News and Opinions  –  2018

Ghana's National Action Plan on AMR – ReAct Africa supports the process

2018-06-11

Ghana recently launched the Antimicrobial Use and Resistance Policy and the accompanying comprehensive National Action Plan. Ghana’s road to the development of a Cabinet approved National Policy and National Action Plan started in February 2011 when there was a call to action: to be champions and advocates to tackle antimicrobial resistance at a two-day workshop organized with support from ReAct. ReAct has been engaged in the process from there on.

President of Ghana, Akufo Addo, launching the Ghana antimicrobial drug resistance policy. Photo: Ministry of Health, Ghana. Photo: Ministry of Health, Ghana.

11 April 2018, Ghana launched the Antimicrobial Use and Resistance Policy and the accompanying comprehensive National Action Plan on Antimicrobial Resistance (AMR). This launch was done by His Excellency the President of the Republic of Ghana, Nana Addo Dankwa Akufo-Addo.

The event was attended by over 300 participants made up of Ministers from the implementing ministries and agencies, WHO, FAO regional office, policy makers, civil society organizations, legislators, traditional leaders, diplomatic corps, security officers, regulators and the media.

The country representative of the WHO, Dr. Owen Kaluwa, delivered a speech on behalf of the tripartite organisations, stressing the need to implement the National Action Plan with a One Health approach.

The Minister of Health in his address as the coordinating minister, reiterated the commitment of Ghana to combat antimicrobial resistance and to achieving health goals as well as ensure food security, environmental safety and health security for all in Ghana. He encouraged His Excellency the President to lead the fight on antimicrobial resistance in the sub-region.

Global Sustainable Development Goals are threatened if antimicrobial resistance is not tackled

The president of Ghana, Akufo Addo, delivering his address at the launch of the Ghana AMR policy and the National Action Plan on AMR. Photo: Ministry of Health, Ghana.

The President; who also co-chairs the Global Sustainable Development Goals (SDGs), stated that, the achievement of the SDGs are threatened if antimicrobial resistance is not tackled. He assured his commitment and that of the government’s to the implementation of the National Action Plan on AMR. Among the issues raised by HE the President, he instructed the Attorney General to work with the implementing ministries to move the issues on antimicrobial resistance especially the rational use of medicines, environmental issues into legislation and also instructed the SDG inter-ministerial team to ensure they incorporate the indicators to allow for effective monitoring of targets and goals of the monitoring framework developed by the National Action Plan on AMR.

ReAct workshop initiated the path to Ghana’s National Action Plan on AMR

The development of the Antimicrobial Use and Resistance policy and subsequently the Ghana National Action Plan on AMR began in February 2011 when there was a call to action; to be champions and advocates to tackle antimicrobial resistance at a two-day workshop organized with support from ReAct Europe. In attendance was Dr Andreas Heddini who was the then Manager of ReAct. The workshop was coordinated by the Ministry of Health and sponsored by ReAc. The great leadership and passion provided by the Director of Pharmaceutical Services on tackling antimicrobial resistance in Ghana led to the formation of the National Policy Platform on AMR (NPAR). After this workshop ReAct and ReAct Africa remained a solid technical partner in developing AMR policy that contributed to the Ghana National Action Plan on AMR.

Martha Gyansa Lutterodt, Director of Pharmaceutical Services Ministry of Health, Ghana. Photo: ReAct Africa.

“We are grateful in Ghana for such great mentors like fantastic professor Otto Cars, founder of ReAct and the comradeship of Dr. Mirfin Mpundu, Head of ReAct Africa. Their actions kept urging us on.”

Martha Gyansa-Lutterodt Director of Pharmaceutical Services Ministry of Health, Ghana

5 successes and lessons learned in the Ghana process

  1. The success of the Ghana process is basically hinged on good governance and strong leadership with a committed secretariat and interpersonal relationship. The strong leadership shown by the Chairperson and Deputy as well as individual members of the platform at their various constituents helped push the agenda on antimicrobial resistance forward.
  2. The one single factor that has been key to the successes made is the formation of a multi sectorial platform of champions on antimicrobial resistance. These members are local champions and advocates for awareness creation on antimicrobial resistance issues in their constituents and across all sectors.
  3. Collaborations, partnerships and strategic alliances among various actors ensured information and resource sharing. For example, collaboration with academia and ADMER was key in generation and sharing data on antimicrobial resistance in Ghana.
  4. The policy and the National Action Plan has seen various ministers, directors and different political successions throughout the development stage. Strong inter-sectorial advocacy and involving these actors as early as possible was key in getting the political commitment at every stage.
  5. Early engagement of civils society organisations and the media was also key in carrying the AMR messages to the general public. The media needed to be handled deliberately by training and briefing in order to limit sensationalism whiles addressing facts on antimicrobial resistance.

5 challenges when implementing the Ghana National Action Plan on AMR

  1. Health system challenges such as laboratory infrastructure, human resource, supply chain integrity and enforcement of regulations are among the pressing challenges. These challenges are however noted in the National Action Plan on AMR. Implementation of the National Action Plan on AMR will help to address these challenges.
  2. The policy and the National Action Plan on AMR took about six years to develop. At a point in time, Ghana seem to be ahead of the global move as the draft policy was ready in 2015 before the Global Action Plan on AMR was announced. The slow pace of the work however, was basically a funding issue coupled with political uncertainties (several health and other sector ministers). For example, the policy process is not complete until a cabinet memo is accented to at the cabinet level. The cabinet level stage is independent of the platform activities and determined by the government’s timetable.
  3. Managing donor interest is also key to implementation of interventions in the Ghana National Action Plan on AMR. Donors may want to single out pieces of the National Action Plan on AMR to implement rather than a holistic approach to implementation.
  4. Maintaining the momentum among actors on antimicrobial resistance, especially after the launch of the document, is necessary for implementation.
  5. Funding is also critical for effective implementation.

