Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries. A WHO practical toolkit
Key steps in establishing a national AMS programme to enable facility AMS
Audience: Ministry and/or department/s responsible for delivering quality-assured medical care and access to and rational use of medicines
- Establish a governance structure – e.g. a national AMS technical working group linked to the national AMR steering committee.
- Review and prioritize the national core elements (Chapter 2):
2.1. Identify what is already in place and the level of implementation required.
2.2. Identify the short- and medium/long-term priority core elements.
2.3. Identify the resources required.
- Identify pilot health-care facilities (public and private) for initial AMS rollout:
3.1. Tertiary teaching facilities;
3.2. Regional/state and/or district facilities; and
3.3. Primary care and/or community (as part of community AMS programmes not covered in this toolkit).
- Develop a national AMS strategy* with national indicators.
- Dedicate financial and human resources as required.
- Monitor and evaluate implementation of the national AMS strategy.
- Facilitate access to and/or support pre- and in-service training on optimized antibiotic prescribing.
*Include community and/or primary care AMS programmes (not covered in this toolkit).
Key steps to establishing a health-care facility AMS programme
Audience: Health-care facility leadership, AMS committee and/or AMS team
- Undertake a facility AMS situational/SWOT analysis of:
1.1. Health-care facility core elements – identify what is in place and the implementation level required;
1.2. Available data on antimicrobial consumption (AMC) and/or use, prescription audits and AMR surveillance data; and
1.3. Existing AMS competencies at the facility.
- Establish a sustainable AMS governance structure based on existing structures.
- Prioritize the health-care facility core elements based on the situational analysis:
3.1. Identify the immediate priorities.
3.2. Identify the resources required.
- Identify AMS interventions starting with the low-hanging fruit:
4.1. Identify who, what, where and when.
- 5. Develop a health-care facility AMS action plan that specifies the human and financial resources required.
- Implement AMS interventions.
- Monitor and evaluate AMS interventions
- Offer basic and continued educational resources and training on optimized antibiotic prescribing.
- National Antibiotic Treatment Guideline-2014
- Think Twice. Seek Advice: World Antibiotic Awareness Week, 13-19 November 2017
- Change Can’t Wait. Our Time with Antibiotics is Running Out!
- High levels of antibiotic resistance found worldwide, new data shows
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