2021-08-24-世界卫生组织-Regional_consultation_on_the_WHO_Policy_Guidance_on_Integrated_Antimicrobial_Stewardship_Activities_in_human_health_7页_228kb

Summary of the Regional Consultation on the WHO Policy Guidance on Integrated Antimicrobial Stewardship Activities in Human Health

Core Content

The Regional Consultation on the WHO Policy Guidance on Integrated Antimicrobial Stewardship (AMS) Activities in Human Health was organized by the Pan American Health Organization (PAHO) in collaboration with the World Health Organization (WHO) in the Americas. Two two-day workshops were held in July 2021, one for Latin American countries and the other for Caribbean nations, with the aim of disseminating and adapting the WHO Global Policy Guidance to local contexts.

The consultation focused on the five pillars of the WHO policy, which are:

1. Policies, Regulations and Access
2. Clinical guidelines and digital resources
3. Awareness and behavioral changes
4. Education and research
5. Implementation of interventions/activities

Main Objectives

• To disseminate the WHO Policy Guidance among key stakeholders and national health authorities in the Region.
• To discuss the adaptation and implementation of the five pillars at national and sub-national levels.
• To identify technical cooperation needs.
• To develop a generic roadmap for the adaptation and implementation of the policy in the Americas.

Key Challenges and Facilitators

Policies, Regulations and Access

• Securing support and commitment from authorities at all levels.
• Adapting the policy to the specific realities of each country and region.
• Aligning integrated AMS activities with the "One Health" framework.
• Ensuring access to safe and quality-assured antimicrobials.
• Controlling the importation and disposal of expired antimicrobials.
• Ensuring outpatient antimicrobial dispensing through prescriptions.
• Guaranteeing access to safe water, sanitation, and hygiene (WASH).
• Integrating AMS programs with Infection Prevention and Control (IPC) programs.

Clinical guidelines and digital resources

• Ensuring access to user-friendly, evidence-based treatment guidelines that reflect local epidemiology.
• Developing standardized databases for tracking antimicrobial use, resistance, and healthcare-associated infections (HCAIs).

Awareness and behavioral changes

• Promoting cultural shifts in prescribing, dispensing, administration, and consumption behaviors.
• Strengthening awareness campaigns such as the World AMR Awareness Week (WAAW) using social media for broader reach.

Education and research

• Enhancing training for healthcare personnel across all areas of care.
• Including AMR topics in educational curricula at all levels.
• Promoting fundamental research and quality clinical trials to generate local evidence.

Technical Cooperation Needs

• Generation of quality evidence: Conduct economic evaluations and attributable impact studies on antimicrobial use and HCAIs.
• Implementation of interventions: Support the development of AMS programs in low-complexity hospitals and outpatient settings, expand and validate indicators, train IPC units, and improve diagnostic capacity in microbiology labs.
• Collaborative strategies: Implement multimodal and continuous improvement approaches for AMS, and support the adoption of the AWaRe operational plan.
• Access facilitation: Provide technical assistance to improve access to antimicrobials through PAHO's Strategic Fund.
• Communication campaigns: Develop and implement awareness campaigns targeting all populations.
• Behavior change strategies: Support behavior change initiatives for both health personnel and the general public.
• Monitoring and evaluation: Develop measurement tools and a universal information system for tracking antimicrobial prescription and consumption across levels.

Roadmap Development

The second day of the workshops was dedicated to the development of a roadmap for the adaptation and implementation of the WHO policy. Key aspects identified by participants include:

• Leverage existing infrastructure: Use available human, material, and financial resources effectively.
• Stakeholder mapping and involvement: Engage stakeholders from the beginning to ensure ownership and commitment.
• Collaborative and multidisciplinary approach: Involve regional, subregional, and national entities such as ministries, NGOs, academic institutions, and professional associations.
• Local adaptation: Tailor the policy to national priorities, available resources, and local evidence.
• Identify gaps and pilot projects: Address implementation challenges through pilot projects and formulate recommendations.
• Use past lessons: Incorporate successful strategies and experiences to improve efficiency.
• Set clear timelines and deliverables: Define reasonable timeframes for short-, medium-, and long-term objectives.
• Cyclical planning and monitoring: Implement a continuous assessment and adjustment process to ensure progress and success.

Future Steps

• PAHO will finalize and share a generic roadmap for the adaptation and implementation of the WHO Policy Guidance with all Member States.
• Technical cooperation will continue to support the development and implementation of National Action Plans on AMR.
• Pilot projects will be conducted in four countries: Ecuador, El Salvador, Guyana, and Nicaragua, to further inform the adaptation and implementation of the Global Policy Guidance in other countries of the Region.

Conclusion

The consultation emphasized the importance of a coordinated, evidence-based, and locally adapted approach to antimicrobial stewardship. It highlighted the need for collaboration among various sectors and stakeholders, the integration of "One Health" principles, and the development of sustainable systems for monitoring and improving antimicrobial use.