News and Opinions  –  2018

Kerala, India: launch of the 1st sub-national action plan on AMR

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The state of Kerala became the first Indian state to launch an Action Plan for containing Antimicrobial Resistance. The Kerala Antimicrobial Resistance Strategic Action Plan (KARSAP) was released at a ceremony held at the city of Thiruvananthapuram on 25th October 2018. The action plan is aimed at giving a strategic direction to the various activities undertaken to tackle antimicrobial resistance in the state. The action plan is truly "One-Health" in its approach and was developed through a collaborative exercise involving human, non-human and environment sectors.


The Action Plan was released by the Chief Minister of the state of Kerala Mr Pinaryi Vijayan, who handed over the first copy to Dr Henk Bekedem, WHO’s Representative to India.

The Action Plan was released by the Chief Minister of the state of Kerala Mr Pinaryi Vijayan, who handed over the first copy to Dr Henk Bekedem, World Health Organization’s Representative to India. The Chief Minister congratulated all those who were involved in the process of developing KARSAP and reminded the audience that release of such a plan is only the first baby step in a long journey. He said that the general public should be made aware of the issues associated with misuse of drugs, especially antibiotics. Henk Bekedem said that the state of Kerala has consistently performed well in all areas related to health and development; and this was a reflection of a responsive political system. KK Shailaja, state minister for Health and Family welfare, also spoke at the occasion and highlighted the importance of translating the strategic action plan into reality.

“Kerala is a huge market for medicines and the misuse of antibiotics is soaring. There is a need to sensitize the community about the issues associated with overuse of antibiotics, especially over-the-counter sales of medicines.”

Pinaryi Vijayan, Chief Minister of the Government of Kerala

At the launch, Dr Sujith Chandy, Head of ReAct Asia Pacific, spoke on the need for building awareness and knowledge.

At the launch, Dr Sujith Chandy, Head of ReAct Asia Pacific, spoke on the need for building awareness and knowledge among the various interest groups associated with the implementation. He also pointed at the need to ensure that awareness translates into a sustainable change in behavior. The need for a prioritization exercise prior to the implementation process, was also highlighted by him.

Workshops to create essential components of action plan

The Action Plan was drafted with help from World Health Organization’s Country Office, who led the efforts to bring together various stakeholders. Multiple workshops were organized in Kerala with the purpose of creating the essential components of the action plan. The actual plan and the mapping of different stakeholders involved in the implementation process, was a collaborative exercise between multiple ministries and sectors. The highlight of the action plan is that it recognizes the importance of engaging the private sector and civil society groups in the implementation process.

The process of creating the action plan was led by Rajeev Sadanandan, the senior-most bureaucrat in the health department and Dr Sarada Devi KL, the head of Microbiology at Government Medical College, Thiruvananthapuram. Even though the process was led by the health department, there was robust participation from Animal Husbandry, Dairy Development, Fisheries and Environment Departments; apart from various universities and civil society groups.

State action plans will help implementation

The KARSAP is a follow-up to the National Action Plan on Antimicrobial Resistance, which was brought out by the Government of India. But the size of the country and the complexities involved in the overall implementation process, called for such decentralized plans at the state level. This kind of state level plans can create a sense of ownership among the various players and will give the space to adapt the action plans according to localized needs and socio-cultural considerations.

Also, in countries like India where a federal system of governance is followed, many of the vital sectors in the action on antimicrobial resistance fall under the administrative domain of the state government. Therefore, it is pertinent to develop state level action plans taking into account the local needs and resources; and also based on the spirit of the action plans adopted by the federal governments.

ReAct Asia Pacific helped put focus on AMR

ReAct Asia Pacific has been active in the state of Kerala since early 2017; and it has helped to start a conversation on antimicrobial resistance (AMR) as an issue. It has been successful in engaging multiple stakeholders like hospitals, farmers, local self-government functionaries and students- all key players in the process of implementing the action plan. ReAct Asia Pacific has also been involved in the mission to create models for engaging various interest groups; and to ensure that initiatives follow a multi-stakeholder and ‘One-Health’ approach.

There is significant progress in framing action plans for other states like Madhya Pradesh; and states like Maharashtra has moved forward in creating surveillance networks. These initiatives are surely creating a momentum on the action on antimicrobial resistance in India, which is home to a number of global generic manufacturers.