National Action Plan on Antimicrobial Resistance: stakeholder analysis of implementation in Ghana

Background Understanding potential barriers to implementation of public health policy is important to ensure well-informed decisions, and stakeholders play critical roles in implementation. Stakeholder analysis is expected to shed light on Ghana’s progress with the implementation of the National Action Plan on Antimicrobial Resistance since the completion of the Global Health Security Agenda’s Joint External Evaluation. The outcome of stakeholder analysis can improve understanding of their roles and institutional capacity to promote prudent use of antibiotics in populations at the community level. Methods Eight semi-structured in-depth interviews were conducted with participants of the Joint External Evaluation process, including personnel from the policy, research, and practice programs in Ghana’s public health sector. In-person interviews were conducted between September and October 2018 in the Greater Accra and Upper West regions. Results The analysis revealed four main themes: national burden of disease and antibiotic resistance, policy development, implementation barriers, and strategies. Ghana’s national antimicrobial policy and action plans to enhance public education and awareness align with the objectives of the Global Action Plan on Antimicrobial Resistance. All respondents expressed concern about the increasing proliferation of antibiotic-resistant bacteria, which they attribute in part to the inappropriate use of antibiotics in local communities. Although Ghana has laws to regulate the sale of antibiotics, enforcement has been a major challenge. Inadequate funding for monitoring compliance comprises the greatest challenge. Stakeholders also acknowledged the importance of strengthening cross-sectoral collaboration, and the need to leverage resources from the animal and environmental sectors through a One Health approach to ensure successful implementation of the national action plan. Conclusions This study identified several opportunities for effective implementation of the Ghana’s National Action Plan on Antimicrobial Resistance. Stakeholders were enthusiastic about the effectiveness of the One Health approach, and there is strong political will to promote multisectoral partnership to advance implementation efforts.