How the Scottish perspective is helping combat antibiotic resistance in Ghana – Jacqueline Sneddon

Antibiotic resistance is a threat on a global scale. Protecting these vital medicines for the future is everyone’s problem, not just an issue for one country or continent. There’s little point in ensuring Scotland or even the UK carefully manages its antibiotic use if other countries don’t do the same. There are no boundaries to spread of resistant bacteria. One of the best ways to safeguard these vital medicines is through cooperation and learning from each other. That’s why I’m passionate about sharing the work the Scottish Antimicrobial Prescribing Group (SAPG) have undertaken over the last decade to safeguard antibiotics – and to learn from others’ experiences.

As part of this cooperative approach, we were recently awarded a global volunteering grant from the Fleming Fund’s Commonwealth Partnerships for Antimicrobial Stewardship (AMS). Our project, which will help develop antimicrobial stewardship in two Ghanaian hospitals, is one of 12 Commonwealth health partnerships supporting national antimicrobial resistance action plans in Africa.  At its heart, the project aims to establish antimicrobial stewardship programmes as well as improving infection prevention and control practice, and building capacity and expertise in clinical pharmacy to Ghana. We are being joined on the project by health psychologists from Manchester University’s The Change Exchange, who will help us embed behaviour change within our interventions, ensuring work in both Scotland and Ghana is more sustainable and effective. During our initial scoping visit in May we saw some examples of good practice we’d like to emulate back in Scotland, as well as lots of areas where we could support improvements.

So what did I learn on our first visit? How lucky we are to have free healthcare and comprehensive community services in Scotland. Healthcare in Ghana is funded via a National Health Insurance Card costing $36 per year, covering consultations and medicines. Those without a card can access healthcare on a ‘cash and carry’ basis, paying for consultations and medicines when they need them. There’s also a social welfare system, although it appeared not to be accessed often, and sometimes hospital staff will pay for a patient’s treatment if the family can’t. There’s no community healthcare system, so community pharmacies play a major role in providing advice and medicines; they aren’t allowed to sell antibiotics but many do. Patients requiring medical advice attend a hospital out-patient department akin to our Out-of-Hours service, but they just turn up and wait to be seen. Services open at 6am and patients start queuing at 4am.  If patients are admitted to hospital their family must provide much of their daily care, including bathing and feeding.

All government hospitals have Drug and Therapeutics Committees (DTC) and follow the national Standard Treatment Guidelines 2017, a 1400 page book laid out by clinical condition. Medicines guidance is dispersed throughout chapters and finding antibiotic guidance was challenging. Systems and processes within both hospitals were similar to those in the UK, but staff roles differed with less medical staff and nurses taking on what we would consider medical roles.

While our team will train up to 25 professionals in each hospital to deliver a local stewardship programme to ensure safe use of antibiotics, and establish point prevalence surveys to provide data on antibiotic use, our project very much takes a partnership approach. Using a ‘train the trainer’ approach and joint working on data collection will ensure that local staff can sustain stewardship activities after the project finishes.

Daniel Afriyie, Director of Pharmacy at Ghana’s Police Hospital in Accra, and Israel Sefah, Chief Pharmacist at Keta Municipal Hospital, are lead partners for the project. The SAPG team, which includes pharmacists, nurses and Infectious Diseases Consultants, will bring leadership skills and knowledge back to their NHS boards through involvement in the project.

Next steps are for Daniel and Israel to visit Glasgow in August, attend a SAPG meeting, visit several hospitals and meet with colleagues at the University of Strathclyde. Our next visit to Ghana in October will focus on delivery of training at each hospital. Meetings with the Ministry of Health and the Pharmacy Department of the University of Ghana are also planned.

I can’t wait to go back and hope by undertaking this work we can make a difference to the global problem of antimicrobial resistance.

Jacqueline Sneddon is Project Lead for The Scottish Antimicrobial Prescribing Group.

More information

• Visit the SAPG website for more on the work of The Scottish Antimicrobial Prescribing Group.