National Action Plan on Antimicrobial Resistance (NAP-AMR) 2023 -2028

THE UNITED REPUBLIC OF TANZANIA NOVEMBER 2022 THE NATIONAL ACTION PLAN ON ANTIMICROBIAL RESISTANCE 2023 -2028 iNational Action Plan on Antimicrobial Resistance 2023 - 2028 FOREWORD Antimicrobial resistance (AMR) is projected to cause millions of deaths worldwide, with massive social, economic and global public health consequences. The overarching principle for addressing antimicrobial resistance is the promotion and protection of human health within the framework of a one health approach. Addressing AMR is integral to achieving the Sustainable Development Goals (SDGs); rising levels of AMR will make difficult to achieve the goals for health, poverty reduction, food security and economic growth. In recognition of that, the Tanzanian government is addressing the AMR problem through the implementation of the National Action Plan on Antimicrobial Resistance under one health approach. The formulation of NAP-AMR 2023 - 2028 considered all the recommendations outlined in the report of the Implementation Status of the National Action Plan on Antimicrobial Resistance 2017-2022. While implementing NAP-AMR (2023-2028), it is of paramount importance that we consider and sustain the achievements made, and improve where we did not attain the planned interventions. The NAP-AMR 2023-2028 incorporate six strategic objectives: Strenghten coordination, collaboration and governance for NAP on AMR implementation; Create awareness and understanding of antimicrobial resistance through effective information, education and communication; Strengthen the knowledge and evidence base through surveillance and research; Reduce the incidence of infection through effective sanitation, hygiene, infection prevention, and on-farm biosecurity ; Optimize the use of antimicrobial medicines in human and animal health; and develop the economic case for sustainable investment that takes into account the needs to increase investment in new medicines, diagnostic tools, vaccines and other interventions. Effective implementation of the National Action Plan on Antimicrobial Resistance 2023-2028 will require commitment from responsible ministries, implementing institutions in public and private sectors, projects and all other AMR stakeholders. We therefore request all professionals and stakeholders in the human, animal, agriculture and environment sectors to use this important document and support the government in addressing the problem of antimicrobial resistance. Permanent Secretary, Permanent Secretary, Ministry of Health Ministry of Livestock and Fisheries ii National Action Plan on Antimicrobial Resistance 2023 - 2028 ACKNOWLEDGEMENTS The Government of the United Republic of Tanzania acknowledges the technical and financial support provided by various National and global actors in the implementation of the National Action Plan on Antimicrobial Resistance (NAP-AMR) 2017-2022. The World Health Organization (WHO), Food and Agriculture Organization of the United Nation (FAO), the Fleming Fund – Country and Regional Grant (lead by the American society of Microbiology-ASM and African Society for Laboratory Medicines ASLM), USAID funded projects [Medicines, Technologies and Pharmaceutical Services Program (MTaPS), Infectious Disease Detection and Surveillance (IDDS)], the Health Promotion and System Strengthening (HPSS) project (by the Swiss Tropical and Public Health) are duly acknowledged. We acknowledge the research projects, Holistic Approach to Unravel Antimicrobial Resistance (HATUA), Support the National Action on Antimicrobial Resistance (SNAP-AMR). We acknowledge support from professional associations and non-governmental organizations on creating community awareness on AMR especially during the World Antimicrobial Awareness Week (WAAW). These outstanding efforts laid a foundation for preparation of the NAP-AMR (2023-2028). The Government extends its appreciation to members of the National AMR Multi-sectoral Coordinating Committee (MCC) and AMR Technical Working Groups (TWGs) which were established under the leadership of the former Chief Medical Officer, Professor Muhammad Bakari Kambi; his championship and commitment on AMR will be always remembered. The United Nation organs are dully acknowledged for their pivotal roles in the preparation of this document, and in particular, the World Health Organization (WHO), Food and Agriculture Organization of the United Nation (FAO), and the World Organization for Animal Health (WOAH). Responsible ministries involved in the development of this document are: Vice President’s Office (VPO), Prime Minister’s Office (PMO), Ministry of Livestock and Fisheries (MLF), Ministry of Agriculture (MoA) and Ministry of Health (MoH). Lead Institutions involved in the preparation of this document are cordially acknowledged which included, Catholic University of Health and Allied Sciences (CUHAS); Muhimbili University of Health and Allied Sciences (MUHAS), Sokoine University of Agriculture (SUA), St John’s University and Tanzania Bureau of Standards (TBS). We thank all who contributed in developing, editing and costing this important document. Their names have been appended (appendix I). Lastly, but not least, we express gratitude to the WHO, USAID funded projects (MTaPS and IDDS) for the financial support enabled the development and printing of the document. Prof. Tumaini Nagu CHIEF MEDICAL OFFICER iiiNational Action Plan on Antimicrobial Resistance 2023 - 2028 TABLE OF CONTENTS FOREWORD ............................................................................................................................................... i ACKNOWLEDGEMENTS ........................................................................................................................ ii TABLE OF CONTENTS ........................................................................................................................... iii ABBREVIATIONS AND ACRONYMS .................................................................................................. v DEFINITION OF TERMS .................................................................................................................... viii HOW THE DOCUMENT WAS DEVELOPED ...................................................................................... ix EXECUTIVE SUMMARY ......................................................................................................................... x INTRODUCTION ..................................................................................................................................... 1 SITUATIONAL ANALYSIS .................................................................................................................... 4 2.1 Coordination, collaboration and governance ............................................................................... 4 2.2 Awareness, Risk Communication and Education on AMR .......................................................... 5 2.3 Strengthen the AMR knowledge and evidence through surveillance .......................................7 2.4. Reduce the incidence of infection through effective sanitation, hygiene, and infection prevention measures, and on-farm biosecurity.........................................................................12 2.5 Optimize the Use of Antimicrobial Agents in Human, Animal and Plant Health ...................13 2.6 Develop the economic case for sustainable investment ..........................................................16 2.7 Analysis of strengths, weaknesses, opportunities and threats in the implementation of NAP-AMR.....................................................................................................................................19 STRATEGIC OBJECTIVE ONE ........................................................................................................... 23 STRENGTHEN COORDINATION, COLLABORATION AND GOVERNANCE ..........................23 3.1 The National AMR Multi-Sectoral Coordinating Committee (MCC) .........................................23 3.2 The National AMR Multi-Sectoral Coordinating Committee Secretariat .................................24 3.3 Antimicrobial Resistance Focal Point........................................................................................... 24 3.4 Technical Working Groups ............................................................................................................ 24 3.5 AMR Coordination at Sub-national levels ................................................................................... 24 3.6 Capacity building for effective coordination and governance on AMR ...................................25 STRATEGIC OBJECTIVE TWO .......................................................................................................... 30 IMPROVE AMR AWARENESS, COMMUNICATION AND EDUCATION ..................................30 STRATEGIC OBJECTIVE THREE ....................................................................................................... 38 STRENGTHEN THE KNOWLEDGE AND EVIDENCE-BASED THROUGH SURVEILLANCE AND RESEARCH .................................................................................................................................... 38 iv National Action Plan on Antimicrobial Resistance 2023 - 2028 STRATEGIC OBJECTIVE FOUR ......................................................................................................... 56 REDUCE THE INCIDENCE OF INFECTIONS ................................................................................. 56 STRATEGIC OBJECTIVE FIVE ........................................................................................................... 70 OPTIMIZE THE USE OF ANTIMICROBIAL AGENTS .................................................................. 70 STRATEGIC OBJECTIVE SIX ............................................................................................................. 82 DEVELOP THE ECONOMY CASE FOR SUSTAINABLE INVESTMENT .....................................82 MONITOR AND EVALUATE THE NAP AMR ................................................................................... 86 COSTED NAP-AMR OPERATIONAL PLAN ..................................................................................... 87 APPENDIX I: LIST OF CONTRIBUTORS ........................................................................................ 88 APPENDIX II : TERMS OF REFERENCE FOR THE NATIONAL AMR MULTI-SECTORAL COORDINATING COMMITTEE (MCC) ............................................................................................ 91 APPENDIX III: TERMS OF REFERENCE FOR THE NATIONAL AMR MULTI-SECTORAL COORDINATING COMMITTEE – SECRETARIAT......................................................................... 92 APPENDIX IV: TERMS OF REFERENCE AMR FOCAL POINTS FOR RELEVANT SECTORS ................................................................................................................................................. 94 APPENDIX V: TERMS OF REFERENCE FOR AMR AWARENESS AND EDUCATION TECHNICAL WORKING GROUP ....................................................................................................... 95 APPENDIXES VI: TERMS OF REFERENCE FOR AMR SURVEILLANCE TECHNICAL WORKING GROUP ............................................................................................................................... 96 APPENDIX VII: TERMS OF REFERENCE FOR HYGIENE, INFECTION PREVENTION AND CONTROL - TECHNICAL WORKING GROUP ................................................................................ 98 APPENDIX VIII: TERMS OF REFERENCE FOR ANTIMICROBIAL STEWARDSHIP TECHNICAL WORKING GROUP .................................................................................................... 99 APPENDIX IX: TERMS OF REFERENCE FOR MONITORING AND EVALUATION TECHNICAL WORKING GROUPS .................................................................................................. 101 APPENDIX X: MONITORING AND EVALUATION MATRIX ....................................................102 APPENDIX XI: KEY PERFORMANCE INDICATORS .................................................................115 APPENDIX XII: THE NAP-AMR 2023-2028 COSTED ACTIVITIES (TZS) .........................121 vNational Action Plan on Antimicrobial Resistance 2023 - 2028 ABBREVIATIONS AND ACRONYMS ADDO Accredited Dispensing Drug Outlets AfyaSS Afya support supervision AMR Antimicrobial Resistance AMC Antimicrobial Consumption AMS Antimicrobial Stewardship AMU Antimicrobial Use APHTA Association of Private Hospitals in Tanzania ASLM African Society for Laboratory Medicine ATC Anatomical Therapeutical Chemical AWaRe Access Watch and Reserve BCC Behavior Change Communication BMC Bugando Medical Centre CDE Centre for Disease Control and Prevention CHMT Council Health Management Team CPD Continuous Professional Development CSSC Christian Social Services Commission DDD Daily Defined Dose DEOs District Executive Officers DHIS District Health Information System DPs Development Partners EIDSR Integrated Disease Surveillance and Responses eLMS Electronic Logistics Management System EQA External Quality Assessment FAO Food and Agriculture Organization of the United Nations FBO's Faith base organizations GARP Global Antimicrobial Resistance Partnership GHSA Global Health Security Agenda GLASS Global Antimicrobial Resistance Surveillance System GOVT Government of Tanzania HAART Highly Active Anti-Retroviral Therapy HAIs Hospitals Acquired Infection HCAI Health Care Associated Infections HFs Health Facilities HCW Health Care Workers vi National Action Plan on Antimicrobial Resistance 2023 - 2028 HCF Health Care Facilities HICs High-income countries HIV Human Immunodeficiency Virus HMT Health Management Team HMTC Hospital Medicines and Therapeutics Committee HMIS Health Management Information System ICARS International Centre for Antimicrobial Resistance Solutions IDDS Infectious Disease Detection and Surveillance IDRS Integrated Disease Surveillance and Response IEC Information, Education and Communication IHR International Health Regulation IPC Infection Prevention and Control JEE Joint External Evaluation KAPB Knowledge Attitude Practice and Behavioral KCMC Kilimanjaro Christian Medical Centre LGAs Local Government Authorities MLF Ministry of Livestock and Fisheries MCC Multi-Sectoral Coordinating Committee MDR Multi Drug Resistance M&E Monitoring and Evaluation MoA Ministry of Agriculture MoEST Ministry of Education, Science and Technology MoH Ministry of Health MoW Ministry of Water MSD Medical Stores Department MSH Management Science for Health MTC Medicine and Therapeutics Committee NAP National Action Plan NEMC National Environment Management Council NEMLIT National Essential Medicines List for Tanzania NGO Non-Governmental Organization NPHL National Public Health Laboratory NSASHA National Strategy for Accelerating Sanitation and Hygiene for All NSMIS National Sanitation Management Information System PC Pharmacy Council PST Pharmaceutical Society of Tanzania viiNational Action Plan on Antimicrobial Resistance 2023 - 2028 PT Proficiency Testing PMO Prime Minister’s Office PMOHCS Prime Minister’s Office One Health Coordination Section PORALG President’s Office Regional Administration and Local Government PPP Public Private Partnership ODF Open Defecation Free OH One Health QIT Quality Improvement Team RHMT Regional Health Management Team RRH Regional Referral Hospitals REOs Regional Executive Officers SBCC Social Behaviour Change and Communication Campaigns SDG Sustainable Development Goals STG Standard Treatment Guidelines SOPs Standard Operating Procedures SUA Sokoine University of Agriculture SWOT Strength Weakness Opportunities and Threats TAPI Tanzania Association of Pharmaceutical Industries TAVEPA Tanzania Veterinary Para-professional Association TB Tuberculosis TBS Tanzania bureau of Standard TMDA Tanzania Medicines and Medical Devices Authority TOTs Training of Trainers TPMA Tanzania Pharmaceutical Manufacture Association TrACSS Tripartite AMR Country Self - Assessment Survey TWG Technical Working Group TVA Tanzania Veterinary Association TVLA Tanzania Veterinary Laboratory Agency UNEP United Nation Environmental Programme USAID The United States Agency for International Development VCT Veterinary Council of Tanzania WAAW World Antimicrobial Awareness Week WASH Water Sanitation and Hygiene WHO World Health Organization WOAH World Organization for Animal Health viii National Action Plan on Antimicrobial Resistance 2023 - 2028 DEFINITION OF TERMS Anatomical Therapeutic Chemical (ATC): Classification System used for the classification of active ingredients of drugs according to the organ or system on which they act and their therapeutic, pharmacological and chemical properties. Antibiotic: An agent or substance that is produced by or derived from a microorganism that kills or inhibits the growth of another living microorganism. Antimicrobial: An agent or substance derived from any source (microorganisms, plants, animals, synthetic or semi-synthetic) that acts against any type of microorganism, such as bacteria (antibacterial), mycobacteria (anti-mycobacterial), fungi (antifungal), parasite (anti-parasitic) and viruses (antiviral). All antibiotics are antimicrobials, but not all antimicrobials are antibiotics. Antimicrobial resistance (AMR): Microorganisms such as bacteria, fungi, viruses and parasites change when exposed to antimicrobial drugs such as antibacterials, antifungals, antivirals, antimalarials and anthelmintics. As a result, the medicines become ineffective. Antimicrobial stewardship (AMS): A coherent set of actions which promote the responsible use of antimicrobials. This definition can be applied to actions at the individual level as well as the national and global level, and across human health, animal health and the environment. Antimicrobial stewardship programme (AMS programme): An organizational or system-wide health-care strategy to promote appropriate use of antimicrobials through the implementation of evidence-based interventions. Community-acquired infection: An infection acquired in the community, outside of a health-care setting. Defined daily dose (DDD): Assumed average maintenance dose per day for a medicine used for its main indication in adults as established by the WHO Collaborating Centre for Drug Statistics and Methodology. Hospital-associated infection: An infection occurring in a patient during care in a hospital or other health-care facility, which was not present or incubating at the time of admission. Health-care associated infections can also appear after discharge. They represent the most frequent adverse event associated with patient care. One Health: A collaborative, multisectoral and transdisciplinary approach that recognizes the interconnections between people, animals, plants and their shared environment. ixNational Action Plan on Antimicrobial Resistance 2023 - 2028 HOW THE DOCUMENT WAS DEVELOPED The WHO Implementation Handbook for National Action Plan on Antimicrobial Resistance 2022, provided technical guidance and stepwise approach for the development of this document. The process commenced with the review of the implementation of the NAP-AMR 2017-2022 by documenting the achievements, gaps, challenges and recommendations. Nominated experts from responsible TWG(s) and other key stakeholders developed a list of activities and sub activities for each strategic objective through an inclusive consultative process. The listed activities were based on the recommendations from the end line NAP with consideration of their importance in addressing AMR. The review of the list of key activities and sub activities were done during the stakeholder’s validation meeting. Finally, the NAP AMR activities were costed using the WHO-NAP AMR costing tool. Costing of NAPAMRStakeholders' validation Meetings Development of M & E Framework TWGs meetings to identify prority actions, interventions, activities and sub activities Situational analysis by TWGs' and systematic review of NAP-AMR (2017-2022) implementation status Figure 1. NAP-AMR 2023-2028 development process x National Action Plan on Antimicrobial Resistance 2023 - 2028 EXECUTIVE SUMMARY The National Action Plan on Antimicrobial Resistance (NAP-AMR, 2023-2028) envisage to continue with implementation of the five strategic objectives in line with the Global Action Plan on AMR. It has incorporated governance as an additional objective making a total of six strategic objectives. The plan is specifically informed by the achievements, gaps and challenges identified during the implementation of the NAP-AMR (2017-2022). It deploys globally harmonised plans for comparison purposes but taking into account local context. The document stipulates the governance structure of the NAP-AMR which includes the establishment of the National AMR Coordinating Committee, the Technical Working Groups, the Secretariat and the AMR Focal Point. These are governed by clear roles and responsibilities as stipulated in the respective terms of references. It is also grounded on the whole system approach extending from individual level to macrosystem with clear multi-sectoral and inter-disciplinary involvement using One Health Approach. The deliberated initiatives includes strengthening of an evidence-based public communication, Health Programme that targets human and animal health and the environment, with consideration of AMR along the food value chains; strengthening NAP-AMR implementation activities at national level and establishing such systems at sub-national levels; fostering more private sectors engagement; re-structuring of policy, regulations and guidelines to reinforce conformity at individual level, institutional-level and country-level; utilization of AMR data generated across strategic objectives to inform national and institutional-specific guidelines for priority infectious diseases’ diagnosis, treatment, control and prevention. This plan also equally acknowledges a need to bridge the NAP-AMR implementation gaps between human and animal sectors, with plant and environment sectors. It is projected that more hospitals and veterinary centres will be included with AMR/AMC/AMU surveillance system and, systematic collection of health care associated infections and farm-based biosecurity measures to inform evidence-based practices. The NAP AMR (2023 – 2028) intents to enrol all tertiary and regional referral hospitals, and a few selected district hospitals into the antimicrobial stewardship programs. However, central to these initiatives is to strengthen laboratory diagnostic infrastructures and vaccination in humans and animals which underscore a need to use antimicrobial agents prudently. Interventions to optimize the use of antimicrobial agents in human and animal health will also include strengthening regulatory authority for controlling quality, distribution and use of antimicrobial agents; strengthening patient and health care provider compliance; reducing the prevalence of substandard medicines for both human and veterinary use and inappropriate or unregulated use of antimicrobial agents in agriculture. The operational plan matrix gives details on how each activity will be conducted; and of interest, monitoring and evaluation framework comprises indicators which will be measured in the process of implementation. Finally, this plan envisages to leverage existing resources (human, material and financial resources) so as to maximise the intended outputs, outcomes and ultimately impacts to sustain these initiatives. This document include a total of six strategic objectives which altogether generates 11 priority actions, 34 strategic interventions, and 85 activities. It is estimated that, Tanzania shillings 61,541,380,950 will be needed to support the implementation of the NAP-AMR 2023-2028 and activities were costed across six strategic areas: Governance (TZS. 2,369,702,017/=); Awareness and Education (TZS 4,580,344,679/=); AMR/AMC/AMU Surveillance and Research (TZS 27,953,082,645/=); Infection Prevention and Control (15,578,376,279/=); Optimizie use of antimicrobials (TZS 4,814,203,124) and Sustainable investment (TZS 6,245,672,206/=). 