Tackling Antimicrobial Resistance in Zambia 

Inspired by a talk we attended at the United Kingdom Clinical Pharmacy Association conference in 2016 given by Trudi Hilton on her work as a consultant pharmacist in humanitarian aid and development, we wanted to find a way to become involved in something similar. We contacted a local charity, the Brighton Lusaka Health link, chaired by Professor Melanie Newport, which links Brighton and Sussex University Hospitals and University Teaching Hospital (UTH) in Lusaka.

Connecting with the partnership, we discovered that though the partnership had seen many projects with anaesthetic staff, doctors and nurses, it had not yet had the involvement of pharmacists. The staff already volunteering in the partnership put us in touch with pharmacists at UTH, and we secured funding for a scoping visit to UTH in 2016. We were joined on our visit by pharmacist colleagues from Brighton and Sussex Medical School, University of Brighton and University of Sussex and together we were able to identify projects and collaborative work.

Since then, we have undertaken a number of projects together. Firstly, we collected data on pharmacist initiated clinical interventions in both countries and interstingly initial data showned that the prescribing errors we see in both countries are similar. The UK processes for medicines reconciliation have now been shared with our partners so that medicines reconciliation in Zambia can be standardised, a practice which demonstrably benefits pharmacists. Additionally, we’ve shared experiences for managing and evaluating 24/7 pharmacy services in the UK to give an alternative perspective for a Zambian project, which helped to evaluate the cost effectiveness of their own 24 hours service.

We have also done a lot of work peer reviewing antimicrobial guidelines and with the setup of new specialist posts in Zambia through linking with the equivalent BSUH pharmacist role. We have found that through sharing data and experience of how independent pharmacist prescribing has been used in the UK, we have aided discussions in Zambia on how to implement non-medical prescribing.

Learning approach and teaching style preferred by pharmacy students: Implications for educational strategies in Zambia is the title of a collaboration by the university of Zambia and University of Sussex School of Pharmacy and in addition a Brighton and Sussex Medical School Global Health MSC student was supervised in Zambia by our Colleagues from the University of Zambia School of Pharmacy. We also presented a poster at the UK Clinical Pharmacy Association conference in November 2018.

By comparing the two pharmacy workforce job roles and functions, we have guided the development of the Zambian pharmacy workforce of the future. Finally, we introduced antimicrobial stewardship into the undergraduate pharmacy courses at the University of Zambia by having the lectures electronically recorded by the BSUH antimicrobial pharmacist in the UK. This project was short-listed for an antimicrobial stewardship award!

Most of all, we believe that getting the Commonwealth Partnership Antimicrobial Stewardship (CWPAMS) Grant is our biggest achievement to date, and will make a significant contribution to supporting and developing antimicrobial stewardship in Zambia. In a country like Zambia with limited resources, the irrational use of antibiotics has serious ramifications – antibiotic resistance results in the high cost of treatment and poor health outcomes. This project will help to up skill Zambian pharmacists, which is a vital component of AMS activities and help NHS staff involved to develop leadership and AMS awareness in Low and Middle income coutries.

One of the biggest challenges that we face is financing and sustaining the various activities being undertaken by the partnership. Distance can also present a challenge to working together. However, we have managed to make good use of social media – for instance, we have a link pharmacist Whatsapp group – and other technologies such as video calling on Zoom. Most recently, we have used Trello to help organise project work. All of these mediums have allowed us to work closely together despite being hundreds of miles apart.

Our biggest hope for the future is that the outcome of this new CWPAMS project will ensure a robust AMS program for UTH and will act as a model which can then be up scaled to the rest of the country in addition to increasing the profile of volunteering in our trust.