Health Partnerships to tackle drug resistance: An interview with Hope Michael Chadwala, a Pharmacist at Kamuzu Central Hospital, Malawi.

In the realm of healthcare, collaboration and partnerships are vital in fostering positive change and improving patient outcomes. One such remarkable partnership is between the dedicated healthcare professionals at Kamuzu Central Hospital in Malawi and a team of experts from Betsi Cadwaladr University Health Board in Wales. As part of the program, this collaboration has yielded transformative results in combating antimicrobial resistance (AMR) and implementing evidence-based practices.

The focus of the project was based on training pharmacists as antimicrobial stewardship leads in Malawi by:

• Equipping pharmacists with a toolkit to enable them to tackle AMS problems at ward level.
• Developing AMS key performance indicators to identify targets for improvement.
• Provisioning behavioral change training for clinical staff.

We spoke with Hope Michael Chadwala, a pharmacist at Kamuzu Central Hospital in Lilongwe, to delve into the changes witnessed in the workplace and the invaluable impact of this collaborative effort.

Q: Can you tell us about the changes you have observed among the staff as a result of the Health Partnership?

Hope: One significant change is the improved adherence to standards and evidence-based practices. Our staff now understand the importance of ordering medication based on laboratory evidence, such as blood count and sensitivity tests. This has led to a greater commitment to rational antibiotic use. Additionally, communication between different cadres, including nurses, clinicians, and pharmacy personnel, has improved. If we encounter prescriptions that seem out of line with the established guidelines, we now proactively inquire further with the doctors. This collaborative approach ensures the rational use of antibiotics and reinforces teamwork.

Q: How has the Health Partnership with the Betsi Cadwaladr University Health Board influenced these changes?

Hope: The partnership with the UK team has been invaluable in driving these positive changes. Their expertise as antimicrobial consultants in the field of AMR has shed light on best practices and provided guidance tailored to our context in Malawi. By visiting our hospital and experiencing the local realities, they gained a deeper understanding of the challenges we face. This first-hand knowledge informed the development of the toolkit and interventions specifically designed to address our needs. Moreover, they assisted us in utilizing various therapeutic guidelines and adapting them to our local context. The partnership has truly been exceptional.

Q: In what ways did the UK team contribute to the development of the AMS toolkit?

Hope: The UK team played a significant role in developing the toolkit. They introduced us to the concept of conducting audits, which became a fundamental aspect of the toolkit. Previously, we lacked awareness about the importance of antibiotic stewardship. Additionally, they shared their knowledge of IV-to-oral switching, which we integrated into our practices. Their contributions enriched our toolkit and empowered us to implement more effective strategies.

Q: What valuable insights have your team provided to UK colleagues?

Hope: Our team provided insights into how we control antibiotic use in Malawi, which may differ from practices in the UK. We have implemented various restrictions to limit access to medications. We use a tool that requires testing and evidence before prescribing antibiotics. By sharing our approach and processes, we helped the UK colleagues understand the unique challenges we face and the strategies we employ to ensure responsible antibiotic use. It was a fruitful exchange of knowledge and experiences.

Q: For you, what has been the most valuable aspect of this Health Partnership?

Hope: Personally, the most valuable aspect has been the in-person visit from the UK team. While online meetings were helpful, it was during their visit that we truly aligned and gained a deep understanding of each other’s contexts. The visit allowed them to witness the realities on the ground, observe our practices during handovers and ward rounds, and experience the challenges we face firsthand. This shared experience helped them make more informed decisions while developing the toolkit and ensured its practicality for Malawi.

The Department of Health and Social Care’s Fleming Fund is a UK Aid programme supporting up to 25 countries across Africa and Asia to tackle antimicrobial resistance (AMR) which is a leading public health threat across the world. The Fleming Fund invests in strengthening data surveillance systems through a portfolio of country grants, regional grants and fellowships managed by Mott MacDonald, and global projects managed by partners.