1National Action Plan on Antimicrobial Resistance 2023 - 2028 INTRODUCTION Antimicrobials play an essential role in combatting infectious diseases in both humans, animals and plants. Antimicrobials are most often named according to the spectrum of microorganisms they target (e.g., antibacterials, antivirals, antifungals and antiparasites) or the microbial ultrastructure where the agents act (e.g., cell wall/cell membrane inhibitors, protein synthesis inhibitors, DNA inhibitors, metabolic pathway inhibitors). Antimicrobial resistance (AMR) is a complex and multi-factorial phenomenon which refers to non-susceptibility of microorganisms to antimicrobial agents. It encompasses both inherent microbial genetic factors and/or acquired factors related to overuse/misuse of these agents resulting into antimicrobial selective pressure killing susceptible microorganisms and selecting the resistant ones which in turn propagate. The emergence and spread of antimicrobial drug-resistant organisms is a global challenge. AMR is causing adverse social-cultural, economic and clinical impacts both in developed and developing countries. Infectious diseases notably, urinary tract infections, skin and soft tissue infections, and blood stream infections caused by multidrug resistant pathogens result into prolonged hospitalization, morbidity, mortality and extra cost. It is projected that if multi-sectoral responsive actions are not coordinated and systematically undertaken at country and global levels, by 2050, the economic and clinical impacts attributable to AMR will be enormous with approximately 10 million deaths yearly and an average annual loss of approximately 3 trillion dollars (or a cumulative loss of more than 100 trillion USD). Furthermore, the impacts will be predominantly in the African and Asian regions (O’Neill J et al., 2014).1 In recognition of the global threat posed by antimicrobial resistance (AMR), in May 2015, the World Health Assembly adopted the Global Action Plan (GAP) on AMR. Tanzania, being one of the countries that ratified the GAP on AMR, in April 2017, it established the National Action Plan (NAP) on AMR in line with the GAP objectives. The aim of establishing the NAP was to tackle AMR using a sound one health AMR coordination mechanism. There have been remarkable progresses in implementation of the NAP-AMR (2017-2022), although with notable inter- and intra-sectoral variations in the level of achievements. For examples, most of the priority actions, strategic interventions and activities were largely implemented at the national-levels (ministerial level, national/zonal hospitals, and in selected regional referral hospitals; as well as central and zonal veterinary centers). Therefore, the proposed NAP-AMR (2023- 2028) will extend the implementation activities to sub national levels (i.e. more regional and district/council levels engagement). It will also engage more private sectors (especially in human health) to address implementation gaps which were obvious in the previous NAP to ensure holistic implementation activities. It is also important to reiterate the fact that the previous NAP-AMR (2017-2022) had implementation variations across sectors. For example, implementation was largely done in the human sector compared to animal sector, and implementation were sparsely done in the plant and environment sectors. Therefore, the NAP AMR will strengthen the established milestones in the human sector, while equally establishing/developing tangible actions in the animal, plant and environmental sectors. 1 O’Neill, J. (2014) Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. The Review on Antimicrobial Resistance, 20, 1-16. 2 National Action Plan on Antimicrobial Resistance 2023 - 2028 The NAP-AMR (2023-2028) will also aim to translate deliverables from the previous NAP-AMR into evidence based practices and policy changes. For example, the prevailing evidence on the high susceptibility patterns of nitrofurantoin against Escherichia coli and other pathogens causing urinary tract infection was used to inform the revised Tanzania Standard Treatment Guidelines and National Essential Medicines List, 2021. Similarly, the higher resistance profiles to pathogens causing blood stream infections in the tertiary and regional referral hospitals compared to primary health care facilities underscore a need to have antimicrobial treatment guidelines which are tier-specific. The NAP-AMR will also operationalize the newly incorporate feature in the DHIS-2 on routinely monitoring of surgical site infections across secondary and tertiary health facilities, and guide specific infection and control measures. Systematic collection of antimicrobial consumption and antimicrobial use data as proposed in the NAP-AMR will also enable assessment of country’s conformity to the global frameworks (such as AWaRe categorization of antibiotics). Finally, the NAP-AMR (2023-2028), emphasize on monitoring and enable real time tracking of activity implementation and thereby, provide tailored responsive measures, as well as impact evaluation. Addressing AMR is crucial in achieving the Sustainable Development Goals (SDGs) and through the NAP-AMR (2023-2028), Tanzania will uphold the Agenda of the Sixty-eighth World Health Assembly of May 2015 which urged the Member States to develop and subsequent systematically revise their National Action Plans for AMR using a “One Health Approach”. The NAP provides a structure for a coordinated response and strengthening AMR interventions among the numerous sectors and actors, including human, animal, agriculture, finance, environment, and well-informed consumers. The NAP-AMR 2023 – 2028 is grounded on the whole system approach extending from individual level to macrosystem. Our vision is to effectively contain AMR using One Health Approach towards the attainment of Universal Health Coverage and the UN Sustainable Development Goals by 2030. The NAP-AMR 2023-2028 is structured around key strategic objectives, interventions and activities to slow the development and spread of AMR and improve health outcomes in humans, animals and plants. The NAP-AMR 2023-2028 has incorporated governance as an additional strategic objective making a total of six strategic objectives. i. Strengthen coordination, collaboration and governance for NAP on AMR implementation. ii. Create awareness and understanding of antimicrobial resistance through effective information, education and communication. iii. Strengthen the knowledge and evidence based through surveillance and research. iv. Reduce the incidence of infection through effective sanitation, hygiene, infection prevention, and on-farm biosecurity. v. Optimize the use of antimicrobial agents in human and animal health. vi. Develop the economic case for sustainable investment that takes account of the needs of countries to increase investment in new medicines, diagnostic tools, vaccines and other interventions. 3National Action Plan on Antimicrobial Resistance 2023 - 2028 The NAP-AMR 2023 - 2028 is costed based on the WHO NAP-AMR costing tool. Monitoring and evaluation section is well framed with key performance indicators for tracking the effectiveness and efficiency of NAP AMR implementation. Additionally, monitoring and evaluation TWG has been established making a total of five TWGs (instead of four TWGs in the NAP-AMR 2017-2022). OUR 10-YEAR VISION FOR CONTAINING AMR Tanzania will lead the way in �nding sustainable solutions to tackling AMR in line with global ambitions and in collaboration with other nations, partners and the international community. We will achieve this through delivering six strategic objectives. By 2030, AMR is e�ectively contained through multi-sectoral and inter - disciplinary coordination in line with the National Development Plan (2021/22-2025/26), Universal Health Coverage, Global Health Security Agenda and the UN Sustainable Development Goals. Tanzania is determined to sustain its e�orts to combat AMR, taking local and national actions using a One Health approach and working across the whole system. This system spans from microbial communities to human and animal communities and their shared social, political and physical environment. Box 1. A 10 Year Vision for containing AMR in Tanzania 4 National Action Plan on Antimicrobial Resistance 2023 - 2028 SITUATIONAL ANALYSIS The GHSA supports antimicrobial resistance (AMR) containment through its AMR action package, 1 of the 19 technical areas addressed by the agenda. In February 2016, Tanzania was the first country to undergo Joint External Evaluation (JEE). The findings demonstrated that although there had been significant progress in establishing laws and policies for IHR, gaps still existed in the country’s core capacities to prevent, detect, and respond to public health emergencies. Tanzania’s mainland was rated as having “no capacity” (score one) for antimicrobial stewardship (AMS) and “developed capacity” (score three) for health care-associated infection (HCAI) prevention and control (IPC) programs. The previous NAP AMR (2017-2022) has allowed significant progress to be made in addressing the gaps outlined in the JEE and addressing WHO benchmark actions. Through the multisectoral and interdisciplinary collaboration, the following major milestones were reached during implementation of the NAP-AMR (2017- 2022) which in turn laid the background frameworks for the NAP-AMR (2023-2028): AMR Milestones in Tanzania in the NAP-AMR (2017-2022) 2015 Global Antimicrobial Resistance Partnership (GARP) Tanzania Working Group Situational analysis 2019 Enrollment in global antimicrobial resistance and use surveillance system (GLASS) 2016 Joint External evaluation (JEE) report 2017 National Action plan on Antimicrobial Resistance (NAP - AMR) launched + Multisectoral Coordinating Committe & 4 Technical Working Group 2017 - 2020 Submitted yearly National AMC data to GLASS 2021 Standrd Treatment Guidelines and National Essential Medicines List (STG/ NEMLIT) 2021 edition included AWare categorization 2022 Standrd Treatment Guidelines for Animal Diseases 2018 - 2021 Conducted WHO Point Prevalence Surverys in 16 hospital (2018 2020) 2020 National Antibiotics AWaRe Classification 2018 - 2022 Tripartite AMR Country self Assessment Survey (TrACSS) Figure 2: NAP-AMR Milestones 2017-2022 Detailed information on the current situation is described under section 2.1, 2.2, 2.3, 2.4,2.5, 2.6 & 2.7 below. 2.1 Coordination, Collaboration and Governance The National Multi-Sectoral Coordinating Committee (MCC) on AMR is the central national steering committee mandated to provide an oversight and coordination of all NAP-AMR activities through its Secretariat and Technical Working Groups (TWGs). These include TWG for awareness, effective communication and education; TWG for surveillance and research; TWG for sanitation, hygiene and infection prevention and control (IPC); and TWG for antimicrobial stewardship. 5National Action Plan on Antimicrobial Resistance 2023 - 2028 The Tanzania NAP-AMR framework is grounded on One Health approach to ensure holistic interventional measures to combat AMR. Key stakeholders implementing this plan include (but not limited to) ministries, departments and agencies including the quadripartite United Nation Agencies (WHO, FAO, WOAH and UNEP) through their global, regional and country’s offices. Various ministries, departments and sections include Vice President’s Office, Tanzania One Health Coordination Section under the Prime Minister’s Office, Ministry of Health, Ministry of Livestock and Fisheries, Ministry of Agriculture and President’s Office Regional and Local Government Authorities. Others are Hospitals and veterinary centers; Universities; Regulatory Authorities; Professional Bodies; and Research Institutions. In addition, stakeholders include Development Partners and Local and International Non - Government Organizations. The NAP- AMR is also well integrated in existing national programs and policies relevant to AMR such as infection prevention and control (IPC), Water Sanitation and Hygiene (WASH), optimization of antimicrobial use (Stewardship), National Antimicrobial Resistance Surveillance Framework, and Multsectoral Antimicrobial Resistance Communication Strategy (Moving from Awareness to Action. The implementation of NAP- AMR is also well aligned with global and national initiatives related to the Global Health Security Agenda (GHSA). With its quarterly meetings, the MCC provides leadership and coordination, momentum building, advocacy, communication, evidence building and monitoring of the implementation of the NAP. Co-chaired by the Chief Medical Officer (Health Sector) and the Director of Veterinary Services (Animal Sector), the MCC has high level support, authority and clear lines of accountability to lead the Technical Working groups and oversee the implementation of AMR activities from different sectors. 2.2 Awareness, Risk Communication and Education on AMR The first Strategic Objective recognizes the importance of improving awareness and understanding of AMR, and of promoting behavioral change, through effective communication, education and support at national and sub-national levels. Therefore, priority actions of NAP-AMR 2017-2022 included health communications and education of healthcare providers. Understanding the whole system helps point to where we can best intervene. The causes of AMR are complex and different in low-and-middle income countries (LMICs) compared to high-income countries (HICs). Therefore, developing communications around AMR can be challenging and approaches used in certain contexts may not apply to others. Overall challenges around AMR communication relate to the fact that it is a multi-faceted problem spanning a range of health issues, from surgery to the management of chronic diseases, and the treatment and prevention of infectious diseases. Furthermore, AMR is often an invisible problem with multiple drivers and affecting multiple systems, including humans, livestock and the environment. Complicated terminology makes AMR a difficult concept to explain and understand. These complexities can result in conflicting and confusing messages that ask people to act in contradictory ways. Finally, global messages around AMR have often limited adaptations to specific local situations and audiences. Therefore, tailoring information to audiences in human health, animal health and agricultural practice as well as consumers is essential and this information should be developed based on the specific context within which it is going to be used. Recognizing the complexities of effective AMR communication, NAP-AMR 2017-2022 encouraged research and activities around the creation of awareness and understanding of AMR amongst the public using informative, sensitive, thoughtful and locally-relevant communications. It also explored health communications between patients and providers in order to establish trust while supporting social networks that affect health outcomes. 6 National Action Plan on Antimicrobial Resistance 2023 - 2028 There have been Knowledge, Attitude, Practice and Behavioral (KAPB) studies as well as other key mixed method and qualitative research conducted in both the human and animal health sectors across the country. There have been both small scale (in a few regions) and broader studies (cross-country) conducted by various Universities and Research Institutions across the country. The country has a Multi-sectoral Antimicrobial Resistance Communication Strategy “Moving from Awareness to Action” 2020-2025, which was successfully developed in 2020 through One Health Approach. This was shared successfully to all relevant stakeholders. In addition, the country is commemorating WAAW successfully annually since 2017 to date. The themes for WAAW for each year are adopted from, WHO the chief custodian of GAP and NAP AMR at global and National scales. During WAAW commemorations, which are mostly done at the National level, high-level dignitaries from the line ministries and the quadripartite organizations for AMR (WHO, WOAH (OIE), FAO and UNEP) deliver key statements to mark the week. At the same time, a wide range of AMR dissemination activities are done through television, radios, newspapers and social media. NGO’s including Roll Back AMR, Tanzania Pharmacy Students Association (TAPSA), Hermargs Institute Alliance for Solutions (HIASO), One Health Society, Students one Health Innovation Clubs (SOHIC) carry out AMR activities that cascade to community and grass-root levels. An example of awareness campaign using SNAP-AMR staged model which takes into account six sequential stages (inputs, implementation plan, testing, baseline data collection, outcome measures, and process evaluation) is presented in the box below: Box 2: An example AMR awereness campaigns conducted during NAP-AMR 2017-2022 In Tanzania AMR education is provided through pre-service and in-service training programmes. The pre service training is well covered at universities (regulated by TCU) and Technical Institutions (regulated by NACTVET). Through Continuous Profession Development (CPD) and short courses, AMR education is provided to in-service personnel. Such courses are regulated by the Professional Councils such as Tanzania Veterinary Council (TVC), Tanganyika Medical Council (TMC) Tanzania Nursing and Midwifery Council (TNMC). and Pharmacy Council (PC). 7National Action Plan on Antimicrobial Resistance 2023 - 2028 2.3 Strengthen the AMR Knowledge and Evidence through Surveillance The country has a National One Health AMR surveillance protocol (AMR surveillance Framework 2018) to guide AMR surveillance in Tanzania. The protocol was developed based on a desk review of the existing infectious disease surveillance system. Further, AMR specific surveillance protocols were developed for poultry, dairy cattle to cover zoonotic and mastitis pathogens, and a national framework on antifungal medication use and resistance surveillance. Several Standard Operating Procedures (SOPs) for AMR surveillance implementation were established based on the developed protocols. Assessment of capacity was done in human and animal health laboratories. As a result, the National Public Health Laboratory (NPHL) and Central Veterinary Laboratory (CVL) were designated reference laboratories for AMR surveillance in humans and animals, respectively. In addition, 25 human and 11 animal health laboratories were considered suitable for culture and antimicrobial susceptibility testing. Of these, ten human laboratories and five animal laboratories were enrolled to carry out AMR surveillance. These laboratories were renovated and supplied with essential equipment for storage, testing, isolate identification and antimicrobial susceptibility testing. At present, two GLASS priority samples (blood and urine) are currently prioritised for AMR surveillance in humans. The laboratories selected for implementation of AMR surveillance in Tanzania received training, mentorship, and supportive supervision of AMR activities. In the animal health sector, a total of nine training courses, six on basic AMR surveillance and three on AMR data management, were conducted at the CVL and zonal laboratories in Mwanza, Arusha, SUA, and Iringa. In the human health sector, more than ten training sessions were conducted, including basic microbiology, AMR data quality, forecasting and quantification of microbiological commodities, sample and data management, biosafety and biosecurity. In addition, the AMR surveillance sites received quarterly mentorship and supportive supervision supported by AMR implementing partners. A master list of materials, reagents, and items for AMR surveillance is required for AMR activities to run smoothly. Laboratory supply master lists and supply chain mechanisms such as electronic Logistic Information Management Systems (e-LIMS) has been developed in the human sector. A master list and SOPs for monitoring supplies has also been developed in the animal sector, although this information is not captured electronically. Laboratory personnel working in the human and animal health sectors have been trained. In addition, in these sectors, support for implementing an external quality assurance (EQA) scheme, which covers AMR priority pathogens and samples, has been provided. The National Public Health Laboratory participates in EQA programs provided by NICD-South Africa and EQuAFRICA twice a year. NPHL also serves as an EQA service provider for Tertiary and Referral Regional Hospitals with the capacity to perform culture and antimicrobial susceptibility testing in the country, including AMR surveillance sentinel sites. Regarding the animal health sector, EQA on AMR is carried out by the Tanzania CVL, which acts as a national reference laboratory, and selected TVLA zonal laboratories (Arusha and Iringa) as well as Sokoine University of Agriculture (focusing on surveillance) and EQuAfrica as the EQA provider. Existing studies in Tanzania are showing overarching drivers for AMR in the health care settings and communities requiring holistic interventions involving the whole system as shown in the figure 3 below: 8 National Action Plan on Antimicrobial Resistance 2023 - 2028 Figure 3: Drivers of resistance in healthcare settings and community level Specific surveillance systems exist in the animal and human health sectors. In the human health sector, sentinel hospitals for AMR surveillance are: Muhimbili National Hospital, Bugando Medical Centre, Benjamin Mpaka Zonal Referral Hospital (ZRH), Mbeha ZRH, Kilimanjaro Christian Medical Centre, Morogoro Regional Referral Hospital (RRH), Maweni RRH, Mnazi Mmoja Hospital and Temeke RRH. These hospitals report AMR data to the NPHL. National aggregated data is shared with the Global Antimicrobial Resistance Surveillance System (GLASS) after being approved by the MCC. In the animal health sector, AMR data from sentinel sites including Sokoine University of Agriculture, Mwanza Tanzania Veterinary Laboratory Agency (TVLA), Arusha TVLA and Central Veterinary Laboratory (CVL) is are submitted to the at CVL. The aggregated animal health data is sent to the DVS to be reported to the World Organization for Animal Health (WOAH). Tanzania successfully submitted AMR data to WHO - GLASS in 2020 (n=7926) and in 2021 (n=21957), with an overall 46.9% increase. The predominant isolates in the two samples were Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus (figure 4 below). 