treatment hindered the identification and treatment of affected individuals (Brennen et al., 2020; Walker & Adukwu, 2020). Patients escaped from health and quarantine centres on several occasions for fear of dying due to a lack of trust and confidence (Chan, 2014). Communication, information and education are important in the effective management and preparation for disease outbreaks (Afulani et al., 2020; Gilbert et al., 2020). Communication played a critical role in communities and public health institutions in the 2019–2020 outbreak of COVID-19 in Africa given the sensitivity of the pandemic, which reduced the trust and confidence in healthcare personnel and authorities (Bonful et al., 2020; Gilbert et al., 2020). COVID-19 has created vulnerabilities in Africa for the scientific analysis of communication and media strategies supported by primary and secondary data used in the 2019–2020 outbreak. The purpose of this study is to provide an in-depth social understanding of the coronavirus pandemic from African perspectives, which situates cultural, communication and media into public health, and analyses published research on COVID-19 in South Africa and Ghana in scientific repositories to investigate the outcomes of interventions used to address the pandemic. This study sought to achieve the following objectives.

Research Objectives

To investigate how governments and health institutions in South Africa and Ghana communicated COVID-19 to improve knowledge, attitudes and practices, as well as outcomes.

To compare how governments and health institutions in South Africa and Ghana communicated knowledge, attitudes and practices with respect to COVID-19.

To explore how governments and health institutions in South Africa and Ghana dispelled fake news, disinformation and conspiracies, as well as communication strategies used to address them.

To examine how governments and health institutions in South Africa and Ghana communicated to de-stigmatise COVID-19 and outcomes.

Research Questions

This study addressed the following questions to achieve research objectives:

How did governments and health institutions in South Africa and Ghana communicate COVID-19 to improve knowledge, attitudes and practices, and what were the outcomes?

How did South Africa and Ghana compare in the communication of knowledge, attitudes and practices with respect to COVID-19?

How did governments and health institutions in South Africa and Ghana dispel fake news, disinformation and conspiracies, and which communication strategies were used to address them?

How did governments and health institutions in South Africa and Ghana communicate to de-stigmatise COVID-19, and what were their outcomes?

Research Methods

This study used a qualitative research approach and conducted an interpretative systematic review of published articles on the COVID-19 pandemic in South Africa and Ghana. The study sampled these countries because the pandemic has impacted South Africa more than any other country in Africa with the highest COVID-19 cases and fatalities. While Ghana had the highest cases in West Africa at the initial outbreak of COVID-19 and among the countries that had a relatively higher number of coronavirus cases on the continent. Hence, these countries could provide rich data and interesting communication experiences regarding the coronavirus pandemic in Africa for research. As Higgins and Green (2008) and Stevens (2001) highlight, systematic review is an important method that underpins evidence-based research and practices, and inform decisions in public health, human and social activities. Systematic reviews often called overviews entail the collation and analysis of empirical medical-related literature or evidence, which uses explicit and reproducible methods to search, critically appraise and synthesise data on specific issues that meet pre-specified eligibility, inclusion and exclusion criteria to answer specific research questions (Higgins & Green, 2008). The study used Methley et al.’s (2014) population, intervention, comparison, outcome, study design (PICOS) framework to systematically review existing literature on media and communication of COVID-19 in South Africa and Ghana to address research objectives and questions.

Search Strategy

The study based its search strategy on Methley et al.’s (2014) PICOS framework. PICOS is a mnemonic applied in evidence-based research to frame and answer health-related questions, which helps to undertake literature search strategies for systemic reviews (Methley et al., 2014). This study was a multi-country inquiry focused on South Africa with Ghana as a comparator. The study examined communication and media strategies used in South Africa and Ghana as interventions to address the outbreak of COVID-19. The outcomes are implications and reactions to communication and media interventions and strategies used in South Africa and Ghana.

Using a Boolean operator to extend the reach and focus online searches on-target for productive results, the study conducted searches on sampled database collections and repositories for COVID-19 or coronavirus data. The study analysed scientific data from research-based literature and articles that have high scholastic integrity. The study conducted extensive and exhaustive searches on Medline, PubMed, Google Scholar, Web of Science, North-West University Library search, University of Education, Winneba Library search, Cochrane Library, Directory of open access journals and Scopus (Walker & Adukwu, 2020) to identify published articles that used systematic, rigorous and reproducible methods to study COVID-19 in South Africa and Ghana for synthesis and critical appraisal. This study sampled the identified databases for the research because it sought to analyse science-driven reports on COVID-19. The selected repositories are recognised for keeping quality research data and articles. The search results and articles were screened to limit the study’s sample to research that focused on communication of COVID-19 in South Africa and Ghana, which were retrieved and printed for systematic review, synthesis, analysis and discussion of findings.

