Advancing clinical care in Ghana

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The Eastern Regional Hospital in Koforidua (ERHK), Ghana, is an antimicrobial resistance (AMR) surveillance site supported by the Fleming Fund, which has seen a significant improvement in clinical engagement. Structured healthcare collaboration and targeted interventions for AMR have boosted patient outcomes.

AMR in Ghana has become an increasing public health challenge, with severe consequences, leading to increased illness and deaths, prolonged hospital stays, higher healthcare costs, and threats to food security due to resistant infections in livestock and aquaculture.

Studies show that over 70% of bacterial infections in hospitals are resistant to commonly used antibiotics. This high resistance rate is driven by the misuse and overuse of antibiotics in human medicine, veterinary care, and agriculture. Limited public awareness, weak enforcement of prescription regulations, and inadequate infection prevention and control measures in healthcare settings compound the issue.

We speak to staff from the EHRK and the Fleming Fund Country Grant team, led by The Aurum Institute in Ghana, on how the hospital’s commitment to antimicrobial stewardship (AMS) and laboratory improvement has reduced AMR rates and advanced clinical care.

Ghana’s efforts are supported by the Fleming Fund, led by the Aurum Institute, which has been strengthening One Health AMR surveillance nationwide and contributing data to the Global Antimicrobial Resistance Surveillance System. The Aurum Institute has made strong progress in improving engagement between clinicians and laboratory staff at the surveillance site, ERHK. Regular sessions to discuss emerging issues, review patient case studies, and align on best practices have fostered a culture of open communication and learning.

Infrastructure challenges affecting the efficiency and quality of microbiological services can also influence how clinicians perceive the services. “Before Fleming Fund investment, the laboratory lacked access to certain automated technologies for microbial identification and antimicrobial susceptibility testing, and as a result, some samples were referred to an alternative hospital, causing delays in diagnosis and treatment,” said Georgina Tetteh-Ocloo, Head of Microbiology and Surveillance Site Lead, ERHK.

Another factor is the financial burden of bacteriology testing, which often falls on patients. When patients can’t afford to pay, clinicians are compelled to rely on empirical treatment, which may compromise the accuracy and effectiveness of care. Some clinicians also remain hesitant about the results of microbiological diagnostics, which limits the integration of laboratory data into clinical choices.

Microbiology investigation backing

ERHK's improved responsiveness to requests for AMR tests from clinicians has ensured timely processing and reporting, benefiting clinical care. “Follow-up discussions between clinicians and laboratory personnel have become more frequent, helping to clarify results and support informed clinical decision-making,” said Dr Gabriel Attipoe-Djagmah, Head of AMS Committee, ERHK. The ongoing, day-to-day communication between the two teams has led to better mutual understanding, quicker issue resolution, and more coordinated patient care.”

With backing from the Fleming Fund, the laboratory has received essential consumables, modern equipment, and staff training. These enhancements have boosted the reliability of laboratory services and increased clinicians’ confidence in requesting microbiological investigations: “For the successful implementation and sustainability of microbiological activities, ERHK management has a strong commitment to sustaining laboratory operations, which promotes a supportive environment for continuous improvement. A steady supply of consumables and timely maintenance of equipment ensured uninterrupted laboratory operations and better service delivery,” added Ms Ocloo.

The establishment of accountability mechanisms and revolving funds has significantly reduced stock-out incidents and the financial burden on patients, enabling consistent availability of essential laboratory testing materials. “The stores department maintained excellent inventory and consumable management practices, contributing to operational efficiency and resource optimisation,” said Ms Ocloo. “Routine and planned preventive maintenance of laboratory equipment minimised downtime and extended the lifespan of critical assets.”

Antimicrobial stewardship

To support AMS initiatives within the facility, AMR champions have been instrumental, with laboratory staff, clinicians, and pharmacists implementing and promoting best practices across departments. “The team’s motto, ‘AMS is teamwork; AMS is a day-to-day activity’, encapsulates the shared ownership and collaborative spirit that underpin these efforts. It reflects how stewardship has become embedded in routine clinical practice, with champions promoting accountability, learning, and multidisciplinary engagement,” said Dr Attipoe-Djagmah.

Such interventions have directly contributed to improved patient care and outcomes. Regular AMS audits and multidisciplinary ward rounds for rational prescribing have reduced inappropriate AMU, improving treatment efficacy. Training and mentorship extended to sister facilities strengthen the regional AMR response for consistent care and early detection of resistant infections.

“Education has empowered healthcare workers to make informed decisions, leading to safer and more effective patient management,” said Dr Attipoe-Djagmah. “Integration of the laboratory, pharmacy, and clinical teams during ward rounds has enabled more accurate diagnoses and tailored treatments, reduced complications and improved recovery rates.”

Quarterly AMS meetings, supported by the Fleming Fund, have also provided a forum for reviewing cases, sharing lessons learned, and coordinating efforts to enhance the quality of care delivered.

Sustainable clinical gains

Sustaining the gains made in AMS and laboratory strengthening requires continued investment, policy support, and institutional commitment across key areas. Advocacy for the inclusion of bacteriology testing under the National Health Insurance Scheme reduces financial barriers for patients and encourages evidence-based treatment.

“Hospitals should maintain revolving funds to ensure the consistent availability of essential reagents and consumables,” said Dr Kwame Essah, Project Director, Fleming Fund Country Grant. “Ongoing implementation of AMS interventions such as regular audits, multidisciplinary ward rounds, and quarterly review meetings will reinforce stewardship practices and improve clinical outcomes.”

Preventive maintenance of laboratory equipment and timely replenishment of consumables must be institutionalised to ensure uninterrupted service delivery. Finalising and analysing the hospital antibiogram will also provide valuable data to inform treatment guidelines, support clinical decision-making, and shape national policy on AMU.

“Such hospital management and leadership support are critical to embedding AMS and laboratory strengthening into routine operations and strategic planning,” added Dr Attipoe-Djagmah. Regular training and mentorship for healthcare workers will reinforce AMS practices and build a resilient workforce capable of responding to AMR challenges.”