9National Action Plan on Antimicrobial Resistance 2023 - 2028 Figure 4: Percentage increase in the total number of samples submitted from sentinel hospitals to the NPHL which were validated and submitted to WHO-GLASS (July – December 2020, and January – December 2021). N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 10Ta bl e 1. P er ce nt ag e of s us ce pt ib le p at ho ge ns f ro m u ri ne a nd b lo od s am pl es b et w ee n Ja nu ar y an d D ec em be r 20 21 11National Action Plan on Antimicrobial Resistance 2023 - 2028 Although Tanzania has not developed a national multi - sectoral research agenda, some academic and research institutions/organizations in the human and animal health sectors, like NIMR, SUA, MUHAS, and SACIDS, have research agenda and strategies that include AMR and One Health. The need to have a national research agenda and clear guidelines for combating AMR is still high. Sharing research findings is a crucial way to inform policy makers. One of the ways to do this is through organizing and conducting National AMR scientific conferences and symposia. Specific National AMR symposia were conducted in April 2017 and November 2022. In addition, several AMR conferences and symposia have been held by some institutes including NIMR, TVA, and academic institutions through scientific symposia and conferences. However, most shared AMR information was from the human and animal health sectors. Other sectors still have no systems for sharing information obtained through AMR research. National reference laboratories for human and animal health host AMR data repositories and bio-banks related to support surveillance activities sustainably. Establishing a national multi-sectoral AMR data repository and bio-bank center is in progress. The Tanzania AMR Surveillance framework is centered at tertiary hospitals and a few selected RRHs. During the implementation of the NAP-AMR (2017-2022), the SNAP-AMR project conducted a research on the feasibility of cascading these initiatives to district hospitals by providing laboratory diagnostic infrastructures and human capacity development. A total of 2316 patients were enrolled between June 2019 and June 2022 in five hospitals (Bugando Medical Center, Sekou Toure RRH and three district hospitals). Resistance to the third generation cephalosporins among Gram negative bacteria isolated from patients with blood stream infection, skin and soft tissue infection and urinary tract infection was low in the 3 district hospitals in compared to Sekou Toure RRH and Bugando Medical Center underscoring a need to have health care facility tier’ specific treatment guidelines. DHS RRH ZRH Blood 12.5 52.4 47.3 Pus 11.4 36.4 56.2 Urine 9.7 8.3 45.9 0 10 20 30 40 50 60 Pr op or tio n (% ) o f 3 rd g en er at io n Ce ph al os po rin re sis ta nc e in G ra m n eg at iv e ba ct er ia Figure 5: Antimicrobial resistance patterns of Gram negative in the cascade of referral health care systems in Mwanza, Tanzania (n = 2,316). DHS – District Hospitals, RRH – Regional Referal Hospital, ZRH – Zonal Referal Hospital. Source: The Supporting National Action Plan on AMR (SNAP-AMR) Technical Report to the MCC, October 2022. 12 National Action Plan on Antimicrobial Resistance 2023 - 2028 2.4. Reduce the Incidence of Infection Through Effective Sanitation, Hygiene, and Infection Prevention Measures, and On-farm Biosecurity Better hygiene and infection prevention measures are essential to limit the development and spread of antimicrobial resistant infections and multi-drug resistant pathogens. The third strategic objective recognizes the importance of reducing the incidence of infection through sanitation, hygiene and infection prevention measures. A revised Standard Based Management – Recognition (SBM-R) tool for IPC supportive supervision has integrated in an Afya Supportive Supervision digital tool. The SBMR tool has been used in Tanzanian health facilities for supportive supervision and assessment, and recognizing best performance in health facilities since 2004. The tool has been revised with IPC standards and assessment criteria and is now more comprehensive and inclusive of all levels of health care delivery in human health. It has also been integrated in the MOH digital platform for supportive supervision (Afya SS). The IPC guidelines have also been revised in line with WHO guidelines, and SOPs to assist in the implementation of IPC have been formulated, printed and disseminated. An IPC curriculum and training package has been developed and integrated into the national e-learning platform at the Center for Distance Education based in Morogoro. This guideline has now been accredited for Continuous Professional Education. Using this IPC guideline, mentorship was provided and training was conducted in two (2) national hospitals, three (3) zonal hospitals, 26 regional referral hospitals, 49 district hospitals, 62 health centers and eight (8) dispensaries. A total of 4883 health care workers have been trained using the training package as well as the SBMR tool. A protocol for Health Care Associated Infections (HAIs) and surveillance tools for surgical site infections (SSIs) has been developed and disseminated to 136 health facilities. IPC key indicators have been developed, integrated in DHIS2 and disseminated to health care workers. Health facilities and councils have begun submitting reports based on these indicators. From the Animal Health side, Regulations regarding import, export and registration of animal feeds were developed in 2020. The Animal Disease Vaccine and Vaccination Regulation 2020 was prepared and enacted. Annual vaccination calendars for 13 priority animal diseases have been developed, with vaccination for those diseases made mandatory. Furthermore, the Animal Disease (Acaricide Application and Management) Regulation 2020 was prepared, according to which dipping is mandatory. A total of 277 new dip tanks have been constructed and 854 dip tanks rehabilitated. Further achievements included the procurement and distribution of 45,112.78 liters of acaricides and the dipping (michovyo) of 1,172,558,935 animals. To strengthen dipping programs, a dipping guideline was formulated and disseminated to all 185 LGAs. In addition, 1,883 animal dip tank committees have been established and operationalized. Vaccination guidelines have been prepared and disseminated. Animal vaccination programs have been carried out to cover the following: Peste des Petits Ruminants (PPR) [13,928,484]; Contagious Bovine Pleuropneumonia (CBPP) [50,297,290]; Contagious Caprine Pleuropneumonia (CCPP) [182,000]; Anthrax [7,349,953]; Brucellosis [543,113]; Rabies [4,323,135]; Foot-and-Mouth Disease (FMD) [2,551,011]; and Newcastle disease (ND) [406824819]. Availability of vaccines has been enhanced through facilitation by the Tanzania Vaccines Institute (TVI) that is equipped with a new building for production of bacterial vaccines. Strengthening National Linkages and Partnership for IPC has been achieved in Secondary school in Morogoro, Njombe and Iringa regions where teachers were taught how to prevent HIV among adolescent children when some component of IPC especially in relation to HIV was done. Also, during COVID-19 pandemic, communities were sensitized to wear masks, practice social distancing in public places, transport facilities as well as through partial lockdown. Hand washing/sanitization was insisted in all public places. Communities 13National Action Plan on Antimicrobial Resistance 2023 - 2028 have been educated about burials and bereavements as per IPC guidelines. Waste collection points for masks and other waste were installed in public places. Local expert participated in revising the global document of codex Alimentarius organized by FAO. 2.5 Optimize the Use of Antimicrobial Agents in Human, Animal and Plant Health Health care facilities cannot operate without medicines, and a significant proportion of health care expenditures is most often committed to procuring medicines (which include antimicrobials). Rational use of antimicrobial agents is critical in ensuring appropriate utilization of resources, prevention of harmful effects related to misuse of antimicrobials, prevent development of AMR and ultimately increase longevity of antimicrobial agents. Given the escalating burden of AMR, it is therefore, pertinent to closely monitor antimicrobial consumption and use in human, animal and plant sectors in conformity with the policy, regulations and guidelines. A total of seven policies, laws and guidelines on the use of antimicrobial agents in humans, animals, agriculture and fisheries were developed and disseminated for utilization during the NAP-AMR (2017-2022) implementation: They include: i. Standard Treatment Guidelines/National Essential Medicine List (which includes also AWaRe categorization of antibiotics), 6th Edition 2021. ii. Standard Treatment Guidelines for Animal Diseases, 2022 iii. Policy Guideline for Implementation Antimicrobial Stewardship, June 2020 iv. The Animal Diseases (Vaccine and Vaccination) Regulation, 2020 v. The Animal Diseases (Acaricides Application and Management) Regulation 2019 vi. The Pharmacy (Prescription Handling and Control) Regulation, 2020 vii. The Grazing-Land and Animal Feed Resources (import and Export of Animal Feed Resources) Regulations, 2021 vii. The Grazing-Land and Animal Feed Resources (Registration and Movement of Animal Feed Resources and products) Regulations, 2021. Tanzania has successfully enrolled a total of 16 hospitals in the AMS program (10 under Ministry of Health and MTaPS program; 3 under Ministry of Health-WHO Program); and three under other programs. Evaluation of AMS implementation activities has successfully been done in the human sector using ten AMS core elements indicators (six WHO indicators and three Ministry of Health additional indicators) involving tertiary hospitals and RRHs. The overall AMS performance ranged from 40% to 84%. The antimicrobial stewardship program has been established through training of 18 MoH staff and Subject Matter Experts. Training packages on AMS, STG/NEMLIT and MTC, development of Hospital Formulary, and Professional Ethics on prescribing and dispensing of antibiotics have been developed. A total of 12 trainings involving 240 healthcare workers (doctors, pharmacists, nurses, and laboratory experts from 51 hospitals (14 Tertiary – National/ tertiary hospitals and RRHs/ Special), 28 RRHs and 141 Primary level health facilities (District/Council Hospitals, Health Centers and Dispensaries). These trainings were conducted by the MoH – WHO, MoH – USAID MTaPS, MoH-USAID MTaPS-Mzumbe University ECHO Virtual Sessions, FROHUN, and HPSS-Swiss TPH. 14 National Action Plan on Antimicrobial Resistance 2023 - 2028 To facilitate consistency in the development of Hospital Formulary across hospitals, the Ministry of Health developed Tanzania Hospital Formulary Template, July 2022. The MoH has also piloted training on the development of Hospital Formulary in 9 council/district hospitals in Mtwara region in August 2022. This is anticipated to assess the feasibility of hospital formulary at primary levels. The training on professional ethics on proper use of preserved antimicrobial agents (prescribing and dispensing of antibiotics) has been conducted in 14 Tertiary and 28 RRHs involving 240 clinicians, nurses and pharmaceutical and laboratory personnel; and in 141 primary level health facilities (District/Council Hospitals, Health Centers and Dispensaries) in Dodoma region involving. Antimicrobial use surveys were conducted in human and animal’s sectors. A total of thirteen surveys on antimicrobial prescription/use were conducted (12 in human and 1 animal sector) using standardised methodologies. Of these, nine are publications in peer reviewed journal, and four are technical reports. The methodology deployed were WHO PPS (n=4), Global PPS (n=2), WHO INRUD (n=2), and locally customised methods (n=5). The animal survey on antibiotic use was conducted in four out of 184 (2.2%) district councils and followed WOAH methodology. The WHO PPS study conducted in six tertiary hospitals and RRHs (2020), indicated that antibiotics were used in 62.3% of admitted patients (n = 948). Antibiotics were used predominantly on children and surgical patients and they were largely in the Access group (97.9%). Use of culture and antimicrobial susceptibility testing to inform treatment remained extremely low (Seni et al., 2020)2 The WHO-PPS in targeted hospitals showed that despite high antibiotic usage among admitted patients (62.3%), Tanzania is still conforming to the WHO targets in the AWaRe Categorization of antibiotics. For example, utilization in the Access group was 97.9% (WHO target>62.0%), Watch group: 1.8% (WHO target: <28.0%) and Reserve group: 0.3% (WHO target<12.0%). Lastly, the National Standard Prescription was disseminated to all hospitals and is in use. Table 2 below compare key performance indicators of AMS interventions in Dodoma region. 2 Seni, J., et al., 2020. Antimicrobial use across six referral hospitals in Tanzania: a point prevalence survey. BMJ Open 10, e042819. https://doi.org/10.1136/bmjopen-2020-042819 15National Action Plan on Antimicrobial Resistance 2023 - 2028 Table 2: Comparison of the Key Performance Indicators at the Baseline (2012) and post intervention (2021) in Dodoma Region using WHO-INRUD Facility indicators (N=132) 2012 2021 p-value Availability of NEMLIT 49% 74% p-value<0.001 Availability of STG 49% 83% p-value<0.001 Prescription Indicators (n-4150) 2012 2021 p-value Average number of prescribed medicines per patient per encounter 1.9 2.2 NS* Medicines prescribed which were dispensed 78% 75.3% NS* Medicines prescribed from STG/NEMLIT 98% 91% NS* Antibiotics prescribed 66% 81% p-value<0.001 Medicines prescribed as generics 97% 64% p-value<0.001 Percentage of injections 9% 14% p-value<0.001 Patient care indicators (n=1254) 2012 2021 p-value Average consultation time 4.2 min 8.9 min NS* Average dispensing time 39 sec 106 sec NS* Adequate labelling of prescriptions 1% 2.2% NS* Source: Health Promotion and System Strengthening (HPSS)-Swiss TPH Technical Report in Dodoma region., July 2022 NS*: Statistically not signifi cant A study assessed national antimicrobial consumption rates in the human sector between 2017-2019 (Mbwasi et al., 20203 ) indicated a decrease in consumption of antibiotics from 136.4 defi ned daily dose (DDD) in 2017 to 55.0 and 51.0 in 2018 and 2019, respectively (Figure 6). Doxycycline, amoxicillin, and trimethoprimsulfamethoxazole were the most frequently consumed antibiotics during these years, accounting for 20.01, 16.75, and 12.42 DDD/1,000/D, respectively. Based on WHO AWaRe classifi cation >90% of antibiotic consumption was Access group, with Watch and Reserve class medications accounting for <10% and <1%, respectively. Figure 6: Reduction of DDD per 1000 population between 2017 –2019 in Tanzania (Mbwasi et al., 2020) 3 Mbwasi, R., et al., 2020. National Consumption of Antimicrobials in Tanzania: 2017–2019. Frontiers in Pharmacology 11 16 National Action Plan on Antimicrobial Resistance 2023 - 2028 A survey on consumption trend of veterinary antimicrobial in three years (2017-2019) showed that, a total of 20,693 tons were imported and tetracycline was the most antimicrobial group imported (Figure 7 below). ANTIMICROBIAL GROUPS IMPORTED 2017 - 2019 30% 24% 22% 13% 11% 6% 5% 5% 4% 3% 2% 20% 10% 0% Tetracyclines Anthelminthics Antiprotozoas Combination of antiprotozoa agents Beta-lactam antibacterials, penicillins, combinations with other antibacterials Combinations of sulphonamides and Trimethoprim Combinations of antimicrobials Combination of antimicrobial and other agents Figure 7: Consumption trends of veterinary antimicrobial in three years (2017-2019) As per WHO AWaRe categorization, the the importation of Watch antibiotic in the animal sector has steadily increased over the years. In 2017 the Watch antibiotic imported were streptomycin and neomycin. In 2019, products containing Watch antibiotic included streptomycin, neomycin, norfloxacin and kanamycin. Also, the importation of Reserve antibiotics as veterinary drugs has steadily increased over the years e.g. the number of veterinary drug formulations containing colistin rose from one in 2017 to four in 2019. Limited quantitative studies assessing antimicrobial residues have been conducted and published in Tanzania (Mwankuna et al., 20224 ). This gap is recognized, especially in relation to food products (Mdegela et al., 20205 ). To date, antimicrobial agents for testing residuals in different samples have been identified and included in the National Antimicrobial Resistance Surveillance Framework. These include five classes of antibiotics, namely tetracyclines, cephalosporins, aminoglycosides, sulfonamides, and macrolides. 2.6 Develop the Economic Case for Sustainable Investment While acknowledging vast arrays of achievements, gaps and challenges attained during the implementation of the NAP-AMR (2017-2022), there are cross-cutting and overarching drivers of health inequalities which adversely impact on the burden of AMR requiring One Health Approach to be addressed (Figure 6). Similarly, availability of human resources, material resources (like diagnostic infrastructures and uninterrupted supplies of commodities for NAP-AMR implementation) and financial resources are required to be effectively and efficiently harnessed and coordinated to maximize attained of NAP-AMR implementation targets (Figure 8,9,& 10). 4 Mwankuna, C.J., et al., 2022. A HPLC-MS/MS method for screening of selected antibiotic adulterants in herbal drugs. Anal. Methods 14, 1060–1068. https://doi.org/10.1039/D1AY01966J 5 Mdegela, R.H., et al., 2021. Antimicrobial Use, Residues, Resistance and Governance in the Food and Agriculture Sectors, Tanzania. Antibiotics 10, 454. https://doi.org/10.3390/antibiotics10040454 17National Action Plan on Antimicrobial Resistance 2023 - 2028 Figure 8: Drivers of Health Inequalities in Tanzania and Globally 18 National Action Plan on Antimicrobial Resistance 2023 - 2028 Figure 9: Human resource capacity in various AMR related fields from Fleming Fund support (n=26) Figure 10: Improved Laboratory Capacity for Testing (A) Installed VITEK MS for pathogen identification, (B) Installed VITEK 2 COMPACT for AST 19 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 2. 7 A na ly si s of S tr en gt hs , W ea kn es se s, O pp or tu ni ti es a nd T hr ea ts in t he I m pl em en ta ti on o f N A P A M R Th e st re ng th s, w ea kn es se s, o pp or tu ni tie s an d th re at s in t he im pl em en ta tio n of N AP A M R 2 02 3 20 28 a re s um m ar iz ed in t ab le 3 b el ow . Ta bl e 3: S W O T A na ly si s M at ri x St re ng th s W ea kn es se s G ov er na nc e: • Po lic ie s, la w s an d re gu la tio ns in p la ce a t th e na tio na l l ev el • M CC fo r AM R , S ec re ta ria t, a nd f ou r TW G s in p la ce • Cl ea r co m m un ic at io n ch an ne ls w ith in a nd b et w ee n re sp on si bl e m in is tr ie s • G oo d re la tio ns hi ps w ith U N a ge nc ie s, a nd lo ca l a nd in te rn at io na l c ol la bo ra tin g pa rt ne rs A w ar en es s an d ed uc at io n: • Ex is tin g AM R t ra in in g, a w ar en es s an d co m m un ic at io n m at er ia ls • Ex is tin g of lo ca l N G O s re sp on si bl e fo r AM R a w ar en es s • An nu al W AA W c om m em or at io n • Av ai la bi lit y of A M R c om m un ic at io n st ra te gy • Av ai la bi lit y of e le ar ni ng p la tf or m s fo r AM R , A M S an d IP C in t he h um an s ec to r • Tr ai ni ng c ur ric ul a re vi ew ed in u ni ve rs iti es a nd t ec hn ic al in st itu tio ns t o in cl ud e AM R Fi na nc ia l r es ou rc es : • Pa rt ne rs ’ c om m itm en t to s up po rt N AP A M R r el at ed a ct iv iti es Te ch ni ca l c ap ac it y: • Ex is te nc e of A M R s ur ve ill an ce , A M S an d IP C gu id el in es a nd p ro to co ls re la te d to h um an a nd an im al h ea lth • Av ai la bi lit y of s ub je ct m at te r ex pe rt s in a ll TW G s • La bo ra to rie s im pl em en tin g AM R s ur ve ill an ce e nr ol le d an d ac tiv e in E Q A pr og ra m s Im pl em en ta ti on o f N A P A M R a ct iv it ie s: • N at io na l a nd in te rn at io na l c ol la bo ra tio ns o n go in g an d in d ev el op m en t to im pl em en t an d ev al ua te N AP A M R a ct iv iti es M on it or in g an d da ta : • A w ea lth o f pu bl is he d bi om ed ic al a nd s oc ia l-s ci en ce d at a on A M R in h um an s an d an im al s he al th a va ila bl e • In co rp or at io n of I PC in di ca to rs in D H IS 2 • En ro lm en t in W H O G LA SS f or A M R a nd A M C/ AM U d at a • Ex is te nc e of te n an d si x se nt in el s ite s fo r h um an a nd a ni m al h ea lth m on ito rin g, re sp ec tiv el y G ov er na nc e: • La ck o f en fo rc em en t of p ol ic ie s, la w s an d re gu la tio ns a t su b na tio na l l ev el A w ar en es s an d ed uc at io n: • La ck o f sy nt he si s of K AP B st ud ie s • La ck o f A M R a nd I PC tr ai ni ng a nd m at er ia ls b as ed o n Ta nz an ia n da ta a nd c on te xt • Pu bl ic c am pa ig ns d o no t al w ay s ta ke a cc ou nt o f lo ca l c on te xt a nd c on st ra in ts • In ad eq ua te p la nn in g an d ev al ua tio n of c om m un ic at io n ca m pa ig ns • La ck o f tr ai ni ng c ur ric ul a on A M R a t pr im ar y an d se co nd ar y sc ho ol le ve ls Te ch ni ca l c ap ac it y: • La ck o f AM R s ur ve ill an ce g ui de lin es a nd p ro to co ls r el at ed t o fo od s af et y, p la nt an d en vi ro nm en ta l h ea lth • La ck o f on f ar m b io se cu rit y gu id el in es a nd p ro to co ls M on it or in g an d da ta : • In co m pl et e da ta o n AM R re la te d m or bi di ty , m or ta lit y an d ot he r he al th o ut co m es • La ck o f da ta o n ec on om ic im pa ct s of A M R • Li m ite d da ta o n fo od s af et y, p la nt a nd e nv iro nm en ta l a sp ec ts o f AM R • Li m ite d AM R a nd A M U d at a sh ar in g m ec ha ni sm s w ith in a nd b et w ee n in st itu tio ns an d se ct or s • Im pl em en ta tio n of h um an A M R s ur ve ill an ce o n tw o pr io rit y sa m pl es o nl y (b lo od an d ur in e) 20 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 O pp or tu ni ti es C ha lle ng es G ov er na nc e: • Be tt er in te gr at io n w ith O ne H ea lth C oo rd in at io n de sk u nd er P M O • Pr of es si on al b od ie s/ co un ci ls a va ila bl e an d re sp on si bl e fo r CP D s A w ar en es s an d ed uc at io n: • AM R fo ca l p oi nt s to h el p co or di na te c om m un ic at io n ac tiv iti es • SN AP A M R S ta ge d Lo gi c M od el s en si tiz ed t o he lp p la nn in g of c am pa ig ns • Pr of es si on al b od ie s/ co un ci ls t o he lp g ui de t he d el iv er y of C PD • In te rn at io na l o rg an iz at io ns ( W H O , F AO , W O AH , U N EP ) co m m itm en t to s up po rt A M R aw ar en es s an d ed uc at io n • O pp or tu ni tie s to im pr ov e pa tie nt p ro vi de r co m m un ic at io n th ro ug h tr ai ni ng a nd se ns iti za tio n : Im pl em en ta ti on o f N A P A M R a ct iv it ie s: • O pp or tu ni tie s to b ui ld n ew a nd e xi st in g pa rt ne rs hi ps fo r im pl em en ta tio n an d ev al ua tio n of N AP A M R a ct iv iti es M on it or in g an d da ta : • O pp or tu ni tie s fo r in te gr at ed d is ea se s ur ve ill an ce a nd r es po ns e A w ar en es s an d ed uc at io n: • Li m ite d re so ur ce s fo r aw ar en es s an d ed uc at io n m at er ia ls • U nf av or ab le c on te xt f or b eh av io ur c ha ng e an d re si st an ce t o ch an ge • Ch al le ng es in p at ie nt p ro vi de r co m m un ic at io n Fi na nc ia l r es ou rc es : • In ad eq ua te fi na nc ia l r es ou rc es f or A M R a ct iv iti es Te ch ni ca l c ap ac it y: • Li m ite d hu m an r es ou rc es f or im pl em en ta tio n of N AP A M R r el at ed a ct iv iti es Im pl em en ta ti on o f N A P A M R a ct iv it ie s: • Re lia nc e on in te rn at io na l p ar tn er fu nd in g cy cl es a nd p rio rit ie s fo r im pl em en ta tio n IMPLEMENTATION PLAN FOR THE NAP-AMR 2023-2028 Six key strategic Objectives and the system Reduce the incidence of infections Strengthen capacity for AMR surveillance and research 23National Action Plan on Antimicrobial Resistance 2023 - 2028 STRATEGIC OBJECTIVE ONE STRENGTHEN COORDINATION, COLLABORATION AND GOVERNANCE Effective multisectoral coordination and collaboration require an effective governance structure across sectors. Key drivers and consequences of bacterial, viral, parasitic and fungal resistance to antimicrobial medicines are felt across the human and animal health, as well as the agriculture and environment sectors. Interventions to tackle antimicrobial resistance must be addressed in all these sectors through a coordinated One Health and multi-sectoral collaboration which in turn will be translated to sector-specific actions. Sector-specific activities and planning should be undertaken within each sector, acknowledging the need for collaborative work between sectors. Therefore, for the effective implementation of the National Action Plan on Antimicrobial Resistance 2023- 2028, a well-designed multi-sectoral coordination and collaboration structure presently existing at national level will be strengthened while cascading implementation of activities at sub-national levels. National Multisectoral Coordinating Committee (MCC) MCC Secretariat TWG Awereness and Education Sub National Sub National Sub National Sub National Sub National TWG AMR Serveillance TWG IPC TWG Antimicrobial Stewardship TWG M & E Figure 11: National Antimicrobial Resistance Governance Structure 3.1 The National AMR Multi-Sectoral Coordinating Committee (MCC) Like other countries, the National Multi-Sectoral Coordinating Committee (MCC) on AMR remains the central National Steering Body and shall oversee and coordinate all AMR related activities in the country. The AMR Action plan operations shall be managed and implemented through the MCC under the Chairmanship of the Chief Medical Officer and Co-chaired by the Director of Veterinary Services. Members of the MCC shall include representatives from sectors responsible for human and animal health, food safety production and the environment. Membership also includes Development Partners and International Organizations’ including the World Health Organization (WHO), Food and Agriculture Organization (FAO), Centre for Disease Control and Prevention (CDC), World Organization for Animal Health (WOAH) and the United Nations Environmental Programme (UNEP). 