Inclusion and Exclusion Criteria

This study used exclusion and inclusion criteria to identify suitable literature and articles published between 2019 and 2020 on health communication and public information on the risk of COVID-19 to the populations in South Africa and Ghana. The exclusion criteria were articles published before the outbreak of COVID-19 in December 2019 and articles that did not focus on health communication, public information and human studies. The study used the Critical Appraisal Skills Program (CASP) tool to screen and assess titles and abstract of published articles in accordance with the inclusive and exclusive criteria of this research (Singh, 2013). The CASP is a tool used to systematically assess the relevance, trustworthiness and results of published articles that enhances evidence-based approach and allows researchers to examine methodologies and reliability of scientific articles to make conclusions and applications (Singh, 2013). This study addressed three broad issues in the critical appraisal and assessment of published articles in the systematic reviews with respect to (a) the validity of the study, (b) the results of the study and (c) the relevance of the results of the study, as well as their applicability in practice and locality. The published articles were appraised several times to ensure that inclusion and exclusion criteria were sufficiently met to enable the study to select suitable and credible articles to limit potential biases. As systematic reviews could encounter potential biases and the inclusion of non-randomised studies of interventions, this study relied on quality-reviewed published articles for analysis. This study also used the Assessment of Multiple Systematic Review (AMSTAR) to appraise the quality of publications on COVID-19 between 2019 and 2020 in South Africa and Ghana sampled for analysis (Teich et al., 2015). AMSTAR is a tool for assessing the quality of systematic reviews, which enables researchers to undertake rapid and reproducible assessment of the quality of systematic reviews of interventions (Shea, 2008; Teich et al., 2015).

Data Extraction, Synthesis and Analysis

This study identified published articles in databases and repositories that employed qualitative approaches and analytical methods, as well as extracted qualitative data from sampled articles and analysed recurring themes. Themes are the important aspects of data collected in respect of research questions (Braun & Clarke, 2006). Thematic analysis is an analytic method in qualitative research used to identify, analyse and interpret patterns and themes in data (Braun & Clarke, 2006). This involves analytical coding, assigning words and phrases, and summarising the essence-capturing and evocative attributes of data extracted (Saldana, 2015). Thematic analysis promotes flexibility and theoretical freedom (Braun & Clarke, 2006), which this study used as an analytical tool to provide a detailed account of the qualitative data collected from systematic reviews. The study coded and categorised research data into key recurring themes by familiarising with data collected, developing initial codes, searching, reviewing and defining themes, and writing the report (Braun & Clarke, 2006).

This study reviewed the published articles independently at all stages of the research to minimise any potential biases. The study also engaged subject librarians at North-West University in South Africa and University of Education, Winneba in Ghana to independently appraise the search strategies used.

Results/Findings

The study’s search of sampled repositories generated a total of 6,565 articles on COVID-19 communication after screening the titles and abstracts of published articles (see Figure 1). The study found 1,082 potential articles that were relevant to COVID-19 which were retrieved and printed. Duplicated articles were eliminated to the number of articles to 494 after the application of the inclusion criteria of the study (see Figure 1). The study critically appraised articles that met the inclusion criteria to settle on 70 articles for data extraction and analysis (see Figure 1). The study restricted the analysis to 70 articles due to data or thematic saturation, which prevented further inclusion and review of articles. Data or thematic saturation refers to the point in data collection when the ability to obtain additional or new information has been attained, which makes further coding not feasible (Guest et al., 2006). Saturation is the point in data collection and analysis when new data produce little or no information to address the research questions (Benard & Ryan, 2010). The 70 articles on COVID-19 sampled for analysis were subdivided into South Africa and Ghana to compare and conclude the similarities and differences between communication strategies used, reactions and outcomes in their efforts to address the outbreak of the pandemic.

Figure 1.

Diagram Showing Selected Studies After the PICOS Criteria and CASP Tool.

