At the beginning of 2020, the Pepal Team brought a new health focus area to our Uganda Leadership Pioneers Programme, combatting anti-microbial resistance (AMR). This programme was the first of its kind in Uganda, with the teams supporting efforts around AMR stewardship in the Rwenzori Region.
In July 2021, Dolly (Project Manager at Pepal) caught up with Dr. Dennis Ojok, a Medical Officer at Rukunyu Hospital in Uganda, to reflect on his experience on the programme.
Dolly: Can you tell me more about the AMR programme you were involved with?
Dr. Ojok: “My team undertook training on leadership and AMR for one week, which gave us a lot of insight and knowledge into what we are expected to do as far as AMR is concerned.
As a result of the programme we are more focused on CMEs (Continual Medical Education) to remind ourselves of guidelines on different diagnosis and treatment areas. We launch different investigations, especially where we suspect resistance. These investigations look into microbial culture and sensitivity, and we send data to the lab. We also remind ourselves about the right kinds of antibiotics and medicines after making a diagnosis, for the right number of days.”
Dolly: What were your key leadership learnings from the programme?
Dr. Ojok: “When I returned from the training, I mentored other staff within my health facility. Firstly, to increase and broaden their knowledge and awareness of AMR as an issue. Secondly, for them to be more vigilant around gaps in the management of patients.
Combatting AMR requires a multi-disciplinary approach. We need attention from hospital management and interventions from nurses, midwives, doctors, health clinicians and laboratory staff. We also need cooperation from the communities and the beneficiaries of the health service. Making all these people work together for a common cause requires leadership. I am very glad to have been part of the team that was trained and now I feel empowered to train others.”
Dolly: How has the programme impacted Rukunyu Hospital?
Dr. Ojok: “I would say that the programme resulted in reduced workload for the health workers. Because, after you make an accurate diagnosis and give the right treatment, this in turn reduces the length of time that a patient spends in the hospital. I now have more time for all patients that are admitted, this is because of the impact of the programme.
AMR goes hand in hand with infection prevention and control. This means that the learning from the programme is very necessary during the pandemic. When I look at our operations, rates of sepsis infections have steadily declined. Before the programme, 5 people in every 100 contracted sepsis. As I talk now, this rate has dropped to just 2 out of 100 people.”
It was fantastic hearing Dr. Ojok reflect on his experience with the programme. His key learnings embody one of our main beliefs at Pepal; that empowered leaders with the right skills can achieve a huge impact, even in low-resource settings. Dr. Ojok is a champion for AMR protection in Uganda and it is incredible to hear about his efforts to spread the message in Rwenzori.
Anti-microbial resistance threatens to un-do progress within areas such as global health security, poverty, food security and economic growth. Strong leadership is critical for combatting the negative implications of anti-microbial resistance and to build resilient health ecosystems that prevent infection spread.
AMR is a serious threat to the attainment of the Sustainable Development Goals (SDGs) by 2030
Goal 3: Ensure healthy lives and promote well-being for all at all ages
Anti-microbial resistance is a significant global health challenge. AMR is defined as “the resistance of bacterial, viral, parasitic and fungal microorganisms to antimicrobial medicines that were previously effective for treatment of infections” (WHO). AMR occurs naturally over time, but is accelerated by:
The inappropriate use of anti-biotics.
General lack of access to health services.
Antimicrobial residues in soil, crops and water.
If urgent action is not taken, it is predicted that by 2050, AMR will contribute to 10 million deaths and an economic cost of $100 trillion. In Uganda, the threat is heightened by the challenges of a low resource health system. Globally, a collaborative and multi-sectored approach that is grounded in strong leadership is crucial to reduce the threat posed by AMR.
““Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.”
On the programme which took place in February 2020, four teams consisting of leaders from the National Health Service (NHS) UK, Baylor College of Medicine Children’s Foundation Uganda and five hospitals in Rwenzori Region came together with the shared vision of building strong partnerships for improved AMR awareness, and infection protection and control measures. The teams received leadership training from the Cross Sector Leadership Exchange (CSLE), and visited 29 health facilities across Rwenzori to understand the day-to-day challenges AMR places on the health system in Uganda.
Moving forward, we hope to resume our AMR programme in the near future and continue building on the impact already established.