Ghana National Action Plan for Antimicrobial Use and Resistance

Objectives

Ghana’s 2017 to 2021 National Action Plan for Antimicrobial Use and Resistance provides a five-year, cross-sector framework to contain antimicrobial resistance through a One Health approach linking human, animal, plant, food, aquaculture and environmental health. It translates national policy and the World Health Organization global action plan into practical interventions intended to preserve effective antimicrobials for current and future generations.[1][2][3]

• Improve awareness and understanding of antimicrobial resistance through communication, education and training for the public, health professionals, veterinary personnel, farmers, educational institutions, civil society and media organisations.[1][4]
• Strengthen surveillance, research, laboratory capacity and use of antimicrobial resistance and antimicrobial consumption evidence in policy, medicines selection and clinical guidance.[1][5][6]
• Reduce infection incidence through sanitation, hygiene, infection prevention and control, waste management, biosecurity, food safety, animal vaccination, plant resilience and vector control.[1][7][8]
• Optimise antimicrobial use across human health, animal health, aquaculture and plant production by promoting stewardship, responsible prescribing and dispensing, treatment guidance, regulation and access to quality medicines.[1][9][10]
• Develop an economic case and enabling environment for sustainable investment in diagnostics, vaccines, research, local manufacture and long-term medicine development.[1][11][12]

The plan seeks improved public and professional knowledge, increased evidence-based action, fewer infections in establishments, more appropriate antimicrobial use, and stronger conditions for sustainable investment in antimicrobial-resistance reduction.[13]

Its prevention priorities span health facilities, farms and food systems, including implementation of infection prevention and control policies, safe water and sanitation, healthcare-associated infection assessment, farm outbreak containment, biomedical-waste management and safe disposal of unused or unwholesome antimicrobials.[14][11][15]

Responsible-use priorities include antimicrobial stewardship programmes, culture and sensitivity testing, standard treatment guidance, institutional formularies, pharmaceutical-care and veterinary-care standards, monitoring of antibiotic sales and use, post-market surveillance, pharmacovigilance, and action against unauthorised supply and advertising.[16][17][18][19]

The plan also promotes domestic research and development, quality-assured local antimicrobial manufacture, good manufacturing practice, a bioequivalence-centre strategy, incentives and a proposed fund for local manufacturers, although the supplied material does not provide the proposed fund value.[20][21][22]

Implementation

Implementation is designed to use existing systems and a multisectoral One Health delivery model, coordinated through national governance structures, activity-based operational plans, linked budgets and time benchmarks.[2][23]The Ministry of Health is a principal coordinating institution alongside the Ministry of Food and Agriculture, Ministry of Fisheries and Aquaculture Development, Ministry of Environment, Science, Technology and Innovation, Ghana Health Service, Veterinary Services Directorate, Food and Drugs Authority and other relevant agencies.[24][25]

• Govern through an inter-ministerial commission or governing body providing political oversight, supported by an Antimicrobial Resistance Platform, a secretariat, national coordinators, technical working groups and advocacy working groups.[2][26][27]
• Engage academia, research institutions, professional associations, civil society, media, private and mission-sector providers, manufacturers, development partners and international organisations including the World Health Organization and Food and Agriculture Organization.[24][28][29]
• Deliver activities through technical assistance, stakeholder consultations, workshops, public campaigns, professional education, curriculum reform, supportive supervision, facility and farm assessments, laboratory upgrading and procurement.[30][31][32]
• Establish coordinated but separate human and non-human surveillance structures, national reference laboratories, sentinel sites, standard protocols, data-management systems and a Ministry of Health desk to collate resistance and antimicrobial-consumption data.[5][33][34]
• Implement infection-prevention measures through policy roll-out, baseline studies, water and sanitation improvements, protective equipment, waste-management guidance, referral protocols and farmer training on biosecurity and outbreak containment.[15][35][36]

Accountability is structured around named lead implementers and collaborators, terms of reference, reporting lines, quarterly Antimicrobial Resistance Platform meetings, twice-yearly implementation monitoring and annual multi-stakeholder implementation reviews.[37][38][39]

The monitoring and evaluation framework is organised around the five strategic objectives and uses process, output and outcome indicators. It provides for baseline-setting from Year 1 data where prior information is unavailable, with reporting frequencies ranging from quarterly and biannual to annual depending on the indicator.[2][13][40]

Core measures include public awareness, curriculum inclusion, adherence to prescriptions and treatment guidelines, culture and sensitivity-informed prescribing, functional surveillance sites, reporting of confirmed resistance, diagnostic turnaround time, infection rates, health-facility infection-prevention compliance, farm biosecurity, antimicrobial consumption, stewardship programmes, research investment, manufacturing certification and local medicine-development mechanisms.[41][42][43][44][45]

The overall budget is stated as 21,276,047.93, although the supplied total-budget extract does not identify its currency.[46]Indicative activity budgets elsewhere are expressed in United States dollars and identify potential sources as the Government of Ghana, development partners, corporate institutions and non-governmental organisations.[47][48]

