Achievements, challenges and enablers of Ghana’s National Action Plan on antimicrobial resistance during 2017-2021: a mixed-methods study

Background: Antimicrobial resistance (AMR) is a complex national and global challenge. Many countries have already undertaken or are currently implementing AMR policies and national action plans (NAPs) within the “One Health” framework to ensure appropriate antimicrobial use. NAP implementation is important, as these provide lessons for the next phase of its implementation guidance for other countries. Objective: This study analysed Ghana’s AMR national action plan (2017-2022) achievements, challenges, and enablers. Methods: We employed a mixed-method approach to collect and analyse data. Data were collected through document review (n = 20), indepth interviews (n = 27), and a questionnaire. The data were thematically and descriptively analysed according to the NAP’s five strategic objectives. The level of completion was based on the scoring of 143 NAP activities per stated targets. Results: The overall completion rate for all activities, per stated deliverables and targets, was 66.21%. Strategic objective three, which focused on reducing the incidence of infection through sanitation, hygiene, infection prevention measures, and biosecurity practices, was the most implemented, with 77% of activities completed. Strategic objective two had the least, with 56.11% of activities completed and was aimed at generating knowledge and evidence from surveillance systems and laboratory services to inform policy and practice. Some identified implementation barriers were lengthy and complex institutional procedures, packed NAP activities, and inadequate funding. However, dedicated AMR champions, mainstreaming NAP activities into implementing institutions’ programmes, and continuous dialogue through the multisectoral AMR platform were identified as enablers. Conclusion: Implementing national plans to curb AMR is a complex process involving multiple sectors and stakeholders with diverse institutional arrangements, interests, and resources. Therefore, aligning NAP activities with existing institutional plans and securing adequate funding for implementation is critical for sustainable gains in AMR prevention and control.