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Martha Gyansa-Lutterodt
Director Pharmaceutical Services
Ministry of Health
Chairperson, Ghana Antimicrobial Resistance Al...
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...
Ghana
 Total Population (2012)
25,366,000
 Gross National income per
capita (PPP international $,
2012) 1,910
 Total ex...
Introduction: the need for AMR
interventions
Major causes of mortality
Conditions affected directly by
AMR
Conditions Not ...
Introduction: Access to essential
medicines
 Availability
 Availability of medicines >85%
for 65 tracer medicines *
 Af...
Policy perspective
 The National Drug Policy
 Standard Treatment Guidelines (STGs) & Essential
Medicines Lists (EMLs) wi...
Policy assessment:
sustaining the gains made by positive interventions on trends in RUM
 The National Drug Policy recomme...
Other Challenges in the use of
Antibiotics
 Use of antibiotics in aquaculture
 Incentives for the use antibiotics in fir...
The impact of these challenges:
The need for efficient stewardship programmes
0.9
0.9
0.9
0.9
1.7
2.6
2.6
5.2
6.1
14.8
24....
The Beginning of AMR program in
Ghana
 The role of
o ‘The race against Resistance’ - Working Group -Centre for Global
Hea...
What is happening in Ghana-highlights
 Baseline assessment
 Situational analysis, stakeholder analysis, Assessment
of kn...
Training of Trainers – CSOs in Health
CSO – Region/location No.
GCNH: IDC - Northern 37
AWI - Western 33
HFFG - Central 29...
Some pre-post test results of CSO
training
6
2
9
3
12
4
0
5
10
15
20
25
30
35
pre post pre post pre post
Central Northern ...
Orientation/Sensitization of Key
Stakeholders
 Over 80 key
stakeholders sensitized
in western region
 About 30 Queen
mot...
Summary of issues-lessons from
Ghana
① The need for broad policy framework
 Antimicrobial resistance vrs Antibiotic resis...
Summary of issues-lessons from
Ghana
⑥ Need for an expanded monitoring framework
 RUM indicators (1 indicator for Antibio...
Reports, Training Manuals, Educational
materials
Publications and Papers
3 more manuscripts almost ready
www.ghndp.org/antimicrobialresistance
www.admerproject.org
END
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Managing AMR- the case of Ghana. Martha Gyansa-Lutterod (Ghana)

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Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015

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Managing AMR- the case of Ghana. Martha Gyansa-Lutterod (Ghana)