Monitoring & Evaluation

The plan establishes a five-year monitoring and evaluation framework aligned to five strategic objectives: awareness and knowledge; surveillance and research; infection prevention; optimised antimicrobial use; and sustainable investment. It combines process, output and outcome indicators, with activity-level responsibilities, data sources, targets and implementation periods.[29][13]

• Monitor implementation twice yearly through field visits and indicator calculations, disseminate monitoring reports, and convene annual multi-stakeholder implementation reviews.[39][49][50]
• Use a multisectoral accountability structure comprising an inter-ministerial commission, Ministry of Health secretariat, national coordinators, technical working groups, regional and district structures, and the antimicrobial resistance platform.[38][39][27]
• Develop and validate the monitoring framework through data mapping intended to identify efficient and cost-effective monitoring methods.[51][27]

Surveillance arrangements cover antimicrobial resistance and antimicrobial consumption in human, animal, plant and environmental sectors. Planned systems include national reference laboratories, sentinel sites, standardised protocols, diagnostic and sensitivity-testing procedures, data-management tools, reporting modules, access controls and a Ministry of Health desk for collating resistance and consumption data.[33][34][52][53]

• Measure laboratory and surveillance performance through training workshops, personnel trained, laboratories enrolled, percentage of surveillance data reported, laboratory assessment reports and functionality of national systems.[52][53]
• Target training of staff at all sentinel sites, training of all relevant personnel in protocols and standard operating procedures, progressive achievement of complete facility reporting, and functional consumption-surveillance systems with data integrity and global alignment.[52][53]
• Track antimicrobial-resistance-confirmed cases reported through surveillance and the time from sample collection to diagnostic reporting, with quarterly reporting and disaggregation by sector and region.[42][54]
• Monitor use and prescribing through culture and sensitivity-informed prescriptions, antibiotic-containing prescriptions, Daily Defined Doses per capita for key antibiotic classes, and functional stewardship programmes at sentinel sites.[55][10][44][56][57]

Awareness and behaviour indicators include public knowledge of factors driving resistance, adherence to prescribed antimicrobials, adherence by primary health-care and veterinary personnel to treatment guidance, inclusion of antimicrobial-resistance modules in training curricula, and campaign reach.[58][59][60][41][61]

• Report adherence, curriculum and public-knowledge indicators annually and cumulatively, generally using Year 1 data as the baseline where prior data are unavailable.[58][62][60][41]
• Monitor public education through organisations engaged, workshops, people sensitised and trained, campaign materials, and campaign review; stated communication targets include 10 radio stations, 5 television stations, civil-society participation in all 10 regions, 250,000 fliers, stickers and fact sheets, and 100,000 posters.[61]

Infection-prevention monitoring covers healthcare-associated and drug-resistant infections, infection-prevention and control programme availability and adherence, facility reporting, biomedical waste guideline implementation, vaccination of frontline personnel, food safety at slaughter facilities, farm outbreaks, and farm biosecurity and biosafety.[63][64][65][66][43][67][68]

• Conduct baseline and policy-implementation assessments, use supportive supervision, and track the proportion of outbreaks contained, including an intended result that all relevant outbreaks are contained.[15][35][36]
• Use quarterly reporting for infection incidence, drug-resistant infections, farm outbreaks, food-safety practices and prescribing indicators; use annual or biannual reporting for other indicators according to the indicator matrix.[42][54][63][64][69][68][44][57]

Strategic Objective 5 measures the burden of resistance as the additional cost of treating antimicrobial-resistance conditions, alongside government research and development expenditure, certification of local manufacturers, potential antimicrobial candidates, establishment of manufacturing funds and incentives, research agendas, coordination arrangements and a long-term medicine-development model.[12][45][70][71][22][72][73][74]

Costing & Financing

The plan is costed, with activity budgets linked through identifiers to the operational plan and a budget narrative describing expenditure and potential funding sources. The stated total budget is 21,276,047.93, although the supplied total-budget extract does not specify its currency or period.[23][46]

• Allocate an indicative 684,576.04 United States dollars to Strategic Objective 1, Sub-objective 1, covering public and professional education, communication materials, media campaigns, campaign review and curriculum development.[47][75]
• Allocate 302,776.96 United States dollars to Sub-objective 2 surveillance activities and 1,263,852.53 United States dollars to Sub-objective 3 laboratory-related activities.[48][76]
• Identify the Government of Ghana, development partners, corporate institutions and non-governmental organisations as potential sources of financing for listed activities.[47][75][48]

Resource mobilisation is intended to support sustainable investment in diagnostics, vaccines, medicines, laboratory capacity, research, local production and other antimicrobial-resistance interventions. The plan also proposes an incentive package and a fund for quality-assured local antimicrobial manufacture, but the supplied material does not provide a value, confirmed financing source or funding gap for either mechanism.[11][20][77][78][21]

The economic case includes assessing the cost of hospital-acquired infections, the economic implications of resistance in agriculture and aquaculture, the burden of resistance as additional treatment cost, and the commercial viability of potential antimicrobial agents. No quantified results or broader economic assumptions are provided in the supplied extracts.[11][79][12][19]