National Action Plans

5 steps how to get started on developing a National Action Plan on AMR

Dr. Lourdes Jarquin is part of the Technical Committee for developing the National Plan on antimicrobial resistance for El Salvador. She started her mission in 2015 with her first training at the Pan American Health Organization (PAHO-WHO) in Panama.

Dr. Lourdes Jarquin
Dr. Lourdes Jarquin

Dr. Lourdes Jarquin is internist, with a specialty in endocrinology and diabetes.

– I have been a clinical doctor for more than 20 years, but recently I took my medical experience with me to work in the administrative field at the Ministry of Health of El Salvador, dr. Jarquin says.

To prepare for her task at the Technical Committee she started by reading all available guidelines from the World Health Organization (WHO) and based on that prepared a draft for discussion with other colleagues. The draft should serve as inspiration for the National Commission, who will make the final recommendations of the National Action Plan on antimicrobial resistance for El Salvador.

How would you describe the starting point for developing the National Action Plan in El Salvador?

– The first step was to assess the current situation so as to find out how much was done in El Salvador both for human and animal health. Once we had that information it was easier to identify gaps and what areas needed improvement.

How much was known about the actual antibiotic resistance situation in El Salvador?

– In the area of human health we had done a good job in my country. We have guidelines about preventing nosocomial infections, and excellent work on antibiotic surveillance has been done with the support of PAHO. Moreover a Latinamerican cooperative network has been taking care of the quality of reports of antibiotic resistance.

– Unfortunately the same does not happen for animal health. We lack regulations, budget and personnel. There are too few veterinarians for example. Currently we only identify bacteria but do not perform antibiotic susceptibility tests which means we have no robust data to act on in this field. That is why we are falling behind on the animal health side compared to the human health side.

What was the awareness level of antibiotic resistance across the various relevant sectors and ministries?

– Most of the Ministries are aware, especially in the ministry of Agriculture and the Ministry of Health and many doctors working in the public sector understand the concept of antibiotic resistance. But this standard is not the same in the private sector where some of the medical professionals and technicians do not have a good enough understanding of the issue.

– We also need to produce information for farmers growing and slaughtering animals, for food producers more broadly and for consumers. In general we need to improve education and create campaigns that make a broader set of stakeholders aware about antibiotic resistance.

What guidelines were in already in place on how to tackle antibiotic resistance?

– The first commitment of Ministry of Health was made at the World Health Assembly 2015 to prepare a national action plan. In December 2015 we edited the guidelines to contain antibiotic resistance and in January 2016 we created the National Commission for Antibiotic Resistance and mandated the technical committee to work on the national action plan.

5 first important steps for El Salvador to get started on developing a National Action Plan on AMR

  1. Recognize of the magnitude of the problem.
  2. Gain the political commitment and support.
  3. Assess the situation in the relevant sectors (in human health, animal health, for food-born diseases and the environment)
  4. Educate stakeholders all over the country.
  5. Give technical solutions compatible with the reality of the country in question.

What ministries did you first engage with?

–  The Ministry of Health, the Ministry of Agriculture and the Ministry for the Environment. This was an easy process because we already had good relations with all the Ministries and they were very cooperative. All of us are working towards the same goal: One Health. I think that WHO did a good job increasing awareness among governments.

What were the biggest challenges for you in the process?

  1. Convincing a couple of higher ranking people to take a more progressive approach. Their buy-in was crucial in order for the relevant people to do their job.
  2. Power struggles arising at higher decision making levels, which can slow down the technical work.

What helped you overcome and move forward from those challenges?

– It is difficult to move forward in the face of such challenges, but we continue to work at the technical level to be ready to move when the political issues have been solved. We had a productive workshop last September in San Salvador, organized the International Regional Organization for Animal Health in collaboration with the WHO, the Ministry of Health and the Ministry of Agriculture. It was a multi-sectorial meeting with a special focus on animal health. We presented our draft recommendations about legislation, education, monitoring resistance in animals, good practices in food production. So we continue to further develop our national action plan – we will have it soon!