Advancing Antimicrobial Stewardship in Africa through CwPAMS 2

The UK teams set off on their voyage to Africa on May 30th 2023, commencing a series of eight inception events that began in Sierra Leone and concluded in Malawi and Tanzania on June 12th.

Overview

The UK Department of Health and Social Care’s Fleming Fund allocated funding for the next phase of the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS 2) programme which runs from April 2023 to December 2024. This phase of the programme aims to foster new partnerships while building upon the successes achieved with existing partners. By encouraging sustainability and sharing best practices, the programme seeks to establish in-country centres of excellence. CwPAMS 2 projects spanned across Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda, and Zambia, with a focus on various aspects of antimicrobial stewardship both in human and animal health.

To officially launch the CwPAMS 2 programme in country, the CPA and THET teams set off on their voyage to Africa on May 30th, commencing a series of eight inception events that began in Sierra Leone and concluded in Malawi and Tanzania on June 12th. These events served as a platform to bring together crucial in-country stakeholders, including Ministry of Health Officials, National Pharmacy Associations, Fleming Fund delivery partners, and the CwPAMS2 team, including grantees and Programme Managers from the Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET). During these gatherings, productive discussions were stimulated, focusing on fostering collaboration and alignment of Antimicrobial Stewardship (AMS) activities among all stakeholders. The aim was to maximise opportunities and harness each other’s strengths to effectively achieve the objectives outlined in the National Action Plans.

Sierra Leone

30 May 2023

Prior to the event the CPA and THET representatives visited Connaught Hospital, the CwPAMS2 Centre of Excellence in Sierra Leone. With the successes achieved in the previous CwPAMS project at Connaught Hospital, which involved the establishment of a multidisciplinary AMS committee, the hospital’s senior management and AMS committee leadership are now confident and enthusiastic about providing continuous support and promoting capacity building in AMS at other sites during phase two.

The event commenced with a presentation from WHO’s Victoria Katewera, the team lead of the Fleming Fund Country grant in Sierra Leone. The objectives and plans of the country grant caught the attention of the CwPAMS2 partnership, who were excited to learn about the promising progress of renovating the Microbiology Laboratory at Connaught Hospital. Dr. Bawoh from Connaught Hospital and Suzanne Thomas from the King’s Global Health Partnerships jointly presented their hub and spoke project on Strengthening Pharmacy Leadership for Antimicrobial Stewardship in Sierra Leone.

The launch of our health partnership’s project in Sierra Leone was met with great enthusiasm, emphasising the significance of empowering pharmacy leadership to drive effective antimicrobial stewardship. The Project will focus on building the capacity of both clinical and community pharmacists, whilst utilising CPA’s Continuous Professional Development (CPD) Modules. This collaborative effort holds immense potential to make a remarkable impact in combating Antimicrobial Resistance (AMR) and ensuring the responsible use of antimicrobial medications.

Ghana

2 June 2023

During our launch event in Ghana, we had the pleasure of welcoming over 30 colleagues, including grantees from the three CwPAMS2 health partnerships in the country, who presented and discussed their projects. The projects focused on various areas, such as surveillance, capacity building, community health, and awareness creation. Two of the partnerships revealed plans to utilise the hub and spoke model to disseminate evidence-based practices in AMS across multiple sites in Ghana.

Throughout the event, areas of collaboration among the three grantees were identified. With the presence of Fleming Fund representatives, led by Adjo Mfodwo, Mott MacDonald’s Regional Coordinator, and officials from various departments within the Ministry of Health, opportunities for national alignment and engagement were established

During a visit to Lekma Hospital, representatives from CPA and THET observed the achievements of the multidisciplinary AMS team established under the leadership of the hospital director during the first phase of the CwPAMS1 program. The team plans to build on these successes by improving and scaling up good practices, such as promoting microbiology testing and raising AMR awareness in clinical and community settings, and extending these efforts to other healthcare sites. The hospital’s commitment to advancing AMS practices and making a broader impact was evident during the visit.

Nigeria

5 June 2023

Transitioning from one health partnership in the previous CwPAMS phase to launching five CwPAMS 2 health partnerships in Nigeria is a significant achievement that attracted attention and participation of various key stakeholders including the Nigeria Centre for Disease Control and Prevention (NCDC) and Ministry of Health Officials. Our CwPAMS 2 Projects aiming at improving AMS in hospitals and at the community level had an inspiring launch event. The Project leads highlighted the game-changing potential of enhancing the use of clinical microbiology and antimicrobial prescribing data to develop AMS interventions. Through our partnerships, we will leverage these data-driven insights to inform and enhance clinical decision-making. By empowering healthcare professionals with accurate and timely information, we can drive positive change and make significant strides in promoting responsible antimicrobial use and combating AMR in Nigeria.

