1. Antibiotic Policy in Ghana; the way forward
Martha Gyansa-Lutterodt
Director Pharmaceutical Services

2. Outline The challenge and Policy assessment Situation analysis
Global Action Plan (GAP)
Aligning the GAP to Ghana’s Policy Framework
Our Story
The Way Forward
Antimicrobial Policy in Ghana

3. Introduction: Access to essential medicines
Availability
Availability of medicines >85% for 65 tracer medicines *
Affordability
Social health insurance reimbursing 548 medicines (13.1% antibiotics)
Out of pocket payments
Accessibility: Geographical distribution of medicines outlets
Private Pharmacies >80% urban
Licensed chemical sellers >80% rural
Public health facilities, CHPS
Quality
SSFFCs and Storage conditions
Accessibility 20%
Quality
40%
Overall medicines availability (including antimicrobial agents) is fairly commendable >85%
Mechanisms are in place to remove the financial barrier to key antimicrobial agents, but with resistance would affect value for money. Out of pocket payments still exist
Licensed chemical sellers who are not allowed by policy stock and dispense antibiotics are the main players in the rural areas, which is not attractive to the private community pharmacies.
Thus who fills the access gap to provide access? Policy implementation gap!
Antibiotic use in low and middle income countries, as in the case of Ghana, is impacted by systemic and specific challenges that require broad as well as specific solutions
Affordability
40%
*Office of the Chief Pharmacist, 2013
Antimicrobial Policy in Ghana

4. Policy assessment: sustaining the gains made by positive interventions on trends in RUM
The National Drug Policy recommends routine monitoring of Rational use of medicines (RUM)
The WHO core indicators adopted for use in country, includes one direct indicator for antibiotic use
The indicator trend, aligns with investments in DTC training
Ghana AMR initiatives
In the current context of AMR, should the routine indicator set for monitoring antibiotic use, be expanded?
What other data is relevant? What would be the value of the data?
The current indicator is very useful.
Aligns with investments in RUM training of DTCs in public facilities; and thus is also subject to changes in DTC membership and new recruitments and HR dynamics.
How do we sustain the gains and build on.
The reality of the linkages between clinical practice and public health is even stronger in our times,
Thus we must train health professionals to consider
Sustainable broad-based approaches may be more helpful with due cognisance to the aspects requiring specific interventions
This is Public sector data….What about the private sector?
Office of the Chief Pharmacist 1999 to 2013

5. Situational Analysis Irresponsible/inappropriate use of Antimicrobials
Lack of information on the proper use of Antimicrobials
Absence of policy on Antimicrobial use
Spurious, Substandard, Falsified, Fake and Counterfeit Antimicrobials
Unregulated access to Antimicrobials
Antimicrobial Policy in Ghana

6. Situational Analysis Use in agriculture as growth promoters
Poor infection prevention and control in health facilities
Poor environmental sanitation
Poor or absence of surveillance on Antimicrobials use
Poor knowledge on Antimicrobials resistance
Antimicrobial Policy in Ghana

7. Elements of Global Action Plan
Improve awareness and understanding of antimicrobial resistance;
Strengthen knowledge through surveillance and research
Reduce the incidence of infection (Infection Control)
Optimize the use of antimicrobial agents
Develop the economic case for sustainable investment that takes account of the needs of all countries
Increase investment in new medicines, diagnostic tools, vaccines and other interventions.
Antimicrobial Policy in Ghana

8. Elements of Ghana’s Policy Framework for AMR
This Policy Frame work is one of the MoH Aide Memoire deliverables for 2014
Responsible Use of Antimicrobials
Use in Veterinary and Aquaculture
Manufacturing, Supply, distribution, disposal
Regulation and enforcement
Surveillance
Antimicrobial Policy in Ghana

9. Elements of Ghana’s Policy Framework for AMR
Infection prevention and control
Laboratory services
Research and development
Stakeholder collaboration and Governance of Antimicrobial resistance
Antimicrobial Policy in Ghana

10. Our Story !
Antimicrobial Policy in Ghana

11. Orientation/Sensitization of Key Stakeholders
Over 80 key stakeholders sensitized in western region
About 30 Queen mothers in central
10 municipal health directorate staff
Pharmacist AGM
AGM of Ward nurses
AMR TWG
Health Summit
Queen mothers called for support (technical and financial) and collaboration with the municipal health directorate for more education on responsible use of medicines and antibiotics in their communities

12. Way Forward…1 The need for broad policy framework
Antimicrobial resistance vrs Antibiotic resistance
Key policy areas
Community education and Sociocultural change interventions
Potential role of Legislative instruments
Balancing access, excess and equity (inline with distribution of appropriate cadres)
Quality of antimicrobial agents
The role of appropriate Infection control strategies
Hospitals
Communities

13. Way forward…2 Need for an expanded monitoring framework
RUM indicators (1 indicator for Antibiotic use)
Alignment and contextualization within existing policies on medicines
Infection control policy
National Medicines Policy
EML policy
Linking surveillance data with selection of antibiotics

14. The Way forward…3
Research must inform Policy and Practice- The ADMER experience
Continue multi-stakeholder platform work
Continue working with the Academia and research institutions in surveillance, drug development and continuous research to improve antimicrobial use etc
Complete Policy Cycle and Continue with Policy implementation
monitoring and evaluation, communication/education/advocacy
Implementation of the recommendations from KABP on CSO’s and Health professionals
Antimicrobial Policy in Ghana

15. The Way forward…4 Surveillance
Implementing the MARHLAB program
Bench work stardardisation done to provide the baseline
Infection control policy 2011 under review with follow on implementation
One Health Approach to AMR issues
Develop treatment guidelines for Animal use
Collaboration and partnerships with other countries and Institutions as outlined in the Global Action Plan
Antimicrobial Policy in Ghana

16. Announcing our Work ….. 4 more manuscripts ready
Antimicrobial Policy in Ghana

17. Reports, Training Manuals, Educational materials
Antimicrobial Policy in Ghana

18. www.ghndp.org/antimicrobialresistance www.ghndp.org/reactcso
Antimicrobial Policy in Ghana

19. Sights and Sounds- Ghana AMR Alliance
Antimicrobial Policy in Ghana

20. Pictures
Antimicrobial Policy in Ghana

21. THANK YOU TO THE GHANA AMR WORKING GROUP AND TECHNICAL TASK TEAM
OFFICE OF THE CHIEF PHARMACIST FOR ALL THE HARD WORK
Antimicrobial Policy in Ghana

22. End
Thank you