Stakeholders’ perspectives on training over the counter medicine sellers and Community-based Health Planning and Services facilities to dispense antibiotics in Ghana

Background: Dispensing of antibiotics by over the counter medicine sellers (OTCMS) is a major driver of inappropri‑ ate use and resistance in low and middle income countries. Recent studies in Ghana revealed the need to consider training OTCMS and Community-based Health Planning and Services (CHPS)/health posts to dispense some antibiot‑ ics. Feasibility of training OTCMS and CHPS to dispense some antibiotics was explored in this study. Methods: This was an explorative study involving 10 in-depth interviews (IDIs) among staf of Ghana health services (GHS), pharmacy council and the association of OTCMS at the district and regional levels. Next, fndings were pre‑ sented to the Ghana Antimicrobial Resistance (AMR) platform for further discussions at the national level. Five IDIs were also performed among selected members of the AMR platform as a follow-up on emerging issues. Data were thematically analysed and presented as narratives with quotes to support the fndings. Results: Two opposing views were found in our study. Leadership of OTCMS and GHS staf at the district health direc‑ torate supported the suggestion that OTCMS and CHPS should be trained to dispense specifc antibiotics because they are already dispensing them. The leadership of OTCMS explained that some of their members are experienced and could be trained to improve their practices. In contrast, participants from pharmacy council, GHS in the region and national AMR platform generally alluded that OTCMS and CHPS should not be trained to dispense antibiotics because their level of education is inadequate. GHS personnel from the region further explained that training OTCMS could further compromise inappropriate antibiotic use in the context of already weak regulation enforcement. GHS and pharmacy council in the region rather suggested that OTCMS and CHPS should focus on public health education on disease prevention and appropriate antibiotic use. Conclusions: There is general lack of consensus among stakeholders on whether OTCMS and CHPS should be trained to dispense specifc antibiotics

Background: Dispensing of antibiotics by over the counter medicine sellers (OTCMS) is a major driver of inappropri‑ ate use and resistance in low and middle income countries. Recent studies in Ghana revealed the need to consider training OTCMS and Community-based Health Planning and Services (CHPS)/health posts to dispense some antibiot‑ ics. Feasibility of training OTCMS and CHPS to dispense some antibiotics was explored in this study. Methods: This was an explorative study involving 10 in-depth interviews (IDIs) among staf of Ghana health services (GHS), pharmacy council and the association of OTCMS at the district and regional levels. Next, fndings were pre‑ sented to the Ghana Antimicrobial Resistance (AMR) platform for further discussions at the national level. Five IDIs were also performed among selected members of the AMR platform as a follow-up on emerging issues. Data were thematically analysed and presented as narratives with quotes to support the fndings. Results: Two opposing views were found in our study. Leadership of OTCMS and GHS staf at the district health direc‑ torate supported the suggestion that OTCMS and CHPS should be trained to dispense specifc antibiotics because they are already dispensing them. The leadership of OTCMS explained that some of their members are experienced and could be trained to improve their practices. In contrast, participants from pharmacy council, GHS in the region and national AMR platform generally alluded that OTCMS and CHPS should not be trained to dispense antibiotics because their level of education is inadequate. GHS personnel from the region further explained that training OTCMS could further compromise inappropriate antibiotic use in the context of already weak regulation enforcement. GHS and pharmacy council in the region rather suggested that OTCMS and CHPS should focus on public health education on disease prevention and appropriate antibiotic use. Conclusions: There is general lack of consensus among stakeholders on whether OTCMS and CHPS should be trained to dispense specifc antibiotics