This document discusses Ghana's efforts to manage antimicrobial resistance. It provides background on Ghana's healthcare system and challenges with access to medicines. It then outlines Ghana's policy approach to antimicrobial resistance and rational drug use. Key initiatives include establishing a multi-stakeholder alliance, conducting assessments of antimicrobial resistance and antibiotic use, developing an AMR policy, and training programs for health professionals and civil society organizations. Lessons learned include the need for broad policy frameworks, regulatory mechanisms, expanded monitoring, and aligning AMR strategies with existing health policies. The document shares results from training programs and outlines publications and educational materials produced to address antimicrobial resistance in Ghana.

1. Martha Gyansa-Lutterodt
Director Pharmaceutical Services
Ministry of Health
Chairperson, Ghana Antimicrobial Resistance Alliance
3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-
Associated Infections Networks in Stockholm, Sweden on February
12, 2015
Managing Antimicrobial
Resistance: the case of Ghana

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#Y
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LAWRA
LAWRA
TUMU
NADAWLI
WA
SANDEMA
NAVRONGO
BOLGATANGA
BONGO ZEBILLA
GAMBAGA
WALEWALE
BAWKU
TOLON TAMALE
SAVELUGU
GUSHIEGU
YENDI
SABOBA
ZABZUGU
BIMBILA
DAMONGO
BOLE
SALAGA
KINTAMPO
ATEBUBU KWAME DANSO
NKORANZA
TECHIMAN
WENCHI
EJURA
SUNYANI
DROBO
BEREKUM
DORMAAAHENKRO
BECHEM
KENYASENO. 1
TEPA OFINSO
AGONA AKROFOSO
EFFIDUASE
MAMPONTENG
MANKRANSO
GOASO
KUMASI EJISU
NKAWIE
KUNTENASE
KONONGO-ODUMASE
JUASO
BEKWAI
MANSO NKWANTA
MAMPONG ASHANTI
OBUASI
NEW EDUBIASE
NEW ABIREM
MPRAESO
BEGORO
KIBI
KADE
AKIMODA
ASAMANKESE
SUHUM
KOFORIDUA ODUMASE KROBO
SOMANYA
ATIMPOKU
AKROPONGAKWAPIM
DODOWA
NSAWAM
AMASAMAN
ACCRA
TEMAMUNICIPAL AREA
AGONA SWEDRU
WINNEBA
APAM
SALTPOND
CAPECOASTELMINA
DABOASE
TWIFO PRASO
ASSINFOSU
AJUMAKO
BREMAN ASIKUMA
ABURA DUNKWA
HO
DUNKWA-ON-OFIN
TARKWA
SEKONDI/TAKORADI
AGONA NKWANTAAXIM
HALFASSINI
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SEFWI WIAWSO
JUABESO
ENCHI
BIBIANI
AKATSI
DENU
ADA FOAH
SOGAKOPE
ADIDOME
KPANDU
KADJEBI
JASIKAN
HOHOE
DONKORKROM
KETE-KRACHI
NKWANTA
Upper West
Upper East
Northern
Brong Ahafo
Ashanti
Volta
Eastern
Western
Central Greater Accra
Regions
Ashanti
Brong Ahafo
Central
Eastern
Greater Accra
Northern
Upper East
Upper West
Volta
Western
Water body
# District Capital
#Y Regional Capital
Ghana boundary
200 0 200 400 Kilometers
N
EW
S
GhanaMap
Prepared by Alexander Boakye Marful, July 2005

3. Ghana
 Total Population (2012)
25,366,000
 Gross National income per
capita (PPP international $,
2012) 1,910
 Total expenditure on health
per capita (Intl $, 2012) 106
 Total expenditure on health
as % of GDP (2012) 5.2
 Life expectancy at birth m/f
(years, 2012) 61/64
 Probability of dying between
15 and 60 years m/f (per
1000 population, 2012)
263/227
Ghana Facts and figures

4. Introduction: the need for AMR
interventions
Major causes of mortality
Conditions affected directly by
AMR
Conditions Not directly affected by AMR
40% 60%

5. 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
*Office of the Chief Pharmacist 2013 data
Ghana Drug Access Problem Ratio
Quality
40%
Accessibility
20%
Affordability
40%
Quality
40%
Accessibility
20%
Affordability
40%

6. Policy perspective
 The National Drug Policy
 Standard Treatment Guidelines (STGs) & Essential
Medicines Lists (EMLs) with levels of care
 National Health Insurance Lists (NHIL)
 Food and Drugs Authority Register, with classification of
medicines
 Over the Counter medicines, Pharmacy Medicines, Prescription Only
Medicines
 Pharmacy council
-Major/common human
pathogens considered:
E. coli, Klebsiella, Salmonella,
Pneumococci, Staphylococcus
aureus
-Common antibiotics
recommended STGs:
Amoxicillin, Erythromycin,
Ceftriaxone, Tetracycline,
Cefuroxime, Gentamicin,
Ampicillin, Ciprofloxacin