Thematic Analysis

The study has provided the breakdown of sampled articles and data extracted that include characteristics and strategies, aims and objectives, as well as outcomes and findings in Supplementary Figure 2. Four major themes recurred from the data extracted which are highlighted and linked in a thematic map (see Figure 2).

Figure 2.

Thematic Mapping of Issues That Are Associated with Communication Management and Challenges in the 2019–2020 Coronavirus Outbreak in South Africa and Ghana.

Knowledge, Attitudes and Practices of the Public

This study analysed several studies that examined the level of general knowledge of the transmission of COVID-19, risk factors, cultural practices, preventive measures and treatments, which are themed as knowledge, attitudes and practices (Serwaa et al., 2020; Zhong et al., 2020). Researchers conducted interviews and surveys with different sections of the populations in South Africa and Ghana to evaluate their knowledge, attitudes and practices. Many of these studies sub-categorised their results into responses, such as good, satisfactory, poor or unsatisfactory. Information on the knowledge, attitudes and practices of participants regarding the COVID-19 outbreak in South Africa and Ghana was poor; many respondents were misinformed or dis-informed on what to do if they suspected they or other individuals had contracted the coronavirus (Serwaa et al., 2020; Stiegler & Bouchard, 2020). It could be noted from the comparison of the two countries that knowledge and awareness of the public about COVID-19 were better in South Africa than in Ghana as information about the pandemic spread faster in the former because of South Africa’s high level of internet penetration and access to technology.

This study noted from articles analysed that communities affected by COVID-19 were willing or ready to learn more about the disease when they were approached by public health institutions and professionals (Gilbert et al., 2020; Serwaa et al., 2020). Some of the articles highlighted that in communities where there were two-way channels of communication especially social media, the knowledge, attitudes and practices of individuals were improved faster (Bonful et al., 2020; Farao, 2020). There were improvements in knowledge, attitudes and practices of South Africans and Ghanaians as governments and health institutions intervened to communicate the risks of COVID-19. This was evident when health institutions and personnel extended their efforts to stop transmission to locate hotspots and identify at-risk individuals through several strategies such as risk communication, contact tracing, early diagnosis, patient isolation and care, infection control and safe burial (Afulani et al., 2020; Reddy et al., 2020; Rosenthal et al., 2020). The improved understanding, knowledge, attitudes and practices of individuals in South Africa and Ghana minimised the rate of transmission (Farao, 2020; Serwaa et al., 2020).

Fake News, Disinformation, Misinformation and Conspiracies

Research shows that there are many misconceptions, misinformation and disinformation during disease outbreaks especially the coronavirus in Africa (Ahenkora et al., 2020; Russonello, 2020). Several of the research on COVID-19 in South Africa and Ghana that this study reviewed highlighted issues of recurring misinformation, disinformation and conspiracies about the pandemic. There was fake news that promoted false cures, myths and other conspiracy theories during the outbreak of COVID-19 on many media particularly social media, which disseminated different forms of information and fake advertisements and cures (Ahenkora et al., 2020). For example, one misinformation in Ghana was that drinking boiled water, garlic and ginger could cure COVID-19, while in South Africa there was misinformation that spending time in the sun, steaming and taking vitamin C could cure the disease despite the lack of scientific evidence to support such recommendations (Mian & Khan, 2020; Pennycock et al., 2020). There were claims in South African and Ghanaian media that COVID-19 was a biological weapon by China against the United States (Ahinkora et al., 2020; Pennycock et al., 2020). The other fake news was that the causative organism of COVID-19 could not thrive in Africa due to hot temperatures (Ahenkora et al., 2020).

People were dis-informed that Africans had stronger immune systems against COVID-19 (Ryder, 2020). A religious conspiracy was that COVID-19 was a sign of the end time to promote anti-Christ vaccines and ID2020 with the support of Bill Gates to control the population of the world, especially Africa. These fake news, misconceptions and misguided information also related to what happened in COVID-19 quarantine and treatment centres created mistrust, fears and panic among the public about vaccines and trials (Brennen et al., 2020; Mejova & Kalimeri, 2020; Roberto & Johnson, 2020; Shimizu, 2020), which contributed to the spread of the virus in South Africa and Ghana. Misinformation, disinformation, fake news and conspiracies of different forms besieged many media channels, short messaging services texts and word of mouth because many people failed to check the validity of information they received from official sources such as the World Health Organization and national public health institutions (Adebimpe et al., 2015; Farao, 2020).