24 National Action Plan on Antimicrobial Resistance 2023 - 2028 The multi-sectoral coordinating committee plays a convening role in the involvement of all sectors including: public, private, academia, civil society, etc., as these groups have a crucial role in implementing and scaling up the NAP. In addition, it links with other relevant national/subnational committees. The terms of reference for the MCC is attached as appendix II. 3.2 The National AMR Multi-Sectoral Coordinating Committee Secretariat The MCC needs to be supported by a dedicated multidisciplinary Secretariat. The MCC Secretariat shall coordinate meetings and support effective coordination and communication with all AMR stakeholders. The office for the MCC Secretariat needs to be established equipped and funded to enable it carry out its functions effectively. The members of the Secretariat will be nominated and approved by the MCC. The terms of reference for the MCC Secretariat are attached (appendix III). 3.3 Antimicrobial Resistance Focal Point The AMR focal point for the health sector remains the Pharmaceutical Services Unit and the Directorate of Veterinary Services for animal sector. Also, other sectors may appoint a focal point for coordination of AMR activities. The terms of reference for AMR focal points is are attached as appendix IV. 3.4 Technical Working Groups Five technical working groups will be strengthened to support and advise the MCC. The TWGS were established in the previous NAP and are based on the strategic objectives. However, for this edition of the NAP, the research agenda as a cross cutting issue, will be included in the terms of reference for each TWG. The TWGs comprise members who represent relevant sectors, including (but not limited to) human health; animal health; agriculture; food safety; education; environment, water, sanitation and hygiene (WASH). The MCC shall appoint Chairpersons for the five TWGs. Membership to TWGs will be nominated and approved by the MCC. The five technical working groups are as listed below: i. AMR Awareness, effective communication and Education. ii. Antimicrobial Surveillance. iii. Hygiene and Infection Prevention and Control. iv. Antimicrobial Stewardship. v. Sustainable investment, Monitoring and Evaluation. The terms of reference for the TWGs are attached as appendixes V, VI, VII, VIII and IX. 3.5 AMR Coordination at Sub-national levels The governance structure for the implementation of NAP AMR at the sub-national level is insufficiently established with a perspective of the one health approach. At sub national level, AMR focal persons shall be appointed for specific sectors. Furthermore, the established health committees at Regional, Council and Ward levels shall be used to coordinate and collaborate with key stakeholders in the implementation of the National Action Plan on AMR 2023-2028. Membership to the committees shall consider one health approach in tackling AMR. In that regard, it is recommended to co-opt other members whenever AMR agenda will be tabled. The terms of reference for establishing AMR structure at sub national level shall be developed after an assessment. 25National Action Plan on Antimicrobial Resistance 2023 - 2028 3.6 Capacity building for effective coordination and governance on AMR Leadership and managerial skills are needed to promote collaboration and coordinate the sustainable implementation of AMR NAPs within and across sectors and stakeholders. The MCC in collaboration with stakeholders shall perform a training needs assessment and eventually prepare a training package to enhance multisectoral coordination and governance including: i. Building trust and promoting transparency in implementing NAP-AMR. ii. Promoting ethics, values, accountability and equity on antimicrobial use and resistance. iii. Mapping influence and persuasion goals, and understanding specific coalitions, their value, and how to influence them and work with partners towards mutual gains. iv. Structuring commitments and managing alternatives for ongoing evaluation of multisectoral partnerships. 26 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 O pe ra ti on al P la n fo r C oo rd in at io n, C ol la bo ra ti on a nd G ov er na nc e P R IO R IT Y A C TI O N : C O O R D IN A TI O N , C O LL A B O R A TI O N A N D G O V ER N A N C E O be je ct iv e 1. 1 To s tr en gt he n co or di na ti on , c ol la bo ra ti on a nd g ov er na nc e fo r th e im pl em en ta ti on o f A M R I nt er ve nt io n 1. 1. 1 E st ab lis h an d st re ng th en g ov er na nc e st ru ct ur es t o ta ck le A M R A ct iv it y: 1 .1 .1 .1 S tr en gt he n an A M R g ov er na nc e st ru ct ur e at n at io na l l ev el Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 1. 1. 1. 1. 1 Es ta bl is h an o ffi ce fo r N at io na l A M R c oo rd in at io n M O H /M LF /M O A 1 1 N at io na l l ev el 20 23 N at io na l AM R o ffi ce es ta bl is he d 20 ,0 00 ,0 00 G ov / Pa rt ne rs 1. 1. 1. .1 .2 C on ve ne q ua rt er ly M CC m ee tin gs M CC S ec re ta ria t 1 20 N at io na l 20 23 2 02 8 m in ut es a nd pr oc ee di ng s 4 98 ,2 66 ,1 70 G ov / Pa rt ne rs 1. 1. 1. 1. 3 Co nv en e qu ar te rly AM R T W G s m ee tin g TW G s 5 20 N at io na l 20 23 2 02 8 m in ut es a nd pr oc ee di ng s 11 0, 79 3, 82 9 G ov / P ar tn er s 1. 1. 1. 1. 4 Co nv en e bi an nu al AM R S ub T W G m ee tin g TW G s/ Su b TW G 5 10 N at io na l 20 23 2 02 8 m in ut es a nd pr oc ee di ng s 36 ,7 06 ,0 25 G ov / P ar tn er s 1. 1. 1. 1. 5 Re cr ui t co m pe te nt pe rs on ne l t o fa ci lit at e AM R co or di na tio n M CC S ec re ta ria t 3 5 N at io na l 20 23 2 02 8 H R r ep or ts 12 2, 42 4, 12 0 G ov / P ar tn er s 1. 1. 1. 1. 6 Eq ui p th e of fic e fo r N at io na l A M R c oo rd in at io n M CC S ec re ta ria t 1 5 N at io na l 20 23 2 02 8 H R R ep or ts 11 8, 98 8, 94 0 G ov / P ar tn er s 1. 1. 1. 1. 7. P ro cu re a n of fic e ca r M CC S ec re ta ria t 1 1 N at io na l 20 24 Pr oc ur em en t re po rt 10 1, 00 0, 00 0 G ov / P ar tn er s A ct iv it y: 1 .1 .1 .2 . Es ta bl is h an A M R g ov er na nc e st ru ct ur e at S ub n at io na l l ev el Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 1. 1. 1. .2 .1 E st ab lis h AM R co or di na tio n m ec ha ni sm a t su b na tio na l l ev el M oH /M LF /M O A/ PO R AL G 1 1 Su b na tio na l 20 23 Te rm s of Re fe re nc e 0 G ov / P ar tn er s 1. 1. 1. 2. 2 N om in at e AM R F oc al Pe rs on s at R eg io na l a nd C ou nc il le ve ls M oH /M LF /M O A/ PO R AL G 1 1 Su b na tio na l 20 23 Ap po in tm en t le tt er s w ith To R s 46 ,1 64 ,0 95 G ov / P ar tn er s 1. 1. 1. 2. 3 Co nv en e bi an nu al AM R c oo rd in at io n m ee tin g at su b na tio na l l ev el a nd s ub m it re po rt t o M CC M oH /M LF /M O A/ PO R AL G 2 5 Su b na tio na l 20 23 2 02 8 m in ut es a nd pr oc ee di ng s 2 76 ,4 74 ,4 71 G ov / P ar tn er s 27 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 1. 1. 1. 2. 4 Re gu la r A M R a nd A M C da ta a na ly si s an d re po rt in g TW G 2 5 N at io na l 20 23 2 02 8 D at a an al ys is re po rt . 22 9, 54 5, 22 5 G ov / Pa rt ne rs A ct iv it y: 1. 1. 1. 3. C on du ct t ra in in g on A M R , O ne H ea lt h, g ov er na nc e an d co or di na ti on Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 1. 1. 1. 3. 1. C on du ct n ee d as se ss m en t on g ov er na nc e, co or di na tio n at n at io na l a nd su b na tio na l l ev el s M CC S ec re ta ria t 1 8 N at io na l / Su b 20 23 As se ss m en t re po rt 83 ,7 60 ,0 00 G ov / Pa rt ne rs 1. 1. 1. 3. 2. P re pa re t ra in in g m at er ia l f or A M R c oo rd in at io n an d go ve rn an ce M CC S ec re ta ria t 1 1 N at io na l / Su b 20 23 Tr ai ni ng m at er ia ls 7 8, 69 4, 41 0 G ov / Pa rt ne rs 1. 1. 1. 3. 3. C on du ct t ra in in g fo r N at io na l an d su b na tio na l AM R co or di na tio n le ad er s M CC S ec re ta ria t 3 1 N at io na l / Su b 20 23 2 02 8 Tr ai ni ng r ep or t 13 8, 02 4, 08 5 G ov / Pa rt ne rs 1. 1. 1. 3. 4. P ar tic ip at e in N at io na l, Re gi on al a nd in te rn at io na l m ee tin gs / w or ks ho ps /s ci en tifi c co nf er en ce s M CC S ec re ta ria t 4 5 N at io na l 20 23 2 02 8 M ee tin g/ W or ks ho p re po rt 22 9, 54 5, 22 5 G ov / Pa rt ne rs In te rv en ti on 1 .1 .2 S tr en gt he n co m m un ic at io n an d co lla bo ra ti on s on A M R 1. 1. 2. 1 D ev el op a w eb b as ed p or ta l t o sh ar e A M R s ur ve ill an ce p ub lic at io n an d ot he r in fo rm at io n Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 1. 1. 2. 1. 1 Co nd uc t co or di na tio n m ee tin gs t o de ve lo p a w eb ba se d po rt al M oH 1 3 N at io na l 20 23 M ee tin g re po rt 13 ,0 90 ,2 48 G ov / Pa rt ne rs 1. 1. 2. 1. 2 Id en tif y de ve lo pe r of th e w eb p or ta l M oH 1 1 N at io na l 20 23 To R f or w eb de ve lo pm en t 12 ,2 00 ,0 00 G ov / Pa rt ne rs 1. 1. 2. 1. 3 La un ch in g th e w eb po rt al M oH 1 1 N at io na l 20 23 La un ch in g re po rt 2, 00 0, 00 0 G ov / Pa rt ne rs 1. 1. 2. 1. 4 M ai nt ai ni ng t he w eb po rt al M oH 5 5 N at io na l 20 23 W eb m ai nt en an ce re po rt 10 ,0 00 ,0 00 G ov / Pa rt ne rs 28 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 1. 1. 2. 2 A dv oc at e fo r st ra te gi es t o in cr ea se t he n at io na l b ud ge t co nt ri bu ti on t o O ne H ea lt h A M R in te rv en ti on s Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 1. 1. 2. 2. 1 Co nd uc t m ee tin gs w ith b ud ge t of fic er s fr om re sp on si bl e m in is tr ie s M o H /M L F /V P O / M oA 5 5 N at io na l/S ub na tio na l 20 23 2 02 8 55 ,0 00 ,0 00 G ov / Pa rt ne rs 1. 1. 2. 2. 2. S en si tiz e M em be r of P ar lia m en t to s up po rt A M R ag en da M o H /M L F /V P O / M oA 5 5 N at io na l/S ub na tio na l 20 25 2 02 8 25 0, 00 0, 00 0 G ov / Pa rt ne rs In te rv en ti on 1 .1 .3 M on it or a nd e va lu at e N A P A M R 2 02 3 – 20 28 1. 1. 3. 1 C on du ct b as el in e su rv ey o f N A P A M R 2 02 3 20 28 Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 1. 1. 3. 1. 1 M ee tin g to re vi ew AM R r ep or t of 2 01 7 20 22 M oH /M oL F/ M oA M ee tin g 1 N at io na l 20 23 M ee tin g re po rt 40 ,6 25 ,0 00 G ov / Pa rt ne rs 1. 1. 3. 1. 2 W or ks ho p to d ev el op da ta c ol le ct io n to ol s to c ap tu re ba se lin e re su lts M oH /M oL F/ M oA W or ks ho p 1 N at io na l 20 23 D at a co lle ct io n to ol s w or ks ho p re po rt 22 ,5 00 ,0 00 G ov / Pa rt ne rs 1. 1. 3. 1. 3 Co nd uc t ba se lin e su rv ey M oH /M oL F/ M oA Su rv ey 1 N at io na l 20 23 Fi el d re po rt 22 4, 40 6, 99 4 G ov / Pa rt ne rs 1. 3. 1. 4 Co nd uc t w or ks ho p to an al yz e da ta a nd w rit e ba se lin e re po rt M oH /M oL F/ M oA W or ks ho p 1 N at io na l 20 23 Ba se lin e su rv ey re po rt 45 ,2 13 ,5 00 G ov / Pa rt ne rs 1. 1. 3. 2 C on du ct m on it or in g of N A P A M R 2 02 3 20 28 Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 1. 1. 3. 2. 1. D ev el op M on ito rin g Fr am ew or k fo r an nu al op er at io na l p la n M oH /M oL F/ M oA 1 1 N at io na l 20 23 Tr ai ni ng m at e ria ls 44 ,0 17 ,5 00 G ov / Pa rt ne rs 1. 1. 3. 2. 2 Co nd uc t AM R m on ito rin g M oH /M oL F/ M oA 4 5 N at io na l 20 23 2 02 8 Fi el d vi si t re po rt 24 0, 00 0, 00 0 G ov / Pa rt ne rs 1. 1. 3. 2. 3 Pr ep ar e M & E r ep or t an d su bm it to M CC M oH /M oL F/ M oA 1 5 N at io na l 20 23 2 02 8 M & E r ep or t 0 G ov / Pa rt ne rs 29 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 1. 1. 3. 3 C on du ct e va lu at io n of N A P A M R 2 02 3 20 28 Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 1. 1. 3. 3. 1 Co nd uc t m id te rm ev al ua tio n M oH /M oL F/ M oA 1 1 N at io na l 20 25 Ev al ua tio n re po rt 12 5, 00 0, 00 0 G ov / Pa rt ne rs 1. 1. 3. 3. 2 Co nd uc t en d te rm ev al ua tio n M oH /M oL F/ M oA 1 1 N at io na l 20 28 Ev al ua tio n re po rt 12 5, 00 0, 00 0 G ov / Pa rt ne rs 1. 1. 3. 4 D oc um en t be st p ra ct ic es o f N A P – A M R Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 1. 1. 3. 4. 1 Pr ep ar at io n of t er m s of r ef er en ce ( To R ) to e ng ag e co ns ul ta nt M oH /M oL F/ M oA M ee tin g 1 N at io na l 20 28 To R d oc um en t 0 G ov / Pa rt ne rs 1. 1. 3. 4. 2 Co ns ul ta nt t o pr es en t in ce pt io n re po rt M oH /M oL F/ M oA M ee tin g 1 N at io na l 20 28 In ce pt io n re po rt 36 ,0 60 ,5 35 G ov / Pa rt ne rs 1. 1. 3. 4. 3 Co nd uc tin g do cu m en ta ry o f N AP – A M R 2 02 3 2 02 8 M oH /M oL F/ M oA 1 N at io na l 20 28 D oc um en ta ry re po rt 57 ,0 00 ,0 00 G ov / Pa rt ne rs 30 National Action Plan on Antimicrobial Resistance 2023 - 2028 STRATEGIC OBJECTIVE TWO IMPROVE AMR AWARENESS, COMMUNICATION AND EDUCATION The causes of AMR are complex and different in low-and-middle income countries (LMICs) compared to high-income countries (HICs). Therefore, developing communications around AMR can be challenging and approaches used in certain contexts may not apply to others. Overall challenges around AMR communication relate to the fact that it is a multi-faceted problem spanning a range of health issues, from surgery to the management of chronic diseases, and the treatment and prevention of infectious diseases. Furthermore, AMR is often an invisible problem with multiple drivers and affecting multiple systems, including humans, animal, agriculture and the environment. AMR is still a new concept to explain and understand especially for the public. These complexities can result in conflicting and confusing messages that are not understood. Finally, global messages around AMR sometimes may have limited adaptations to specific local situations and audiences. Therefore, tailoring information to the Tanzanian audiences in human health, animal health, the environment and agricultural practice as well as consumers is essential, and this information should be developed based on the specific context within which it is going to be used. Steps need to be taken to raise awareness of antimicrobial resistance and promote behavioral change, through public communication programmes that target different audiences in human, animal, environmental and plant health. Similarly, there is need to establish AMR knowledge Management and sharing mechanisms at all levels (e.g. Data bases, Websites, symposium etc.). The pandemic left positive legacies that normalized mask usage and handwashing which will help prevent the transmission of many different infectious diseases. Now, there is a need to increase efforts to include AMR multisectoral coordination in line with the One Health approach, expand efforts to include all of the strategic objectives and fully acknowledge that sex and gender impacts need to be understood to contain antimicrobial resistance. Body weight, blood volume, and fat distribution differences between sexes have biological effects on how antibiotics are absorbed, distributed, metabolized, and eliminated6. This is one of the reasons that females have more Adverse Drug Events (ADE) and more frequently suffer from AMR than males. Making antimicrobial resistance as core component of professional education, training, certification, continuing education and development in the health, animal, environmental sectors and agricultural and food chain practice, will help to ensure proper understanding and awareness among professionals. At the same time the inclusion of the use of antimicrobial agents and resistance in school curricula will promote better understanding and awareness from an early age. In order to achieve these, a list of priority actions, objectives, interventions need to be addressed through implementation of planned activities of this strategic plan. The priority action in this strategic objective are as follows: awareness-raising and risk communication and education 6 Soldin OP, Mattison DR. Sex differences in pharmacokinetics and pharmacodynamics. Clin Pharmacokinet. 2009;48(3):143– 57. doi: http:// dx.doi .org/ 10 .2165/ 00003088 -200948030 -00001 PMID: 19385708 31National Action Plan on Antimicrobial Resistance 2023 - 2028 32 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 O pe ra ti on al P la n fo r A w ar en es s R ai si ng a nd R is k C om m un ic at io n P R IO R IT Y A C TI O N : A W A R EN ES S R A IS IN G A N D R IS K C O M M U N IC A TI O N O bj ec ti ve 2 .1 I nc re as e na ti on al a w ar en es s on A M R In te rv en ti on 2 .1 .1 E st ab lis h an e vi de nc e ba se d pu bl ic c om m un ic at io ns o n A M R t ar ge ti ng h um an , a ni m al a nd p la nt in cl ud in g fo od c ha in . A ct iv it y: 2 .1 . 1 .1 . C on du ct a s ys te m at ic r ev ie w o f K A P B s tu di es t o de te rm in e th e co un tr y st at us in a ll se ct or s Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t qu an ti ty Im pl em en ta ti on le ve l ( na ti on al / su b na ti on al ) Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 2. 1. 1. 1. 1 Co nd uc t sy st em at ic re vi ew o f st ud ie s in a ll se ct or s to id en tif y ga ps ( po pu la tio n, c ad re s, pr of es si on al s, s ec to rs , g eo gr ap hi c ar ea s et c. ) M O H /M LF / M oA /V PO Su rv ey 5 N at io na l l ev el 20 23 2 02 4 re po rt s an d pu bl ic ca tio ns 11 4, 02 9, 00 0 G ov /P ar tn er s 2. 1. 1. 1. 2 Co nd uc t KA P st ud ie s in ar ea s th at s ys te m at ic r ev ie w h as fo un d ga ps in cl ud in g in ce nt iv es an d ba rr ie rs t o be ha vi or al c ha ng e. M O H /M LF / M oA /V PO Su rv ey 5 N at io na l l ev el 20 24 2 02 8 re po rt s an d pu bl ic at io ns 50 ,0 00 ,0 00 G ov /P ar tn er s 2. 1. 1. 1. 3 Co nd uc t a m ee tin g to di ss em in at e KA P st ud y fin di ng s M O H /M LF / M oA /V PO M ee tin g 2 N at io na l l ev el 20 24 2 02 8 m in ut es a nd pr oc ee di ng s 86 ,9 61 ,0 00 G ov /P ar tn er s 2. 1. 1. 1. 4 D ev el op g ui de lin e on h ow th e st ud ie s on K AP B b e co nd uc te d M O H /M LF / M oA /V PO M ee tin g 2 N at io na l l ev el 20 23 G ui de lin e 53 ,9 88 ,8 00 G ov /P ar tn er s 2 .1 .1 .1 .5 C on du ct s tu di es o n be ha vi or al c ha ng e co m m un ic at io n (B CC ) M O H /M LF / M oA /V PO Su rv ey 5 N at io na l l ev el 20 24 2 02 8 re po rt s an d pu bl ic at io ns 16 ,5 15 ,4 19 G ov /P ar tn er s A ct iv it y: 2 .1 .1 .2 T ra ns la te a nd d is se m in at e a co m m un ic at io n st ra te gy f or A M R a nd o th er r el ev an t A M R d oc um en ts Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t qu an ti ty Im pl em en ta ti on le ve l (n at io na l/ f ac ili ty / co m m un it y) Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 2. 1. 1. 2. 1 Co nd uc t a w or ks ho p to d is se m in at e/ un pa ck s im pl ifi ed Ta ilo r m ad e ve rs io n of t he co m m un ic at io n st ra te gy f or e ac h sp ec ifi c ac to r M O H /M LF / M oA /V PO / PO R AL G W or ks ho p 1 N at io na l l ev el 20 23 2 02 4 M in ut es a nd pr oc ee di ng s 14 3, 30 0, 00 0 G ov /P ar tn er s 33 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 2. 1. 1. 2. 2 Tr an sl at e co m m un ic at io n st ra te gy in to K is w ah ili M O H /M LF / M oA /V PO / PO R AL G Pe rs on / fir m 1 N at io na l l ev el 20 23 2 02 4 Sw ah ili v er si on o f th e AM R c om m un ic at io n st ra te gy 25 ,0 00 ,0 00 G ov /P ar tn er s 2. 1. 1. 2. 3 Co nd uc t a w or ks ho p to di ss em in at e tr an sl at ed s im pl ifi ed ve rs io n of t he c om m un ic at io n St ra te gy M O H /M LF / M oA /V PO / PO R AL G W or ks ho p 1 N at io na l l ev el 20 24 2 02 5 M in ut es a nd pr oc ee di ng s 66 ,9 63 ,1 50 G ov /P ar tn er s In te rv en ti on 2 .1 .2 . A dv oc at e fo r A M R a nd C on du ct c am pa ig ns A ct iv it y: 2 .1 .2 .1 C on du ct c om m em or at io n of t he W or ld A nt im ic ro bi al A w ar en es s W ee k an d ot he r re le va nt n at io na l a nd in te rn at io na l c er em on ie s/ ex ib it io ns Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t qu an ti ty Im pl em en ta ti on le ve l (n at io na l/ f ac ili ty / co m m un it y) Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 2. 1. 2. 1. 1 D ev el op a h ar m on iz ed to ol f or c on du ct io n of p re a nd p os t su rv ey s. M O H /M LF / M oA , / VP O / PO R AL G Su rv ey 5 N at io na l & S ub na tio na l 20 23 2 02 8 re po rt s 52 ,6 00 ,0 00 G ov /P ar tn er s 2. 1. 2. 1. 2 Co nd uc t a pr e an d po st su rv ey o f ac tiv iti es ( ca m pa ig ns ) co nd uc te d du rin g th e W AA W M O H /M LF / M oA /V PO / PO R AL G Su rv ey 5 N at io na l & S ub na tio na l 20 23 2 02 8 re po rt s 20 ,4 04 ,0 20 G ov /P ar tn er s 2. 1. 2. 1. 3 Pr ep ar e an d is su e ac tiv at io n ci rc ul ar o n AM R t o al l se ct or s at d iff er en t le ve ls d ur in g th e W AA W M O H /M LF / M oA , / VP O / PO R AL G Ci rc ul ar 5 N at io na l & S ub na tio na l 20 23 2 02 8 Ac tiv at io n ci rc ul ar 14 4, 50 0, 00 0 G ov /P ar tn er s 2 .1 .2 .1 .4 C on du ct m ul til ev el a dv o ca cy w or ks ho ps f or c om m em or at in g th e AM R w ee k th ro ug h ex is tin g st ru ct ur es in cl ud in g th e pr iv at e se ct or M O H /M LF / M oA , / VP O / PO R AL G W or ks ho p 1 N at io na l & S ub na tio na l 20 23 2 02 8 m in ut es a nd pr oc ee di ng 14 4, 30 7, 43 1 G ov /P ar tn er Pa rt ne rs 2. 1. 2. 1. 5 D ev el op a nd d is se m in at e BC C an d IE C m at er ia ls o n AM R du rin g th e W AA W M O H /M LF / M oA , / VP O / PO R AL G Co pi es , T V sp or ts , 1 N at io na l & S ub na tio na l 20 23 2 02 8 m at er ia ls d ev el op ed an d di st rib ut ed 25 ,5 05 ,0 25 G ov /P ar tn er s 2. 1. 2. 1. 6 Co nd uc t w or ks ho ps t o se ns iti ze F BO 's , i nfl ue nt ia l p eo pl e an d m em be rs o f th e pr iv at e se ct or to p ar tic ip at e du rin g th e W AA W M O H /M LF / M oA , / VP O / PO R AL G W or ks ho p 1 N at io na l & S ub na tio na l 20 23 2 02 8 m in ut es a nd pr oc ee di ng 27 6, 22 8, 53 7 G ov /P ar tn er s 34 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 2. 1. 2. 1. 7 Co m m em or at e th e W or ld An tim ic ro bi al A w ar en es s W ee k (W AA W ) an d AM R e xi bi tio ns a t na tio na l a nd s ub na tio na l l ev el M O H /M LF / M oA , / VP O / PO R AL G Sy m po si um / Ca m pa ig ns 1 N at io na l & S ub na tio na l 20 23 2 02 8 m in ut es a nd p ro ce ed in g 5 10 ,1 00 ,5 01 G ov /P ar tn er s A ct iv it y: 2 .1 .2 .2 C on du ct T ra in in g of T ra in er s (T O Ts ) at N at io na l, R eg io na l a nd C ou nc il le ve l o n A M R Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t qu an ti ty Im pl em en ta ti on le ve l (n at io na l/ f ac ili ty / co m m un it y) Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 2. 1. 2. 2. 1 Co nd uc t w or ks ho p to tr ai n AM R T O Ts o n AM R a t na tio na l le ve ls M O H /M LF / M oA , / VP O / PO R AL G W or ks ho p 1 N at io na l & S ub na tio na l 20 23 2 02 4 m in ut es a nd p ro ce ed in g 10 9, 08 0, 00 0 G ov /P ar tn er s 2. 1. 2. 2. 2 Co nd uc t w or ks ho ps t o tr ai n AM R t ra in er s at c ou nc il le ve l M O H /M LF / M oA , / VP O / PO R AL G W or ks ho p 5 N at io na l & S ub na tio na l 20 23 2 02 8 m in ut es a nd p ro ce ed in g 90 3, 90 2, 02 5 G ov /P ar tn er s 2. 1. 2. 2. 3 Co nd uc t im pl em en ta tio n su rv ey o f AM R T O T' s tr ai ni ng s at co un ci l l ev el M O H /M LF / M oA , / VP O / PO R AL G Su rv ey 1 N at io na l & S ub na tio na l 20 27 2 02 8 re po rt s 60 ,0 63 ,4 88 G ov /P ar tn er s A ct iv it y: 2 .1 .2 .3 C on du ct s en si ti za ti on m ee ti ng s to p ri va te a nd p ub lic s ta ke ho ld er s at N at io na l, R eg io na l a nd C ou nc il le ve ls o n A M R Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t qu an ti ty Im pl em en ta ti on le ve l (n at io na l/ f ac ili ty / co m m un it y) Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 2. 