2021-10-06-世界卫生组织-Regional_consultation_on_the_WHO_Policy_Guidance_on_Integrated_Antimicrobial_Stewardship_Activities_in_human_health_5页_1mb

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

Core Content

The World Health Organization (WHO) Regional Office for the Eastern Mediterranean, in collaboration with the AMR Global Coordination Department, organized a two-day virtual regional consultation workshop on 15–16 September 2021. The workshop aimed to disseminate and discuss the implementation of the WHO Policy Guidance on Integrated Antimicrobial Stewardship (AMS) Activities in Human Health, which was published in 2021. The policy guidance provides a programmatic framework for implementing comprehensive and integrated AMS activities at national and subnational levels.

Main Objectives

• Disseminate the WHO policy guidance at the regional level and discuss its adaptation and implementation at the country level.
• Identify challenges and enablers for implementing the five pillars of the policy guidance.
• Determine key technical assistance (TA) needs for adaptation and rollout.
• Develop a generic roadmap for country-level adaptation and implementation.

Five Pillars of the Policy Guidance

1. Establish and develop national coordination mechanisms for AMS and develop guidelines
2. Ensure access to and regulation of antimicrobials
3. Improve awareness, education and training
4. Strengthen water, sanitation and hygiene (WASH), and infection prevention and control (IPC)
5. Surveillance, monitoring and evaluation

Key Challenges Identified

• Low political engagement and understanding of the importance of AMS programs.
• Inadequate financial and human resources, including lack of competencies and multidisciplinary teams.
• Unclear AMS coordination structures and their integration with other governance frameworks.
• Weak regulation systems and mechanisms to monitor antimicrobial use.
• Limited IT infrastructure leading to manual data collection and analysis.
• Lack of AMS education in school curricula and healthcare worker training.
• Weak diagnostic capacities and microbiology lab quality.
• Political instability and insecurity in some countries.

Key Enablers Identified

• Political will and commitment from government.
• Strong advocacy to policy makers and stakeholders.
• National AMR action plans endorsed by the government with AMS as a core objective.
• Digital innovation and access to IT facilities.
• Awareness and behavior change campaigns targeting patients and the general public.
• Surveys and studies to generate quality data on AMR and AMU.
• Electronic data management systems.
• Training of healthcare workers on data collection and analysis.

Technical Assistance Needs

• Development of national policies, guidelines, and tools.
• Training of country focal points on AMS.
• Data analysis, use, and prioritization.
• Digitalization of data management systems.
• Strengthening laboratory capacities for pathogen identification and susceptibility testing.
• Designing a platform for cross-country learning and best practices sharing.

Implementation Considerations

• Use of WHO Periodic National and Health-Care Facility Assessment Tools to evaluate AMS preparedness.
• Emphasis on tailoring the implementation to the national, subnational, and local context.
• Strengthening existing governance structures and coordinating mechanisms.
• Avoiding the creation of alternative structures, working within current AMR frameworks.

Generic Roadmap for Implementation

The following steps were proposed for country-level adaptation and implementation of the policy guidance:

• Conduct baseline and situational analyses to identify gaps and needs.
• Engage stakeholders and decision-makers through advocacy.
• Establish a national multidisciplinary governance structure and link it with other programs.
• Build strong partnerships across sectors.
• Develop a costed implementation plan with defined timelines and responsibilities.
• Create national policies and regulations that incorporate AMS into accreditation criteria.
• Enforce legislation to restrict the dispensing of antimicrobials without a prescription.
• Set up a national coordination unit involving public and private stakeholders.
• Establish stewardship committees at the healthcare facility level.
• Support national champions to promote AMS through awareness campaigns.
• Prioritize activities based on country-specific analysis.
• Allocate sustainable and adequate funding.
• Build capacity through training and integrate AMS into education curricula.
• Strengthen laboratory capacities for accurate diagnosis.
• Set up auditing and feedback mechanisms for prescribers.
• Develop standard treatment guidelines using the AWaRe classification and WHO EML.
• Implement digitalization and electronic data management systems.
• Monitor and evaluate using key performance indicators and integrate with IPC and WASH programs.

Conclusion

The workshop was highly participatory, with in-depth discussions and collaborative efforts to develop a roadmap for AMS implementation. It highlighted the importance of political will, sustainable funding, and capacity building in advancing AMS activities. Participants expressed a unanimous commitment to adapt and implement the policy guidance according to local contexts. The guidance is seen as a valuable tool for promoting evidence-based and integrated antimicrobial stewardship across the Eastern Mediterranean region.