Sharing and learning about antimicrobial stewardship from eight African countries
Outcomes from a CwPAMS Extension Sharing and Learning Event
On the 30th of June 2022, in partnership with the Tropical Health and Education Trust (THET), we hosted a CwPAMS Sharing and Learning event which celebrated and showcased some of the pioneering AMS work taking place in eight African countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda, and Zambia) together with their respective partners in the UK. Funded by the UK Department of Health and Social Care’s Fleming Fund and managed by THET and the CPA, the Commonwealth Partnerships for Antimicrobial Stewardship Programme (CwPAMS) was established in 2018 to support antimicrobial stewardship (AMS) initiatives to tackle antimicrobial resistance (AMR).
Qualifying criteria for successful CwPAMS funding applications for the most recent extension phase included creating initiatives to address:
- Antimicrobial stewardship (AMS), including surveillance
- Utilising/developing pharmacy expertise and capacity
- Infection Prevention Control (IPC)
- Strengthening capacity of using clinical microbiology data
The CwPAMS Programme was initiated with 12 Health Partnerships (HPs) between the UK and Ghana, Tanzania, Uganda and Zambia to tackle AMR through improved stewardship. These partnerships leveraged the expertise of UK health institutions and technical experts to strengthen the capacity of the LMIC national health workforce to address AMR challenges identified in each country’s AMR National Action Plans (NAP). In June 2021, following an independent evaluation, an extension phase was awarded to include an additional four countries (Sierra Leone, Nigeria, Kenya, Malawi) and 14 HPs, running until June 2022. To mark the end of the extension phase, a Sharing and Learning event was organised by the CPA and THET in collaboration with the HPs.
The event which was attended by over 150 people from across the globe was opened with inspirational keynotes from THET’s Chief Executive, Ben Simms who outlined some of the innovative tools and resources that resulted from the programme including an antimicrobial stewardship game (AMS game), Gender Equality and Social Inclusion (GESI) training, a Prescribing App, Point Prevalence Survey Training (PPS) and AMS Explainer Videos followed by the CPA Executive Director’s Victoria Rutter and Prof. Dame Sally Davies UK Special Envoy on AMR, expressing their congratulations to the HPs for their continued efforts and progress made developing local and sustainable interventions.
The outputs of the HPs were summarised by country-specific presentations. Betsi Cadwaladr University Health Board in Wales and Pharmaceutical Society of Malawi partnership working in Mzuzu Central and Kamuzu Central Hospitals presented first. Work carried out included AMS Leads trained on KPI development, installation of TV screens in the two hospitals for dissemination of awareness videos and 120 total health workers trained in sessions conducted by lead pharmacists.
Our Nigerian partnership between the UK Faculty of Public Health and College of Medicine of the University of Lagos continued with some of their major achievements including writing a 3-year national action plan which was presented to management and advocating for Electronic Medical Records (EMR) to strengthen surveillance and stewardship.
King’s Global Health Partnerships, King’s College London and Connaught Hospital, University of Sierra Leone Teaching Hospital Complex further highlighted their work which included awareness raising activities, AMR young pharmacists champion training, establishing a hospital AMS committee and action plan as well as G-PPS data collection.
Cambridge University Hospital NHS Foundation Trust and Kakamega County Referral Hospital in Kenya inspired us with an explanation about their inaugural G-PPS carried out on 106 patients, AMS game tournament and inclusion of locally manufactured alcohol gel to improve IPC in their 3-year AMS action plan.
Ghana’s partnership between University College London Hospitals (UCLH) NHS Foundation Trust and the University of Health and Allied Sciences, Ho’s motivating achievements included Antibiogram development, baseline information on the practices around disposal of unused/unwanted antimicrobials in Ho Teaching Hospital and awareness raising with their student association during World Antimicrobial Awareness Week.
Ghana’s second partnership between the UK Faculty of Public Health (FPH) and Ghana Public Health Association integrated training of staff on GESI for the first time, PPS for in-patients and community pharmacists’ outreach which resulted in 15 Pharmacies and 48 Participants taking part in training for AMR/AMS/IPC and Laboratory Surveillance.
The third partnership in Ghana between University Hospital, KNUST (UHS) and Ulster University, School of Pharmacy, Coleraine-NI project outcomes included the development of draft guidelines on antimicrobial prescription and use, multidisciplinary AMS committee and team set up in the hospital and three PPSs conducted over a 7-month period.
Zambian partnerships consisted of the University of Sussex; Brighton and Sussex Medical School and Hospital Pharmacy Association of Zambia as well as between NHS Highland and Chipata Central Hospital and demonstrated the establishment of AMS hubs at Kabwe and Kitwe hospitals, improved knowledge and practice of AMS and IPC in both hospitals (Post-test average score = 84%), alcohol-based hand rub production units, development of an antimicrobial drug chart and Standard Operating Procedure Handbook.
Northumbria Healthcare NHS Foundation Trust (NHCFT) and Kilimanjaro Christian Medical Centre in Tanzania highlighted their achievements around PPS training among 76 HCPs, prescription audits at four health facilities, campaign materials for the community such as posters, flyers and an explainer video in the native language.
