Antimicrobial resistance national level dialogue and action in Ghana: setting and sustaining the agenda and outcomes

Abstract

Background Antimicrobial resistance (AMR) has gained national and international attention. The design and launch of national policy on antimicrobial use and resistance and action plan marked a milestone in Ghana’s commitment to control AMR. These strategies are some outcomes of getting and sustaining AMR issues prominence on government’s agenda. Understanding the agenda setting processes, policy actors involved and policy change is important as this provides insights on how and why policy actors defined and framed AMR issues to sustain its prominence despite the changing priorities of government agenda. Objective To examine the processes of setting and sustaining AMR issues on government agenda, the policy actors involved and resulting outcomes. Methods A qualitative study was conducted and data collected through interviewing twenty-four respondents and reviewing technical working group meeting reports and health sector documents. Data was analysed drawing on Kingdon’s agenda setting framework. Result Members of a multisectoral technical working group (AMR platform) formed in 2011 constantly built consensus on AMR problem definition, solutions and actively engaged decision makers to mobilise support and interest. The AMR platform members sustained AMR attention and prominence on government’s agenda through the following multisectoral coordination mechanisms: (1) institutionalising AMR platform activities (2) gathering evidence, sharing findings, and supporting research (3) creating awareness and training (4) gaining and maintaining political support. The activities of the AMR platform contributed to three remarkable outcomes and these are (1) maintained network of AMR Champions, (2) design of a national policy on antimicrobial use and resistance in Ghana (1st edition) and national action plan (2017–2021), and (3) Ghana’s hosting of the second Global call to action on AMR. Conclusion The AMR platform members as influencers concentrated their efforts to move and sustain AMR issues on government agenda. The identified multisectoral coordination mechanisms collectively contributed to agenda setting processes and policy change. The AMR platform engagements are ongoing and it is important the momentum is maintained. As multisectoral coordination and activities are vital especially for AMR ‘One Health’ approach, we hope this paper presents lessons for better understanding of how and why multisectoral groups influence national level agenda setting processes.

Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future

“…The WHO GAP resulted in the development of National Action Plans (NAPs) across countries to combat rising levels of AMR [ 68 , 69 ]. Africa is no exception; currently, African countries are at different stages of implementation and monitoring of their NAPs [ 70 , 71 , 72 , 73 , 74 ]. A key activity within the NAPs is understanding current antimicrobial utilization and resistance patterns.…”

Fighting Antimicrobial Resistance: Development and Implementation of the Ghanaian National Action Plan (2017–2021)

“…In the following years members from various fields joint the AMR platform: non-governmental organisations (NGOs), industry, media, health professional bodies, regulators, the animal/veterinary field and the environmental sector. From 2015 to 2019, about 190 members from the aforementioned institutions actively participated in the NPAR work [10]. A recent article by Koduah et al [10] provides detailed information on the role the NPAR plays in sustaining the national AMR agenda.…”

“…From 2015 to 2019, about 190 members from the aforementioned institutions actively participated in the NPAR work [10]. A recent article by Koduah et al [10] provides detailed information on the role the NPAR plays in sustaining the national AMR agenda. These include supporting and sharing research findings, strengthening AMR awareness creation, supporting training and advocacy, gaining and maintaining political support and supporting the implementation of the national action plan on AMR.…”

“…Further important issues that require attention in the evaluation of the NAP implementation are AMR-related capacity-building in academic institutions, the level of awareness in Ghanaian society (see [34]) and the role of Ghana in the international discourse on AMR, for example, its role in the Global Call to Action on AMR and the Ghanaian approach to the formation of a national working group on antibiotic resistance (the NPAR) [10,35].…”

Beyond political will: unpacking the drivers of (non) health reforms in sub-Saharan Africa

“…In Ghana, the framing of Anti-Microbial Resistance (AMR) not as a health problem but a multisectorial threat enabled stakeholder cohesion that helped to set and sustain the AMR agenda under the OneHealth Approach. 50 The form and expression of power Power is defined as the ability or capacity to 'do something or act in a particular way' and to 'direct or influence the behaviour of others or the course of events'. Koduah et al 43 combined Mintzberg's power concept, arenas of conflict of Grindle and Thomas 28 and Sterman's concept of policy resistance (2006) to examine the rise and fall of primary care maternal services from Ghana's capitation policy.…”