1. 2. 3. 1 Co nd uc t se ns iti za tio n m ee tin gs t o pr iv at e an d pu bl ic st ak eh ol de rs a t N at io na l, Re gi on al an d Co un ci l l ev el s on A M R M O H /M LF / M oA , / VP O / PO R AL G M ee tin g 3 N at io na l 20 23 2 02 5 pr oc ee di ng s an d re po rt s 24 1, 16 3, 57 8 G ov /P ar tn er s 2. 1. 2. 3. 2 Co nd uc t se ns iti za tio n m ee tin gs t o pr iv at e an d pu bl ic st ak eh ol de rs a t N at io na l, Re gi on al an d Co un ci l l ev el s on A M R M O H /M LF / M oA , / VP O / PO R AL G M ee tin g 3 Su bn at io na l 20 23 2 02 5 pr oc ee di ng s an d re po rt s 20 1, 20 3, 55 5 G ov /P ar tn er s 2. 1. 2. 3. 3 Co nd uc t se ns iti za tio n m ee tin gs t o pr iv at e an d pu bl ic st ak eh ol de rs a t N at io na l, Re gi on al an d Co un ci l l ev el s on A M R M O H /M LF / M oA , / VP O / PO R AL G M ee tin g 3 Su bn at io na l 20 23 2 02 5 pr oc ee di ng s an d re po rt s 35 8, 15 7, 82 0 G ov /P ar tn er s 35 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 A ct iv it y: 2 .1 .2 .4 C on du ct m ul ti m ed ia a w ar en es s ca m pa ig ns o n A M R Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t qu an ti ty Im pl em en ta ti on le ve l (n at io na l/ f ac ili ty / co m m un it y) Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 2. 1. 2. 4. 1 Id en tif y m ul tim ed ia ch an ne ls /a ge nc ie s M O H /M LF / M oA , / VP O / PO R AL G M ee tin g 5 N at io na l & S ub na tio na l 20 23 2 02 8 pr oc ee di ng s an d re po rt s 40 ,6 06 ,0 20 G ov /P ar tn er s 2. 1, 2. 4. 2 In vo lv e m ed ia in Pr ep ar in g AM R a w ar en es s m at er ia ls M O H /M LF / M oA , / VP O / PO R AL G M ee tin g 5 N at io na l & S ub na tio na l 20 23 2 02 8 pr oc ee di ng s an d re po rt s 2. 1. 2. 4. 3 Pr in t AM R a w ar en es s m at er ia ls M O H /M LF / M oA , / VP O / PO R AL G 1 5 N at io na l & S ub na tio na l 20 23 2 02 8 Av ai la bi lit y of A M R aw ar en es s m at er ia ls 40 6, 06 0, 00 0 G ov /P ar tn er s 2. 1. 2. 4. 4 Co nd uc t ca m pa ig ns o n AM R M O H /M LF / M oA , / VP O / PO R AL G Ca m pa ig n 5 N at io na l & S ub na tio na l 20 23 2 02 8 pr oc ee di ng s an d re po rt s 25 5, 05 0, 25 0 G ov /P ar tn er s In te rv en ti on 2 .1 .3 . D ev el op k no w le dg e sh ar in g m ec ha ni sm a t al l l ev el s (w eb p or ta l, so ci al m ed ia h an dl es a nd m ob ile a pp s) A ct iv it y: 2 .1 .3 .1 E st ab lis h A M R k no w le dg e M an ag em en t an d sh ar in g m ec ha ni sm a t al l l ev el s Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t qu an ti ty Im pl em en ta ti on le ve l (n at io na l/ f ac ili ty / co m m un it y) Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 2. 1. 3. 1. 1 D ev el op a w eb p or ta l lin ke d to s oc ia l m ed ia h an dl es c on ta in in g m ul til ev el m at er ia ls o n AM R M O H /M LF / M oA , / VP O / w eb p or ta l 1 N at io na l & S ub na tio na l 20 26 2 02 8 W eb p or ta l 40 ,7 40 ,0 00 G ov /P ar tn er s 2. 1. 3. 1. 2 Co nd uc t a w or ks ho p to de ve lo p m ul til ev el m at er ia ls o n AM R fo r kn ow le dg e sh ar in g M O H /M LF / M oA , / VP O / PO R AL G W or ks ho p 2 N at io na l & S ub na tio na l 20 26 2 02 8 pr oc ee di ng s an d re po rt s 5, 00 0, 00 0 G ov /P ar tn er s 36 National Action Plan on Antimicrobial Resistance 2023 - 2028 37 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 O pe ra ti on al P la n fo r Ed uc at io n P R IO R IT Y A C TI O N : E D U C A TI O N O bj ec ti ve 2 .2 : Im pr ov e kn ow le dg e on A M R In te rv en ti on 2 .2 .1 : In cl ud e A M R a s a co re c om po ne nt o f pr of es si on al e du ca ti on , t ra in in g, c er ti fi ca ti on , a nd d ev el op m en t A ct iv it y: 2 .2 .1 .1 D ev el op a nd in te gr at e ta ilo r m ad e cu rr ic ul a le ar ni ng o ut co m es o n A M R f or p re p ri m ar y, p ri m ar y an d se co nd ar y sc ho ol s Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t qu an ti ty Im pl em en ta ti on le ve l (n at io na l/ f ac ili ty / co m m un it y) Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 2. 2. 1. 1. 1 Co nd uc t w or ks ho p to or ie nt e du ca tio na l p ol ic y m ak er s, R EO ’s a nd D EO ’s o n O ne h ea lth an d AM R M O H /M LF / M oA /V PO / M oE W or ks ho p 3 N at io na l l ev el 20 26 2 02 8 pr oc ee di ng s an d re po rt s 17 9, 98 7, 94 0 G ov /P ar tn er s 2. 2. 1. 1. 2 D ev el op a nd in te gr at e ta ilo r m ad e cu rr ic ul a le ar ni ng ou tc om es o n AM R fo r pr e pr im ar y, pr im ar y an d se co nd ar y sc ho ol s M O H /M LF / M oA , / VP O / M oE Li st o f cu rr ic ul a le ar ni ng ou tc om es 2 N at io na l l ev el 20 26 2 02 8 pr oc ee di ng s, r ep or ts , an d nu m be r of c ur ric ul a in te gr at ed 51 ,7 12 ,0 00 G ov /P ar tn er s 2. 2. 1. 1. 3 D ev el op a nd in te gr at e AM R & O ne h ea lth c on ce pt le ar ni ng o ut co m es in t ea ch er s tr ai ni ng c ur ric ul um a t al l l ev el s M O H /M LF / M oA , / VP O / M oE Li st o f cu rr ic ul a le ar ni ng ou tc om es 2 N at io na l l ev el 20 26 2 02 8 pr oc ee di ng s, r ep or ts , an d nu m be r of c ur ric ul a in te gr at ed 52 ,2 29 ,1 20 G ov /P ar tn er s In te rv en ti on 2 .2 .2 I nc lu de A M R a s a co re c om po ne nt o f C on ti nu in g P ro fe ss io na l d ev el op m en t (C P D ) A ct iv it y: 2 .2 .2 .1 A dv oc at e th at C P D /s ho rt c ou rs es o n A M R a nd o ne h ea lt h be co m e m an da to ry c ou rs es f or a ct or s of a ll re sp ec ti ve s ec to rs 2. 2. 2. 1. 1 Co nd uc t w or ks ho p to or ie nt p ro fe ss io na l c ou nc ils o n th e im po rt an ce o f ad di ng A M R a nd o ne he al th a s m an da to ry C PD r eq ui re m en ts M O H /M LF / M oA , / VP O / M oE W or ks ho p 1 N at io na l l ev el 20 23 2 02 4 W or ks ho p re po rt 0 G ov /P ar tn er s 2. 2. 2. 1. 2 D ev el op fa ce t o fa ce a nd on lin e AM R a nd o ne h ea lth c ou rs e fo r al l r es pe ct iv e ac to rs M O H /M LF / M oA , / VP O / M oE sh or t co ur se s 2 N at io na l l ev el 20 27 2 02 8 lis t of s ho rt c ou rs es de ve lo pe d 84 ,4 36 ,0 00 G ov /P ar tn er s 2. 2. 2. 1. 3 To u pl oa d O ne h ea lth an d AM R le ar ni ng m at er ia ls t o th e e le ar ni ng p la tf or m M O H /M LF / M oA , / VP O / M oE m at er ia ls 4 N at io na l l ev el 20 24 2 02 8 Tr ai ni ng r ep or t 5, 05 0, 00 0 G ov /P ar tn er s 38 National Action Plan on Antimicrobial Resistance 2023 - 2028 STRATEGIC OBJECTIVE THREE STRENGTHEN CAPACITY FOR AMR SURVEILLANCE AND RESEARCH Surveillance of antimicrobial resistance and use is vital in combating AMR. Thus, in 2018 Tanzania developed the National Antimicrobial Resistance Surveillance Framework in the context of one health, which addresses challenges associated with AMR through effective monitoring of pathogens, antimicrobial susceptibility testing, antimicrobial residues testing, and enhancing the prudent use of antimicrobials through the communication of outcomes to the public. The National Antimicrobial Resistance Surveillance Framework enables standardized, comparable, and validated data on AMR/AMC/AMU to be collected, analysed, and shared to inform decision making, drive local and national actions, and provide evidence for action and advocacy. Laboratory-based AMR surveillance is required to monitor emergencies and the spread of antimicrobial resistance. For reliable microbiological and antimicrobial susceptibility testing, it is imperative to equip laboratories with equipment, reagents, and human resource. Develop Standard Operating Procedures (SOPs) and methodologies for surveillance of AMR in humans, animals, food, agriculture, aquaculture, and environment consistent and harmonized with international standards. Other initiatives for effective AMR surveillance include strengthening the system for AMC/AMU surveillance, capacity of national reference laboratories and designated laboratories for AMR surveillance, developing a multisectoral reporting system, and strengthening and supporting a coordinated mechanism to ensure harmonized AMR/AMC/AMU guidelines, data management, and information-sharing systems. Strategic objective three aims to generate the knowledge and evidence needed through surveillance and research to identify emerging and re-emerging AMR issues and inform best practices for slowing down AMR and guiding policy using the One Health approach. The interventions under surveillance and research include surveillance system for AMR, AMC and AMU, laboratory capacity and research and development. 39 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 O pe ra ti on al P la n fo r Su rv ei lla nc e Sy st em P R IO R IT Y A C TI O N : S U R V EI LL A N C E SY ST EM O bj ec ti ve 3 .1 : S tr en gt he n N at io na l S ur ve ill an ce S ys te m f or A nt im ic ro bi al R es is ta nc e In te rv en ti on 3 .1 .1 . D ev el op o r re vi ew g ui di ng d oc um en ts f or A M R S ur ve ill an ce A ct iv it y: 3 .1 .1 .1 . R ev ie w t he e xi st in g N at io na l A M R s ur ve ill an ce f ra m ew or k. Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 1. 1. 1. 1 Co nd uc t a si tu at io na l an al ys is t o gu id e th e re vi ew o f th e N at io na l AM R su rv ei lla nc e fr am ew or k M O H , M oL F, PO R AL G , V PO , M oA w or ks ho p 1 N at io na l 20 23 W or ks ho p Re po rt an d D oc um en ts 3 28 ,4 98 ,9 85 G ov t/ Pa rt ne r 3. 1. 1. 1. 2 O rg an iz e st ak eh ol de rs m ee tin g to r ev ie w t he e xi st in g N at io na l A M R s ur ve ill an ce fr am e w or k M O H , M oL F, PO R AL G , V PO , M oA m ee tin g 2 N at io na l 20 23 Re po rt a nd D oc u m en ts 2 92 ,6 22 ,6 15 G ov t/ Pa rt ne rs 3. 1. 1. 1. 3 Co nd uc t st ak eh ol de rs ' m ee tin g to v al id at e th e re vi se d N at io na l A M R s ur ve ill an ce fr am e w or k M O H , M oL F, PO R AL G , V PO m ee tin g 1 N at io na l 20 23 Re po rt a nd D oc u m en ts 3 4, 40 0, 00 0 G ov t/ Pa rt ne r 3. 1. 1. 1. 4 Pr od uc e an d di ss em in at e th e fin al r ev is ed N at io na l AM R s ur ve ill an ce f ra m ew or k M O H , M oL F, PO R AL G , V PO w or ks ho p 9 N at io na l 20 23 D oc um en ts pr o du ce d 28 ,1 50 ,0 00 G ov t/ Pa rt ne r 40 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 A ct iv it y: 3 .1 .1 .2 . D ev el op p ro to co ls a nd s ta nd ar d op er at in g pr oc ed ur es ( SO P s) f or A M R s ur ve ill an ce in h um an , a ni m al , f oo d, a gr ic ul tu re , a qu ac ul tu re , a nd e nv ir on m en t Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 1. 1. 2. 1 D ev el op m is si ng p ro to co ls fo r AM R s ur ve ill an ce in h um an , a ni m al , fo od , a gr ic ul tu re , a qu ac ul tu re , a nd en vi ro nm en t M O H , M oL F, PO R AL G , V PO w or ks ho p 6 N at io na l 20 23 2 02 8 W or ks ho p re po rt 1 39 ,2 00 ,0 00 G ov t/ Pa rt ne r 3. 1. 1. 2. 2 Co nd uc t w or ks ho ps t o de ve lo p SO Ps fo r AM R s ur ve ill an ce in h um an , a ni m al , f oo d, a gr ic ul tu re , aq ua cu ltu re , a nd t he e nv iro nm en t. M O H , M oL F, PO R AL G , V PO w or ks ho p 6 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 1 39 ,2 00 ,0 00 G ov t/ Pa rt ne r 3. 1. 1. 2. 3 Va lid at e de ve lo pe d pr ot oc ol s an d SO Ps fo r AM R s ur ve ill an ce M O H , M oL F, PO R AL G , V PO la bo ra to ry 6 Fa ci lit y 20 23 2 02 8 Re po rt a nd D oc um en ts 3 4, 40 0, 00 0 G ov t/ Pa rt ne r 3. 1. 1. 2. 4 U se r tr ai ni ng o n de ve lo pe d SO Ps f or A M R s ur ve ill an ce M O H , M oL F, PO R AL G , V PO tr ai ni ng 6 Fa ci lit y 20 23 2 02 8 Re po rt a nd D oc um en ts 2 5, 05 0, 00 0 G ov t/ Pa rt ne r In te rv en ti on 3 .1 .2 . C on du ct A M R s ur ve ill an ce in h um an , a ni m al , f oo d, a gr ic ul tu re , a qu ac ul tu re , a nd e nv ir on m en t A ct iv it y: 3 .1 .2 .1 C ol le ct s am pl es f or A M R s ur ve ill an ce Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 1. 2. 1. 1 Tr ai ni ng o n qu an tifi ca tio n of s am pl e co lle ct io n m at er ia l f or A M R su rv ei lla nc e M O H , M oL F, PO R AL G , V PO , M oA Tr ai ni ng 4 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 5 0, 35 0, 50 0 G ov t/ Pa rt ne r 3. 1. 2. 1. 2 Pr oc ur e sa m pl e co lle ct io n m at er ia ls f or A M R a ct iv e su rv ei lla nc e M O H , M oL F, PO R AL G , V PO si te s 24 su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts , M at er ia l 7 6, 67 0, 63 5 G ov t/ Pa rt ne r 3. 1. 2. 1. 3 Tr ai n pe rs on ne l o n sa m pl e co lle ct io n an d sa m pl in g te ch ni qu es fo r AM R a ct iv e su rv ei lla nc e M O H , M oL F, PO R AL G , V PO tr ai ni ng 12 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 3 ,8 56 ,3 59 ,7 88 G ov t/ Pa rt ne r 3. 1. 2. 1. 4 Co nd uc t fie ld v is its f or A M R ac tiv e su rv ei lla nc e sa m pl e co lle ct io n in h um an , a ni m al , f oo d, a gr ic ul tu re , aq ua cu ltu re , a nd e nv iro nm en t M O H , M oL F, PO R AL G , V PO , M oA vi si t 36 fa ci lit y 20 23 2 02 8 Re po rt a nd D oc um en ts 3 3, 66 6, 63 3 G ov t/ Pa rt ne r 41 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 A ct iv it y: 3 .1 .2 .2 P ac ka ge a nd t ra ns po rt c ol le ct ed s am pl es t o de si gn at ed la bo ra to ri es f or A M R s ur ve ill an ce Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 1. 2. 2. 1 Id en tif y co ur ie r an d de ve lo p a m em or an du m o f un de rs ta nd in g fo r AM R a ct iv e su rv ei lla nc e sa m pl e tr an sp or ta tio n M O H , M oL F, PO R AL G , V PO ,M oA co nt ra ct 1 fa ci lit y 20 23 2 02 8 co nt ra ct 6 12 ,1 20 G ov t/ Pa rt ne r 3. 1. 2. 2. 2 Tr ai n pe rs on ne l o n sa m pl e pa ck ag in g an d tr an sp or ta tio n M O H , M oL F, V PO , PO R AL G , M oA tr ai ni ng 12 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 6 12 ,1 20 G ov t/ Pa rt ne r In te rv en ti on 3 .1 .3 D ev el op a m ul ti se ct or al A M R s ur ve ill an ce r ep or ti ng s ys te m A ct iv it y: 3 .1 .3 .1 D ev el op a nd o pe ra ti on al iz e a m ul ti se ct or al A M R s ur ve ill an ce r ep or ti ng s ys te m Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 1. 3. 1. 1 Co lle ct a nd c om pi le in fo rm a tio n on p re e xi st in g re po rt in g sy st em s ac ro ss s ec to rs f or A M R s ur ve ill an ce . M O H , M oL F, PO R AL G , V PO , M oA Se ct or s 5 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 9 ,3 50 ,0 00 G ov t/ Pa rt ne r 3. 1. 3. 1. 2 Co nd uc t st ak eh ol de rs ' m ee tin gs t o id en tif y th e m ec ha ni sm o f in te ro pe ra bi lit y of t he A M R s ur ve ill an ce re po rt in g sy st em M O H , M oL F, PO R AL G , V PO m ee tin g 3 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 7 6, 67 0, 63 5 G ov t/ Pa rt ne r 3. 1. 3. 1. 3 D ev el op a n in te gr at ed A M R su rv ei lla nc e re po rt in g sy st em a cr os s al l se ct or s M O H , M oL F, PO R AL G , V PO de ve lo pe r 2 N at io na l 20 23 2 02 8 Re po rt in g sy st em 2 7, 00 0, 00 0 G ov t/ Pa rt ne r 3. 1. 3. 1. 4 Co nd uc t a st ak eh ol de rs ' m ee tin g to v al id at e th e AM R su rv ei lla nc e re po rt in g sy st em M O H , M oL F, PO R AL G , V PO m ee tin g 2 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 1 7, 54 5, 72 0 G ov t/ Pa rt ne r 3. 1. 3. 1. 5 La un ch A M R s ur ve ill an ce m ul tis ec to ra l A M R s ur ve ill an ce r ep or t in g sy st em M O H , M oL F, PO R AL G , V PO , M oA w or ks ho p 1 N at io na l 20 23 2 02 8 Re po rt an d D oc u m en ts 2 4, 89 6, 50 0 G ov t/ Pa rt ne r 42 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 In te rv en ti on 3 .1 .4 . S tr en gt he n A M C a nd A M U s ur ve ill an ce in h um an , a ni m al , a qu ac ul tu re , a nd a gr ic ul tu re A ct iv it y 3. 1. 4. 1 C on du ct r eg ul ar A M C /A M U s ur ve ys o n se le ct ed a nt im ic ro bi al a ge nt s in h um an a nd a ni m al s ec to rs . Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 1. 4. 1. 1 Id en tif y ar ea s fo r AM C/ AM U su rv ey o n se le ct ed a nt im ic ro bi al a ge nt s M O H , M oL F, PO R AL G , V PO M ee tin g 1 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 11 0, 40 0, 00 0 G ov t/ Pa rt ne r 3. 1. 4. 1. 2 Ad op t an d cu st om iz e th e ex is tin g m et ho do lo gy fo r th e AM C su rv ey M O H , M oL F, PO R AL G , V PO M ee tin g 3 Su b na tio na l 20 23 2 02 8 Pr ot oc ol d oc um en t 25 ,0 00 ,0 00 G ov t/ Pa rt ne r 3. 1. 4. 1. 3 Tr ai n pe rs on ne l o n AM C/ AM U da ta c ol le ct io n M O H , M oL F, PO R AL G , V PO Tr ai ni ng 4 Su b na tio na l 20 23 2 02 8 Tr ai ni ng r ep or t 33 4, 21 3, 55 0 G ov t/ Pa rt ne r 3. 1. 4. 1. 4 Co nd uc t fie ld v is its f or A M C/ AM U d at a co lle ct io n, a na ly si s, a nd re po rt in g M O H , M oL F, PO R AL G , V PO Vi si t 10 Su b na tio na l 20 23 2 02 8 Su rv ey r ep or ts 67 0, 00 0, 00 0 G ov t/ Pa rt ne r 3. 1. 4. 1. 5 D is se m in at e AM C/ AM U s ur ve y fin di ng s th ro ug h ex is tin g m ec ha ni sm s. M O H , M oL F, PO R AL G , V PO M ee tin g 5 Su b na tio na l 20 23 2 02 8 Fi nd in g re po rt 27 7, 28 0, 22 6 G ov t/ Pa rt ne r 3. 1. 4. 1. 6 Ca pa ci ta te t he d es ig na te d in st itu tio ns f or A M C/ AM U d at a m an ag em en t. M O H , M oL F, PO R AL G , V PO , T BS In st itu tio ns 5 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 12 0, 00 0, 00 0 G ov t/ Pa rt ne r In te rv en ti on 3 .1 .5 . S tr en gt he n su rv ei lla nc e of a nt im ic ro bi al r es id ua l A ct iv it y 3. 1. 5. 1. R ev ie w a nt im ic ro bi al a ge nt s fo r re si du al s ur ve ill an ce in f oo ds o f an im al a nd n pl an t or ig in a nd e nv ir on m en t. Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 1. 5. 1. 1 Co nd uc t st ak eh ol de rs m ee tin g to id en tif y an tim ic ro bi al ag en ts f or r es id ua l s ur ve ill an ce M O H , M oL F, PO R AL G , V PO m ee tin g 4 N at io na l 20 23 2 02 8 M ee tin g re po rt G ov t/ Pa rt ne r 3. 1. 5. 1. 2 D is se m in at e th e lis t of s e le ct ed a nt im ic ro bi al a ge nt s fo r re si du al su rv ei lla nc e. M O H , M oL F, P O R AL G , V PO st ak eh ol de rs 1 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts G ov t/ Pa rt ne r 43 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 A ct iv it y: 3 .1 .5 .2 I de nt if y, a ss es s, a nd s up po rt la bo ra to ri es f or t es ti ng a nt im ic ro bi al r es id ua ls in f oo d, a qu ac ul tu re , a nd e nv ir on m en t. Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 1. 5. 2. 1 Co nd uc t la bo ra to ry c ap ac ity as se ss m en t us in g a st an da rd iz ed t oo l M O H , M oL F, PO R AL G , V PO la bo ra to ry 5 N at io na l 20 23 2 02 4 As se ss m en t re po rt 3 4, 74 4, 00 0 G ov t/ Pa rt ne r 3. 1. 5. 2. 2 Co nd uc t a st ak eh ol de rs ' m ee tin g to d is se m in at e as se ss m en t fin di ng s an d se le ct t he la bo ra to rie s fo r te st in g an tim ic ro bi al r es id ua ls . M O H , M oL F, P O R AL G , V PO m ee tin g 1 N at io na l 20 23 2 02 4 Li st o f id en tifi ed la bo ra to rie s 1 5, 30 1, 50 0 G ov t/ Pa rt ne r A ct iv it y: 3 .1 .5 .3 D ev el op a nd h ar m on iz e SO P a nd m et ho ds o f te st in g th e an ti m ic ro bi al r es id ua l. Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 1. 5. 3. 1 Co nd uc t w or ks ho p to d ev el op SO Ps f or a nt im ic ro bi al r es id ua l t es tin g M O H , M oL F, T BS , PO R AL G , V PO w or ks ho p 3 N at io na l 20 23 2 02 4 SO Ps d oc um en t 6 ,6 66 ,0 00 G ov t/ Pa rt ne r 3. 1. 5. 3. 2 Va lid at e th e de ve lo pe d SO Ps fo r an tim ic ro bi al r es id ua l t es tin g M O H , M LF , P O R AL G , VP O w or ks ho p 3 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 1 0, 50 4, 00 0 G ov t/ Pa rt ne r 3. 1. 5. 3. 3 U se r tr ai ni ng o n de ve lo pe d SO Ps f or a nt im ic ro bi al r es id ua l t es tin g M O H , M LF , P O R AL G , VP O la bo ra to ry 5 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 4 8, 37 9, 00 0 G ov t/ Pa rt ne r A ct iv it y: 3 .1 .5 .4 B ui ld t ec hn ic al a nd in fr as tr uc tu ra l c ap ac it y in t he id en ti fi ed la bo ra to ri es f or a nt im ic ro bi al r es id ua l t es ti ng . Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 1. 5. 4. 1 Pr ep ar e a tr ai ni ng p ac ka ge fo r an tim ic ro bi al r es id ua l t es tin g. M O H , M oL F, PO R AL G , V PO w or ks ho p 5 N at io na l 20 23 2 02 8 Tr ai ni ng p ac ka ge s de ve lo pe d 1 7, 37 2, 00 0 G ov t/ Pa rt ne r 3. 1. 5. 4. 2 Co nd uc t TO T tr ai ni ng fo r an tim ic ro bi al r es id ua l t es tin g M O H , M oL F, PO R AL G , V PO Tr ai ni ng 1 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 2 6, 26 0, 00 0 G ov t/ Pa rt ne r 3. 1. 5. 4. 3 Ro ll ou t th e tr ai ni ng p ac k ag e to t he p er so nn el in t he id en tifi ed la bo ra to rie s fo r an tim ic ro bi al r es id ua l te st in g M O H , M oL F, PO R AL G , V PO La bo ra to ry 10 Su n at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 2 34 ,0 00 ,0 00 G ov t/ Pa rt ne r 3. 1. 5. 4. 4 Pr ov id e in fr as tr uc tu re a nd eq ui pm en t su pp or t fo r th e id en tifi ed la bo ra to rie s M O H , M oL F, PO R AL G , V PO La bo ra to ry 5 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 9 09 ,0 00 ,0 00 G ov t/ Pa rt ne r N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 44 3. 1. 5. 4. 5 Co nd uc t re gu la r m en to rs hi p in t he id en tifi ed la bo ra to rie s fo r an tim ic ro bi al r es id ua l t es tin g. M O H , M oL F, PO R AL G , V PO M en to rs hi p 45 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 1 57 ,1 10 ,9 55 G ov t/ Pa rt ne r 3. 1. 5. 4. 6 Co nd uc t re gu la r su pp or tiv e su pe rv is io n in t he id en tifi ed la bo ra to rie s fo r an tim ic ro bi al r es id ua l te st in g. M O H , M oL F, PO R AL G , V PO M en to rs hi p 45 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 5 66 ,8 22 ,6 56 G ov t/ Pa rt ne r A ct iv it y: 3 .1 .5 .5 C ol le ct a nd t ra ns po rt o f sa m pl es f or a nt im ic ro bi al r es id ua l s ur ve ill an ce Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 1. 5. 5. 1 Tr ai ni ng o n qu an tifi ca tio n of m at er ia ls f or a nt im ic ro bi al r es id ua l su rv ei lla nc e. M O H , M oL F, PO R AL G , V PO tr ai ni ng 5 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 2 5, 30 0, 00 0 G ov t/ Pa rt ne r 3. 1. 5. 5. 2 Pr oc ur em en t of m at er ia ls f or an tim ic ro bi al r es id ua l s ur ve ill an ce M O H , M oL F, PO R AL G , V PO la bo ra to ry 5 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 5 05 ,0 00 ,0 00 G ov t/ Pa rt ne r 3. 1. 5. 5. 3 Tr ai n pe rs on ne l o n sa m pl e m an ag em en t fo r an tim ic ro bi al r es id ua l su rv ei lla nc e M O H , M oL F, PO R AL G , V PO tr ai ni ng 4 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 2 5, 30 0, 00 0 G ov t/ Pa rt ne r 3. 1. 5. 5. 4 Co nd uc t fie ld v is its f or sa m pl e co lle ct io n an d tr an sp or ta tio n M O H , M oL F, PO R AL G , V PO vi si t 30 Su b na tio n 20 23 2 02 8 Re po rt a nd D oc um en ts 1 1, 22 1, 65 6 G ov t/ Pa rt ne r 45National Action Plan on Antimicrobial Resistance 2023 - 2028 LABORATORY CAPACITY 46 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 O pe ra ti on al P la n fo r La bo ra to ry C ap ac it y P R IO R IT Y A C TI O N : L A B O R A TO R Y C A P A C IT Y O bj ec ti ve 3 .2 : St re ng th en L ab or at or y ca pa ci ty t o pr od uc e hi gh q ua lit y m ic ro bi ol og ic al d at a m an ag em en t In te rv en ti on 3 .2 .1 . D es ig na te a nd s tr en gt he n La bo ra to ri es f or A M R s ur ve ill an ce in a gr ic ul tu re , a qu ac ul tu re , f oo ds , a nd t he e nv ir on m en t. A ct iv it y: 3 .2 .1 .1 . A ss es s th e ex is ti ng la bo ra to ri es ' c ap ac it y an d se le ct o ne la bo ra to ry to b e a na ti on al re fe re nc e la bo ra to ry fo r A M R s ur ve ill an ce in a gr ic ul tu re , f oo d, a qu ac ul tu re , an d th e en vi ro nm en t. Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on L ev el Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 3. 2. 1. 1. 1 D ev el op /a do pt la bo ra to ry ca pa ci ty a ss es sm en t to ol s M O H , M oL F, P O R AL G , VP O w or ks ho p 2 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 1 9, 07 6, 81 4 G ov t/ Pa rt ne rs 3. 2. 1. 1. 