Antibiotic Policy in Ghana; the way forward Martha Gyansa-Lutterodt Director Pharmaceutical Services

Outline The challenge and Policy assessment Situation analysis Global Action Plan (GAP) Aligning the GAP to Ghana’s Policy Framework Our Story The Way Forward Antimicrobial Policy in Ghana

Introduction: Access to essential medicines Availability Availability of medicines >85% for 65 tracer medicines * Affordability Social health insurance reimbursing 548 medicines (13.1% antibiotics) Out of pocket payments Accessibility: Geographical distribution of medicines outlets Private Pharmacies >80% urban Licensed chemical sellers >80% rural Public health facilities, CHPS Quality SSFFCs and Storage conditions Accessibility 20% Quality 40% Overall medicines availability (including antimicrobial agents) is fairly commendable >85% Mechanisms are in place to remove the financial barrier to key antimicrobial agents, but with resistance would affect value for money. Out of pocket payments still exist Licensed chemical sellers who are not allowed by policy stock and dispense antibiotics are the main players in the rural areas, which is not attractive to the private community pharmacies. Thus who fills the access gap to provide access? Policy implementation gap! Antibiotic use in low and middle income countries, as in the case of Ghana, is impacted by systemic and specific challenges that require broad as well as specific solutions Affordability 40% *Office of the Chief Pharmacist, 2013 Antimicrobial Policy in Ghana

Policy assessment: sustaining the gains made by positive interventions on trends in RUM The National Drug Policy recommends routine monitoring of Rational use of medicines (RUM) The WHO core indicators adopted for use in country, includes one direct indicator for antibiotic use The indicator trend, aligns with investments in DTC training Ghana AMR initiatives In the current context of AMR, should the routine indicator set for monitoring antibiotic use, be expanded? What other data is relevant? What would be the value of the data? The current indicator is very useful. Aligns with investments in RUM training of DTCs in public facilities; and thus is also subject to changes in DTC membership and new recruitments and HR dynamics. How do we sustain the gains and build on. The reality of the linkages between clinical practice and public health is even stronger in our times, Thus we must train health professionals to consider Sustainable broad-based approaches may be more helpful with due cognisance to the aspects requiring specific interventions This is Public sector data….What about the private sector? Office of the Chief Pharmacist 1999 to 2013

Situational Analysis Irresponsible/inappropriate use of Antimicrobials Lack of information on the proper use of Antimicrobials Absence of policy on Antimicrobial use Spurious, Substandard, Falsified, Fake and Counterfeit Antimicrobials Unregulated access to Antimicrobials Antimicrobial Policy in Ghana

Situational Analysis Use in agriculture as growth promoters Poor infection prevention and control in health facilities Poor environmental sanitation Poor or absence of surveillance on Antimicrobials use Poor knowledge on Antimicrobials resistance Antimicrobial Policy in Ghana

Elements of Global Action Plan Improve awareness and understanding of antimicrobial resistance; Strengthen knowledge through surveillance and research Reduce the incidence of infection (Infection Control) Optimize the use of antimicrobial agents Develop the economic case for sustainable investment that takes account of the needs of all countries Increase investment in new medicines, diagnostic tools, vaccines and other interventions. Antimicrobial Policy in Ghana

Elements of Ghana’s Policy Framework for AMR This Policy Frame work is one of the MoH Aide Memoire deliverables for 2014 Responsible Use of Antimicrobials Use in Veterinary and Aquaculture Manufacturing, Supply, distribution, disposal Regulation and enforcement Surveillance Antimicrobial Policy in Ghana

Elements of Ghana’s Policy Framework for AMR Infection prevention and control Laboratory services Research and development Stakeholder collaboration and Governance of Antimicrobial resistance Antimicrobial Policy in Ghana

Our Story ! Antimicrobial Policy in Ghana

Orientation/Sensitization of Key Stakeholders Over 80 key stakeholders sensitized in western region About 30 Queen mothers in central 10 municipal health directorate staff Pharmacist AGM AGM of Ward nurses AMR TWG Health Summit Queen mothers called for support (technical and financial) and collaboration with the municipal health directorate for more education on responsible use of medicines and antibiotics in their communities

Way Forward…1 The need for broad policy framework Antimicrobial resistance vrs Antibiotic resistance Key policy areas Community education and Sociocultural change interventions Potential role of Legislative instruments Balancing access, excess and equity (inline with distribution of appropriate cadres) Quality of antimicrobial agents The role of appropriate Infection control strategies Hospitals Communities

Way forward…2 Need for an expanded monitoring framework RUM indicators (1 indicator for Antibiotic use) Alignment and contextualization within existing policies on medicines Infection control policy National Medicines Policy EML policy Linking surveillance data with selection of antibiotics

The Way forward…3 Research must inform Policy and Practice- The ADMER experience Continue multi-stakeholder platform work Continue working with the Academia and research institutions in surveillance, drug development and continuous research to improve antimicrobial use etc Complete Policy Cycle and Continue with Policy implementation monitoring and evaluation, communication/education/advocacy Implementation of the recommendations from KABP on CSO’s and Health professionals Antimicrobial Policy in Ghana

The Way forward…4 Surveillance Implementing the MARHLAB program Bench work stardardisation done to provide the baseline Infection control policy 2011 under review with follow on implementation One Health Approach to AMR issues Develop treatment guidelines for Animal use Collaboration and partnerships with other countries and Institutions as outlined in the Global Action Plan Antimicrobial Policy in Ghana

Announcing our Work ….. 4 more manuscripts ready Antimicrobial Policy in Ghana

Reports, Training Manuals, Educational materials Antimicrobial Policy in Ghana

www.ghndp.org/antimicrobialresistance www.ghndp.org/reactcso Antimicrobial Policy in Ghana

Sights and Sounds- Ghana AMR Alliance Antimicrobial Policy in Ghana

Pictures Antimicrobial Policy in Ghana

THANK YOU TO THE GHANA AMR WORKING GROUP AND TECHNICAL TASK TEAM OFFICE OF THE CHIEF PHARMACIST FOR ALL THE HARD WORK Antimicrobial Policy in Ghana

End Thank you