The AMR Project in Ghana

George Hedidor – Interim CoordinatorOn behalf of the Project Lead and the AMR

working group, Ghana

BackgroundIts common knowledge that use of

antibiotics is not optimal in Ghana and Africa as a whole (Contributing to the increased prevalence and spread of Antibiotic resistance[ABR])

Problems exist with regards to the quality of antibiotics available and used in the country (Impacting on access to quality, safe and effective antibiotics (RUM))

There are issues related to weak health system, enforcement of regulations bordering on market authorisation and the supply of antibiotics leading to unrestricted access, over use and misuse both in the community & in health facilities.

The use of antibiotics for disease prevention and growth promotion in animal husbandry, and the reported existence of antibiotic residues in food chain

Evidence exist currently to show that many infecting pathogens are failing to respond to the common and potent antimicrobials available (Increased morbidity and mortality from microbial infections)

Bacterial isolates that were sensitive to common and affordable antibiotics in the health system are now multi-drug resistant

The threat of antibiotic resistance is real and has serious health and economic implications

Marked decrease in the pipeline for the development of new antimicrobials with novel mechanisms of action to deal with drug resistant & multidrug resistant strain of pathogens

The need to address the problem led to the formation of the National Antimicrobial Resistance Working Group (AMR WG), supported by International collaborators; ReACT (SIDA)

AMR- WG CHARACTERISTICS

Multidisciplinary in nature with representation from all sectors in the health & other determinants in the health system, other stakeholders like CSOs.

Institutions/Organisations represented include:MoH/GHS (Dep Minister & CD, Directors for

Institutional Care & Pharmaceutical Services) - direction and ownership

Consultant Clinicians from Teaching hospitals & Ghana college of Physicians and Surgeons - technical and expertise inputs

Academic Institutions/Universities involved with research in health systems/health services, Clinical Microbiology and Pharmacy – research, data and evidence generation

continue from previous slide..Vetinary Medicine Practitioners & Researchers –

animal useRegulatory authorities in the Pharmaceutical

Industry such as Food & Drugs Board and Pharmacy Council – law enforcement

Pharmaceutical Manufacturers Association – industry

Civil Society Organisation - consumer and advocacyLapag, Coalition of NGOs in Health, CSHC

Health professional bodies: eg. Nurses & Midwives , Doctors and pharmacists

WHO – sub-regional strategic directionWater and Sanitation

INDEPTH – strategic in surveillance on antibioticsMedia – channels for communication

Supported technically and financially by our International partners ReACT of Sweden (SIDA)

Goal of the AMR Working Group

To develop and implement a comprehensive national AMR policy

Propose action points to guide the development of a national policy that addresses antibiotic use and the prevention and management of AMR (But the initial focus is on issues related to antibiotic use & resistance to generate data)

Strengthen partnership with international collaborators; ReACT, ReAct partners, GARP and all major stakeholders to develop a platform to discuss and address issues related to antibiotic use and resistance as well as its health and economic implications (Phd work in the offering)

Specific Objective(s)To analyse the local situation to generate

data

As part of the process the under listed activities are to be undertaken (evidence to feed policy):

To review the KABP of health professionals and on CSOs on antibiotics and antibiotic resistance

Surveillance on antibiotic use and resistance in health facilities and in the communities

Develop the capacity of health professionals and laboratories to deal with issues related to AB and resistance in the health system

Link medicine selection to evidence from antibiotic surveillance and antibiotic resistant patterns

Review and enforce the regulations on antibiotic medicines management in Ghana

To promote research that encourages the generation of data for BCC and the promotion of rational use of antibiotics

Engage CSO for social mobilization, health education and communication

The Ghana Project Ghana is running two projects under

different agreement but same focus:◦ NPAR project (addresses some aspects on

ABR which is not directly captured in the CSO project)

◦ CSO project◦ Funding from SIDA (ReACT- Sweden)

To ensure focus:◦A comprehensive concept note

detailing the goals and objectives have been developed;

(prevent duplication, ownership, captures cso work)

So far...

Several stakeholders meeting have been held where important issues regarding activities and data generation discussed and actions taken (Discussions have been enriched with the participation of experts from ReACT )

ReACT and partners have actively supported the Ghana working group

The NPAR contract documents has been signed between the CD of MoH and ReAct, Sweden

Following that a request was made for the release of funds for the NPAR project; honoured by ReACT in September 2012

On the CSO’s project, the contract documents and ToR have also been signed by ReACT & MoH in September.

Request was made for the release of funds (lodged in the accounts on October 18 2012)

The research subgroup have worked on a proposal for KABP study and Antibiotic use in the community. [Narrowing the focus to meet project and budget needs]

This protocol is also being adapted for use on health professionals (health care providers; public sector; private...?)◦The KABP on both professionals and CSOs

will hopefully be done by the end of november 2012

Letters of Aggreements and Time linesA meeting was held with the

representatives of the CSOs to strategise on project implementation. ◦Review the LoAs to reflect activities and

budget for 2012 and push the rest to 2013

◦CSOs requested to meet from 24th to define the time lines for 2013

◦Agreed to carry out the KABP through to dissemination of results for 2012

Ghana AMR website has been developed and launched on the back of GNDP website (still under development)

(http://ghndp.org/antimicrobialresistance/)

Protocol for needs assessment and monitoring of antibiotic resistance in some selected hospitals (NPAR)

Sensitizations forumsAGM for Pharmacist:

Conference of the Pharmaceutical Society of Ghana this year to discuss issues related to antibiotic use and resistance and the role of Pharmacists in addressing the issues

Coalition of NGOs in health (22nd November)

LAPAG – sensitizes its members and community on appropriate use of medicines, in sports, in pregnancy, lactation, in WOMEN from childhood, adolescence thru reproduction, menopause etc)

Current Challenges:

The working group have less than a month to implement the activities slated for this year

Usually the last quarter of the year is a period for stocktaking, report writing and forecasting for the impending year in most governmental agencies

The year 2012 is also an election year and this presents people organisation challenges !!!

By December 2012

KABP survey:◦for CSOs ◦Health Providers in the public hospitals

(community and private..?)◦Dissemination of KABP results

Stakeholder Mapping (NPAR)Needs assessment on antibiotic

use surveillanceSensitizations

Cartoon by jparables (CSHC)

THANK YOUGRACIAS