Antimicrobial Access and Use at the Community Level in Ghana

An innovative means of tracking access to antimicrobials and their use at the community level. Data from community members and community pharmacies will be analysed to identify sources and consumption patterns of antimicrobials and used to develop training modules for community pharmacists. This project will be piloted in a district.

Yvonne Yirenkyiwaa Esseku (PhD)

Rector, Ghana College of Pharmacists.

Although development of antimicrobial resistance is a slow natural process, it is also known that the misuse and overuse of antimicrobials in humans, animals and plants are the main drivers in the development of drug-resistant pathogens (WHO, 2023). 

Information available on AMR is mainly from hospital settings and from the global north. There is currently an untouched gap with respect to information from community settings in Ghana (Jimah, Fenny, & Ogunseitan, 2020). Most community pharmacies in LMICs, including Ghana, are unable to provide evidence-based interventions relating to AMA and AMU as a result of this information gap. 

Factors that contribute to this lack of information may include;
a) Lack of awareness on the essence of collecting AMU data at the community level
b) Lack of reporting mechanisms on AMU data at the community level
c) Insufficient resources for collecting data
The solution we propose is to address the insufficiency in resource, including human resource, for data collection and analysis. We will also deploy a platform to capture and process the relevant data.

Community Practice Pharmacists Association (CPPA) is the community pharmacy practitioners wing of the Pharmaceutical Society of Ghana (PSGH). They make up more than fifty percent of the membership of PSGH. They frequently conduct needs assessment for their members and provide training accordingly.
Our proposed solution seeks to support the CPPA with the architecture to generate relevant data on access and use of antibiotics among community members and build their capacity to collect and report data from the community-level. The data will be analysed to understand the sources and consumption of antibiotics among community members. This will support the provision of evidence-based interventions.

The evidence gathered from these analyses will aid the development of training curricula to build the capacity of community pharmacists in making appropriate interventions. This will ultimately improve health outcomes among community members.

We have engaged the leadership of CPPA to assess their needs with respect to information on the access and use of antimicrobials at the community level.
Our discussions with the leadership of CPPA have revealed that due to a lack of resources, community pharmacists deemphasize activities such as research which could generate data for evidence-based interventions.

We expect our solution to provide new data on community access and use of antibiotics. Such data will be relevant to inform policy to guide access and use of antibiotics by community members. The data will be used to inform curriculum development to train community pharmacists in making evidence-based interventions. 

The analysed data will be disseminated through peer-reviewed papers and conference presentations. The information will also be made available on various public platforms such as our website and library as data sources for future research. 

Pharmacies that participate in the project will have a free-to-use dashboard to inform them on the trends of supply and consumption of antibiotics within their community based on the AWaRe classification. Participation will be free for all interested community pharmacies in the project districts. 

Most community pharmacies in Ghana are unable to provide evidence-based interventions relating to AMA and AMU as a result of the paucity of information on the access and use of antimicrobials from community settings in Ghana. Our proposed solution will build the capacity of community pharmacists, a critical cadre of community health workers, with respect to data collection relating to AMA and AMU among community members. 

The data collected will also be used by community pharmacists to assess the use of antibiotics by community members based on the AWaRe classification. This will help community pharmacists to provide evidence-based recommendations, judicious antibiotic dispensing, improved patient education on appropriate antimicrobial use and improve efforts at combating AMR to promote antimicrobial stewardship. 

This responds to the needs of community pharmacists in Ghana as gathered from engagements with the leadership of CPPA.

Our proposed solution will be used to capture AMA and AMU data from one district in the first year. We expect to analyse the data collected to identify access and use patterns among community members in the district.  The information will be used to improve pharmaceutical care delivery for community members and will be used to develop curricula for training pharmacists on AMS. 

Learnings will also be leveraged to facilitate data collection and analysis in up to 9 other districts in Ghana.  The scale up will be done in batches of three districts every six months after the first years to ensure we are always able to identify and respond to issues rapidly.  The three districts in each batch will be selected with one from each of the three geographical belts in of Ghana: coastal, middle and northern.  Thus, over the next three years, there will be AMA & AMU data available from across the country to improve practice and advise policy on appropriate interventions to improve access and use of antibiotics across the country.

In the last six months, we will conduct an endline survey to assess the impact of interventions implemented for pharmacists on AMU among community members.

A comprehensive M&E plan will be prepared by an M&E expert which will allow for step-by-step verification of the scheduled activities and also allow us to detect and respond to problems quickly. 

The plan will include reporting schedules for recruiters and researchers.  Reporting will be within an agreed format to allow for easy identification of issues and facilitate resolution.  There will be orientation sessions and periodic catch-up meetings with project staff.

Measurable Indicators include:

1. Access to antimicrobials by assessing the sources from which community members acquire their antimicrobials.

2. Antimicrobial usage patterns through surveys, interviews and pharmacy sales data to understand their appropriate usage. Where the respondents obtained their antimicrobials without a prescription or recommendation by a pharmacist, symptoms will be captured.

3. Proportions of antibiotics dispensed from the AWaRe categories by participating community pharmacies to assess the appropriateness of antibiotic use.

4. Curricula to train community pharmacists on AMS.

5. Effectiveness of capacity building by assessing changes in knowledge and practices of community pharmacists with respect to antimicrobial stewardship and data collection.

6. Number of evidence-based interventions made by participating community pharmacists using reported documentations. 

7. Impact of interventions using endline surveys.

Challenges in engaging the community members and obtaining their cooperation may arise due to cultural and language barriers, or distrust of researchers. These will be addressed by engaging community leaders and traditional leaders for support to gain effective community entry.

Challenges with ensuring the quality and validity of collected data, especially with data collection methodologies, respondent biases and incomplete or inaccurate reporting. These will be addressed by implementing rigorous quality assurance measures including regular monitoring and supervision of data collection activities, validation checks and data quality audits using an advanced security feature which protects sensitive information.

Over the next three years, as we scale up, we envisage the need to retrain data collectors using the information obtained in the first year of implementation.  This we will do by developing a training plan at the end of the first year, having identified all issues that will need to be addressed during the training.

We are applying to The Trinity Challenge for its esteemed platform and expertise in addressing global health challenges, including antimicrobial resistance (AMR). Specifically, we seek assistance in overcoming identified barriers in obtaining community level data on AMA and AMU. The Trinity Challenge's support will enhance our community engagement strategies and support community pharmacies with resources to obtain and utilise community level information for evidence-based decision-making. In addition, access to resources and expertise will strengthen our data quality assurance measures, ensuring the integrity of collected data. As we scale up, the funding will support retraining of data collectors, ensuring sustained effectiveness in our efforts against AMR. Through collaboration with The Trinity Challenge, we aim to leverage our solution effectively and make significant strides in addressing AMR on a global scale.

Commonwealth Pharmacists Association (CPA): the CwPAMS project has been running since 2019 and is likely to be a source of relevant information for an AMR project like ours.

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