Fear of COVID-19 Survivors and Seeking Medical Advice and Attention

There were fears and panic about COVID-19 linked to misinformation, disinformation, fake news and conspiracies. The fear of COVID-19 survivors was notable in the articles on the pandemic in South Africa and Ghana. Evidence from articles and data that this study analysed indicates that many survivors of COVID-19 were stigmatised and excluded from community engagements and communication (Person et al., 2004). This made it difficult for survivors of the coronavirus to live normal lives after discharged from quarantine and treatment centres (Roberto & Johnson, 2020). The lack of information about what happened in quarantine and treatment centres, and deaths of patients made many people afraid and unwilling to seek medical attention when they noticed symptoms of COVID-19 or got into contact with individuals infected, which contributed to the spread of infections because individuals avoided to diagnose, or ran away from quarantine centres to communities where they were not known (Walker & Adukwu, 2020).

The Role of the Media Including Social Media

The different forms of media in South Africa and Ghana gave opportunities to the awareness and risk communication of COVID-19. Governments and public health institutions in South Africa and Ghana used different modes of communication (written, aural and visuals), perceptions and strategies to communicate the risk and awareness of the COVID-19 outbreak. Many individuals in these countries relied on traditional or conventional media such as television, radio and newspapers as the main avenues and sources of COVID-19 information (Bateman et al., 2020; Gillespie et al., 2016; Le et al., 2020), where governments used regular presidential addresses to communicate the pandemic to the public. Aside presidential addresses, ministers and representatives of national health institutions provided public communication, regular updates and announcements on the coronavirus (Roberto & Johnson, 2020). Many communicators and reporters in the media who include healthcare personnel that speak on viruses are not trained on how to speak professionally on health crises (Figueroa, 2017). Health personnel in South Africa were, however, repurposed and trained to equip them with information and knowledge of the medical care required by COVID-19 patients, as compared to their counterparts in Ghana who lacked such training because of the novelty of the disease. The lack of sufficient knowledge, communication and health workforce contributed to the over-burdened health facilities and increased fatalities during the outbreak.

There was a significant increase in media attention to the pandemic at the initial stage of the COVID-19 outbreak after the slow public service announcements and communication due to large proportions of unmoderated information (Brennen et al., 2020; Mian & Khan, 2020; Roberto & Johnson, 2020). Many people particularly the youth in South Africa and Ghana received COVID-19–related information through social media (Farao, 2020; Serwaa et al., 2020), which makes these platforms useful for public information on pandemics. However, the lack of moderation of COVID-19 information on social media made it difficult to relay trustworthy and reliable information that met the minimum standard and ethics of reporting disease outbreaks.

Other Findings

This study established a correlation between increased knowledge and COVID-19 information, and attitudes and behaviours towards efforts to seek medical attention and healthcare (Bonful et al., 2020; Gilbert et al., 2020; Walker & Adukwu, 2020). Some of the articles that this study analysed indicated that individuals who had inadequate information or poor knowledge of COVID-19 were more fearful, which prevented them from seeking healthcare and medical treatment (Brennen et al., 2020; Serwaa et al., 2020). These emphasise that communication, education and sensitisation programmes in pandemics are important to improve public knowledge and information to encourage people to seek medical care (Afulani et al., 2020; Rosenthal et al., 2020). Interpersonal and interactive communication could be more productive than public information, where information about COVID-19 was passively disseminated to the public. Interpersonal and interactive communication in the forms of practical demonstrations and community engagements enhanced the knowledge of individuals about the coronavirus and promoted responses to the health crisis, which improved attitudes and practices to curb the pandemic in South Africa and Ghana (Adom, 2020; Ansumana et al., 2014; Serwaa et al., 2020; Walker & Adukwu, 2020).

The evidence from the articles analysed shows that information communicated about COVID-19 and their acceptance increased over time, which reinforces the need for continuous risk communication efforts and access to health information on the coronavirus (Afulani et al., 2020; Farao, 2020; Rosenthal et al., 2020). It is important for health professionals to have adequate understanding, knowledge and acceptance of communities in times of virus outbreaks especially how individuals adapt to the communication strategies to promote the success of education and sensitisation (Abramowitz et al., 2017). The sharing of information, data and experiences regarding the management of virus diseases between institutions and countries can improve risk communication, disease management, quality and the credibility of information sources and acceptability in communities affected by the pandemic (Walker & Adukwu, 2020).

