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Policy  –  Examples from the field

Supporting development of National Action Plans

In 2015, the Sixty-eighth World Health Assembly adopted the Global Action Plan on antimicrobial resistance. As part of the plan, all Member States have committed to develop and implement National Action Plans on antimicrobial resistance that should be aligned with the objectives of the Global Action Plan. Since then, there has been a growing demand for support from Member States.

The World Health Organization office of the European Region (WHO EURO) has developed a model to support countries in their efforts, bringing together a pool of experts that help to facilitate the processes at the country level. Lars Blad shared with ReAct some experiences working as a consultant for WHO EURO to support countries in the development of their National Action Plans for antimicrobial resistance, in the Eastern European and Central Asian regions.

Lars Blad is an infectious disease specialist with over 15 years working on antibiotic resistance, mainly in Sweden. Together with other experts, he has so far visited three countries during 2015, 2016 and 2017 to provide support and assistance in the development of their National Action Plans, namely in Tajikistan, Kazakhstan and Turkmenistan.

Four men standing outside a white building
A WHO AMR Mission Team in front of the Ministry of Health and Medical Industry of Turkmenistan, in Ashgabat.

Regional support and assistance at the country level

When a Ministry of Health from a country in the WHO EURO region identifies that they could use some external support, they, through the WHO Country Office, make contact with WHO EURO and its Program for control of AMR. Typically, after an initial dialogue discussing their needs for support, WHO EURO identifies appropriate people from their assembled team of experts to join WHO EURO staff on an initial visit to the country. During this first visit, the WHO team meets together with the country representatives and experts, learning about the current on-going work and barriers and facilitators for development and implementation of their National Action Plan. The mission then conducts an overall country assessment in relation to antimicrobial resistance, to get an overview of potential areas for the country to focus on.

A country driven process

Every country has its own way of working that is dependent on the particular context including the national governmental structure, capacity, resources and priorities. In most countries, a person is appointed as the National Focal Point to coordinate the ongoing work around antimicrobial resistance. After the initial assessment of the country has been conducted, a national intersectoral working group is usually appointed by the Minister of Health to move forward with development and later implementation of the National Action Plan. Sometimes, in parallel to working on the National Action Plan, the country in dialogue with WHO may decide to start or increase action in specific areas identified in the assessment. This may be in the form of media campaigns, or meetings, workshops and seminars on specific topics, e.g. in clinical microbiology and antibiotic sensitivity testing. One or more WHO missions may follow. The intersectoral working groups are responsible to coordinate the work at the country level; however, if need be, the National Focal Points reach out to the WHO EURO experts for their input and support, on site or as “remote support” over e-mail.

Large room with many people around a U-shaped table
Meeting with Intersectoral Working Group and other stakeholders during a WHO mission in Central Asia.

“To be able to provide the best support possible, it is crucial to, in dialogue, identify the relevant stakeholders to be involved. Of utmost importance is to get an early involvement of the Agricultural/Veterinary sector – ensuring there is a One Health approach in the work and in the Plan from the outset” – Lars Blad

Lars Blad mainly has the role of providing support on National Action Plans. Depending on the country needs, WHO EURO experts may be asked to provide assistance in specific areas such as surveillance. For example, experts have supported countries on their involvement in Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR), a network of national antimicrobial surveillance systems.

Support on National Action Plans

WHO, FAO and OIE have developed a manual for developing National Action Plans together with an accompanying series of tools and templates. These tools may be downloaded and adapted for use by countries. WHO EURO experts may recommend some of these tools to the national working groups to help them in their work. Lars Blad noted that the “Sample template of National Action Plan on Antimicrobial Resistance” was a useful resource for the countries he had been working with. The template provides a basis for what should be considered to cover so that each country does not need to re-invent the wheel.

Lessons learned

When asking Lars Blad if he has any specific advice for people who are starting out on similar work, he says:

Three bottles of antibiotics and three boxes with antibiotics on a counter in a pharmacy
Broad antibiotics that can be purchased by the public in one pharmacy in a Central Asian country.

-My most important advice is to understand the context, and to prepare in advance. Language can be a major barrier, so consider how this will be tackled. Knowing the health system development of the country is also of importance, and especially whatever data there is on AMR. The last thing I would like to emphasize in giving support is just that, to always remember that you are there to give support and advice to the local administration; in the end  they of course make the priorities and take the decisions on planning and actions in their country.

Selected Resources

Resource Description
Antimicrobial resistance: A manual for developing national action plans The manual outlines an incremental approach, which countries can adapt to their specific circumstances and available resources, developed by the World Health Organizaiton.
National action plans (NAP): Supporting documents and tools Tools and templates developed by WHO, FAO and OIE to accompany the manual for developing National Action Plans on antimicrobial resistance.

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