King’s Global Health Partnership

Antimicrobial Resistance (AMR) is one of the largest global health threats facing humanity, as misuse and overuse of antimicrobials has driven the development of drug-resistant pathogens. Within Sierra Leone, anti-microbial misuse is common in both hospital and community settings. Facility based prescribing is often based on presumptive treatment as laboratory capacity to validate these choices is limited. In addition, non-medical practitioners are able to sell and supply antibiotics in a variety of community-based settings such as buses and marketplaces without appropriate knowledge of the consequences. The National Action Plan for Health Security identified Antimicrobial Stewardship (AMS) as a core priority across national and facility levels, and pharmacy expertise should play a central role in addressing AMR.  

KGHP approached this project by building capacity in two key areas. Firstly, we supported the development of an AMS subcommittee within Connaught Hospital – the main adult referral hospital in Sierra Leone – establishing governance structures and processes that fed into wider hospital systems. This subcommittee provides guidance and oversight of activities to promote and deliver successful AMS across the hospital. Secondly, KGHP recruited 10 ‘AMS Champions’ from across the pharmacy sector in Freetown and delivered a blended learning programme with support from two UK volunteers. The AMS Champions were involved in case discussions and presentations and assisted in the collection and analysis of Global Points Prevalence Survey (GPPS) datasets as part of their training. The AMS subcommittee and AMS Champions also supported awareness campaigns that were run within the hospital with senior national stakeholders and within the local community through television, radio, and in person discussions. 

As a result of the project, Connaught Hospital is the first public hospital in Sierra Leone to establish an AMS subcommittee, dedicated to raising awareness of AMR and AMS. This has increased the awareness of antimicrobial usage within Connaught Hospital, and the surrounding communities, through external campaigns. The 10 pharmacists trained as AMS Champions have been empowered to take key lessons and practices to their own facilities, promoting rational drug use and antimicrobial surveillance. All Champions explained that their practice as pharmacists has changed since starting the training programme with many referencing their use of the guidelines when prescribing or checking prescriptions, and their increased confidence in reviewing patient charts. Others said that they would now be confident enough to train other staff about AMS and conduct the GPPS again, giving necessary advice to improve institutional practices. 

“I am now able to interact with doctors with regards to their prescriptions.  Most of them were not aware of the treatment guidelines.” AMS Champion.  

The launch of AMS at Connaught, and the establishment of an AMS subcommittee has been hailed as a celebration of pharmacy, with successful engagement from senior stakeholders from the Pharmacy Board of Sierra Leone, the Pharmaceutical Society of Sierra Leone, the National Medicines Supply Agency, the Ministry of Health and Sanitation and the Young Pharmacists’ Group. KGHP’s approach to partnership working is built around long-term commitment. We are embedded within our partner organisations and communities which allows us to respond to our partners needs and priorities. This approach was well evidenced throughout this project, and we look forward to continuing to strengthen AMS practice within Sierra Leone in the future.