The government in South Africa was the first to react and impose a nationwide lockdown at the beginning of the COVID-19 outbreak, and implemented a comprehensive public health response to declare a national state of disaster based on a Disaster Management Act (Stiegler & Bouchard, 2020). The South African government developed a risk-adjusted strategy in line with the Disaster Management Act based on five levels to return its economic activity to normal as it moved the country through five stages to ease lockdown restrictions (Nkonki & Fonn, 2020). Situations were different in Ghana because there was no clear immediate plan to address the coronavirus though the government imposed a partial lockdown on its two major cities, which was lifted shortly after citizens were mandated to use face masks in public places (Adom, 2020; Kenu et al., 2020). Health facilities and caregivers in Ghana experienced inadequate and inconsistent supply of personal protective equipment, as well as non-payment of allowances and strikes that threatened efforts to curb the outbreak of COVID-19 (Tawiah et al., 2021).

The emphasis of the communication strategies and education in South Africa and Ghana about COVID-19 was to encourage people to wash their hands with soap and use hand sanitisers, as well as distance socially, avoid the touch of eyes, mouth and nose with hands, and cover the mouths with tissue or arm when they coughed or sneezed (Afulani et al., 2020; Bonful et al., 2020). Governments and health institutions encouraged people especially the old age and individuals at high risk to stay home during the coronavirus outbreak and lockdown (Gyasi, 2020; Lloyd-Sherlock et al.,2020). When the lockdown was eased, the communication strategies adopted to communicate COVID-19 in South Africa and Ghana focused on people to wear face masks and comply with safety and precautionary measures and protocols to curb the spread of the disease (Gilbert et al., 2020; Serwaa et al., 2020).

Discussion

This study investigated the strategies used in South Africa and Ghana to communicate the risk and awareness of COVID-19 during its outbreak in 2019 and 2020. The study identified communication, community engagement and education (Afulani et al., 2020; Hernández-García & Giménez-Júlvez, 2020; Rosenthal et al., 2020) as preventive responses used in the sampled countries. The study analysed data on COVID-19 in South Africa and Ghana in the sampled repositories shows that authorities in these countries communicated and informed the public about the pandemic (Bonful et al., 2020; Hernández-García & Giménez-Júlvez, 2020). The study thematically analysed data collected and compared findings to ascertain whether communication strategies and interventions used to address the coronavirus were successful or unsuccessful in South Africa and Ghana. The selection of media to communicate the risk of COVID-19 was critical in the responses of governments and health institutions in the two countries to the pandemic. For example, the two countries used presidential addresses to the nations to provide regular updates on COVID-19 to the public, which were supplemented with further details from other designated authorities such as the ministers of information and health who were officially charged with the responsibility to communicate issues about the pandemic.

South Africa was more resourced and prepared to respond to the coronavirus pandemic than Ghana in terms of infrastructure, materials, equipment and public education. However, key responses in South Africa and Ghana included identifying communities and specific groups to reach them through different modes of communication which include written, aural and visual strategies to inform the public about the coronavirus (Le et al., 2020). Such responses to COVID-19 were communicated horizontally and vertically to communities, which targeted their information to individuals especially older people with health or medical conditions that required more education due to their higher risks of contracting the disease (Gyasi, 2020; Lloyd-Sherlock et al., 2020).

The internet and social media platforms such as WhatsApp, Facebook, Twitter and Short Messaging Services were used to distribute and exchange information during the COVID-19 pandemic (Farao, 2020; Hernández-García & Giménez-Júlvez, 2020). The governments in South Africa and Ghana imposed full and partial lockdown which compelled many citizens to rely on online sources particularly websites of media outlets, governments and public health institutions, as well as phone-based applications to obtain information updates and instructions on COVID-19 (Farao, 2020; Pennycock et al., 2020). This is especially true because large meetings in churches, mosques, universities and schools were prohibited by the lockdown during the outbreak.

