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Antibiotic resistance: National actions contribute to a global solution NEPAL

This article explores the actions taken by Nepal to address antibiotic resistance, including the development of a national surveillance system and policy guidelines.

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Antibiotic resistance: National actions contribute to a global solution NEPAL

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  1. Antibiotic resistance: National actions contribute to a global solutionNEPAL Professor Paras K Pokharel Vice Chair GARP Nepal

  2. AMR Activities in Nepal: How it Began • 1978: GoN, Drug Act • 1995: GoN, National Drug Policy, Nepal • 1998: GoN, Infectious Disease Control Program launched • to develop a sustainable national surveillance of AMR • 1999: GoN, NPHL started Laboratory Based AMR Surveillance • Network of 13 laboratories • 1999: APUA (Alliance for Prudent Use of Antibiotics) – Nepal was formed • 2001: National Drug Policy Amended- “prudent use of antibiotics added” • 2013: Global Antibiotic Resistance Partnership (GARP)-Nepal was formed; CDDEP & NPHF collaboration • 2014: GoN, National Antibiotics Treatment Guidelines

  3. Before GARP Nepal • APUA Nepal • Started with Assisting GoN with drafting of National Antibiotic Policy (Major Contributor) • Pharmacologist & Microbiologists mostly from Kathmandu • Prudent use of Antibiotics; Major Focus • Laboratory Surveillance : NPHL • Laboratory Based Surveillance Network ; Many hospitals around the country (Training Laboratorians, Quality Assuarance)

  4. GARP Nepal • GARP: International network that sensitizes AMR issues locally and gives Nepal a voice in antibiotic resistance in the international arena. • GARP-Nepal Working Group formed 2013 • Civil Society, National Public Health Body Engagement: NPHF • Academicians/Practitioners in Public Health, Medicine, Microbiology, Policy, Lab Science, Veterinary Medicine, from all over the country.

  5. GARP Nepal • Long-term goal: • To lay the groundwork for a national action plan for antibiotic resistance in Nepal • Specific objectives: • Carry out situation analysis of antibiotic use, resistance and related topics—human and animal—in Nepal • Develop Policy Brief(s) for mitigating antibiotic resistance in humans and animals

  6. AMR • This is not just about rational use of drugs. • Not confined to hospital practice and medical specialty. • Broadly anything that reduces the need for antibiotics will reduce antibiotic resistance.

  7. AMR • Vaccines (both antibacterial and antiviral) • Clean water • Sewage Disposal • Rapid Diagnostics (reliable ones, not Widal tests, more like Gene Xpertvs AFB stains) • Sub therapeutic use of Antibiotics in Animal/bird/fish farming • Phasing out widespread use of antibiotics in poultry, cattle and fish farms.

  8. AMR Hospitals are not “off the hook” • Hospital-acquired infections are the most resistant: NDM1, for example. • Hand washing between patients ( Not standard practice in Nepal) • Antibiotics “ just in case”

  9. GARP-Nepal Situation Analysis, 2014 • Respiratory infections (one-half of the cases were resistant) • Diarrhea (one-third of the cases were resistant) • Bloodstream infections, STDs, UTI: no better

  10. GARP-Nepal Situation Analysis, 2014 • “By prescription only” laws have limited usefulness in Nepal • Not enough for only a small group of people to know about AMR. • Health care workers at all levels, ( humans and veterinarians) in collaboration with professionals and policy makers. • Government support is critical.

  11. GARP-Nepal Situation Analysis, 2014 • Multi-sectoral engagement • Health Academia/Research • Medical Practitioners/ Lab Scientists • Agriculture/Veterinary Sectors • Policy Makers • Ministry of Health Owned Health Sciences Universities • Policy Advocacy one of the objectives • Engaging Government support at Ministerial Level • Global Network • Celebrated Global Antibiotics Awareness Week 2015 • Health Sciences University, Agricultural University & Civil Society Engagement in Awareness & Campaigns

  12. Working with Government • Autonomous/Semiautonomous Govt bodies represented on GARP-Nepal Working Group • GoN, MoHP on board since 2014, since the Situation Analysis was launched. • Interest of MoH remains; supported by current minister as well

  13. Challenges • Political Instability / Humanitarian crisis • National Health Policy 2071 (2014) Implementation plan for transition between the old policy and new policy • Lack of National coordination body mandated by Government

  14. Way Forward • Engagement of local stakeholders • Community based research • Participatory (Qualitative) research • Behavior change Initiatives for people/drug shops • Generate more research from animal/fish sectors • Partner with existing rational drug use & laboratory surveillance networks esp. National Public Health Laboratory, GoN • Engage more private sector health groups

  15. Way Forward National Action Plan for Antibiotic Resistance • Collaborative, covering all sectors, building on GARP framework

  16. Mount Fish Tail

  17. Thank you

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