2 Co nd uc t la bo ra to ry c ap ac ity as se ss m en t fo r AM R s ur ve ill an ce in fo od s af et y, a gr ic ul tu re , a qu ac ul tu re , an d th e en vi ro nm en t. M O H , M oL F, P O R AL G , VP O La bo ra to ry 8 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 6 ,6 66 ,0 00 G ov t/ Pa rt ne r 3. 2. 1. 1. 3 Co nd uc t a m ee tin g to ap po in t su rv ei lla nc e si te s an d re fe re nc e la bo ra to rie s in f oo d sa fe ty , ag ric ul tu re , a qu ac ul tu re , a nd t he en vi ro nm en t. M O H , M oL F, P O R AL G , VP O m ee tin g 2 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 1 0, 50 4, 00 0 G ov t/ Pa rt ne r 3. 2. 1. 1. 4 Co nd uc t se ns iti za tio n m ee tin gs o n AM R s ur ve ill an ce t o st ak eh ol de rs f ro m f oo d sa fe ty , ag ric ul tu re , a qu ac ul tu re , a nd t he en vi ro nm en t. M O H , M oL F, P O R AL G , VP O M ee tin g 4 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 18 5, 46 0, 30 1 G ov t/ Pa rt ne r 3. 2. 1. 1. 5 Re no va te a pp oi nt ed re fe re nc e la bo ra to rie s in f oo d sa fe ty , aq ua cu ltu re , a gr ic ul tu re , a nd t he en vi ro nm en t. M O H , M oL F, P O R AL G , VP O La bo ra to ry 4 Fa ci lit y 20 23 2 02 8 Re po rt a nd D oc um en ts 40 4, 00 0, 00 0 G ov t/ Pa rt ne r 3. 2. 1. 1. 6 Su pp or t pl ac em en t of ad va nc ed e qu ip m en t to a pp oi nt ed re fe re nc e la bo ra to rie s in f oo d sa fe ty , aq ua cu ltu re , a gr ic ul tu re , a nd t he en vi ro nm en t. M O H , M oL F, P O R AL G , VP O La bo ra to ry 4 Fa ci lit y 20 23 2 02 8 Re po rt a nd D oc um en ts 2, 02 0, 00 0, 00 0 G ov t/ Pa rt ne r 47 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 In te rv en ti on 3 .2 .2 . C ap ac it y bu ild in g fo r de si gn at ed la bo ra to ri es f or A M R s ur ve ill an ce in h um an , a ni m al , f oo d, a gr ic ul tu re , a qu ac ul tu re , a nd e nv ir on m en t. A ct iv it y: 3 .2 .2 .1 . C on du ct t ra in in g, m en to rs hi p, a nd s up po rt iv e su pe rv is io n fo r pe rs on ne l o n di ag no st ic s an d an ti m ic ro bi al s us ce pt ib ili ty t es ti ng . Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on L ev el Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 3. 2. 2. 1. 1 Co nd uc t a ba se lin e as se ss m en t fo r la bo ra to ry c ap ac ity on d ia gn os tic s an d an tim ic ro bi al su sc ep tib ili ty t es tin g. M O H , M oL F, P O R AL G , VP O La bo ra to ry 24 N at io na l 20 23 2 02 4 As se ss m en t re po rt 6 ,7 32 ,9 93 G ov t/ Pa rt ne r 3. 2. 2. 1. 2. C on du ct t ra in in g on la bo ra to ry t ec hn iq ue s fo r pa th og en id en tifi ca tio n an d an tim ic ro bi al su sc ep tib ili ty t es tin g, in cl ud in g AM R pr io rit y pa th og en s. M O H , M oL F, P O R AL G , VP O La bo ra to ry 24 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 1 42 ,0 04 ,9 50 G ov t/ Pa rt ne r 3. 2. 2. 1. 3 Co nd uc t tr ai ni ng o f la bo ra to ry p er so nn el o n AM R d at a m an ag em en t an d an al ys is . M O H , M oL F, P O R AL G , VP O La bo ra to ry 24 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 1 02 ,7 30 ,1 75 G ov t/ Pa rt ne r 3. 2. 2. 1. 4 Co nd uc t re gu la r su pp or tiv e su pe rv is io n of s el ec te d la bo ra to rie s on A M R s ur ve ill an ce . M O H , M oL F, P O R AL G , VP O La bo ra to ry 24 Su n at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 1 42 ,0 04 ,9 50 G ov t/ Pa rt ne r 3. 2. 2. 1. 5 Co nd uc t re gu la r m en to rs hi p pr og ra m s fo r se le ct ed la bo ra to rie s on AM R s ur ve ill an ce . M O H , M oL F, P O R AL G , VP O La bo ra to ry 24 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 1 02 ,7 30 ,1 75 G ov t/ Pa rt ne r 3. 2. 2. 1. 6 Co nd uc t tr ai ni ng o f la bo ra to ry p er so nn el o n bi os af et y, bi os ec ur ity , a nd is ol at e m an ag em en t M O H , M oL F, P O R AL G , VP O Tr ai ni ng 6 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 14 2, 00 4, 95 0 G ov t/ Pa rt ne r A ct iv it y: 3 .2 .2 .2 . S up po rt t ra ns po rt at io n of p ri or it y is ol at es t o re fe re nc e la bo ra to ri es a nd b io re po si to ri es Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on L ev el Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 3. 2. 2. 2. 1 Es ta bl is h bi o ba nk in g of A M R is ol at es a t re fe re nc e la bo ra to rie s. M O H , M oL F, P O R AL G , VP O la bo ra to ry 2 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 7 07 ,0 00 ,0 00 G ov t/ Pa rt ne r 3. 2. 2. 2. 2 Su pp or t a co nt ra ct ag re em en t fo r se le ct ed c ou rie r on tr an sp or ta tio n of A M R is ol at es t o na tio na l r ef er en ce la bo ra to rie s. M O H , M oL F, P O R AL G , VP O co nt ra ct 1 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 1 0, 20 2, 01 0 G ov t/ Pa rt ne r 48 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 In te rv en ti on 3 .2 .3 S tr en gt he n th e su pp ly c ha in s ys te m t o su pp or t la bo ra to ry A M R s ur ve ill an ce A ct iv it y: 3 .2 .3 .1 . R ev ie w a nd u pd at e th e m as te r lis t fo r th e m at er ia ls / re ag en ts / it em s re qu ir ed f or A M R s ur ve ill an ce a nd s up pl y m ec ha ni sm t o en su re c on st an t av ai la bi lit y. Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t qu an ti ty Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 2. 3. 1. 1 Co nd uc t a m ee tin g w ith te ch ni ca l p er so nn el t o re vi ew t he m as te r lis t fo r th e m at er ia ls / re ag en ts / ite m s re qu ire d fo r AM R s ur ve ill an ce in r el ev an t se ct or s. M O H , M oL F, PO R AL G , V PO M ee tin g 5 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 3 5, 09 3, 17 7 G ov t/ Pa rt ne r A ct iv it y: 3 .2 .3 .2 . B ui ld in g ca pa ci ty o f st af f at t he d es ig na te d la bo ra to ry f or A M R s ur ve ill an ce o n su pp ly c ha in m an ag em en t Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t qu an ti ty Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 2. 3. 2. 1 Co nd uc t tr ai ni ng o n th e qu an tifi ca tio n an d fo re ca st in g of A M R su rv ei lla nc e co m m od iti es M O H , M oL F, PO R AL G , V PO tr ai ni ng 5 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 5 1, 10 9, 54 0 G ov t/ Pa rt ne r 3. 2. 3. 2. 2 Tr ai n la bo ra to ry p er so nn el o n th e m an ag em en t of e LM S M O H , M oL F, PO R AL G , V PO Tr ai ni ng 10 Su b na tio na l 20 23 2 02 8 Re po rt a nd D oc um en ts 5 1, 10 9, 54 0 G ov t/ Pa rt ne r 3. 2. 3. 2. 3 Su pp or t on a va ila bi lit y of ba ct er io lo gi ca l r ea ge nt s an d su pp lie s fo r te st in g M O H , M oL F, PO R AL G , V PO La bo ra to ry 24 Fa ci lit y 20 23 2 02 8 Re po rt a nd D oc um en ts 9, 33 9, 32 2, 27 7 G ov t/ Pa rt ne r In te rv en ti on 3 .2 .4 . S tr en gt he n qu al it y m an ag em en t sy st em f or d es ig na te d la bo ra to ri es f or A M R s ur ve ill an ce . A ct iv it y: 3 .2 .4 .1 . A ss es s an d en ro ll de si gn at ed la bo ra to ri es f or A M R s ur ve ill an ce o n th e EQ A p ro gr am Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t qu an ti ty Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 2. 4. 1. 1 Co nd uc t a m ee tin g to id en tif y th e EQ A sc he m e pr ov id er t o en ro ll AM R s ur ve ill an ce la bo ra to rie s. M O H , M oL F, PO R AL G , V PO M ee tin g 2 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 1 0, 50 4, 00 0 G ov t/ Pa rt ne r 3. 2. 4. 1. 2 As se ss de si gn at ed la bo ra to rie s fo r pa rt ic ip at io n in t he E Q A pr og ra m . M O H , M oL F, PO R AL G , V PO As se ss m en t 12 Fa ci lit y 20 23 2 02 8 Re po rt a nd D oc um en ts 3 ,3 33 ,0 00 G ov t/ Pa rt ne r 3. 2. 4. 1. 3 Su pp or t di st rib ut io n of E Q A m at er ia ls t o de si gn at ed la bo ra to rie s. M O H , M oL F, PO R AL G , V PO La bo ra to ry 36 Fa ci lit y 20 23 2 02 8 Re po rt a nd D oc um en ts 1 ,0 20 ,2 01 ,0 02 G ov t/ Pa rt ne r 49 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 A ct iv it y: 3 .2 .4 .2 . S up po rt r ef er en ce la bo ra to ri es t o co or di na te a nd d is tr ib ut e EQ A m at er ia ls f or A M R s ur ve ill an ce Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t qu an ti ty Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 2. 4. 2. 1 Co nd uc t tr ai ni ng t o re fe re nc e la bo ra to rie s on P T pr od uc tio n an d di st rib ut io n. M O H , M oL F, PO R AL G , V PO Tr ai ni ng 2 Fa ci lit y 20 23 2 02 8 Re po rt a nd D oc um en ts 1 5, 25 1, 00 0 G ov t/ Pa rt ne r 3. 2. 4. 2. 2 Su pp or t pr oc ur em en t of m at er ia ls n ec es sa ry f or p ro du ct io n an d di st rib ut io n of P T M at er ia ls M O H , M oL F, PO R AL G , V PO la bo ra to ry 2 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 2 ,0 40 ,4 02 ,0 04 G ov t/ Pa rt ne r A ct iv it y: 3 .2 .4 .3 . S up po rt a cc re di ta ti on p ro ce ss t o de si gn at ed la bo ra to ri es f or A M R s ur ve ill an ce Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t qu an ti ty Im pl em en ta ti on le ve l Ti m el in e O ut pu t in di ca to r co st Fu nd in g so ur ce 3. 2. 4. 3. 1 Tr ai n la bo ra to ry s ta ff o n IS O 15 18 9 fo r Q M S. M O H Tr ai ni ng 4 N at io na l 20 23 2 02 8 Re po rt a nd D oc um en ts 5 1, 10 9, 54 0 G ov t/ Pa rt ne r 3. 2. 4. 3. 2 Su pp or t m en to rs hi p pr og ra m o n IS O 1 51 89 fo r Q M S M O H La bo ra to ry 24 Fa ci lit y 20 23 2 02 8 Re po rt a nd D oc um en ts 1 9, 19 0, 00 0 G ov t/ Pa rt ne r 3. 2. 4. 3. 3 Su pp or t m en to rs hi p pr og ra m o n IS O 1 70 43 fo r EQ A pr od uc tio n M O H , M oL F, PO R AL G , V PO La bo ra to ry 2 Fa ci lit y 20 23 2 02 8 Re po rt a nd D oc um en ts 1 57 ,1 10 ,9 55 G ov t/ Pa rt ne r 3. 2. 4. 3. 4 Su pp or t de si gn at ed l ab or at or ie s fo r ac cr ed ita tio n on I SO 1 51 89 fo r Q M S M O H La bo ra to ry 24 Fa ci lit y 20 23 2 02 8 Re po rt a nd D oc um en ts 1 17 ,3 23 ,1 15 G ov t/ Pa rt ne r 3. 2. 4. 3. 5 Su pp or t Re fe re nc e la bo ra to rie s on I SO 1 70 43 fo r EQ A pr od uc tio n. M O H , M oL F, PO R AL G , V PO La bo ra to ry 2 Fa ci lit y 20 23 2 02 8 Re po rt a nd D oc um en ts 5 2, 00 0, 00 0 G ov t/ Pa rt ne r 50 National Action Plan on Antimicrobial Resistance 2023 - 2028 51 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 O pe ra ti on al P la n fo r R es ea rc h an d D ev el op m en t P R IO R IT Y A C TI O N : R ES EA R C H A N D D EV EL O P M EN T O bj ec ti ve 3 .3 : St re ng th en r es ea rc h an d de ve lo pm en t in a dd re ss in g an ti m ic ro bi al r es is ta nc e In te rv en ti on 3 .3 .1 : In te gr at e A M R in t he ir r es pe ct iv e se ct or al r es ea rc h ag en da A ct iv it y: 3 .3 .1 .1 : En ga ge r el ev an t st ak eh ol de rs t o id en ti fy c ur re nt g ap s in k no w le dg e an d po te nt ia l r es ea rc h to pi cs Su b A ct iv it y Im pl em en ti ng E nt it y U ni t Q ua nt it y Im pl em en ta ti on L ev el Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 3. 3. 1. 1. 1 Id en tif y cu rr en t ga ps in A M R r es ea rc h in se ct or s an d in st itu tio ns M oH , M LF , M oA , V PO , P M O , N EM C, G CL A, r es ea rc h an d ac ad em ic I ns tit ut io ns W or ks ho p 1 N at io nw id e Fe b 23 A w or ks ho p be in g co nd uc te d 2 7, 00 0, 00 0 G ov /P ar tn er s 3. 3. 1. 1. 2 Fo rm ul at e an d ag re e on t he p rio rit y re se ar ch t op ic s an d is su es to b e in te gr at ed in R es ea rc h ag en da M oH , M LF , M oA , V PO , P M O , N EM C, G CL A, r es ea rc h an d ac ad em ic in st itu tio ns W or ks ho p 2 N at io nw id e M ar 2 3 N um be r of w or k sh op s co nd uc te d 4 5, 20 0, 00 0 G ov /P ar tn er s A ct iv it y: 3 .3 .1 .2 : D ev el op n at io na l r es ea rc h gu id el in es o n A M R Su b A ct iv it y Im pl em en ti ng E nt it y U ni t Q ua nt it y Im pl em en ta ti on L ev el Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 3. 3. 1. 2. 1 D ev el op A M R re se ar ch g ui de lin es M oH , M LF , M oA , M oI T, V PO , PM O , r es ea rc h an d ac ad em ic in st itu tio ns W or ks ho p 2 N at io nw id e Ju l-2 3 N um be r of w or k sh op s co nd uc te d 5 5, 02 0, 00 0 G ov /P ar tn er s 3. 3. 1. 2. 2 D ev el op t he St an da rd s O pe ra tin g Pr oc ed ur es ( SO P) f or A M R re se ar ch M oH , M LF , M oA , M oI T, V PO , PM O , r es ea rc h an d ac ad em ic in st itu tio ns W or ks ho p 2 N at io nw id e Ju l-2 3 N um be r of w or k sh op s co nd uc te d 3 6, 20 0, 00 0 G ov /P ar tn er s 3. 3. 1. 2. 3 Va lid at e th e de ve lo pe d SO Ps fo r AM R re se ar ch M oH , M LF , M oA , M oI T, V PO , PM O , r es ea rc h an d ac ad em ic in st itu tio ns W or ks ho p 2 N at io nw id e Ju l-2 3 N um be r of w or k sh op s co nd uc te d 1 9, 55 0, 00 0 G ov /P ar tn er s 3. 3. 1. 2. 4 U se r tr ai ni ng o n de ve lo pe d SO Ps fo r AM R re se ar ch M oH , M LF , M oA , M oI T, V PO , PM O , r es ea rc h an d ac ad em ic in st itu tio ns W or ks ho p 2 N at io nw id e Ju l-2 3 N um be r of w or k sh op s co nd uc te d 2 4, 43 0, 00 0 G ov /P ar tn er s 3. 3. 1. 2. 5 Pr in tin g an d di ss em in at io n of A M R gu id el in es M CC Pr of es si on al co nf er en ce s, M ed ia co ve ra ge 6 N at io nw id e Ju l-2 3 N um be r of c op ie s pr od uc ed , N um be r of c on fe re nc es at te nd ed 1 34 ,9 80 ,0 00 G ov /P ar tn er s 52 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 A ct iv it y: 3 .3 .1 .3 : C on du ct A M R r es ea rc h ac ti vi ti es Su b A ct iv it y Im pl em en ti ng E nt it y U ni t Q ua nt it y Im pl em en ta ti on L ev el Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 3. 3. 1. 3. 1 M ap t he st ak eh ol de rs a nd t he ir ca pa ci tie s an d to c on du ct AM R r es ea rc he s M oH , M LF , M oA , M oI T VP O , PM O , r es ea rc h an d ac ad em ic in st itu tio ns D es k re vi ew s/ Su rv ey s 4 N at io nw id e 20 23 2 02 4 N um be r of r ev ie w s co nd uc te d N um be r of s ur ve ys co nd uc te d 1 ,5 00 ,0 00 ,0 00 G ov /P ar tn er s 3. 3. 1. 3. 2 Se ns iti ze st ak eh ol de rs a nd d on or s to co nd uc t an d su pp or t AM R re se ar ch a cr os s se ct or s M oH , M LF , M oA , M oI T VP O , PM O , r es ea rc h an d ac ad em ic in st itu tio ns Se m in ar s/ W or ks ho ps 4 N at io nw id e 20 23 2 02 4 N um be r of w or k sh op s co nd uc te d 3 9, 10 0, 00 0 3. 3. 1. 3. 3 To fa ci lit at e ac qu is iti on o f ba se lin e da ta t o su pp or t bi g gr an t ap pl ic at io ns . M oH , M LF , M oA , M oI T VP O , PM O , r es ea rc h an d ac ad em ic in st itu tio ns Re se ar ch pr oj ec ts 10 N at io nw id e 20 23 2 02 4 N um be r of r e se ar ch p ro je ct s co nd uc te d 3 0, 58 0, 00 0 Re se ar ch a nd Ac ad em ic I n st itu tio ns /G vt 3. 3. 1. 3. 4 D ev el op A M R re la te d re se ar ch p ro po sa ls w ith o ne h ea lth a pp ro ac h in re sp on se t o ca lls . M oH , M LF , M oA , M oI T VP O , PM O , R es ea rc h an d Ac ad em ic In st itu tio ns , N G O s W or ks ho p 10 N at io nw id e 20 23 2 02 8 N um be r of p ro po s al s de ve lo pe d 2 0, 00 0, 00 0 G ov /P ar tn er s 3. 3. 1. 3. 5 Im pl em en t re se ar ch p ro je ct s on A M R . Re se ar ch a nd A ca de m ic I ns ti tu tio ns e tc . N at io nw id e 20 23 2 02 8 Am ou nt o f da ta ge ne ra te d an d an al ys ed 0 G ov /P ar tn er s 3. 3. 1. 3. 6 Co nd uc t st ak eh ol de rs m ee tin g to tr ac k th e im pl em en ta tio n of AM R r es ea rc h M oH , M LF , M oA , V PO , N EM C W or ks ho p 5 N at io nw id e M ay 2 3 A w or ks ho p be in g co nd uc te d 1 33 ,5 00 ,0 00 G ov /P ar tn er s A ct iv it y: 3 .3 .1 .4 E st ab lis h an d op er at io na liz e th e na ti on al b io b an k as s ou rc e of is ol at es f or A M R r es ea rc h in t he c ou nt ry Su b A ct iv it y Im pl em en ti ng E nt it y U ni t Q ua nt it y Im pl em en ta ti on L ev el Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 3. 3. 1. 4. 1 Se le ct io n of o ne re fe rr al la bo ra to ry t o be na tio na l b io ba nk o f is ol at es fo r AM R r es ea rc h M oH , M LF , M oA , M oI T, V PO M ee tin g 1 N at io nw id e Ju l-2 3 Th e m ee tin g be in g co nd uc te d 0 G ov /P ar tn er s 3. 3. 1. 4. 2 Co nd uc t a ne ed s as se ss m en t of t he s el ec te d la bo ra to ry t o se rv e as a N at io na l B io ba nk M oH , M LF , M oA , M oI T, V PO N at io na l B io ba nk Ju l-2 3 N ee ds a ss es sm en t co nd uc te d 1 3, 60 0, 00 0 G ov /P ar tn er s 53 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 3. 3. 1. 4. 3 Id en tif y in st itu tio ns / si te s to p ro vi de is ol at es f or A M R r es ea rc h M oH , M LF , M oA , M oI T, V PO N at io nw id e Ju l-2 3 Th e m ee tin g be in g co nd uc te d 0 G ov /P ar tn er s 3. 3. 1. 4. 4 Su pp or t th e N at io n al B io ba nk w ith e qu ip m en t, fa ci lit ie s an d su pp lie s M oH , M LF , M oA , M oI T, V PO N at io na l B io ba nk Ju l-2 3 Su pp or t ex te nd ed to t he la bo ra to ry 3 24 ,0 00 ,0 00 G ov /P ar tn er s 3. 3. 1. 4. 4 O pe ra tio na liz e th e bi ob an k M oH , M LF , M oA , M oI T, V PO N at io na l B io ba nk Ju l-2 3 A w or ki ng b io ba nk 2 0, 78 0, 00 0 G ov /P ar tn er s P ri or it y In te rv en ti on 3 .3 .2 : Es ta bl is h an d su pp or t a fr am ew or k fo r di ss em in at io n, s to ra ge a nd s ha ri ng o f A M R r es ea rc h fi nd in gs A ct iv it y: 3 .3 .2 .1 I de nt if y an d ut ili ze d if fe re nt a pp ro ac he s fo r di ss em in at io n of A M R r es ea rc h fi nd in gs Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on Le ve l Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 3. 3. 2. 1. 1 Es ta bl is h a N at io na l A M R b ul le tin / ou tr ea ch m at er ia ls M CC Bu lle tin 5 N at io nw id e 20 23 2 02 8 N um be r of b ul le tin is su es p ub lis he d G ov /P ar tn er s 3. 3. 2. 1. 2 Es ta bl is h an d op er at io na liz e a vi rt ua l pl at fo rm M O H ,M LF , PO R AL G 5 N at io nw id e 20 23 2 02 8 nu m be r of pl at fo rm s G ov t/ Pa rt ne rs 3. 3. 2. 1. 3 Su pp or t sy nt he si s an d in te rp re ta tio n of A M R da ta Re se ar ch a nd ac ad em ic in st itu tio ns N at io nw id e N um be r of w or ks ho ps co nd uc te d N um be r of do cu m en ts w ith sy nt he si ze d da ta . G ov t/ Pa rt ne rs 3. 3. 2. 1. 4 Pu bl is h AM R re se ar ch fi nd in gs in re pu ta bl e jo ur na ls / bo ok s/ bo ok c ha pt er s M CC Ar tic le s 30 0 N at io nw id e 20 23 2 02 8 N um be r of a rt ic le s pu bl is he d G ov /P ar tn er s 54 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 3. 3. 2. 1. 5 Su pp or t pr ep ar at io n an d di ss em in at io n of A M R p ol ic y br ie fs M CC W or ks ho ps 10 N at io nw id e 20 23 2 02 8 N um be r of p ol ic y br ie fs d ev el op ed N um be r of w or k sh op s co nd uc te d G ov /P ar tn er s 3. 3. 2. 1. 6 D is se m in at e AM R re se ar ch t hr ou gh m ed ia a nd pu bl ic g at he rin gs M CC Se ss io ns 15 0 N at io nw id e 20 23 2 02 8 N um be r of se ss io ns G ov /P ar tn er s 3. 3. 2. 1. 7 Co nd uc t m ul ti se ct or al O ne H ea lth A M R sc ie nt ifi c sy m po si a an d ro un dt ab le d is cu ss io ns an nu al ly M CC Sy m po si um 5 N at io nw id e 20 23 2 02 8 N um be r of sy m po si a co nd uc te d N um be r of ro un dt ab le di sc us si on s co nd uc te d G ov /P ar tn er s 3. 3. 2. 1. 8 Su pp or t pr ep ar at io n an d di ss em in at io n of A M R re se ar ch e vi de nc e M CC . M at er ia ls 5 N at io nw id e 20 23 2 02 8 N um be r of m at er ia ls p re pa re d an d di ss em in at ed G ov /P ar tn er s A ct iv it y: 3 .3 .2 .2 E st ab lis h po lic y gu id el in es t o ad dr es s A M R d at a se cu ri ty a nd s ha ri ng in t he c ou nt ry Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on Le ve l Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 3. 3. 2. 2. 1 En ga ge st ak eh ol de rs t o st ra te gi ze on h ow t he y ca n in cl ud e a po lic y st at em en t du rin g th ei r se ct or al r es ea rc h po lic y re vi ew M CC W or ks ho p 1 N at io nw id e 20 23 2 02 8 A w or ks ho p be in g co nd uc te d G ov /P ar tn er s 3. 3. 2. 2. 2 Fo rm ul at e po lic y st at em en t an d its s tr at eg ic ob je ct iv es t ha t w ill b e ad op te d by a ll se ct or s to al lo w r es ea rc h da ta s ec ur ity an d sh ar in g ac ro ss O H se ct or s M CC W or ks ho p 1 N at io nw id e 20 23 2 02 8 A w or ks ho p be in g co nd uc te d G ov /P ar tn er s 55 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 A ct iv it y: 3 .3 .2 .3 E st ab lis h an d su st ai n a na ti on al A M R d at a re po si to ry Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on Le ve l Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 3. .3 .2 .3 .1 E st ab lis h a ce nt ra liz ed d at ab as e on AM R M oH /M LF /M oA 1 N at io nw id e Ja n 23 D at ab as e de ve l op ed G ov t/ Pa rt ne rs 3. 3. 2. 3. 2 En ga ge st ak eh ol de rs t o es ta bl is h AM R d at ab as e fr am ew or k M CC W or ks ho p 1 N at io nw id e 20 23 2 02 4 N um be r of w or k sh op s co nd uc te d, N um be r an d ty pe s of s ta ke ho ld er s in vo lv ed G ov /P ar tn er s 3. 3. 2. 3. 3 D ev el op a n el ec tr on ic s ys te m f or A M R da ta r ep os ito ry M CC Re po si to ry 1 N at io nw id e 20 23 2 02 4 Pr es en ce o f a de ve lo pe d an d pi lo te d AM R d at a re po si to ry G ov /P ar tn er s 3. 3. 2. 3. 4 O pe ra tio na liz e an el ec tr on ic s ys te m f or A M R da ta r ep os ito ry M CC Re po si to ry 1 N at io nw id e 20 23 2 02 8 Pr es en ce o f a fu nc tio na l A M R d at a re po si to ry G ov /P ar tn er s 56 National Action Plan on Antimicrobial Resistance 2023 - 2028 STRATEGIC OBJECTIVE FOUR REDUCE THE INCIDENCE OF INFECTIONS Adequate water supply, sanitation, vaccines and better hygiene are key for infection prevention. This works to limit the development and spread of antimicrobial resistant infections as well as multi drug resistant pathogens. Pregnancy, abortion, and childbirth, especially where these events take place in healthcare settings without safe or hygienic conditions, put these individuals at a higher risk of exposure to AMR7. Drug resistance does not only occur in health care settings but also at the community level. There is also evidence of gender-based behaviors in handwashing that give men a two-fold increase in AMR infections compared with women8. And, men tend to self-prescribe and may not finish the full course of antimicrobials, leaving themselves at risk for AMR infections9. To facilitate infection prevention and control in health settings, the the NAP AMR 2017 - 2022 facilitated the establishment and strengthening of the national infection prevention and control program. Several key achievements were noted in the human sector, little was done for plants, animals and the environment sectors. Infection prevention and control measures including proper training of health personnel and education in the community is needed during the implementation of NAP-AMR 2023-2028. Vaccination as part of IPC reduces the risk that antimicrobial resistant pathogens will develop and spread through food chain and other means including contact, vector bites, droplet etc. Several regulations were developed in animal sector and country vaccination programs, vaccine supply, capacity building and infrastructure was strengthened during the implementation of NAP AMR 2017-2022. Having strong vaccination program in the implementation of NAP AMR 2023-2028 will lead to reduced use of antimicrobials in animal and human which will lead to improved individual and country economy. Interventions for achieving minimum standards for maintaining a safe and clean environment and on farm biosecurity are also prioritized. To achieve this strategic objective, two priority actions have been identified: strengthen IPC and health waste management system. 7 World Health Organization. Tackling Antimicrobial Resistance (AMR) Together Working Paper 5.0: Enhancing the focus on gender and equity. 2018. Available at: https://cdn.who.int/media/docs/default-source/antimicrobial resistance/amr-spc-npm/nap-working-papers/tackling-amr-together-working-paper-5-genderandequity-sept2018-en. pdf?sfvrsn=8b53f887 1&download=true. [cited 2022 June 15]. 8 Soldin OP, Mattison DR. Sex differences in pharmacokinetics and pharmacodynamics. Clin Pharmacokinet. 2009;48(3):143– 57. doi: http:// dx.doi .org/ 10 .2165/ 00003088 -200948030 -00001 PMID: 19385708 9 World Health Organization. Tackling Antimicrobial Resistance (AMR) Together Working Paper 5.0: Enhancing the focus on gender and equity. 