Antibiotic resistance: National actions contribute to a global solution

NEPAL

Professor Paras K PokharelVice Chair

GARP Nepal

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

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)

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.

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

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.

AMR

• Vaccines (both antibacterial and antiviral)• Clean water• Sewage Disposal• Rapid Diagnostics (reliable ones, not Widal tests,

more like Gene Xpert vs AFB stains) • Sub therapeutic use of Antibiotics in

Animal/bird/fish farming• Phasing out widespread use of antibiotics in

poultry, cattle and fish farms.

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”

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

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.

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

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

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

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

Way Forward

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

Mount Fish Tail

Thank you