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Policy  –  Examples from the field

Thailand’s policy work

In Thailand in 2010, antimicrobial resistance caused at least 3.2 million extra hospitalization days and 38,481 deaths.

In the Thai health care system, there is no divide between prescription and dispensing: both physicians and pharmacists can prescribe and dispense antibiotics. Moreover, incentives to sell antibiotics are misaligned since physicians and pharmacists benefit from selling antibiotics under a fee-for-service system. In addition, the consumer demand for antibiotics is high.

To deal with this situation, the Antibiotics Smart Use (ASU) program was started in 2007 as an innovative way to promote the rational use of antibiotics by strengthening human resources, improving health facility infrastructure, and empowering communities in a setting with limited resources and difficulty translating rational use of medicines from theory into practice. The project targeted three conditions not requiring antibiotic treatment: upper respiratory tract infections, especially common cold with sore throat, acute diarrhea and simple wounds. Read more about the ASU program in RATIONAL USE: Examples from the field.

Today, the ASU program is part of the overall 2012-2016 Antimicrobial Resistance Containment Program (AMRCP) in Thailand. This program was initiated in 2011 by a group of stakeholders that had the motivation, academic and social credit, and leadership in antimicrobial resistance. They also had a shared vision of how to contain and prevent the emergence and spread of the common or important antimicrobial resistant bacterial infections in Thailand.

A Committee on Research and Development of Antimicrobial Resistance Containment and Prevention was appointed by the Health Systems Research Institute to design a desirable antimicrobial resistance containment system in Thailand. 10 antimicrobial resistance containment operational actions were developed to close the gap between existing antimicrobial resistance containment systems and the new system proposed (see box below). These actions were aligned with global and regional actions, and were endorsed by the relevant stakeholders at a national workshop on antimicrobial resistance containment and prevention in Thailand in May 2012. 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

10 antimicrobial resistance containment actions

  1. Estimate national antimicrobial resistance burden
  2. Establish dynamics of antimicrobial resistance chains to understand how antimicrobial resistance develops and spreads’
  3. Develop national infrastructure of antimicrobial resistance containment and prevention
  4. Develop laboratory and information technology systems for surveillance of antimicrobial resistance, antibiotic use and hospital-acquired infections
  5. Regulate distribution of antibiotics to be used in human, animal, agriculture and industry
  6. Raise awareness and campaign on antimicrobial resistance and antimicrobial resistance containment to all relevant stakeholders
  7. Generate local evidence for promoting responsible use of antibiotics and efficient practices for infection prevention and control in local context
  8. Develop antimicrobial resistance containment package that includes manual, tool, media and activity on a) surveillance of antimicrobial resistance, antibiotic use and hospital-acquired infections, b) responsible use of antibiotics, and c) infection prevention and control practices for responsible health personnel, patient and public
  9. Implement antimicrobial resistance containment package in 4 selected prototype antimicrobial resistance containment communities to determine the resources and benefits of such implementation prior to expanding the efficient antimicrobial resistance containment package to the rest of 873 communities across Thailand
  10. Conduct research on the agenda that are relevant to local antimicrobial resistance burden and collaborate with international partners to conduct research on innovative diagnostics, therapy and prevention of antimicrobial resistance infections.

From Thailand Antimicrobial Resistance Containment Program

Selected Resources

Resource Description
Thailand Antimicrobial Resistance Containment and Prevention Program A short communication article describing the Thailand Antimicrobial Resistance (AMR) Containment and Prevention Program and its evaluation.
Thailand Antimicrobial Resistance Containment Program 2012-2016 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 A WHO Bulletin highlighting the Antibiotics Smart Use project.
Antibiotics Smart Use Program: Thailand’s experiences in promoting rational use of antibiotics (PDF) A presentation describing the Antibiotics Smart Use project.