GTA

On Friday, June 10, 2022, GTA Foundation, with support from the Henry Ford Health Global Health Initiative (HFH GHI) and in collaboration with the Government of Nepal's Ministry of Health and Population (MOHP), convened a one-day dissemination workshop on Antimicrobial Resistance (AMR) and Stewardship at the Everest Hotel in Kathmandu. The workshop saw participation from numerous distinguished individuals representing both governmental and non-governmental organizations.

Mr. Tyler Prentiss (Sr. Program Manager, HFH GHI) initiated the proceedings with an overview of the workshop. Ms. Usha Tandukar (Senior Drug Administrator, QSRD, MOHP) then provided an update on the National Action Plan (NAP) concerning AMR. Insights into the current national strategy and trends in AMR surveillance in Nepal were shared by Ms. Jyoti Acharya (Chief Medical Technologist, NPHL). Following this, Mr. Bhagwan Shrestha (Country Director, FHI 360)/Dr. Ritu Amatya (Fleming Fund/FHI 360) and Dr. Nimesh Poudyal (Associate Research Scientist, IVI) presented the findings of the Fleming Fund AMR Surveillance and CAPTURA projects. The focus then shifted to hospital and community-based stewardship programs, which were shared and discussed by Dr. Linda Kaljee (Sr. Investigator, HFH GHI) and Dr. Rajesh Dhoj Joshi (Hospital Director, Kathmandu Model Hospital), highlighting the roles of pharmacists and nurses. Mr. Tyler Prentiss also introduced the WHO toolkit for Antimicrobial Stewardship in low and middle-income countries (LMICs).

The discussions yielded several key insights into AMR/AMS, acknowledging both the existing challenges and the progress made. A central theme was the recognition of AMR as a global issue demanding a collaborative, worldwide approach. While acknowledging that AMR, as an evolutionary process, cannot be entirely halted, participants agreed that it can be controlled. The national policy framework in Nepal, particularly the "One Health" policy, was noted as a positive aspect in addressing AMR. The NAP for AMR in the human health sector, drafted and approved by the National Technical Working Group (NTWG) in 2011, is currently awaiting discussion and approval from the upper multi-sectorial steering committee, with two remaining steps before potential cabinet approval.

Concerns were raised regarding the inconsistent implementation of existing medicine-related policies across Nepal's numerous hospitals and health centers. Participants emphasized the need for stricter governmental oversight to ensure antibiotics are sold according to established guidelines and dispensed only by certified medical personnel, addressing the issue of unqualified individuals working in pharmacies. Public awareness regarding the purchase and consumption of medications from local pharmacies was also highlighted as crucial, as public ignorance and negligence could have detrimental health consequences. The consensus was that antibiotic use is a matter of public health and should strictly adhere to prescriptions from certified medical professionals. The current status of the National Action Plan indicates a concerning statistic: globally, 700,000 deaths annually are attributed to the development of antimicrobial resistance.

Between 2011 and 2021, substantial efforts were dedicated to developing strategies for antimicrobial resistance stewardship. The Global Action Plan on AMR, developed in 2015, was adopted as Nepal's National Action Plan and approved in 2077 B.S. The AMR program was officially launched in 2016, initiating the National Content Action Plan. Based on this NAP, a five-priority draft phase for AMR management is underway.

Furthermore, GTA, with the support of HFH GHI, has actively engaged in AMR/AMS initiatives and research. The introduction of the antimicrobial stewardship program in Kathmandu Model and Kirtipur Hospitals in mid-2016 marked a significant step. This program adapted antibiotic treatment guidelines for use in Nepal, training select physicians to champion improved antibiotic usage within their hospital departments. This training led to increased knowledge and awareness among physicians regarding antimicrobial resistance and antibiotic prescribing practices, laying the groundwork for further development of antimicrobial stewardship programs in Kathmandu and other parts of Nepal.

Moreover, GTA has conducted various training programs on AMR stewardship and related issues for nurses, pharmacists, and physician champions. A total of 151 pharmacists, 129 nurses, and 10 physicians within the Kathmandu valley have received training on Antimicrobial Stewardship, Infection Prevention and Control, and the WHO TOOLKIT for AMS. Additionally, GTA successfully trained over 200 healthcare providers through their web-based learning platform, 'www.glamr-gta.org'.

The workshop concluded with insightful suggestions, productive discussions, and identification of challenges related to AMR and strategies for future progress. Participants agreed that minimizing AMR requires a multi-faceted approach, including adherence to antibiotic treatment guidelines, the use of antibiograms in hospitals, strict prescription practices, community awareness campaigns, stringent monitoring of pharmacies, and a unified "One Health" approach. Ms. Tandukar emphasized that combating AMR is a collective responsibility, requiring collaboration among all government and non-governmental stakeholders to achieve positive outcomes in the future.