Uganda partnerships consisted of 1) Cambridge University Hospitals (CUH), UK and Makerere University Department of Obstetrics and Gynaecology, 2) Buckinghamshire Healthcare NHS Trust and Makerere University Health Services, 3) London School of Hygiene and Tropical Medicine and the Infectious Disease Research Collaboration as well as 4) Nottingham Trent University and Makerere University School of Public Health. IPC was an action point for all the four partnerships and consisted of alcohol based hand sanitizer production onsite and introduction to fixed manual alcohol dispensers in wards as well as establishing an IPC committee, staff training and improved waste management. All four partnerships also revamped their Medicines & Therapeutic Committees (MTCs) and the AMS subcommittee was created. Students also participated in these activities including in awareness activities during World Antimicrobial Awareness Week. One partnership trained 52 health workers including over 30 community pharmacy staff and secured over 540 members into their community of practice.
The CwPAMS Sharing and Learning event ended with an engaging session with renowned AMR panel experts Dr Nandini Shetti who is a Clinical and Scientific Advisor to the Fleming Fund, Deborah Tong, Technical Officer at the World Health Organisation (WHO) Antimicrobial Stewardship and Awareness Unit and Dr Yewande Alimi, AMR Program Coordinator at the Africa Centre for Disease Control and Prevention (Africa CDC) who all motivated the continuation of our important work in the African region. CPA programme team members Maxencia Nabiryo and Fran Garraghan revealed some of the exciting new projects underway through CwPAMS including a prescribing app for both human and animal health and Dr Rebecca R Turner, Health Psychology Researcher and Chartered Psychologist from the University of Manchester explained the Principles of Partnerships for the Commonwealth Antimicrobial Stewardship Scheme.
The event was not only an opportunity for sharing our CwPAMS programme achievements, but also a source of valuable feedback from worldwide stakeholders, that will be important in shaping the next phase of the CwPAMS programme (CwPAMS 2) which will build on the strengthen of the previous phases to continue addressing the global health threat of AMR.
To watch the event, click on the video below:
“Through our partnership with The Welsh Antimicrobial Pharmacists Group ( WAPG) we carried out the Global PPS at both Kamuzu Central Hospital(KCH) and Mzuzu Central Hospital ( MCH), we also developed an AMS training and development toolkit and managed to train a total of 120 health care workers . We strongly believe our work will continue to make a meaningful impact in the lives of patients in both these sites as the training toolkit was adopted by their Management to train more healthcare workers.” – William Freloh Mpute, Pharmacist and Life Coach, Blantyre, Malawi
“The CwPAMS partnership between King’s Global Health Partnerships and Connaught Hospital in Sierra Leone allowed us to invest in 10 early-career pharmacists through a blended learning course on AMS. They have gone on to conduct a GPPS survey at Connaught to inform a new 3-year action plan on AMS. They have also been successful at influencing doctors, nurses, pharmacists and their family and friends to be more aware of AMR and adjust their behaviours accordingly.” – Hannah Lewis, King’s Global Health Partnerships in Sierra Leone and Zambia
“Through our CwPAMS partnership with Cambridge University Hospitals, UK we established a team of 35 trainers of trainers (TOT) and Antimicrobial Stewardship (AMS) champions at the Kakamega County Referral Hospital surgical wards. The group is to spearhead AMS activities within their respective wards in the hospital.” – Anthony Sifuna, Kakamega /Cambridge Partnership, Kenya
“As a result of our partnership, we now have an idea of the antimicrobial prescription patterns and resistance profiles of common microbes in Ho Teaching Hospital. There is also a functioning Antimicrobial Stewardship Committee in the hospital championing AMS and related matters.” – Cornelius Cecil Nii Otto Dodoo, UCLH/UHAS/HTH Health Partnership, Ghana
“As a result of the CwPAMS partnership, there is a better trend of antibiotic usage as evidenced by the GPPS. We are positive that our collaboration with community pharmacists and the community at large will have a positive outcome in our fight against AMR.” – Dr Amofah George, GPHA/FPH/Lekma Partnership, Ghana
“Using a One Health approach in our partnership between Nottingham Trent and Makerere Universities together with Buckinghamshire Healthcare NHS Trust, training on AMS for over 200 community pharmacists, laboratory technologists, veterinary officers, and community health workers was successfully carried out in Wakiso district, Uganda. The feedback from the training showed improved knowledge which will lead to better AMS practices at health facilities and in the community.” – Michael Brown, Nottingham Trent University and Makerere University Partnership
“Through our CwPAMS partnership, we carried out GPPS across six hospitals – the first time for most hospitals! This led to the formation of an AMS network that worked together to develop training resources and promote clinical pharmacy, to raise awareness of AMR and improve healthcare outcomes for the people of Tanzania.” – Scott Barrett, Lead Clinical Pharmacist and Joe Brayson, Senior Clinical Pharmacist, Northumbria Healthcare NHS Foundation trust
About the CPA
The CPA works to support pharmacists in strengthening healthcare systems; through the safe and effective use of medicines, improving access and quality of medicines and vaccines, and the prevention of disease and promoting healthy lifestyles. Through their government channels, they are vocal advocates for improved access and quality of medicines and vaccines; embedding pharmacists at all levels of medicines management to achieve this goal.
About THET
THET has a vision of a world where everyone has access to healthcare. We achieve this by training and educating health workers in Africa and Asia, working in partnership with organisations and volunteers from across the UK. Founded in 1988 by Professor Sir Eldryd Parry, we are the only UK charity with this focus.
About the Fleming Fund
The Fleming Fund is a £265 million UK aid investment managed by the Department of Health and Social Care to tackle antimicrobial resistance by supporting low- and middle-income countries to generate, use and share data on AMR. .