7. 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
Office of the Chief Pharmacist, 1999 to 2013
The indicator trend,
aligns with
investments in DTC
training
56.3
40.5 41.4 43.1
36.4
45.2
40.7
37.6
48.7 49.5
42.0 43.6 43.3 41.4 39.9
15.0
25.0
35.0
45.0
55.0
65.0
75.0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Percentage of outpatient encounters with an antibiotic
prescribed from 1999 to 2013 in Ghana
Ghana AMR
initiatives

8. Other Challenges in the use of
Antibiotics
 Use of antibiotics in aquaculture
 Incentives for the use antibiotics in firm farming
 ‘Tilapia’ fish farming
 Use of antibiotics in animal husbandry
 Need to strengthen rational use of medicines in veterinary
practice (treatment protocols and standards)
 Veterinary public health service has been engaged on the Ghana
AMR platform
 Nascent surveillance system
 The Surveillance system is nascent that requires standardization
and quality assurance to feed into global actions

9. The impact of these challenges:
The need for efficient stewardship programmes
0.9
0.9
0.9
0.9
1.7
2.6
2.6
5.2
6.1
14.8
24.3
39.1
Deworm Drug
Flucloxacillin
Methicillin
Nivaquine
Co-trimoxazole
Amodiaquine
Ciprofloxacin
Cloxacillin
Chloroquine
Amoxicillin
Ampicillin
Choramphenicol
Proportion (%)
Examples of ineffective antibiotics as given by respondents in KABP
assessment on CSOs, Non-Health professionals
Medicines users are faced with the implications of AMR on treatment
outcomes, cost etc.
Aligns with Resistance to
Amp, Chl in Ghana
-Ampicillin 76%
-Chloramphenicol 75%
Newman et al, 2011

10. The Beginning of AMR program in
Ghana
 The role of
o ‘The race against Resistance’ - Working Group -Centre for Global
Health Development
o The Uppsala Summit on ABR in 2010
o Local institutional leadership in a multi-stakeholder approach
 The Ghana Ministry of Health (AMR agenda at May 2014 Health
Forum in Ghana)
 Multi-stakeholder approach (Ghana AMR stakeholder platform)
o Partnerships and synergies
 Swedish International Development Agency, ReAct Project-
Uppsala University),
 World Health Organization (WHO)

11. What is happening in Ghana-highlights
 Baseline assessment
 Situational analysis, stakeholder analysis, Assessment
of knowledge attitudes beliefs and practices of Health
professionals and CSOs in health, baseline
assessment of resistance
 Policy processes. Ghana AMR policy is ready for
parliamentary action
 Capacity building
 CSOs in Health
 Capacity building programs (under ADMER-project)
 African Antibiotic Use conference March 18-20 ,2015
 Communication
 Papers, Websites, Media

12. Training of Trainers – CSOs in Health
CSO – Region/location No.
GCNH: IDC - Northern 37
AWI - Western 33
HFFG - Central 29
LAPAG - Greater Accra 25
CSHC - Greater Accra 32
TOTAL 156

13. Some pre-post test results of CSO
training
6
2
9
3
12
4
0
5
10
15
20
25
30
35
pre post pre post pre post
Central Northern Western
Pre-Post test response to Bacteria and
Virus are the same for 3 regions
No No Answer Yes
0
5
10
15
20
25
30
35
post pre post pre post pre post pre
AccraLapag Central Northern Western
Pre-Post test response to Microbes live in
harmony with the environment for 4 CSO
groups
No No answer Yes

14. 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 Annual
Meeting
 AGM of Ward nurses
 AMR TWG
 Health Summit

15. Summary of issues-lessons from
Ghana
① The need for broad policy framework
 Antimicrobial resistance vrs Antibiotic resistance
 Key policy areas
 Community education and Sociocultural change interventions
② Role of Legislative instruments
① Distribution and use
③ Balancing access, excess and equity (inline with
distribution of appropriate cadres and level of use)
④ Quality of antimicrobial agents- regulatory mechanisms
⑤ The role of health system issues
 Infection Control strategies- Policy review in progress
 Laboratory capacity and logistics
 Community actions and participation

16. Summary of issues-lessons from
Ghana
⑥ Need for an expanded monitoring framework
 RUM indicators (1 indicator for Antibiotic use)
⑦ Alignment and contextualization within existing
policies on medicines
 Infection control policy
 National Medicines Policy
 EML policy
⑧ Linking surveillance data with selection of
antibiotics

17. Reports, Training Manuals, Educational
materials

18. Publications and Papers
3 more manuscripts almost ready

19. www.ghndp.org/antimicrobialresistance
www.admerproject.org

20. END
Thank you