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Policy  –  Inspirational examples

Thailand’s policy work

Realizing the enormous costs of antibiotic resistance to Thai society, Thailand has paved its own unique road to dealing with resistance.

Before 2007, rational use of medicines was a concept not routinely practiced in Thailand. Furthermore, there were very little resources in the fight against the irrational use of antibiotics. In addition, the consumer demand for antibiotics is high.

Antibiotics Smart Use in short

The Antibiotics Smart Use (ASU) program started in 2007 as an action research project to promote the rational use of antibiotics by strengthening human resources, improving health facility infrastructure, and empowering communities. The primary concept is: “No antibiotics for non-bacterial infection.” ASU targets three conditions not requiring antibiotic treatment: upper respiratory tract infections (especially common cold with sore throat), acute diarrhea and simple wounds. ASU stands out because it induced behavioral change with limited resources through a local approach with a clear simple health message that got carried and promoted by small teams of trained health educators creating local networks with local ownership that connect to central networks. The program was scaled-up to the entire country where a pay-for-performance element was added.

Read more about the ASU program in RATIONAL USE: Inspirational examples.

Community-level initiative evolving to national policy

Thailand’s ASU illustrates an example where a policy was started as a project from the community-level and not from a top-down approach. Through various community, local and provincial government structures, it was taken to the national level. However, the decentralized network with local ownership has remained in place and has been considered crucial in maintaining sustainability especially during financial and human resource constraints.

Key stakeholders that initiated ASU at the local level included physicians, pharmacists, nurses, health volunteers, local administrators and community leaders who all promoted the rational use of antibiotics in their various health-care settings and communities. Key interventions are highlighted in Box 1.

Box 1: Key Interventions

  • On-site training for health professionals focusing on educating prescribers about antibiotic rational use and the ASU program.
  • Successful rational use experiences were shared amongst professionals during training sessions.
  • Educational materials were given to health professionals for display or distribution to patients, along with instructions on their proper use – display posters, DVDs to be played in waiting rooms, brochures.
  • ASU treatment guidelines for upper respiratory tract infections, diarrhea and simple wounds were distributed with posters showing diagnosis and treatment algorithms, and diagnostic tools such as white light illuminators for throat examination.

Intervention effectiveness was assessed in terms of four indicators:

  • A reduction in antibiotic prescription rates;
  • Improved knowledge and attitudes of prescribers;
  • Percentage of patients with the targeted conditions who were not prescribed antibiotics (since they did not need them); and
  • Patients perceived health and satisfaction with the treatment outcome.

Integration into the National Program

Starting from 2012, ASU became integrated into Thailand’s national program to curb antimicrobial resistance known as the Antimicrobial Resistance Containment Program (AMRCP). AMRCP was initiated in 2011 by a group of stakeholders with a shared vision of how to contain and prevent the emergence and spread of common antibiotic resistant bacterial infections in Thailand with a One Health approach.

A Committee on Research and Development of AMRCP was appointed by Thailand’s Health Systems Research Institute to design a desirable antimicrobial resistance containment system. AMRCP includes ten containment operational actions described in detail in RATIONAL USE: Examples from the field. The AMRCP program is supported by the Thai Health Promotion Foundation, the Health Systems Research Institute (Thailand), the faculty of medicine at the Siriraj Hospital, the Government pharmaceutical organization (Thailand) and the International Development Research Center (Canada).

Front page of Thailand's AMR containment program 2012 to 2016

Becoming National Policy

Upon national scale-up, ASU was first adopted into the Thai healthcare system’s Pay-for-Performance (P4P) policy. This was a major achievement as there was stiff competition from other health priorities vying for the same status. ASU’s intervention effectiveness evaluation component collected the appropriate learnings and demonstrated the impact of the program to help get it adopted into P4P.

For close to a decade Thai stakeholders committed to work on resistance at local and community levels without a National Action Plan. In 2017, a comprehensive National plan was developed (2017-2021) where ASU is still reflected. The current plan is a multisectoral action plan where the budget was embedded within each of the implementing agencies. The National Strategic Plan on Antimicrobial Resistance (2017-21) promotes multisectoral collaboration to reduce antimicrobial consumption and antimicrobial resistance morbidity, and improve public awareness. ASU is part of the stewardship component.

Selected Resources

Resource Description
Thailand Antimicrobial Resistance Containment and Prevention Program Journal article. A short communication article describing the Thailand Antimicrobial Resistance (AMR) Containment and Prevention Program and its evaluation.
Thailand Antimicrobial Resistance Containment Program 2012-2016 (PDF 3,8MB) Case study. A detailed report describing the antimicrobial resistance containment program in Thailand.
Antibiotics Smart Use: a workable model for promoting the rational use of medicines in Thailand Journal article in the WHO Bulletin highlighting the Antibiotics Smart Use project.
Antibiotics Smart Use Program: Thailand’s experiences in promoting rational use of antibiotics (PDF) Slide show. A presentation describing the Antibiotics Smart Use project.
1.
Thamlikitkul V, Rattanaumpawan P, Boonyasiri A, Pumsuwan V, Judaeng T, Tiengrim S, et al. Thailand Antimicrobial Resistance Containment and Prevention Program. Journal of Global Antimicrobial Resistance [Internet]. 2015 [cited 2016 Mar 8];3(4):290–4. Available from: http://linkinghub.elsevier.com/retrieve/pii/S2213716515000958
1.
Sumpradit N, Chongtrakul P, Anuwong K, Pumtong S, Kongsomboon K, Butdeemee P, et al. Antibiotics Smart Use: a workable model for promoting the rational use of medicines in Thailand. Bull World Health Organ [Internet]. 2012 Dec 1;90(12):905–13. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23284196
1.
Visanu Thamlikitkul. Thailand Antimicrobial Resistance (AMR) Containment Program 2012-2016 [Internet]. 2015. Available from: http://www.reactgroup.org/toolbox/wp-content/uploads/2015/03/Thailand-AMR-Containment-Program-TOTAL.pdf
1.
Sumpradit N. Antibiotics Smart Use Program: Thailand’s experiences in promoting rational use of antibiotics [Internet]. Powerpoint presented at; 2012. Available from: http://who.int/patientsafety/implementation/amr/presentation_NithimaSumpradit.pdf
1.
Bigdeli M, Peters DH, Wagner AK. Medicines in Health Systems: Advancing access, affordability and appropriate use [Internet]. World Health Organization; 2014 [cited 2015 Apr 24]. Available from: http://www.who.int/alliance-hpsr/resources/flagshipreports/en/index1.html