2018. Available at: https://cdn.who.int/media/docs/default-source/antimicrobial resistance/amr-spc-npm/nap-working-papers/tackling-amr-together-working-paper-5-genderandequity-sept2018-en. pdf?sfvrsn=8b53f887 1&download=true. [cited 2022 June 15]. 57National Action Plan on Antimicrobial Resistance 2023 - 2028 58 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 O pe ra ti on al P la n fo r In fe ct io n P re ve nt io n an d C on tr ol in H ea lt hc ar e P R IO R IT Y A C TI O N : I N FE C TI O N P R EV EN TI O N A N D C O N TR O L IN H EA LT H C A R E O bj ec ti ve 4 .1 : St re ng th en in fe ct io n pr ev en ti on a nd c on tr ol P ro gr am s In te rv en ti on 4 .1 .1 : P ro m ot e of I P C p ro gr am m es in a ll hu m an h ea lt h ca re s et ti ng s A ct iv it y 4. 1. 1. 1: C on du ct s ch ed ul ed s up po rt iv e su pe rv is io n an d m on it or in g to h ea lt h fa ci lit ie s by q ua lit y as su ra nc e te am s (M in is tr y le ve l, R H M T, C H M T) Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on Le ve l ( N at io na l/ Fa ci lit y/ C om m un it y) Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 4. 1. 1. 1. 1 Co nd uc t su pp or tiv e Su pe rv is io n to h ea lth fa ci lit ie s M O H a nd P O R AL G H CF 50 00 H CF N at io na l/F ac ili ty 20 23 2 02 8 N um be r of su pe rv is ed fa ci lit ie s 9 06 ,7 84 ,5 08 G ov t/ Pa rt ne rs 4. 1. 1. 1. 2 Co nd uc t IP C as se ss m en ts o n ad he re nc e of I PC st an da rd s by H CW s in a ll H Fs a nd re co gn iz e be st p er fo rm in g H Fs M O H a nd P O R AL G H CF 50 00 H CF N at io na l/F ac ili ty 20 23 2 02 8 N um be r of fa ci lit ie s as se ss ed 2 75 ,7 40 ,9 99 G ov t/ Pa rt ne rs 4. 1. 1. 1. 3 Co nd uc t m en to rs hi p to he al th fa ci lit ie s M O H a nd P O R AL G H CF 50 00 H CF N at io na l/F ac ili ty 20 23 2 02 8 N um be r of fa ci lit ie s m en to re d 4 9, 73 4, 79 9 G ov t/ Pa rt ne rs 7. 1. 1. 4 Tr ai n H ea lth ca re W or ke rs of a ll he al th fa ci lit ie s on I PC M on ito rin g an d Ev al ua tio n M oH H CW 50 00 H CF N at io na l/F ac ili ty 20 23 2 02 8 N um be r of p eo pl e tr ai ne d 4 56 ,5 39 ,9 49 G ov t/ Pa rt ne rs 4. 1. 1. 1. 5 Co nd uc t an nu al D at a Q ua lit y as se ss m en t of I PC M on ito rin g an d ev al ua tio n re po rt s in h ea lth fa ci lit ie s M oH H CF 50 00 H CF N at io na l/F ac ili ty 20 23 2 02 8 N um be r of fa ci lit ie s ev al ua te d an d m on ito re d 3 99 ,4 08 ,6 92 G ov t/ Pa rt ne rs A ct iv it y 4. 1. 1. 2: C on du ct a dv oc ac y an d se ns it iz at io n on I P C Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on Le ve l ( N at io na l/ Fa ci lit y/ C om m un it y) Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 4. 1. 1. 2. 2 D ev el op I PC In fo rm at io n, E du ca tio n an d co m m un ic at io n (I EC ) & b eh av io ra l ch an ge c om m un ic at io n m at er ia ls (B CC m at er ia ls ) M oH , M LF , M in is tr y of ag ric ul tu re a nd N EM C W or ks ho ps 5 N at io na l 20 23 2 02 8 N um be r of IE C m at er ia ls de ve lo pe d 7 28 ,7 84 ,8 42 G ov t/ Pa rt ne rs 4. 1. 1. 2. 3 Re vi se N at io na l I PC co m m un ic at io n an d be ha vi or s ch an ge s tr at eg y fo r by J un e, 2 02 5 M oH , M LF , M oA a nd N EM C W or ks ho ps 3 N at io na l 20 23 2 02 8 N at io na l I PC co m m un ic at io n an d be ha vi or s ch an ge s tr at eg y re vi se d 2 39 ,6 53 ,1 24 G ov t/ Pa rt ne rs 59 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 4. 1. 1. 2. 4 Co nd uc t se ns iti za tio n an d or ie nt at io n se ss io ns t o st ak eh ol de rs a t al l l ev el s M oH , M LF , M oA , a nd N EM C Se ns iti za tio n an d or ie nt at io n se ss io ns 10 N at io na l 20 23 2 02 8 Se ss io ns /M ee tin gs re po rt s 3 60 ,2 09 ,1 98 G ov t/ Pa rt ne rs A ct iv it y 4. 1. 1. 3: F ac ili ta te a va ila bi lit y of I P C r el at ed e qu ip m en t, s up pl ie s, u ti lit ie s (w at er s up pl y) a nd g ui de lin es Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on Le ve l ( N at io na l/ Fa ci lit y/ C om m un it y) Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 4. 1. 1. 3. 1 D ev el op T ra in in g m at er ia ls f or E m er gi ng / re em er gi ng d is ea se s by J un e, 20 25 M oH a nd M LF w or ks ho ps 10 N at io na l 20 23 2 02 8 w or ks ho ps r ep or ts 2 68 ,1 54 ,5 48 G ov t/ Pa rt ne rs 4. 1. 1. 3. 2 Fi na liz at io n of I PC M & E pr ot oc ol b y Ju ne , 2 02 5 M oH a nd M LF W or ks ho ps 2 N at io na l 20 23 2 02 5 W or ks ho ps re po rt s 5 4, 48 1, 00 0 G ov t/ Pa rt ne rs 4. 1. 1. 3. 3 Fi na liz at io n of P at ie nt sa fe ty G ui de lin es . M oH W or ks ho ps 3 N at io na l 20 23 2 02 6 W or ks ho ps re po rt s 7 7, 40 0, 00 0 G ov t/ Pa rt ne rs 4. 1. 1. 3. 4 Fi na liz at io n of H AI s su rv ei lla nc e pr ot oc ol b y Ju ne 20 25 . M oH W or ks ho ps 5 N at io na l 20 23 2 02 6 W or ks ho ps re po rt s 6 7, 55 0, 00 0 G ov t/ Pa rt ne rs 4. 1. 1. 3. 5 Fi na liz at io n of s ta nd ar d op er at in g pr oc ed ur es f or H AI s pr ev en tio n. M oH W or ks ho ps 3 N at io na l 20 23 2 02 6 W or ks ho ps re po rt s 7 0, 52 0, 00 0 G ov t/ Pa rt ne rs 4. 1. 1. 3. 6 Pr in tin g of I PC G ui de lin es a nd m at er ia l h an do ut s by J un e 20 25 . M oH Co pi es 20 00 N at io na l 20 23 2 02 5 IP C m at er ia ls pr in te d 5 55 ,5 00 ,0 00 G ov t/ Pa rt ne rs 4. 1. 1. 3. 7 D is se m in at e M & E, H AI pr ot oc ol , I PC g ui de lin es , S O Ps , an d st an da rd s to lo w er h ea lth fa ci lit ie s. M oH D is se m in at io n se ss io ns 5 N at io na l 20 23 2 02 8 D is se m in at io n se ss io ns r ep or ts 3 44 ,5 02 ,8 29 G ov t/ Pa rt ne rs 4. 1. 1. 3. 8 Su pp or t pr ov is io n of ad eq ua te a nd a pp ro pr ia te ly m ai nt ai ne d w at er , s an ita tio n, a nd he al th c ar e w as te m an ag em en t fa ci lit ie s i.e ., Im pr ov ed t oi le ts f or cl ie nt s& s ta ff, h an d w as hi ng fa ci li tie s an d in ci ne ra to rs ) M oH H CF 40 00 H CF s Fa ci lit y 20 23 2 02 8 N um be r of H CF m ai nt ai ne d w ith w at er a nd sa ni ta tio n fa ci lit ie s 1 ,0 15 ,0 50 ,0 00 G ov t/ Pa rt ne rs 60 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 St ra te gi c In te rv en ti on 4 .1 .2 : St re ng th en v ac ci na ti on P ro gr am m e in h um an A ct iv it y 4. 1. 2. 1: S tr en gt he ni ng v ac ci na ti on a nd v ec to r co nt ro l p ro gr am m es in h um an Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on L ev el (N at io na l/ F ac ili ty / C om m un it y) Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 4. 1. 2. 1. 1 To r ev ie w g ui de lin es M O H M ee tin gs 8 N at io na l 20 23 2 02 5 D is se m in at io n se ss io ns r ep or ts 9 8, 10 0, 00 0 G ov t/ Pa rt ne rs 4. 1. 2. 1. 2 To d is se m in at e/ re vi ew ed g ui de lin es ( va cc in es an d va cc in at io n. M O H M ee tin gs 92 N at io na l 20 23 2 02 5 M ee tin g re po rt s 7 50 ,4 98 ,1 34 G ov t/ Pa rt ne rs 4. 1. 2. 1. 3 To c on du ct c ap ac ity bu ild in g/ Su pe rv is or y m ee tin gs w ith L G As t ec hn ic al s ta ff a nd ot he r st ak eh ol de rs in v ac ci na tio n pr og ra m m es M O H M ee tin gs 92 N at io na l 20 23 3 02 8 N um be r m ee tin gs 83 5, 03 4, 52 1 G ov t/ Pa rt ne rs In te rv en ti on 4 .1 .3 : Es ta bl is h an d de si gn I P C p ro gr am m es in a ni m al , a qu at ic , p la nt h ea lt h se rv ic es a nd E nv ir on m en ta l M an ag em en t A ct iv it y 4. 1. 3. 1: D es ig n an d in tr od uc e IP C in te rv en ti on s ac ro ss a ni m al h ea lt h ca re s et ti ng 4. 1. 3. 1. 1 To d ev el op N at io na l IP C gu id el in e, s ta nd ar ds a nd tr ai ni ng m at er ia ls fo r ve te rin ar y Fa ci lit ie s, A ni m al & A qu at ic he al th p ra ct iti on er s an d di ffe re nt ty pe s of fa rm in g sy st em s M LF a nd M oA W or ks ho ps 20 N at io na l 20 23 2 02 5 W or ks ho ps r ep or ts 3 12 ,2 51 ,8 05 G ov t/ Pa rt ne rs 4. 1. 3. 1. 2 To d ev el op I PC M & E pr ot oc ol . M LF a nd M oA W or ks ho ps 3 N at io na l 20 23 2 02 5 W or ks ho ps r ep or ts 4 6, 00 0, 00 0 G ov t/ Pa rt ne rs 4. 1. 3. 1. 3 To d ev el op N at io na l Re si du e M on ito rin g Pl an s fo r fr es hw at er a nd M ar in e w at er s in w ild a nd v ar io us t yp es o f fa rm in g sy st em s at a ll le ve ls . M LF a nd M oA W or ks ho ps 2 N at io na l 20 23 2 02 6 W or ks ho ps r ep or ts 1 99 ,1 52 ,8 10 G ov t/ Pa rt ne rs 4. 1. 3. 1. 4 To d ev el op N at io na l IP C gu id el in es a nd S O P fo r pl an t, a qu at ic a nd a ni m al h ea lth pr ac tit io ne rs b y Ju ne 2 02 5. M LF a nd M oA W or ks ho ps 2 N at io na l 20 23 2 02 7 W or ks ho ps r ep or ts 2 70 ,8 28 ,7 47 G ov t/ Pa rt ne rs 4. 1. 3. 1. 5 To d ev el op N at io na l co m m un ic at io n st ra te gy a cr os s pl an t, a qu ac ul tu re a nd a ni m al , he al th s et tin g fo r IP C M LF a nd M oA W or ks ho ps 3 N at io na l 20 23 2 02 7 W or ks ho ps r ep or ts 1 97 ,1 82 ,0 00 G ov t/ Pa rt ne rs 4. 1. 3. 1. 6 To d ev el op S ur ve ill an ce pr ot oc ol o n pe st ic id es w ith A M R ef fe ct s M LF a nd M oA W or ks ho ps 3 N at io na l 20 23 2 02 7 W or ks ho ps r ep or ts 3 2, 05 0, 00 0 G ov t/ Pa rt ne rs 61 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 4. 1. 3. 1. 7 To d is se m in at e de ve lo pe d na tio na l I PC gu id el in e, s ta nd ar ds a nd t ra in in g m at er ia ls f or a ni m al , p la nt & aq ua tic h ea lth fa rm in g sy st em s M LF a nd M oA D is se m in at io n se ss io ns 50 N at io na l 20 23 2 02 8 D is se m in at io n se ss io ns r ep or ts 1 ,1 72 ,3 53 ,6 15 G ov t/ Pa rt ne rs 4. 1. 1. 1. 8 To d is se m in at e de ve lo pe d IP C M & E p ro to co l M LF a nd M oA D is se m in at io n se ss io ns 50 N at io na l 20 23 2 02 8 D is se m in at io n se ss io ns r ep or ts 1 78 ,1 64 ,0 00 G ov t/ Pa rt ne rs 4. 1. 3. 1. 9 To d is se m in at e de ve lo pe d H AI S ur ve ill an ce pr ot oc ol o n pe st ic id es in r el at io n to A M R M LF a nd M oA D is se m in at io n se ss io ns 50 N at io na l 20 23 2 02 8 D is se m in at io n se ss io ns r ep or ts 2 37 ,9 79 ,0 28 G ov t/ Pa rt ne rs In te rv en ti on 4 .1 .4 : St re ng th en v ac ci na ti on P ro gr am m e in a ni m al h ea lt h A ct iv it y 4. 1. 4. 1: S tr en gt he ni ng v ac ci na ti on a nd v ec to r co nt ro l p ro gr am m es f or a ni m al h ea lt h Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on L ev el (N at io na l/ F ac ili ty / C om m un it y) Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 4. 1. 4. 1. 1 To d ev el op a ca ric id e us e gu id el in es M LF M ee tin gs 8 N at io na l 20 23 2 02 5 D is se m in at io n se ss io ns r ep or ts 1 58 ,9 56 ,8 30 G ov t/ Pa rt ne rs 4. 1. 4. 1. 2 To d is se m in at e/ re vi ew ed r eg ul at io ns ( va cc in es an d va cc in at io n re gu la tio ns (2 02 0) a nd a ca ric id e an d ac ar ic id e ap pl ic at io n re gu la tio n (2 02 0) M LF M ee tin gs 92 N at io na l 20 23 2 02 5 M ee tin g re po rt s 1 30 ,2 94 ,3 00 G ov t/ Pa rt ne rs 4. 1. 4. 1. 2 To c on du ct c ap ac ity bu ild in g/ Su pe rv is or y m ee tin gs w ith L G As t ec hn ic al s ta ff a nd ot he r st ak eh ol de rs in li ve st oc k in du st ry M LF M ee tin gs 92 N at io na l 20 23 3 02 8 N um be r m ee tin gs 19 1, 58 1, 10 3 G ov t/ Pa rt ne rs In te rv en ti on 4 .1 .5 : St re ng th en in g co m m un it y IP C , l in ka ge s an d P ar tn er sh ip f or I P C A ct iv it y 4. 1. 5. 1: E ng ag e co m m un it ie s on im pl em en ta ti on o f pe rs on al h yg ie ne a nd e nv ir on m en ta l s an it at io n Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on L ev el (N at io na l/ F ac ili ty / C om m un it y) Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 4. 1. 5. 1. 1 To d ev el op c om m u ni ty I PC g ui de lin es a nd S O Ps on im pl em en ta tio n of p er so na l H yg ie ne a nd e nv iro nm en ta l sa ni ta tio n M oH , M LF a nd N EM C W or ks ho ps 10 N at io na l 20 23 2 02 5 W or ks ho ps r ep or ts 1 27 ,0 84 ,2 60 G ov t/ Pa rt ne rs N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 624. 1. 5. 1. 2 To c on du ct a dv oc ac y an d ca m pa ig ns o n im pl em en ta tio n of p er so na l H yg ie ne a nd en vi ro nm en ta l s an ita tio n M oH , M LF , N EM C, M ee tin gs , co nf er en ce s, tv /r ad io se ss io ns 20 N at io na l 20 23 2 02 5 N um be r of m ee t in gs , c am pa ig ns , ra di o se ss io ns 13 7, 84 3, 79 0 G ov t/ Pa rt ne rs 4. 1. 5. 1. 3 To d is se m in at e co m m un ity I PC g ui de lin es a nd S O Ps on im pl em en ta tio n of p er so na l H yg ie ne a nd e nv iro nm en ta l sa ni ta tio n M oH , M LF , N EM C, D is se m in at io ns 50 N at io na l 20 23 2 02 8 N um be r of d is se m in at io ns 15 3, 03 0, 15 0 G ov t/ Pa rt ne rs A ct iv it y 4. 1. 5. 2: P ro m ot e Fo od C ha in H yg ie ne Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on L ev el (N at io na l/ F ac ili ty / C om m un it y) Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 4. 1. 5. 2. 1 To d ev el op g en er al fo od c ha in h yg ie ne g ui de lin e fo r IP C in r el at io n to A M R in t he co m m un ity . M oH , M oA , M LF , M II T, M in is tr y of N at ur al R es ou rc es an d To ur is m , P O R AL G W or ks ho ps 10 N at io na l a nd c om m un ity 20 23 2 02 8 G ui de lin e do cu m en t 4 8, 52 0, 00 0 G ov t/ Pa rt ne rs 4. 1. 5. 2. 2 To d is se m in at e of de ve lo pe d fo od c ha in h yg ie ne IP C gu id el in e w ith f oc us o n fo od ha nd lin g M oH , M oA , M LF , M II T, M in is tr y of N at ur al R es ou rc es an d To ur is m , P O R AL G M ee tin gs 10 0 N at io na l a nd c om m un ity 20 23 2 02 8 M ee tin g re po rt s 1 90 ,7 88 ,7 98 G ov t/ Pa rt ne rs 4. 1. 5. 2. 3 To c on du ct a dv oc ac y an d aw ar en es s ca m pa ig ns o n fo od h yg ie ne a nd I PC . M oH , M oA , M LF , M II T, M in is tr y of N at ur al R es ou rc es an d To ur is m , P O R AL G Se ss io ns /m ee t in gs /t ra in in gs 20 0 N at io na l a nd c om m un ity 20 23 2 02 8 Ad vo ca cy a nd aw ar en es s ca m pa ig ns r ep or ts 2 5, 98 6, 56 6 G ov t/ Pa rt ne rs 63National Action Plan on Antimicrobial Resistance 2023 - 2028 64 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 O pe ra ti on al P la n fo r H ea lt h W as te M an ag em en t Sy st em P R IO R IT Y A C TI O N : H EA LT H W A ST E M A N A G EM EN T SY ST EM O bj ec ti ve 4 .2 : St re ng th en h ea lt h w as te m an ag em en t at a ll le ve ls In te rv en ti on 4 .2 .1 : St re ng th en H ea lt h W as te M an ag em en t at a ll le ve ls A ct iv it y 4. 2. 1. 1: P ro m ot e en vi ro nm en ta l s an it at io n an d w as te m an ag em en t Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on Le ve l ( N at io na l/ Fa ci lit y/ C om m un it y) Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 4. 2. 1. 1. 1 To r ev ie w n at io na l I PC St an da rd O pe ra tin g Pr oc ed ur es ( SO Ps ) fo r H az ar do us W as te s Co nt ro l a nd M an ag em en t. M oH , V PO – N EM C D oc um en t 1 N at io na l 20 23 2 02 5 S O Ps do cu m en t 2 39 ,6 53 ,1 24 G ov t/ Pa rt ne rs 4. 2. 1. 1. 2 To r ev ie w o f ha za rd ou s w as te s co nt ro l a nd m an ag em en t gu id el in e (t o in co rp or at e IP C is su es ) by J un e 20 23 . VP O – N EM C D oc um en t 1 N at io na l 20 23 2 02 5 R ev ie w ed do cu m en t 1 99 ,1 52 ,8 10 G ov t/ Pa rt ne rs 4. 2. 1. 1. 3 To d ev el op I PC t ra in in g m at er ia ls f or H az ar do us W as te C on tr ol & M an ag em en t (H W CM ) ge ne ra te d fr om h um an h ea lth , a gr ic ul tu re a nd liv es to ck . M oH , V PO – N EM C D oc um en t 1 N at io na l 20 23 2 02 5 T ra in in g m at er ia ls 1 56 ,6 00 ,0 00 G ov t/ Pa rt ne rs 4. 2. 1. 1. 4 D ev el op m en t of H CW M s su rv ei lla nc e pr ot oc ol . VP O – N EM C D oc um en t 1 N at io na l 20 23 2 02 4 H CW M s su rv ei lla nc e pr ot oc ol 4 9, 00 5, 20 0 G ov t/ Pa rt ne rs 4. 2. 1. 1. 5 To d ev el op I PC M on ito rin g an d Ev al ua tio n pr ot oc ol / G ui de lin es f or W as te M an ag em en t fr om v ar io us fa rm , fa ct or ie s, a nd h ea lth c ar e se tt in gs . M oH , V PO – N EM C, PO R AL G D oc um en t 1 N at io na l 20 23 2 02 6 D ev el op ed IP C M on ito rin g an d Ev al ua tio n pr ot oc ol 10 4, 59 5, 60 0 G ov t/ Pa rt ne rs 4. 2. 1. 1. 6 To r ev ie w a nd d is se m in at e th e Pu bl ic H ea lth A ct 2 00 9 to ad dr es s pr op er w as te m an ag em en t (a nt im ic ro bi al s) in r el at io n to A M R M oH D oc um en t 30 N at io na l 20 23 2 02 4 D oc um en t 1 67 ,6 68 ,3 00 G ov t/ Pa rt ne rs 65 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 4. 2. 1. 1. 7 To c on du ct s oc ia l b eh av io rs , ch an ge a nd c om m un ic at io n ca m pa ig ns (S BC C) t o pr om ot e im pr ov ed t oi le ts , ha nd w as hi ng fa ci lit ie s an d m en st ru al he al th a nd h yg ie ne ( M H H ) M oH , P O R AL G M ed ia ca m pa ig ns / gr ou nd ac tiv at io ns 50 0 na tio na l 20 23 2 02 4 N um be r im pr ov ed to ile ts , ha nd w as hi ng fa ci lit ie s an d m en st ru al he al th a nd hy gi en e (M H H ) 3 99 ,4 08 ,6 92 G ov t/ Pa rt ne rs 4. 2. 1. 1. 8 To d ev el op g ui de lin es f or pu bl ic p riv at e pa rt ne rs hi p (P PP ) on s af e pi t em pt yi ng , f ec al s lu dg e tr an sp or ta tio n an d tr ea tm en t to a tt ai n ar ea w id e op en d ef ec at io n fr ee ( O D F) M oH , M oW , P O R AL G W or ks ho ps / G ui de lin es 30 0 N at io na l 20 23 2 02 4 D ev el op ed gu id el in e 3 6, 38 1, 00 0 G ov t/ Pa rt ne rs 4. 2. 1. 1. 9 To d is se m in at e de ve lo pe d gu id el in e on p ub lic p riv at e pa rt ne rs hi p (P PP ) on s af e pi t em pt yi ng , f ec al sl ud ge t ra ns po rt at io n an d tr ea tm en t to at ta in a re aw id e op en d ef ec at io n fr ee (O D F) M oH , M oW , P O R AL G Ev al ua tio n re po rt 20 0 N at io na l 20 23 2 02 8 N um be r of di ss em in at io n m ee tin g 1 58 ,1 66 ,0 00 G ov t/ Pa rt ne rs 4. 2. 1. 1. 10 T o co nd uc t M id a nd En d te rm e va lu at io n of t he N at io na l St ra te gy f or a cc el er at in g Sa ni ta tio n an d H yg ie ne f or A ll (N SA SH A) 2 02 0 20 25 M oH , M oW , P O R AL G Re po rt Ev al ua tio n re po rt s 2 20 23 2 02 8 M id te rm e va lu at io n re po rt 36 ,5 62 ,0 00 G ov t/ Pa rt ne rs A ct iv it y 4. 2. 1. 2: P ro m ot e Zo os an it ar y an d ph yt os an it ar y en vi ro nm en ta l s et ti ng s Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on Le ve l ( N at io na l/ Fa ci lit y/ C om m un it y) Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 4. 2. 1. 2. 1 To d ev el op a ni m al w as te , ef flu en t, a nd m an ur e di sp os al gu id el in es M LF W or ks ho ps 3 N at io na l 20 23 2 02 5 W or ks ho ps re po rt s 3 13 ,2 00 ,0 00 G ov t/ Pa rt ne rs 4. 2. 1. 2. 2 To d ev el op g ui de lin es , S O P, an d tr ai ni ng m at er ia ls fo r fe rt ili za tio n of a qu af ar m s ys te m s pa rt ic ul ar ly pr ob io tic s an d se aw ee d fe rt ili ze r to cu rb d ow n in tr od uc tio n of a nt im ic ro bi al re si du e M LF W or ks ho ps 5 N at io na l 20 23 2 02 5 W or ks ho ps re po rt s 1 58 ,1 66 ,0 00 G ov t/ Pa rt ne rs 66 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 4. 2. 1. 2. 3 To d ev el op I PC g ui de lin es f or Zo o sa ni ta ry / ph yt os an ita ry in sp ec to rs at p or ts o f en tr ie s/ ex its ( fe ed s, li ve an im al s, a ni m al b yp ro du ct s an d ag ri cu ltu ra l p ro du ct s) M LF W or ks ho ps 5 N at io na l 20 23 2 02 5 W or ks ho ps re po rt s 1 58 ,9 56 ,8 30 G ov t/ Pa rt ne rs 4. 2. 1. 2. 4 To p rin t IP C gu id el in es f or Zo os an ita ry /p hy to sa ni ta ry in sp ec to rs at p or ts o f en tr ie s/ ex its M LF Co pi es 50 00 N at io na l 20 23 2 02 8 Pr in te d gu id e lin es 9 0, 00 0, 00 0 G ov t/ Pa rt ne rs 4. 2. 1. 2. 5 To d is se m in at e de ve lo pe d gu id el in es , S O P, a nd t ra in in g m at er ia ls fo r fe rt ili za tio n of a qu af ar m s ys te m s an d Zo o sa ni ta ry / ph yt os an ita ry in sp ec to rs a t po rt s of e nt rie s/ ex its in sp ec to rs a t po rt s of e nt rie s/ ex its M LF D is se m in at io n se ss io ns 10 N at io na l 20 23 2 02 8 Se ss io ns /M ee t in gs r ep or ts 3 17 ,9 13 ,6 60 G ov t/ Pa rt ne rs A ct iv it y 4. 2. 1. 3: S tr en gt he n na ti on al a nd s ub na ti on al m on it or in g sy st em in t he fi el d of w as te m an ag em en t Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Im pl em en ta ti on Le ve l ( N at io na l/ Fa ci lit y/ C om m un it y) Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 4. 2. 1. 3. 1 To in te gr at e he al th fa ci lit y w as te in di ca to rs in to D H IS 2/ N SM IS M O H a nd P O R AL G W or ks ho ps 5 M O H a nd P O R AL G 20 23 2 02 7 In di ca to rs in D H IS 2 11 4, 57 0, 00 0 G ov t/ Pa rt ne rs 4. 2. 1. 3. 2 To d is se m in at e w as te m on i to rin g to ol s M oH a nd PO R AL G W or ks ho ps 6 M O H a nd P O R AL G 20 23 2 02 8 In di ca to rs in D H IS 3/ N SM IS 15 8, 16 6, 00 0 G ov t/ Pa rt ne rs 4. 2. 1. 3. 3 To e st ab lis h w as te r eg is tr y at al l d is tr ic ts in t he c ou nt ry M O H , P O R AL G an d N EM C w or ks ho ps 5 N at io na l 20 23 2 02 6 W or ki ng r eg is tr y 28 ,5 00 ,0 00 G ov t/ Pa rt ne rs 4. 2. 1. 3. 4 To d ev el op c om m un ity gu id el in es , S O Ps a nd t ra in in g m at er ia ls fo r ha nd lin g an d di sp os al o f re m na nt s, un us ed a nd e xp ire d an tim ic ro bi al s M oA , M LF , M oH , N EM C an d PO R AL G W or ks ho ps 10 N at io na l a nd c om m un ity 20 23 2 02 8 Po lic y do cu m en t de ve l op ed 15 8, 95 6, 83 0 G ov t/ Pa rt ne rs 4. 2. 1. 3. 5 To d is se m in at e de ve lo pe d co m m un ity g ui de lin es , S O Ps a nd t ra in in g m at er ia ls fo r ha nd lin g an d di sp os al of r em na nt s, u nu se d an d ex pi re d an tim ic ro bi al s M oA , M LF , M oH , N EM C an d PO R AL G Se ss io ns / m ee tin gs 10 N at io na l 20 23 2 02 8 Se ss io ns /M ee t in gs r ep or ts 16 0, 54 6, 39 8 G ov t/ Pa rt ne rs 4. 2. 1. 3. 6 To p ro vi de a de qu at e an d ap pr op ria te ly m ai nt ai ne d w as te m an ag e m en t eq ui pm en t M oH , N EM C, P O R AL G H CF a nd w ar ds N at io na l, su b na tio na l a nd c om m u ni ty 20 23 2 02 8 Su pe rv is io n re po rt 20 ,0 00 ,0 00 G ov t/ Pa rt ne rs 67 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 4. 2. 1. 3. 7 To c on du ct s en si tiz at io n an d or ie nt at io n se ss io ns t o co m m un ity on p ro pe r ha nd lin g an d di sp os al of r em na nt s, u nu se d an d ex pi re d an tim ic ro bi al s M oA , M LF , M oH , N EM C an d PO R AL G se ss io ns / m ee tin gs / tr ai ni ng s 10 0 N at io na l a nd c om m un ity 20 23 2 02 8 Se ss io ns /M ee t in gs r ep or ts 39 9, 40 8, 69 2 G ov t/ Pa rt ne rs A ct iv it y 4. 2. 1. 4: P ro m ot e m an ag em en t of e m er gi ng p ol lu ta nt s in t er re st ri al e nv ir on m en t e. g. , a nt im ic ro bi al r es id ue s an d ot he rs Su b Ac tiv ity Im pl em en tin g En tit y U ni t Q ua nt ity Im pl em en ta tio n Le ve l ( N at io na l/ Fa ci lit y/ C om m un ity ) Ti m el in e O ut pu t In di ca to r Co st Fu nd in g So ur ce 4. 2. 1. 4. 1 To d ev el op a s ys te m f or co lle ct io n of t he e m er gi ng p ol lu ta nt s in th e en vi ro nm en t VP O /N EM C W or ks ho ps 2 N at io nw id e Se pt em be r 20 23 A sy st em f or co lle ct io n of th e em er gi ng po llu ta nt s in t he en vi ro nm en t de ve lo pe d 78 ,3 00 ,0 00 G ov t/ Pa rt ne rs 4. 2. 1. 4. 2 To d ev el op a t oo l f or m an ag in g em er gi ng p ol lu ta nt s in t he e nv iro n m en t VP O /N EM C W or ks ho p 2 N at io nw id e O ct ob er 2 02 3 A to ol fo r m an ag in g em er gi ng po llu ta nt s in t he en vi ro nm en t de ve lo pe d 36 ,3 81 ,0 00 G ov t/ Pa rt ne rs 4. 2. 1. 4. 3 To d ev el op a t oo l t o m on ito r th e em er gi ng p ol lu ta nt s in t he e nv i ro nm en t VP O /N EM C w or ks ho ps 2 N at io nw id e D ec em be r 20 23 A to ol fo r m on ito rin g em er gi ng po llu ta nt s in t he en vi ro nm en t de ve lo pe d 0 G ov t/ Pa rt ne rs 68 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 A ct iv it y 4. 2. 1. 5: M on it or d is po sa l o f an ti m ic ro bi al in t he e nv ir on m en t Su b A ct iv it y Im pl em en ti ng En ti ty U ni t Q ua nt it y Ti m el in e O ut pu t In di ca to r C os t Fu nd in g So ur ce 4. 2. 1. 5. 