  1. 1. Martha Gyansa-Lutterodt Director Pharmaceutical Services Ministry of Health Chairperson, Ghana Antimicrobial Resistance Alliance 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare- Associated Infections Networks in Stockholm, Sweden on February 12, 2015 Managing Antimicrobial Resistance: the case of Ghana
  2. 2. # # # # # # # # # # # # # # # # # # # # # # # # # ## # # ## # ## # # # # # # # # # # # # # # # # # # # # # # # # # # # ## # # # # # # # # # # # # # # # ## # # # # ## # # # # # # # # # # # # # # # # # # # # # # # # #Y #Y #Y #Y #Y #Y #Y #Y #Y #Y LAWRA LAWRA TUMU NADAWLI WA SANDEMA NAVRONGO BOLGATANGA BONGO ZEBILLA GAMBAGA WALEWALE BAWKU TOLON TAMALE SAVELUGU GUSHIEGU YENDI SABOBA ZABZUGU BIMBILA DAMONGO BOLE SALAGA KINTAMPO ATEBUBU KWAME DANSO NKORANZA TECHIMAN WENCHI EJURA SUNYANI DROBO BEREKUM DORMAAAHENKRO BECHEM KENYASENO. 1 TEPA OFINSO AGONA AKROFOSO EFFIDUASE MAMPONTENG MANKRANSO GOASO KUMASI EJISU NKAWIE KUNTENASE KONONGO-ODUMASE JUASO BEKWAI MANSO NKWANTA MAMPONG ASHANTI OBUASI NEW EDUBIASE NEW ABIREM MPRAESO BEGORO KIBI KADE AKIMODA ASAMANKESE SUHUM KOFORIDUA ODUMASE KROBO SOMANYA ATIMPOKU AKROPONGAKWAPIM DODOWA NSAWAM AMASAMAN ACCRA TEMAMUNICIPAL AREA AGONA SWEDRU WINNEBA APAM SALTPOND CAPECOASTELMINA DABOASE TWIFO PRASO ASSINFOSU AJUMAKO BREMAN ASIKUMA ABURA DUNKWA HO DUNKWA-ON-OFIN TARKWA SEKONDI/TAKORADI AGONA NKWANTAAXIM HALFASSINI ASANKRAGUA SEFWI WIAWSO JUABESO ENCHI BIBIANI AKATSI DENU ADA FOAH SOGAKOPE ADIDOME KPANDU KADJEBI JASIKAN HOHOE DONKORKROM KETE-KRACHI NKWANTA Upper West Upper East Northern Brong Ahafo Ashanti Volta Eastern Western Central Greater Accra Regions Ashanti Brong Ahafo Central Eastern Greater Accra Northern Upper East Upper West Volta Western Water body # District Capital #Y Regional Capital Ghana boundary 200 0 200 400 Kilometers N EW S GhanaMap Prepared by Alexander Boakye Marful, July 2005
  3. 3. Ghana  Total Population (2012) 25,366,000  Gross National income per capita (PPP international $, 2012) 1,910  Total expenditure on health per capita (Intl $, 2012) 106  Total expenditure on health as % of GDP (2012) 5.2  Life expectancy at birth m/f (years, 2012) 61/64  Probability of dying between 15 and 60 years m/f (per 1000 population, 2012) 263/227 Ghana Facts and figures
  4. 4. Introduction: the need for AMR interventions Major causes of mortality Conditions affected directly by AMR Conditions Not directly affected by AMR 40% 60%
  5. 5. 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 *Office of the Chief Pharmacist 2013 data Ghana Drug Access Problem Ratio Quality 40% Accessibility 20% Affordability 40% Quality 40% Accessibility 20% Affordability 40%
  6. 6. Policy perspective  The National Drug Policy  Standard Treatment Guidelines (STGs) & Essential Medicines Lists (EMLs) with levels of care  National Health Insurance Lists (NHIL)  Food and Drugs Authority Register, with classification of medicines  Over the Counter medicines, Pharmacy Medicines, Prescription Only Medicines  Pharmacy council -Major/common human pathogens considered: E. coli, Klebsiella, Salmonella, Pneumococci, Staphylococcus aureus -Common antibiotics recommended STGs: Amoxicillin, Erythromycin, Ceftriaxone, Tetracycline, Cefuroxime, Gentamicin, Ampicillin, Ciprofloxacin
  7. 7. 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 Office of the Chief Pharmacist, 1999 to 2013 The indicator trend, aligns with investments in DTC training 56.3 40.5 41.4 43.1 36.4 45.2 40.7 37.6 48.7 49.5 42.0 43.6 43.3 41.4 39.9 15.0 25.0 35.0 45.0 55.0 65.0 75.0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Percentage of outpatient encounters with an antibiotic prescribed from 1999 to 2013 in Ghana Ghana AMR initiatives
  8. 8. Other Challenges in the use of Antibiotics  Use of antibiotics in aquaculture  Incentives for the use antibiotics in firm farming  ‘Tilapia’ fish farming  Use of antibiotics in animal husbandry  Need to strengthen rational use of medicines in veterinary practice (treatment protocols and standards)  Veterinary public health service has been engaged on the Ghana AMR platform  Nascent surveillance system  The Surveillance system is nascent that requires standardization and quality assurance to feed into global actions
  9. 9. The impact of these challenges: The need for efficient stewardship programmes 0.9 0.9 0.9 0.9 1.7 2.6 2.6 5.2 6.1 14.8 24.3 39.1 Deworm Drug Flucloxacillin Methicillin Nivaquine Co-trimoxazole Amodiaquine Ciprofloxacin Cloxacillin Chloroquine Amoxicillin Ampicillin Choramphenicol Proportion (%) Examples of ineffective antibiotics as given by respondents in KABP assessment on CSOs, Non-Health professionals Medicines users are faced with the implications of AMR on treatment outcomes, cost etc. Aligns with Resistance to Amp, Chl in Ghana -Ampicillin 76% -Chloramphenicol 75% Newman et al, 2011
  10. 10. The Beginning of AMR program in Ghana  The role of o ‘The race against Resistance’ - Working Group -Centre for Global Health Development o The Uppsala Summit on ABR in 2010 o Local institutional leadership in a multi-stakeholder approach  The Ghana Ministry of Health (AMR agenda at May 2014 Health Forum in Ghana)  Multi-stakeholder approach (Ghana AMR stakeholder platform) o Partnerships and synergies  Swedish International Development Agency, ReAct Project- Uppsala University),  World Health Organization (WHO)
  11. 11. What is happening in Ghana-highlights  Baseline assessment  Situational analysis, stakeholder analysis, Assessment of knowledge attitudes beliefs and practices of Health professionals and CSOs in health, baseline assessment of resistance  Policy processes. Ghana AMR policy is ready for parliamentary action  Capacity building  CSOs in Health  Capacity building programs (under ADMER-project)  African Antibiotic Use conference March 18-20 ,2015  Communication  Papers, Websites, Media
  12. 12. Training of Trainers – CSOs in Health CSO – Region/location No. GCNH: IDC - Northern 37 AWI - Western 33 HFFG - Central 29 LAPAG - Greater Accra 25 CSHC - Greater Accra 32 TOTAL 156
  13. 13. Some pre-post test results of CSO training 6 2 9 3 12 4 0 5 10 15 20 25 30 35 pre post pre post pre post Central Northern Western Pre-Post test response to Bacteria and Virus are the same for 3 regions No No Answer Yes 0 5 10 15 20 25 30 35 post pre post pre post pre post pre AccraLapag Central Northern Western Pre-Post test response to Microbes live in harmony with the environment for 4 CSO groups No No answer Yes
  14. 14. 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 Annual Meeting  AGM of Ward nurses  AMR TWG  Health Summit
  15. 15. Summary of issues-lessons from Ghana ① The need for broad policy framework  Antimicrobial resistance vrs Antibiotic resistance  Key policy areas  Community education and Sociocultural change interventions ② Role of Legislative instruments ① Distribution and use ③ Balancing access, excess and equity (inline with distribution of appropriate cadres and level of use) ④ Quality of antimicrobial agents- regulatory mechanisms ⑤ The role of health system issues  Infection Control strategies- Policy review in progress  Laboratory capacity and logistics  Community actions and participation
  16. 16. Summary of issues-lessons from Ghana ⑥ Need for an expanded monitoring framework  RUM indicators (1 indicator for Antibiotic use) ⑦ Alignment and contextualization within existing policies on medicines  Infection control policy  National Medicines Policy  EML policy ⑧ Linking surveillance data with selection of antibiotics
  17. 17. Reports, Training Manuals, Educational materials
  18. 18. Publications and Papers 3 more manuscripts almost ready
  19. 19. www.ghndp.org/antimicrobialresistance www.admerproject.org
  20. 20. END Thank you

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