Fighting Antimicrobial Resistance: Development and Implementation of the Ghanaian National Action Plan (2017–2021)

Abstract

In recent years, Ghana has been recognised as a leading player in addressing antimicrobial resistance (AMR) in Africa. However, based on our literature review, we could not ascertain whether the core elements of the national action plan (NAP) were implemented in practice. In this paper, we present a qualitative analysis of the development of AMR-related policies in Ghana, including the NAP. We conducted 13 semi-structured expert interviews to obtain at a more thorough understanding of the implementation process for the AMR NAP and to highlight its accomplishments and shortcomings. The results show that AMR policies, as embodied in the NAP, have led to an extended network of cooperation between stakeholders in many political fields. Broadly, limited allocation of financial resources from the government and from international cooperation have been deplored. Furthermore, the opportunity for using the NAP in mainstreaming the response to the threat of AMR has not been seized. To the general public, this remained hidden behind a number of other relevant health topics such as infection prevention, veterinary services and pharmaceutical regulation. As a One Health (OH) challenge, developing countries could integrate AMR NAPs into other health and environmental programmes to improve its implementation in practice.

Evaluation of Healthcare Students’ Knowledge on Antibiotic Use, Antimicrobial Resistance and Antimicrobial Stewardship Programs and Associated Factors in a Tertiary University in Ghana: Findings and Implications

“…This is beginning to change with help from the UK Fleming fund in collaboration with UK institutions as well as input from the WHO giving guidance on implementing ASPs with the help of a toolkit [ 76 , 77 ]. This builds on successful ASPs already being implemented across Africa [ 35 , 37 , 38 ], and is in line with the goals of the Ghanian NAP [ 30 , 32 ]. However, to date, the Ministry of Health in Ghana is yet to roll-out a full-scale, nationwide implementation of ASPs at different levels of the healthcare system.…”

“…This is because they are key stakeholders in the prescription, administration, and counselling on antibiotic use across all sectors in Ghana. Furthermore, there must be efforts to instigate mandatory, continuous professional development programs surrounding AMR and ASPs among all HCP groups post-qualification as Ghana strives to achieve the goals of the NAP [ 31 , 32 ]. This should help with combating rising rates of AMR across Ghana [ 31 , 85 ].…”

“…One of the five strategies to reduce the impact of AMR in the Global Action Plan is the need to optimize antimicrobial use through the implementation of antimicrobial stewardship programs (ASPs) [ 27 , 28 , 29 ]. Ghana, similar to other African countries, has developed its NAP and is currently implementing a range of agreed activities [ 30 , 31 , 32 ], with the goal to improve future antibiotic utilisation, reduce possible side-effects from antibiotics as well as reduce AMR [ 18 , 19 , 33 , 34 , 35 , 36 , 37 , 38 ].…”

“…However, most studies particularly in LMICs that have evaluated the knowledge of healthcare students regarding antibiotics and AMR have typically been conducted separately among medical students [ 47 , 51 , 52 , 53 , 54 , 55 , 56 ], pharmacy students [ 57 , 58 , 59 , 60 , 61 , 62 ], nursing and paramedic students with only a limited number of studies conducted among a combination of healthcare students [ 48 , 63 , 64 , 65 , 66 , 67 , 68 ]. This is a concern as a good uniform knowledge regarding antibiotic use, AMR, and ASPs is essential to optimize the future use of antimicrobials with all key stakeholders involved, which is in line with the goals of the Ghanaian NAP and beyond [ 30 , 32 ]. This is particularly important in Ghana given concerns with current high rates of AMR, considerable and inappropriate prescribing and dispensing of antibiotics across all sectors often without a prescription, and issues with poor compliance with national guidelines [ 12 , 69 , 70 , 71 , 72 , 73 , 74 , 75 ].…”

An Assessment of the Current Level of Implementation of the Core Elements of Antimicrobial Stewardship Programs in Public Hospitals in Ghana

“…However, there are ongoing financial concerns to effectively implement agreed activities. 36 Encouragingly, through the help of UK-based institutions, AMS experts, and the Fleming Fund, some hospitals in Ghana have implemented ASPs, with this number increasing through continuous support. 37 - 39 However, currently, there is paucity of data regarding the extent of implementation of the core elements of ASPs in hospitals in Ghana to provide future guidance, especially among hospitals that have not currently undertaken any ASPs.…”