From ReAct Africa Conference: 6 gaps and 7 key outputs how to make implementation of NAPs on AMR possible

2017-09-22

Antimicrobial resistance (AMR) champions from 14 predominantly African countries gathered in Machakos, Kenya to share experiences and updates on the progress of their implementation of National Action Plans (NAPs) on AMR.

The RAN conference, hosted by ReAct African Node (RAN) and Ecumenical Pharmaceutical Network (EPN) had the theme Moving Beyond Antimicrobial Resistance National Action Plans Development to Implementation and was attended by key global leaders on antimicrobial resistance.

Keynote speakers were:

• Dr. Marc Sprenger, Director of World Health Organization (WHO) AMR Secretariat
• Dr. Laetitia Gahimbare, AMR Focal point at WHO AFRO
• Ms. Martha Gyansa-Lutterodt, Director of Pharmaceutical Services – Ministry of Health, and member of the UN Interagency Coordination Group on Antimicrobial Resistance

Ten African countries namely: Ethiopia, Ghana, Kenya, Malawi, Mozambique, Nigeria, South Africa, Uganda, Zambia and Zimbabwe gave updates on their National Action Plans on AMR. Some successes were announced with enthusiasm, however, gaps still exist.

6 gaps in processes towards strong National Action Plans on AMR

1. Lasting political will is needed to validate antimicrobial resistance expenditure in national budgets.
2. Many confounders, including the decentralized nature of government institutions, the low literacy levels, the dire state of resource and commodity levels in parts of African healthcare facilities, represent an obstacle in implementation efficiency.
3. The inclusion of the animal, agriculture and environmental sectors in antimicrobial resistance containment and how to integrate these sectors into the National Action Plans is a continuous challenge.
4. Surveillance efforts to monitor antimicrobial resistance on the country level are taxing due to several identified bottlenecks, including lack of human resources, inadequate or non-existent surveillance infrastructure, inaccuracy of data and facility mapping, and limitations in identification and engagement of informal stakeholders.
5. Costing of interventions to contain antimicrobial resistance is a challenging issue that the country representatives specifically requested further assistance for.
6. The dilemma of access versus an excess of antibiotics underlined by the countries’ struggle to maintain antibiotics quality-assured as part of an overall robust health system strengthening. Promotion of continent-based pharmaceutical innovation and innovation of practice, and research and development (R&D) play also an important role.

Tackling implementation of National Action Plans on AMR

The conference systematically addressed the strategies necessary to implement National Action Plans on AMR. The strategies were based on the priority areas listed in the Global Action Plan (GAP) on AMR:

• Context-specific raising awareness for behavior change on various actors
• Strengthening surveillance and spin-off research to inform targeted interventions
• Infection prevention and control (IPC) programs.
• Stewardship of antimicrobials in both human and animal sectors.
• Research and Development (R&D) in new medicines and vaccines.
• Monitoring, Evaluation and Accountability mechanisms

7 key outputs how to make implementation of National Action Plans on AMR possible

Frameworks

1. National Action Plans on AMR require collaborative efforts that involve all stakeholders/sectors beyond One Health approach (human health, animal health, and environment).

2. Importance of aligning country National Action Plans with the Sustainable Development Goals implementation as one mechanism of gaining political will and alternative streams of funding at the national level, as accountability is attached to an international commitment.

Raising Awareness

3. Raising awareness through culturally-specific public campaigns that “put a face” on antimicrobial resistance and address behavior change i.e. a mix of traditional media and unorthodox synergies e.g. churches, local celebrities etc. Further, these campaigns should include awareness raising that target various stakeholders, including farmers, feed-millers, veterinary practitioners, policy makers and consumers.

4. There is need to share experiences, best practices and ideas across countries as these can be an inspiration to actors at varied stages of implementation.

Surveillance

5. Monitor antimicrobial resistance stewardship through empowering key-point persons at decentralized-government institutions, hospitals and low-level stakeholders such as community workers, healthcare workers, retail-pharmacists, public health officers in other disciplines and technicians.

Infection, Prevention and Control

6. Exploration and adoption of non-antibiotic alternatives in agriculture and animal sectors in an effort to phase-out use of critically important antibiotics in human health.

7. Infection prevention measures through IPC programs, with a dedicated focal point person that continuously monitors adherence to guidelines. One key recommendation was to integrate IPC on antimicrobial resistance into more established existing preventive programs such as HIV, Tuberculosis, and Malaria.