Uganda

6 June 2023

The CwPAMS 2 Uganda inception event commenced with valuable insights from national key stakeholders, highlighting the importance of collaboration and coordination in aligning facility-level partnership work with national AMR priorities. Presentations from CwPAMS health partnerships introduced project aims, key strengths, measures of success, and anticipated barriers. The diverse range of projects centered around the common themes of AMS and Infection Prevention and Control (IPC). The CwPAMS Cards for Change were distributed to all health partnerships, supporting the integration of behaviour change principles into AMS programmes. The meeting with the Director of Kawempe National Referral Hospital was very positive, and the anticipation of welcoming him and Makerere University College of Health to Cambridge later this year further emphasises the commitment to the CwPAMS project. Uganda’s momentous launch event showcased their strong dedication to empower healthcare professionals and institutions in combating AMR through promoting AMS, IPC, and data-driven clinical decisions.

Kenya

8 June 2023

The “one health” guided antimicrobial stewardship activities were launched in Nairobi. The partnerships fostered learning and shared expertise. The CwPAMS initiative was inaugurated with a remarkable event, emphasising antimicrobial pharmacy capacity building and responsible antimicrobial use.

The CPA and THET CwPAMS team further visited Mbagathi hospital, seeing progress in establishing an AMS committee and touring the lab and pharmacy. The Nairobi launch marked a milestone for the Dharura, University Hospitals Bristol and Weston, and Laikipia Health partnership. Discussions at the National Reference Laboratory focused on using national AMR data for stewardship programmes, which aligns with the CwPAMS 2 programme aim of integrating microbiology data with AMS. The launch event emphasised building antimicrobial pharmacy capacity.

Zambia

9 June 2023

Positive discussions were held at the Zambia National Public Health Institute and Centre for Infectious Disease Research in Zambia (CIDRZ), where our teams came together to prepare for the inception meeting of CwPAMS 2. During the meeting, we explored ways to unite and enhance our collaborative efforts in the battle against antimicrobial resistance (AMR).

Zambia possesses valuable Antimicrobial Use, Consumption & Sensitivity Data, but the challenge lies in finding means to effectively share and collaborate on these narratives for the cause of AMR. Our dedicated CwPAMS 2 initiative in Zambia is diligently working towards facilitating this vital task.

We successfully concluded our launch events in Zambia, marking a significant achievement. The partnerships established in Zambia will work together to strengthen antimicrobial stewardship, bolster pharmacy expertise, and enhance infection prevention efforts. These collective endeavours will contribute towards a healthier Zambia.

Tanzania

12 June 2023

During an exciting day for our CwPAMS 2 Tanzania team, Chief Pharmacist Daudi Msasi opened the inception event, emphasising the significance of disseminating the impact of each project on the National Action Plan (NAP). Furthermore, one of our Prescribing Companion Champions assisted Tanzanian partnerships and national stakeholders in downloading the App, which enhances access to antimicrobial prescribing guidelines at the point of care and effectively improving adherence to guidelines.

Our teams also focused on developing clinical pharmacy training and support for medical and surgical ward rounds. This event brought together key personnel from the Ministry of Health and the Prime Minister’s Office, demonstrating their commitment to tackling the global challenge of antimicrobial resistance (AMR). Additionally, pharmacists gained valuable knowledge on ward-based clinical pharmacy, particularly in supporting patients with acute kidney injury (AKI) and sepsis.

Malawi

12 June 2023

During our visit to Malawi, we engaged in fruitful brainstorming sessions and shared valuable ideas and experiences as part of the Malawi-Wales Antimicrobial Pharmacist partnership. Together, we worked through the National Action Plan in the country, sharing our achievements from CwPAMS with Mzuzu and Kamuzu hospitals as centres of excellence and further serving as the hubs for collaboration. Another successful meeting with the hospital director and key staff from Dedza District Hospital, one of the new spoke sites further solidified our partnership following of the official CwPAMS project inception meeting in Lilongwe.

Excitement filled the air as we encountered yet another new hospital, Ntcheu District Hospital, where there was a strong enthusiasm to develop Antimicrobial Stewardship activities as part of our CwPAMS 2 project. We also welcomed Queen Elizabeth Central Hospital in Blantyre as one of our new tertiary centres joining the CwPAMS project.

Our discussions extended beyond the hospital walls, as we utilised available resources to delve into the National Action Plans in animal and agriculture sectors. This comprehensive approach aimed to tackle antimicrobial resistance holistically. Another significant partnership was formed with Mchinji District Hospital, as we officially joined forces to drive progress in our new initiative. Additionally, we had a productive meeting with the management of Zomba Central Hospital, further strengthening our collaboration.

Throughout our journey, we visited five hospitals in Malawi, each bringing its unique perspectives and challenges. The insights gained from Mzuzu Central Hospital and Kamuzu Central Hospital were particularly invaluable, guiding our efforts to implement activities in Queen Elizabeth Hospital and Zomba through the hub and spoke model.

Overview of CwPAMS

The Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) is a health partnership programme funded by the UK aid Fleming Fund to tackle antimicrobial resistance (AMR) globally. CwPAMS is managed by the Commonwealth Pharmacists Association (CPA) and the Tropical Health Education Trust (THET), an international NGO with expertise in delivering global health partnerships.

CwPAMS aim has been to enhance implementation of protocols and evidenced based decision making to support antimicrobial prescribing, as well as capacity for antimicrobial use surveillance. The 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 programme is managed by the UK Department of Health and Social Care.