Going forward

The Ghana National Action Plan on AMR though was launched officially in April this year, has seen some of the activities already ongoing. Notable among them is the awareness creation and antimicrobial consumption surveillance among human health.

  • Prior to and after the launch of the documents, a lot of media engagement on some major private and public electronic media has been ongoing.
  • The Veterinary Services Division of the Ministry of Food and Agriculture with support from OIE has carried out a survey to compile the list of antimicrobials used in animals. Some cadres in the public sector hospitals have been trained in the WHO methodology for antimicrobial consumption.
  • Activities in the Ghana National Action Plan has been mainstreamed for implementing partners for inclusion into their sector work plans and medium term activities. This is to leverage on sector budgetary allocation and also ensure resource pooling for effective implementation.
  • To further consolidate the one health approach, an inter-ministerial committee made up of the implementing partners (tripartite) will be formed. This body will be the highest decision making body on antimicrobial resistance issues in Ghana.
  • With support from Fleming Fund, activities are ongoing to establish a surveillance system for monitoring antimicrobial resistance in the laboratory.
  • Ghana has also benefitted and participated in ReAct Africa organised workshops over the years. In November 2017, ReAct Africa supported the Ministry of Health in the annual World Antibiotic Awareness Week celebrations on the theme; ‘‘seek professional advice before using antibiotics.’’ Partnerships like this go a long way to share country experiences and to learn from each other.
  • Achievement of goals of the National Action Plan on AMR will require the needed resources and effective governance mechanisms. Implementation of these documents among other things will ensure a systemic balance between access and excess as well as food, health and environmental safety.

Summary on the development of Ghana AMR Policy and NAP on AMR

  1. The development of the Antimicrobial Use and Resistance policy and subsequently the Ghana National Action Plan on AMR began in February 2011 when there was a call to action; to be champions and advocates to tackle antimicrobial resistance at a two-day workshop organized with support from ReAct. In attendance was Dr Andreas Heddini who was the then Manager of ReAct. The workshop was coordinated by the Ministry of Health and sponsored by ReAct. The great leadership and passion provided by the Director of Pharmaceutical Services on tackling antimicrobial resistance in Ghana led to the formation of the National Policy Platform on AMR (NPAR).
  2. The NPAR brought together multi stakeholders with interest in antimicrobials. This included policy makers, academia/research, civils society organisations in health, media, veterinarians, regulators, health professionals etc. Over the years the support and expertise of this multidisciplinary platform was garnered to start interventions to fight antimicrobial resistance.  With a concept note which sort to focus all interventions on antimicrobial resistance, a common pathway was laid for all to come on board to holistically tackle antimicrobial resistance.
  3. One of the main objectives of this concept note was to create awareness and also develop a policy on antimicrobial resistance for Ghana. Leveraging on donor support from ReAct and ADMER (Antibiotic Drug use, Monitoring and Evaluation of Resistance) Project a DANIDA supported research project in Ghana, local data was generated to inform evidence for the policy development. Stakeholder analysis, baseline resistance data, knowledge, attitude, practice and perceptions of civil society organizations and health professionals were some of the data generated to inform some aspects of the situation on Ghana AMR issues. A Technical Task Team was put together to consider all the evidences, stakeholder inputs, and also formulate statements to develop the policy for validation in one health.
  4. The Ghana National Action Plan outlines the steps required to achieve the desired goals in tackling antimicrobial resistance. It seeks to interpret the AMR policy directives as well as ensure convergence of efforts and investments in fighting antimicrobial resistance.
  5. The Ghana National Action Plan was developed based on the framework and the strategic objectives of the Global Action Plan on AMR, and in the context of the AMR policy for Ghana. With support from FAO and the WHO country office, a team represented by all stakeholders in one health led by consultants, was put together to define interventions, detailed operational plan with timelines, define lead and collaborating implementers, cost all the activities as well as develop a monitoring and evaluation plan for key objectives for stakeholder review and validation.
  6. With collaboration of Ministries of Food and Agriculture, Environment, Science, Technology and Innovation, Fisheries and Aqua-culture Development, the Ministry of Health led the sectors to develop and present a cabinet memo on the two documents for presidential approval. This is a government requirement for all new policies to ensure coherence in policy implementation as well as budgetary allocation.

In May 2015, the World Health Assembly at its 68th meeting adopted a Global Action Plan on antimicrobial resistance (AMR). This plan outlined five key strategies to combat the threat of AMR. Member states were encouraged to align and develop their own National Action Plans (NAP), depending on the country context in the framework of the Global  Action Plan on AMR.

Sources

World Health Organization. Antibiotic Resistance: Multi-country public awareness survey. 

Project ADMER. Antibiotic Drug use Monitoring and Evaluation of Resistance Project.

Opintan JA, Newman MJ, Arhin RE et al. Laboratory-based nationwide surveillance of antimicrobial resistance in Ghana. Infect Drug Resist. 2015;8:379-389.

Asante KP, Boamah EA, Abdulai MA et al. Knowledge of antibiotic resistance and antibiotic prescription practices among prescribers in the Brong Ahafo Region of Ghana; a cross-sectional study. BMC Health Serv Res. 2017;17:422.

Yevutsey SK, Buabeng KO, Aikins M et al. Situational analysis of antibiotic use and resistance in Ghana: policy and regulation. BMC Public Health. 2017;17:896.

Ghana National Action Plan on Antimicrobial Resistance.

Launch of Policy Documents by President of Ghana. 

Ghana government web page.

ReAct would like to thank Georpfe KWesi Hedidor in connection to this article.

More news and opinion