The governments in South Africa and Ghana were commended for their responses and community engagements during the initial outbreak of COVID-19 despite their over-burdened healthcare facilities. The South African and Ghanaian public was made aware of the transmission and preventive measures, such as handwashing or hand sanitising, avoidance of touch of face or nose and safe burial after the widespread of COVID-19 (Bonful et al., 2020; Gilbert et al., 2020). The emphasis of communication and education by the governments and health institutions to the public in South Africa and Ghana after the lockdown restrictions were eased was to encourage people to wear face masks to prevent them from contracting the coronavirus (Afulani et al., 2020; Bonful et al., 2020). This study noted that South Africa and Ghana used proactive and reactive responses to address the COVID-19 pandemic which focused on risk communication and preventive measures (Frost et al., 2019; Hernández-García & Giménez-Júlvez, 2020) and ensure that health systems and care professionals were ready to treat infected patients (Afulani et al., 2020; Gilbert, 2020).

Several challenges are associated with the management and dissemination of information to diverse groups during pandemics (Walker & Adukwu, 2020). Education materials on COVID-19 were translated into local languages because of the multi-ethnic groups in South Africa and Ghana for effective communication with the public to improve knowledge, attitudes and practices towards the health crisis (Appiah et al., 2020). Social media are cost-effective platforms for educating communities (Farao, 2020). However, social media platforms were not adequately exploited in the COVID-19 crisis because health communicators and journalists were not able to effectively exchange experiences and information to improve public knowledge, attitudes and practices in relation to the virus disease outbreaks (Walker & Adukwu, 2020), coupled with problems of fake news and abusers on such platforms (Ahenkorah et al., 2020; Mian & Khan, 2020).

The lack of guidelines for local, national and international media organisations to communicate and disseminate quality information during pandemics is a critical issue (Walker & Adukwu, 2020). There are no professional outlines and frameworks that guided South Africa and Ghana in the communication of the crisis during the coronavirus outbreak. South Africa and Ghana had no health communication frameworks with details of how to address COVID-19, its epidemiology and pathology, as well as how to survey, manage and eradicate the novel disease at the initial outbreak (Walker & Adukwu, 2020) because of its emergency and nature of. However, these countries had to respond quickly to the crisis, which made it impossible for communication strategies and interventions to address COVID-19 to be evaluated before implementation. This could contribute to why South Africa and Ghana used similar approaches to address the coronavirus because they lacked adequate knowledge, experience and initiatives to curb the coronavirus outbreak, hence they followed strategies and measures adopted by Western countries to address their peculiar situations.

Conclusion

This article advances knowledge and understanding of how the communication of coronavirus disease outbreaks can be addressed in South Africa and Ghana by exploring the communication and media strategies employed in the two countries to curb the pandemic. The data analysis highlights challenges and inadequacies regarding interventions to curb the spread of COVID-19. The governments and public health institutions in South Africa and Ghana communicated COVID-19 through written, aural and visual formats in the mass media to create awareness and educate the public to improve their knowledge, attitudes and practices regarding the pandemic. Communication and messages about COVID-19 in Ghana and South Africa were transmitted through the mass media including television, radio, newspapers and online platforms during its outbreak. Comparatively, there were more coordinated communication and media strategies and responses to COVID-19 in South Africa than Ghana as activities deployed in the former were more holistic with respect to engagements between regulators, policymakers and industry players, especially in relation to vaccines, social support and grants, among others.

The communication and media strategies deployed by governments and health institutions in Ghana and South Africa were different because of their respective peculiar situations, available health facilities and human resources. Governments and public health institutions in Ghana and South Africa attempted to dispel fake news, disinformation and conspiracies via several communication and media strategies. These include the provision of regular updates on COVID-19 by responsible government officials and public institutions that receive data from recognised global health authorities. The governments and health authorities in South Africa and Ghana need to put into place adequate checks and balances to monitor the communication of pandemics like COVID-19. The communication and messages from governments and health institutions in Ghana and South Africa sought to promote education and awareness of the pandemic to de-stigmatise COVID-19 to their populations.

This article recommends the improvement of communication and media engagements between governments and health stakeholders in South Africa and Ghana including public health institutions, media outlets and policymakers to create public awareness of the risks, threats and outcomes of the coronavirus. In communicating about COVID-19 the media in South Africa and Ghana must conduct fact-finding of information about coronavirus from official sources in government and health institutions before dissemination to the public to minimise fake news, misinformation and disinformation, and improve the reporting of emergencies. The governments and health institutions must not rely solely on mass media strategies in times of health crisis but also integrate indigenous communication strategies including drama and theatrical performances, folk music and folklores, among others for education and engagements to address the challenges of mass media to increase public awareness about COVID-19 in South Africa and Ghana.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

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