Ensuring effective antibiotic use across Ghana’s Volta Region

Health systems across the world too often struggle with resources – we can do a lot to lessen the burden by ensuring antibiotics for managing infectious diseases remain effective. The Commonwealth Partnerships for Antimicrobial Stewardships (CwPAMS) programme – which funds Health Partnerships between UK and African institutions to strengthen antimicrobial stewardship – has helped form a fruitful partnership between Ghana’s University of Health and Allied Sciences, Ho Teaching Hospital, and University College London Hospitals NHS Trust.  

The successful result was a partnership between University College London Hospitals NHS Trust, Ghana’s University of Health and Allied Sciences, and Ho Teaching Hospital. Our focus at the time was to enhance hospital pharmacists’ ability to support delivery of antimicrobial stewardship programmes in Ho Teaching Hospital.  

Although our initial plan involved ​o​nly pharmacists, we soon realised the importance of engaging other health professionals, and so widened our capacity-building sessions to include nurses, biomedical scientists, medical doctors and hospital administrators. We trained participants on areas including antimicrobial stewardship, infection prevention and control, and basic sign language skills to help communicate with patients with speech and hearing impairments. We completed our infection prevention and control training in January 2020 – within two months we recorded our first case of COVID-19 in the country. The workshop was key to helping us manage cases in the hospital. We also helped establish an Antimicrobial Stewardship Committee in the facility​.  

 In 2021, we received additional funding to expand our work. This time we focused on using local data and safe medicine practices to enhance healthcare providers’ capacities. We developed an antibiogram (which analyses the effectiveness of various antibiotics against a patient’s bacteria) for Ho Teaching Hospital to help with appropriate antibiotic prescribing, and organised a series of training sessions on medicine handling and leadership for members of the Antimicrobial Stewardship Committee. 

Building a Centre of Excellence 

Our current project, which started in March 2023, is to establish Ho Teaching Hospital as a Centre of Excellence for antimicrobial stewardship in the Volta Region, leveraging this to strengthen healthcare professional​s’ capacity to deliver antimicrobial stewardship in other sites within the region. We are adopting a hub and spoke approach, where Ho Teaching Hospital is the hub site ​with four spokes (Ho Municipal Hospital, Ketu South Municipal Hospital, Margret Marquart Catholic Hospital and Volta Regional Hospital). These are all important facilities within the region, playing critical roles in delivering healthcare in northern and central​ areas. Ketu South Municipal Hospital, situated near the Ghana and Togo border, receives several clients from both countries. Our objective is to replicate the systems we developed in Ho Teaching Hospital in all these facilities. 

Last year, we also launched a Take-back Unwanted Medicines (TBUM) Programme in the Volta Region in collaboration with the Food and Drugs Authority. We aim to reduce the​ quantity of leftover and expired medicines, especially antibiotics​, in homes due to the dangers these can pose and the role of improper disposal in antimicrobial resistance. We currently have take-back bins in our hub site and one spoke site – we have received some additional funds to expand this to other sites, especially community pharmacies due to the​ir ease of access.  

Engaging the public
The general public as consumers of antibiotics also have a role. We run radio sessions to educate and create awareness on antimicrobial resistance to ensure compliance to antimicrobial therapy and​ encourage actions such as hand hygiene that reduce the need for antibiotics. 

We are also working with colleagues in community pharmacy practice to ensure they procure quality and unadulterated antimicrobials. We have developed a simple checklist that can help identify potentially substandard or falsified medicines. This was piloted earlier in 2024 and is currently being implemented and monitored in community pharmacies within Ho municipality.
 

Impact of CwPAMS grant
From the start, the CwPAMS grant was an attractive proposition for us: the fact it focuses on implementation research means we could easily observe interventions and impacts. Also, it allows for knowledge sharing between partners from very different countries – the UK and Ghana – a worthy opportunity for capacity building and collaboration. 

 So far, our CwPAMS project in Ghana has achieved:

1. Increased awareness among healthcare providers and the community. 
2. Improved antibiotic prescribing. 
3. Enhanced research skills and capacities of staff: each facility we are working in can now monitor antibiotic use and resistance patterns through the development of antibiograms.  
4. Reduction in leftover and expired medicines in homes due to these medicines being returned. 

Knowledge sharing and partnership
The knowledge sharing aspect of the project has been hugely beneficial. Some team members from Ghana visited our UK partner to learn firsthand about some of their interventions and best practices. The UK team have also visited Ghana to learn about our health systems.

Working in a partnership allows team members to grow professionally. Several team members have acquired additional degrees since we started working together, due to the support and encouragement we provide one another. I have completed training in project management to help me manage our projects better. I am currently a student at the West African Postgraduate College of Pharmacists, about to start my residency in antimicrobial stewardship and infectious diseases. 

Looking forward
To ensure the positive impacts of CwPAMS do not end when the project is completed, we helped establish Antimicrobial Stewardship Committees that have developed two-year action plans​. This will provide short-term continuity and serve as a foundation for a longer-term plan.