The effectiveness of Ghana's antibiotic control policy framework: an analysis using the Anderson governance framework

The burden of antimicrobial resistance is rapidly increasing, with the highest rates anticipated in Sub-Saharan Africa. Most countries around the world have expressed political commitment to strengthen antibiotic control and have adopted corresponding legislative policies. There are also repeated calls for more rigorous antibiotic controls and a coordination framework akin to the international system for controlled medicines. Ghana has instituted a policy on antimicrobial use and resistance, as well as a now-expired National Action Plan (NAP) on Antimicrobial Resistance (AMR). While there is growing support for stricter antibiotic control, concerns remain regarding the suitability of such interventions in local settings. This study examined the effectiveness of Ghana's antibiotic control policies through the lens of the Anderson Governance framework.

The study employed semi-structured interviews with purposively selected stakeholders from the antibiotic control landscape in Ghana. The interviews explored the effectiveness of Ghana's antibiotic control policy and the NAP on AMR within the structural domains such as policy design, implementation tools, monitoring, and evaluation. The emerging data was coded and analysed thematically using Atlas.ti, guided by the Anderson Governance Framework and the COREQ guidelines.

Seventeen (17) stakeholders participated in the study. Participants described several challenges, including fragmented coordination, limited availability of data, insufficient stakeholder inclusivity, barriers to access and minimal use of digital tools. Although participants expressed a need for improved AMR surveillance, several cautioned that adopting a similar system to the international drug control framework could be detrimental to antibiotic access.

The study highlights significant gaps within Ghana's antibiotic control policy framework, particularly in coordination, the integration of emerging digital technologies, and the inclusion of frontline implementers' perspectives. While restrictive control models may compromise access to essential antimicrobials, integrating selected digital components of such systems may offer useful insights for improving AMR surveillance.