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ANTIBIOTIC POLICY IN GHANA; THE WAY FORWARD Martha Gyansa-Lutterodt Director Pharmaceutical Services

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

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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 Quality 40% Accessibility 20% Affordability 40% Antimicrobial Policy in Ghana

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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 Ghana AMR initiatives

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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

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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

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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

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Elements of Ghanas 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

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

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Our Story ! Antimicrobial Policy in Ghana

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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

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Way Forward1 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

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Way forward2 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

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The Way forward3 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 CSOs and Health professionals Antimicrobial Policy in Ghana

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The Way forward4 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

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

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Reports, Training Manuals, Educational materials Antimicrobial Policy in Ghana

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

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Sights and Sounds- Ghana AMR Alliance Antimicrobial Policy in Ghana

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Pictures Antimicrobial Policy in Ghana

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

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END Thank you