Our 2025 Antibiotic Guardian Awards Nominees: the Hub and Spoke Model
Read more about CwPAMS’ adoption of the hub and spoke model and its nomination in the ‘Multi-Country Collaboration’ category
by the CPA CwPAMS 2.0 Team
The Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme is one of the Commonwealth Pharmacists Association (CPA)’s core programmes aimed at tackling antimicrobial resistance (AMR).
Since 2019, we have collaborated with Global Health Partnerships to build strategic pharmacy-led partnerships between UK and African health institutions, fostering intercontinental bidirectional learning between multidisciplinary healthcare teams in aid of strengthening antimicrobial stewardship (AMS) capacity across participating countries.
In the second phase of CwPAMS (March 2023 to March 2025), eight of our health partnerships adopted the ‘hub and spoke model’ (HSM) to promote the strengthening and use of local AMS expertise to scale up and sustain the ongoing achievements of CwPAMS in participating countries. Eight ‘hubs’ onboarded a total of 39 ‘spoke’ sites and cascaded their expertise in tackling AMR through the development and dissemination of capacity and capability building interventions in local health facilities.
In recognition of the success of the HSM in CwPAMS, its usage has been shortlisted for a UK Health Security Agency Antibiotic Guardian Award, celebrating its transformational impact in empowering health partnerships to combat AMR across borders.
The hubs and their respective activities were led by local AMR or AMS experts and supported by their UK counterparts in the partnerships. The sites focused on antimicrobial use surveillance, providing AMR/AMS training, AMS in the context of leadership training, the development of organisational governance structure, and the sharing and learning of lessons across the CwPAMS countries and beyond.
These initiatives provided access to specialised training and AMS initiatives for 39 smaller, local facilities in Ghana, Kenya, Malawi, Sierra Leone, Tanzania, and Uganda, offering learning opportunities that may have otherwise been reserved for larger, national-scale institutions. In doing so, we aim to motivate healthcare workers across the entire health ecosystem to make efforts to improve AMS practices.
Some key successes from the HSM’s implementation include:
- Increased AMS capacity and expertise development, catalysing AMS programmes in participating health institutions and encouraging in-country ownership of AMS initiatives. Hub staff provided on-site support and mentorship to multidisciplinary teams at spoke sites, exposing healthcare workers to various AMS aspects, including behaviour change, microbiology and continuous quality improvement (CQI) methodologies to support best practice.
- Improved AMS prescribing and use practices through the collection, analysis and dissemination of antimicrobial consumption data across HSM links. Local AMS Committees have been developed or reactivated, with all participating health institutions completing AMS assessments and point prevalence surveys, as well as developing their AMS action plans.
- Sustainable resource development and best practice, facilitating the creation of sustainable AMS learning and data science opportunities to continuously improve practice.
As CwPAMS moves into phase 2.5, we have sought to further develop the HSM’s usage and capitalise on its successes. Usage of the HSM in CwPAMS 2.5 will focus on:
- Expanding capacity and expertise in a sustainable way: By promoting a ‘train-the-trainer’ approach, we aim to address staff turnover challenges by creating a cadre of AMS trainers within health systems, allowing for ongoing knowledge dissemination across the hub and spoke networks. This empowers institutions to sustainably develop and maintain their AMS capacity and capabilities without relying on external support.
- Continuous learning and CQI: We aim to continue focusing on strengthening data-driven AMS planning across the network of hubs and spokes with an emphasis on CQI. This strategy allows for more integrated and comprehensive AMS planning: hubs, with their established expertise, can guide spokes in implementing CQI methodologies, ensuring that data-driven decision-making becomes a standard practice across the network.
- Sustainability measures and impact: To ensure the long-term sustainability of AMS efforts, we will continue strategically engaging with national stakeholders, including incorporating AMR Action Plans into broader health policies and strengthening their involvement in technical resource development. The HSM encourages sustainable, locally driven AMS practices by fostering a network of expertise and promoting CQI throughout countries’ health systems.
“Seeing our CwPAMS Hub and Spoke Model shortlisted for an Antibiotic Guardian Award is incredibly validating. It underscores our commitment to innovative, sustainable solutions in the fight against AMR.
“By enabling a train-the-trainer approach and strengthening local capacity, we’re not just tackling current challenges, but building a resilient future for AMS.”
Maxencia Nabiryo
Head of Programmes
CwPAMS’s adoption of the HSM has been shortlisted for the Multi-Country Collaboration award at the 2025 Antibiotic Guardian Awards, taking place in Birmingham, UK on 9th June. Stay up to date with CPA’s channels as we approach the ceremony!
About CwPAMS and the Fleming Fund
The Department of Health and Social Care’s Fleming Fund is a UK aid programme supporting up to 25 countries across Africa and Asia to tackle antimicrobial resistance (AMR), a leading public health threat across the world. The Fleming Fund invests in strengthening data surveillance systems through a portfolio of country grants, regional grants and fellowships managed by Mott MacDonald, and global projects managed by partners.