Implementation of Antimicrobial Stewardship Programmes in Private Hospitals in Lagos State: Challenges and Prospects

Background: Antimicrobial stewardship programmes (ASPs) are evidence-based institutional frameworks designed to optimise antibiotic use, reduce resistance, and improve patient outcomes. While public tertiary institutions have begun implementing ASPs in Nigeria, private hospitals, which serve a significant proportion of urban patients, lag considerably behind. This study examined the implementation status, challenges, and prospects of ASPs in private hospitals in Lagos State. Methods: A mixed-methods study combining a structured questionnaire survey of 60 private hospital administrators and pharmacists with in-depth interviews of 12 key informants was conducted. Variables included ASP components in place, leadership commitment, availability of microbiological support, staff training, and perceived implementation barriers. Results: Full ASP implementation was present in only 8 percent of surveyed private facilities. Partial elements such as antibiotic restriction policies existed in 35 percent. Key barriers included absence of clinical microbiologists, cost of culture diagnostics, limited pharmacist staffing, and perceived lack of regulatory pressure. Facilities with accreditation status showed better readiness scores. Conclusion: ASP implementation in Lagos private hospitals remains nascent and is constrained by structural, financial, and human resource deficits. Regulatory incentives and professional body-led capacity building are essential to accelerating adoption. Keywords: antimicrobial stewardship, private hospitals, Lagos, antibiotic resistance, implementation