Culture, context and crisis: understanding community engagement in Ghana's Ashanti and Northern regions amid COVID-19...

The COVID-19 pandemic highlighted the critical role of community engagement in public health responses. While national-level interventions in Ghana have been documented, limited research exists on how regional differences shape engagement strategies. This study compares the Ashanti and Northern regions, two areas with contrasting socioeconomic, cultural and epidemiological contexts, to examine how community engagement was implemented during the COVID-19 response.

A qualitative study was conducted in the two regions from November 2023 to February 2024. We conducted interviews with 24 key informants and facilitated two focus group discussions with 20 participants. Data collection involved community mapping, key informant interviews and focus group discussions with community leaders, health officials and vulnerable groups in the selected communities. Data were coded and analysed using MAXQDA analysis software employing thematic analysis, guided by frameworks from Gilmore and Popay.

In the Ashanti region, engagement strategies were more centralised and formal, using mass media and structured messaging from health professionals. Conversely, the Northern region implemented decentralised, community-led approaches through traditional leaders, interpersonal communication and community-based surveillance volunteers. Logistics provision also differed; Ashanti benefited from structured supply chains, while the Northern region relied on community-led innovations due to resource limitations. Centralised approaches in Ashanti enabled coordinated messaging, whereas Northern strategies were perceived to foster deeper trust and participation.

Community engagement strategies varied across regions, reflecting underlying governance structures and socio-cultural dynamics. Decentralised approaches were associated with higher levels of community participation and trust, while centralised models supported efficient coordination. While this study does not assess the impact of engagement strategies on health outcomes, it highlights the need for contextually adapted strategies that balance structured public health directives with meaningful community involvement.