Drivers of antimicrobial resistance and the role of community pharmacy engagement in the Greater Kumasi metropolitan area, Ghana: a qualitative study

Background Antimicrobial resistance (AMR) is a growing global health challenge, particularly affecting low- and middle-income countries, such as Ghana. Urban informal settlements have been identified as hotspots of high AMR rates and antibiotic misuse. However, there is limited evidence on the factors driving AMR in these settlements as well as the potential role of community pharmacies in addressing these challenges within the Greater Kumasi Metropolitan Area (GKMA), Ghana.Methods A qualitative study employing problem-centered expert interviews with community pharmacy staff, including pharmacists, pharmacy technicians and medicine counter assistants, was conducted across four urban informal settlements in GKMA. The data was collected using a semi-structured interview guide between August and September 2024. The interviews were analysed deductively and inductively using Kuckartz’s structuring qualitative content analysis.Results The findings identified key challenges to AMR management including limited resources (e.g. time, staff, and training), language barriers, low levels of health literacy, local attitudes towards antibiotic use, and self-medication practices within the urban informal settlements. Informal access and low adherence to guidelines among providers further exacerbate AMR risks. Amidst these challenges, participant community pharmacies demonstrated a strong commitment to community engagement, with relationship-building and AMR education integrated into their daily practice. Participants described community pharmacies as playing an important role in dispensing medicines and as a commonly used entry point into the health care system. Through patient counselling, health education, and other frontline services, they build trust and shape health-seeking behaviour within communities.Conclusion Effectively integrating and leveraging community pharmacies into the health system is essential to developing sustainable community-based solutions to AMR. It is crucial to involve the different cadres of community pharmacy staff, appropriately incentivise them, and equip them with enhanced skills in antimicrobial stewardship, thereby serving as a potential mainstream and frontline channel to the fight against AMR.