1 To d ev el op a s ys te m f or co lle ct io n of a nt im ic ro bi al s in t he en vi ro nm en t V PO /N EM C/ M oH /M LF /M oA N um be r 4 N at io nw id e 20 24 2 02 8 A sy st em f or co lle ct io n of an tim ic ro bi al s in t he en vi ro nm en t de ve lo pe d 41 ,1 00 ,0 00 G ov t/ Pa rt ne rs 4. 2. 1. 5. 2 To e st ab lis h ce nt er s fo r co lle ct io n of a nt im ic ro bi al w as te s at co un ci l l ev el V PO /N EM C/ M oH /M LF /M oA / PO R AL G N um be r 18 7 Su b na tio na l 20 24 2 02 8 Ce nt er s fo r co lle ct io n of an tim ic ro bi al w as te s es ta b lis he d 15 8, 95 6, 83 0 G ov t/ Pa rt ne rs 4. .2 .1 .5 .3 T o co nd uc t co m m un ity e du ca tio n on a nt im ic ro bi al w as te d is po sa l V PO /N EM C/ M oH /M LF /M oA / PO R AL G M ee tin gs 50 0 Su b na tio na l 20 24 2 02 8 Co m m un ity ed uc at io n on an tim ic ro bi al w as te d is po sa l co nd uc te d 12 ,0 60 ,0 00 G ov t/ Pa rt ne rs In te rv en ti on 4 .2 .2 : Es ta bl is h ev id en ce b as ed p ol ic ie s to g ui de m an ag em en t of a nt im ic ro bi al r es id ue s in t he e nv ir on m en t A ct iv it y 4. 2. 2. 1: C on du ct S ys te m at ic R ev ie w o n an ti m ic ro bi al r es id ue in a qu at ic a nd t er re st ri al e nv ir on m en t in a ll se ct or s to id en ti fy g ap s 4. 2. 2. 1. 1 To c on du ct s ys te m at ic re vi ew s of p ub lis he d in fo rm at io n on an tim ic ro bi al r es id ue in a qu at ic e nv i ro nm en t M oH , M LF , V PO N EM C, P O R AL G an d Ed uc at io n In st itu tio ns Co ns ul ta nc y 1 N at io nw id e 20 24 2 02 8 Sy st em at ic re vi ew s of p ub lis he d in fo rm a tio n on a nt im i cr ob ia l r es id ue in a qu at ic en vi ro nm en t co nd uc te d 27 ,1 00 ,0 00 G ov t/ Pa rt ne rs 4. 2. 2. 1. 2 To c on du ct s ys te m at ic re vi ew s of p ub lis he d in fo rm at io n on an tim ic ro bi al r es id ue in t er re st ria l en vi ro nm en t M oH , M LF , V PO N EM C, P O R AL G an d Ed uc at io n In st itu tio ns Co ns ul ta nc y 1 N at io nw id e 20 24 2 02 8 Sy st em at ic re vi ew s of p ub lis he d in fo rm a tio n on a nt im i cr ob ia l r es id ue in t er re st ria l en vi ro nm en t co nd uc te d 78 ,3 00 ,0 00 G ov t/ Pa rt ne rs 69 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 4. 2. 2. 1. 3 To c on du ct a ss es sm en t of ef flu en t fr om w as te w at er t re at m en t sy st em s M oH , M LF , V PO N EM C, P O R AL G an d Ed uc at io n In st itu tio ns Co ns ul ta nc y 1 N at io nw id e 20 24 2 02 8 As se ss m en t of ef flu en t fr om w as te w at er tr ea tm en t sy st em s co n du ct ed 35 8, 12 7, 36 8 G ov t/ Pa rt ne rs 4. 2. 2. 1. 4 To c on du ct s ta ke ho ld er s m ee tin g M oH , M LF , V PO N EM C, P O R AL G an d M ee tin gs 1 N at io nw id e 20 24 2 02 8 M ee tin g re po rt s 0 G ov t/ Pa rt ne rs 4. 2. 2. 1. 5 To c on du ct v al id at io n m ee t in g M oH , M LF , V PO N EM C, P O R AL G an d Ed uc at io n In st itu tio ns M ee tin gs 1 N at io nw id e 20 24 2 02 8 M ee tin g re po rt s 36 ,3 81 ,0 00 G ov t/ Pa rt ne rs 4. 2. 2. 1. 5 To p re pa re p ol ic y br ie f dr af t M oH , M LF , V PO N EM C, P O R AL G an d Ed uc at io n In st itu tio ns Te ch ni ca l m ee tin gs 5 N at io nw id e 20 24 2 02 8 Po lic y br ie f de ve lo pe d 36 ,2 00 ,0 00 G ov t/ Pa rt ne rs 4. 2. 2. 1. 6 To c on du ct d is se m in at io n m ee tin gs M oH , M LF , V PO N EM C, P O R AL G an d Ed uc at io n In st itu tio ns M ee tin gs 20 N at io nw id e 20 24 2 02 8 M ee tin g re po rt s 3 6, 20 0, 00 0 G ov t/ Pa rt ne rs 70 National Action Plan on Antimicrobial Resistance 2023 - 2028 STRATEGIC OBJECTIVE FIVE OPTIMIZE THE USE OF ANTIMICROBIAL AGENTS By exerting selective pressure on microbial populations, antimicrobial use promotes the development of resistance traits and therefore the emergence and perpetuation of AMR. Antibiotics are amongst the most used antimicrobials, both in the human and agricultural sectors, and consumption levels have continued to increase both in high- and low-income countries. While current rates of use raise concerns, antimicrobials are an essential component of health care in all relevant sectors. The high burden of infectious diseases in LMICs, in particular, means that the need for antimicrobials remains high and therefore adequate access is also critical. Rational use of antimicrobial agents is critical in ensuring appropriate utilization of resources, preventing harmful effects related to overuse/misuse of antimicrobials, reducing risks of AMR development, ultimately increasing efficacy of antimicrobial agents. During the implementation of the NAP-AMR (2017-2022), seven policies, laws and guidelines on the use of antimicrobial agents in humans, animals, agriculture and fisheries were developed and disseminated for utilization. However, there are no laws, regulations and guidelines on prescription and use of antimicrobials in aquatic animals and plants in place. Similarly, AMS implementation activities were largely executed at national levels (Tertiary and Regional Referral Hospitals; and at Zonal Veterinary Centres) with limited engagement at sub-national levels (Local Government Authorities). During the NAP-AMR implementation, availability and utilization of STG/NEMLIT was consistently high (84%-91%) in human sector, however, the adequate labelling of prescriptions remained unacceptably low (less than 3%) underscoring need for continuous AMS capacity building. Also, the implementation and reinforcement of STG/NEMLIT in the private sector was not addressed in the previous NAP-AMR (2017 2022), this gap is therefore, emphasized in the NAP-AMR (2023-2028). Monitoring of antimicrobial use based on the WHO AWaRe categorization was evident in human sector and therefore, there is a need to develop a similar categorization scheme for veterinary antibiotics through a critical review and customization of the European Medicines Agency which classify veterinary antibiotics into ABCD (i.e., Avoid, Restrict, Caution and Prudence). Despite commendable performance in AMS core elements in five out of 10 hospitals (>70% score), there were two indicators which showed low performance specifically on the hospital formulary, and reporting feedback within the health care facility which need to be instituted in the NAP-AMR (2023-2028). While there are 42 hospitals eligible to prepare hospital formulary, only 4 had operational hospital formulary, 20 hospitals had hospital formulary at various stages of editing, and 18 hospitals had not yet developed formularies. The revitalization of HMTC in all tertiary (national/zonal/special) and secondary (regional referral) hospitals was evident during the previous NAP-AMR implementation, however, there is a need to strengthen these programs at primary levels (district, health centres and dispensaries). Establishment and implementation of AMS programs in animal, plant and aquaculture sectors need to be addressed in NAP-AMR (2023-2028). Lack of streamlined reporting system for regular inspection of pharmaceutical and agrovet outlets, and reporting system for supportive supervision in slaughter houses, abattoirs and slaughter slabs to ascertain compliance of withdraw periods and slaughter suitability was notable in the NAP-AMR (2017-2022) implementation. It is therefore, critical to streamline inter- and intra-sectoral coordination across regulatory authorities in controlling the use of antimicrobials in various outlets in NAP-AMR (2023-2028) implementation. 71National Action Plan on Antimicrobial Resistance 2023 - 2028 Furthermore, there is a need to conduct systematic surveys and streamlined reporting systems on antimicrobial use and antimicrobial consumption (in time, places and methods) to inform synchronized responsive interventions at national and sub-national levels. In addition, there is a critical need to incorporate monitoring of substandard, falsified and unregistered medical products in routine surveillance in the NAP-AMR (2023 2028). Therefore, in the proposed NAP-AMR (2023 – 2028), two priority actions, four interventions and 18 activities will be conducted. 72 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 O pe ra ti on al P la n fo r R eg ul at or y Fr am ew or k fo r P re se rv at io n of A nt im ic ro bi al a ge nt s P R IO R IT Y A C TI O N : R EG U LA TO R Y F R A M EW O R K F O R P R ES ER V A TI O N O F A N TI M IC R O B IA L A G EN TS O bj ec ti ve 5 .1 : St re ng th en r eg ul at or y sy st em in p ro du ct io n, s up pl y an d p ru de nt u se o f an ti m ic ro bi al a ge nt s In te rv en ti on 5 .1 .1 : R ev ie w P ol ic ie s, L aw s, R eg ul at io ns a nd D ev el op G ui de lin es o n pr es cr ip ti on s an d us e of a nt im ic ro bi al a ge nt s in h um an , a ni m al s, p la nt , e nv ir on m en ta l he al th a nd a qu at ic a ni m al s A ct iv it y 5. 1. 1. 1: D ev el op g ui de lin es f or h an dl in g an d pr es er va ti on o f an ti m ic ro bi al a ge nt s in a ni m al s, p la nt , e nv ir on m en ta l h ea lt h an d aq ua ti c an im al s Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 1. 1. 1. 1 D ev el op g ui de lin es f or ha nd lin g, p re se rv at io n an d us e of an tim ic ro bi al a ge nt s in p la nt s M oA W or ks ho p 3 N at io nw id e Se p 23 G ui de lin es f or h an dl in g an d pr es er va tio n of a nt im ic ro bi al ag en ts in p la nt de ve lo pe d 34 ,4 44 ,3 33 G ov t/ Pa rt ne rs 5. 1. 1. 1. 2 D ev el op g ui de lin es f or ha nd lin g, p re se rv at io n an d us e of a nt im ic ro bi al a ge nt s in a qu at ic an im al s M LF W or ks ho p 3 N at io nw id e O ct 2 3 G ui de lin es f or h an dl in g an d pr es er va tio n of a nt im ic ro bi al ag en ts in a qu at ic an im al s de ve lo pe d 64 ,4 34 ,9 20 G ov t/ Pa rt ne rs 5. 1. 1. 1. 3 Co nd uc t st ak eh ol de rs ’ v al i da tio n m ee tin g on t he g ui de lin es f or us e of a nt im ic ro bi al a ge nt s in p la nt s an d aq ua tic a ni m al s M O A/ M LF W or ks ho p 1 N at io nw id e N ov 2 3 Co nd uc t st ak e ho ld er s’ v al id at io n m ee tin g on t he gu id el in es f or u se of a nt im ic ro bi al ag en ts in p la nt a nd en vi ro nm en t 88 ,6 46 ,6 90 G ov t/ Pa rt ne rs 5. 1. 1. 1. 4 Pr in tin g of t he g ui de lin es fo r us e of a nt im ic ro bi al a ge nt s in pl an ts a nd a qu at ic a ni m al s M O A/ M LF N um be r of co pi es 50 0 N at io nw id e D ec 2 3 Pr in tin g of t he gu id el in es f or u se of a nt im ic ro bi al ag en ts in p la nt a nd en vi ro nm en t 7, 65 0, 75 0 G ov t/ Pa rt ne rs 5. 1. 1. 1. 5 D is se m in at io n of t he gu id el in es f or u se o f an tim ic ro bi al ag en ts in p la nt s an d aq ua tic a ni m al s M O A/ M LF W or ks ho p 4 N at io nw id e Fe b 24 D is se m in at io n of th e gu id el in es f or us e of a nt im ic ro bi al ag en ts in p la nt a nd en vi ro nm en t 62 ,6 85 ,1 45 G ov t/ Pa rt ne rs 73 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 5. 1. 1. 1. 6 D ev el op g ui de lin es on p re sc rip tio ns a nd u se o f an tim ic ro bi al a ge nt s in a ni m al s M O H /M LF W or ks ho p 3 N at io nw id e N ov 2 3 G ui de lin es o n pr es cr ip tio ns a nd us e of a nt im ic ro bi al ag en ts in a ni m al s de ve lo pe d 71 ,1 58 ,8 61 G ov t/ Pa rt ne rs 5. 1. 1. 1. 7 D ev el op s ta nd ar d pr es cr ip tio ns f or a ni m al h ea lth M LF /P O LA R G W or ks ho p 2 N at io na l w id e Au g 23 St an da rd p re sc rip tio n av ai la bl e 28 ,6 53 ,7 00 G ov t/ Pa rt ne rs 5. 1. 1. 1. 8 St ak eh ol de rs ’ v al id at io n m ee tin g on t he s ta nd ar di ze d pr es cr ip tio ns f or a ni m al h ea lth M LF /P O LA R G W or ks ho p 1 N at io na l w id e Se p 23 St an da rd p re sc rip tio n av ai la bl e an d in u se 50 ,2 98 ,0 00 G ov t/ Pa rt ne rs 5. 1. 1. 1. 9 Pr in t th e st an da rd iz ed pr es cr ip tio ns f or a ni m al h ea lth M oH /M LF / PO R AL G Pr es cr ip tio ns 25 0 N at io nw id e N ov 2 3 Re po rt s on u se o f pr es cr ip tio ns 5, 10 0, 50 0 G ov t/ Pa rt ne rs 5. 1. 1. 1. 10 R ev ie w la w s re la te d to d is tr ib ut io n an d re ta ili ng o f an tim ic ro bi al s in h um an a nd a ni m al he al th /s ec to rs M O H /M LF / PO R AL G W or ks ho p 3 N at io nw id e Se p 23 La w s re la te d to di st rib ut io n an d re ta ili ng o f an tim i cr ob ia ls r ev ie w ed 97 ,4 35 ,2 05 G ov t/ Pa rt ne rs 5. 1. 1. 1. 11 C on du ct s ta ke ho ld er s m ee tin g on r eg ul at io ns o f pr es cr ip tio ns a nd u se o f an tim ic ro bi al s in h um an a nd a ni m al he al th /s ec to rs M O H /M LF / PO R AL G M ee tin gs 5 N at io nw id e Ja n 24 N um be r of m ee tin gs co nd uc te d 18 4, 92 2, 92 0 G ov t/ Pa rt ne rs 5. 1. 1. 1. 12 R ev ie w N at io na l H ea lth Po lic y G ui de lin es t o ad dr es s/ in co rp or at e AM S im pl em en ta tio n ac tiv iti es M O H /P O R AL G / PM O O H S ec tio n W or ks ho p 2 N at io nw id e Ju n 25 N um be r of w or k sh op s co nd uc te d 21 ,7 89 ,3 36 G ov t/ Pa rt ne rs A ct iv it y 5. 1. 1. 2: D ev el op o pe ra ti on al g ui de lin es f or im pl em en ta ti on o f A M S at N at io na l, Su b na ti on al le ve l a nd P ri va te s ec to rs in h um an h ea lt h Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 1. 1. 2. 1 Pr ep ar e dr af t on op er at io na l g ui de lin es f or im pl em en ta tio n of A M S at N at io na l, Su b na tio na l l ev el a nd P riv at e se ct or s in h um an h ea lth M O H W or ks ho p 2 N at io nw id e Se p 23 O pe ra tio na l g ui de lin es f or im pl em en ta tio n of A M S 1 5, 67 5, 20 0 G ov t/ Pa rt ne rs 5. 1. 1. 2. 2 Co nd uc t st ak eh ol de rs m ee tin g to v al id at e op er at io na l gu id el in es f or im pl em en ta tio n of AM S M oH W or ks ho p 1 N at io nw id e N ov 2 3 M ee tin g re po rt s 4 4, 74 3, 00 0 G ov t/ Pa rt ne rs 74 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 5. 1. 1. 2. 3 Pr in tin g of t he o f AM S at N at io na l, Su b na tio na l l ev el a nd Pr iv at e se ct or s in h um an h ea lth M O H N o. o f co pi es 80 0 N at io nw id e Ja n 24 N um be r co pi es 1 6, 32 1, 60 0 G ov t/ Pa rt ne rs 5. 1. 1. 2. 4 D is se m in at io n of o pe ra tio na l g ui de lin es f or im pl em en ta tio n of A M S M O H W or ks ho p 4 N at io nw id e M ar 2 4 N um be r of w or k sh op s 2 9, 42 3, 25 4 G ov t/ Pa rt ne rs A ct iv it y 5. 1. 1. 3: D ev el op /r ev ie w a nd d is se m in at e ST G a nd N EM LI T in v et er in ar y pr ac ti ce , l iv es to ck p ro du ct io n, p la nt h ea lt h an d fi sh er ie s; a nd in cl ud e A t o D c at eg or iz a ti on o f an ti bi ot ic s fo r us e in a ni m al s Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 1. 1. 3. 1 Re vi ew v et er in ar y ST G / N EM LI T to in cl ud e aq ua tic a ni m al s M LF /P O R AL G W or ks ho p 4 N at io nw id e Ja n 24 ST G /N EM LI T in ve te rin ar y pr ac tic e, liv es to ck p ro du ct io n an d aq ua cu ltu re re vi ew ed /d ev el op ed 5 7, 30 7, 40 0 G ov t/ Pa rt ne rs 5. 1. 1. 3. 2 Re vi ew a nd in co rp or at e A to D c at eg or iz at io n of a nt ib io tic s fo r us e in a ni m al s M LF /P O R AL G W or ks ho p 2 N at io nw id e M ar 2 4 ST G /N EM LI T in ve te rin ar y pr ac tic e, liv es to ck p ro du ct io n an d aq ua cu ltu re in co rp or at e A to D ca te go riz at io n of an tib io tic s 2 8, 65 3, 70 0 G ov t/ Pa rt ne rs 5. 1. 1. 3. 3 Co nd uc t st ak eh ol de rs ’ va lid at io n m ee tin g M LF /P O R AL G M ee tin g 1 N at io nw id e Ap r 24 N um be r of m ee tin gs he ld 5 0, 29 8, 00 0 G ov t/ Pa rt ne rs 5. 1. 1. 3. 4 Pr in tin g of t he v et er in ar y ST G /N EM LI T M LF /P O R AL G N um be r of co pi es 50 0 N at io nw id e Au g 24 N um be r of c op ie s pr in te d 1 0, 10 0, 00 0 G ov t/ Pa rt ne rs 5. 1. 1. 3. 5 D is se m in at io n of v et er in ar y ST G /N EM LI T M LF /P O R AL G W or ks ho p 1 N at io nw id e Se p 24 N um be r of c op ie s di ss em in at ed 5 0, 29 8, 00 0 G ov t/ Pa rt ne rs A ct iiv it y 5. 1. 1. 4: R ev ie w a nd D is se m in at e N at io na l A W aR e Li st o f an ti bi ot ic s in h um an h ea lt h Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 1. 1. 4. 1 Co nd uc t w or ks ho p to r e vi ew h os pi ta l A M R s ur ve ill an ce d at a at T er tia ry , R R H a nd s el ec te d D is tr ic t H os pi ta ls ( D ia gn os tic s te w ar ds hi p Pr og ra m ) M oH W or ks ho p 2 N at io nw id e Ja n 24 N at io na l A W aR e Li st re vi ew ed 3 0, 20 9, 10 0 G ov t/ Pa rt ne rs 75 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 5. 1. 1. 4. 2 Co nd uc t a re vi ew a nd v al i da tio n m ee tin g fo r th e AW aR e Li st o f an tib io tic s M oH /P O R AL G M ee tin g 3 N at io nw id e Fe b 25 N um be r of m ee tin gs 1 35 ,5 71 ,2 90 G ov t/ Pa rt ne rs 5. 1. 1. 4. 3 Co nd uc t a re vi ew o f AB CD ca te go riz at io n of a nt ib io tic s in a ni m al h ea lth M LF /P O R AL G M ee tin g 3 N at io nw id e Fe b 25 N um be r of m ee tin gs 3 4, 36 0, 20 0 G ov t/ Pa rt ne rs 5. 1. 1. 4. 4 D ev el op n at io na l a nt i bi og ra m f or p rio rit y pa th og en s in hu m an s ec to r ba se d on t he h os pi ta l AM R s ur ve ill an ce d at a M oH W or ks ho p 3 N at io nw id e Ju n 24 N um be r of w or k sh op s co nd uc te d 2 5, 30 0, 50 0 G ov t/ Pa rt ne rs 5. 1. 1. 4. 5 Va lid at io n of a nt ib io gr am fo r pr io rit y pa th og en s in h um an se ct or M oH M ee tin g 1 N at io nw id e Au g 24 N um be r of m ee tin gs 3 0, 43 9, 78 4 G ov t/ Pa rt ne rs 5. 1. 1. 4. 6 In co rp or at e ca te go riz at io n of H AA RT in to t he e xi st in g gu id e lin es M oH /P O R AL G W or ks ho p 2 N at io nw id e M ar 2 5 N um be r of w or k sh op s co nd uc te d 30 ,4 39 ,7 84 G ov t/ Pa rt ne rs 5. 1. 1. 4. 7 In co rp or at e ca te go riz at io n of a nt ip ro to zo al in to t he e xi st in g gu id el in es M oH /M LF /P O R AL G W or ks ho p 2 N at io nw id e M ar 2 5 N um be r of w or k sh op s co nd uc te d 30 ,4 39 ,7 84 G ov t/ Pa rt ne rs 5. 1. 1. 4. 8 In co rp or at e ca te go riz at io n of a nt i-T B in to t he e xi st in g gu id e lin es M oH /P O R AL G W or ks ho p 2 N at io nw id e M ar 2 5 N um be r of w or k sh op s co nd uc te d 30 ,4 39 ,7 84 G ov t/ Pa rt ne rs 5. 1. 1. 4. 9 In co rp or at e ca te go riz a tio n of a nt ifu ng al s in to t he e xi st in g gu id el in es M oH /M LF /M oA / PO R AL G W or ks ho p 2 N at io nw id e M ar 2 5 N um be r of w or k sh op s co nd uc te d 30 ,4 39 ,7 84 G ov t/ Pa rt ne rs A ct iv it y 5. 1. 1. 5: R ev ie w a nd d is se m in at e ST G /N EM LI T fo r hu m an h ea lt h, in cl ud in g A W aR e ca te go ri za ti on o f an ti m ic ro bi al s Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 1. 1. 5. 1 Re vi ew t he S TG /N EM LI T fo r hu m an h ea lth , i nc lu di ng A W aR e ca te go riz at io n of a nt im ic ro bi al s M oH W or ks ho p 7 N at io nw id e N ov 2 3 ST G /N EM LI T fo r hu m an r ev ie w ed 7 5, 50 7, 60 0 G ov t/ Pa rt ne rs 5. 1. 1. 5. 2 Co nd uc t st ak eh ol de rs ’ v al i da tio n m ee tin g fo r th e ST G /N EM LI T M oH M ee tin g 3 N at io nw id e D ec 0 3 M ee tin g re po rt s 7 5, 90 1, 50 0 G ov t/ Pa rt ne rs 5. 1. 1. 5. 3 Pr in tin g of t he r ev is ed ST G /N EM LI T M oH N um be r of co pi es 50 00 N at io nw id e M ar 2 4 N um be r of c op ie s pr in te d 1 01 ,0 00 ,0 00 G ov t/ Pa rt ne rs 76 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 5. 1. 1. 5. 3 D is se m in at io n an d di st rib u tio n of t he r ev is ed S TG /N EM LI T M oH / PO R AL G W or ks ho p 28 N at io nw id e M ay 2 4 W or ks ho p re po rt s 1 02 ,3 17 ,0 40 G ov t/ Pa rt ne rs A ct iv it y 5. 1. 1. 6: R ev ie w a nd D is se m in at e M ed ic in es a nd T he ra pe ut ic C om m it te e G ui de lin es f or H um an h ea lt h se ct or Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t in di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 1. 1. 6. 1 Pr ep ar e dr af t of t he o pe ra tio na l g ui de lin es f or M TC f or h um an he al th /s ec to r M oH W or ks ho p 2 N at io nw id e Ap r 23 M ed ic in es a nd T he r ap eu tic C om m itt ee O pe ra tio na l G ui de lin es r ev ie w ed 2 7, 09 8, 30 0 G ov t/ Pa rt ne rs 5. 1. 1. 6. 2 Co nd uc t st ak eh ol de rs ’ va lid at io n m ee tin g of t he o pe ra tio na l g ui de lin es f or M TC f or h um an he al th /s ec to r M oH M ee tin g 1 N at io nw id e Ju n 23 M ee tin g re po rt s 3 9, 18 8, 00 0 G ov t/ Pa rt ne rs 5. 1. 1. 6. 3 Pr in t th e gu id el in es M oH N um be r of co pi es 50 0 N at io nw id e Au g 23 N um be r of c op ie s pr in te d 1 0, 10 0, 00 0 G ov t/ Pa rt ne rs 5. 1. 1. 6. 4 D is se m in at e th e op er a tio na l g ui de lin es f or M TC f or h um an he al th /s ec to r M oH / PO R AL G W or ks ho p 29 N at io nw id e Se pt em be r to D ec em be r2 02 3 W or ks ho p re po rt s 1 ,1 47 ,8 16 ,5 20 G ov t/ Pa rt ne rs In te rv en ti on 5 .1 .2 : M on it or p ro pe r us e of a nt im ic ro bi al a ge nt s A ct iv it y: 5 .1 .2 .1 C on du ct r eg ul ar in sp ec ti on o n ph ar m ac eu ti ca l a nd a gr o ch em ic al o ut le ts Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 1. 2. 1. 1 Es ta bl is h Jo in t in sp ec tio n te am s w ith T oR s M oH / M LF / M oA / PO R AL G N um be r of in di vi du al s 1 N at io nw id e Ja n 23 Jo in t in sp ec tio n te am s es ta bl is he d 0 G ov t/ Pa rt ne rs 5. 1. 2. 1. 2 M ap P re m is es ( Ph ar m a ci es , A D D O a nd A gr ov et o ut le ts ) ba se d on R is k ap pr oa ch M oH / M LF / M oA / PO R AL G Fi el d vi si ts 28 N at io nw id e M ar 2 3 N um be r of P re m is es m ap pe d 2 23 ,9 43 ,0 00 G ov t/ Pa rt ne rs 5. 1. .2 .1 .3 D ev el op /R ev ie w c he ck lis t an d SO Ps fo r jo in t in sp ec tio n (E le c tr on ic c he ck lis t em be dd ed w ith G IS Te ch e .g ., Af ya SS ) M oH / M LF / M oA / PO R AL G W or ks ho p 1 N at io nw id e M ay 2 3 Ch ec kl is t an d SO Ps fo r jo in t in sp ec tio n de ve lo pe d/ re vi ew ed 1 3, 54 9, 15 0 G ov t/ Pa rt ne rs 5. 1. 2. 1. 4 Co nd uc t st ak eh ol de rs ’ va lid at io n m ee tin g M oH / M LF / M oA / PO R AL G M ee tin g 1 N at io nw id e Ju n 23 M ee tin g re po rt s 3 3, 63 3, 00 0 G ov t/ Pa rt ne rs 5. 1. 2. 1. 5 Pr in t de ve lo pe d ch ec kl is t & S O Ps M oH / M LF / M oA / PO R AL G N um be r of co pi es 50 0 N at io nw id e Au g 23 N um be r of c op ie s pr in te d 50 5, 00 0 G ov t/ Pa rt ne rs 77 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 5. 1. 2. 1. 6 O rie nt in sp ec to rs , H ea lth M an ag em en t Te am o n th e de ve l op ed c he ck lis t & S O Ps M oH / M LF / M oA / PO R AL G N um be r of in di vi du al s 60 0 N at io nw id e Se pt em be r to D ec em be r 20 23 N um be r of in sp ec to rs , H ea lth M an ag em en t Te am or ie nt ed 26 6, 94 3, 00 0 G ov t/ Pa rt ne rs 5. 1. 2. 1. 7 Co nd uc t Jo in t in sp ec tio n M oH / M LF / M oA / PO R AL G N um be r of in sp ec tio ns 20 N at io nw id e 20 24 t o 20 28 N um be r of J oi nt in sp ec tio ns c on du ct ed 7 9, 96 9, 59 8 G ov t/ Pa rt ne rs A ct iv it y 5. 1. 2. .2 : Es ta bl is h a pl at fo rm a m on g th e re gu la to ry a ut ho ri ti es t o m on it or p ro pe r us e of a nt im ic ro bi al a ge nt s in h um an , a ni m al s, a qu at ic , p la nt a nd e nv ir on m en ta l he al th Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 1. 2. 2. 1 Es ta bl is h Q ua rt er ly m ul tis ec to ra l r eg ul at or y au th or iti es ’ m ee tin gs w ith T oR s (T M D A, P C, V CT , N EM C an d En vi ro nm en ta l H ea lth Co un ci l) M oH / M LF / M oA / PO R AL G /V PO M ee tin gs 10 N at io nw id e Ja nu ar y 20 23 t o 20 28 M ul tis ec to ra l R eg ul at or y Au th or iti es M ee tin gs c on du ct ed an nu al ly 1 1, 02 5, 00 0 G ov t/ Pa rt ne rs A ct iv it y 5. 1. 2. 3 C on du ct m en to rs hi p in s la ug ht er h ou se s, a ba tt oi rs , s la ug ht er s la bs a nd a qu at ic f ar m s to c he ck c om pl ia nc e of w it hd ra w p er io ds a nd s la ug ht er s ui ta bi lit y Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 1. 2. 3. 1 D ev el op m en to rs hi p pa ck ag e on c om pl ia nc e of w ith dr aw pe rio ds a nd s la ug ht er s ui ta bi lit y (c he ck lis t/ SO Ps in cl us iv e) M LF / PO R AL G W or ks ho p 1 N at io nw id e Ja n 23 Ch ec kl is t/ SO Ps de ve lo pe d 1 1, 02 5, 00 0 G ov t/ Pa rt ne rs 5. 1. 2. 3. 2 Co nd uc t or ie nt at io n to m en to rs hi p te am M LF / PO R AL G W or ks ho p (R eg io na l) 26 N at io nw id e Fe b 23 W or ks ho p re po rt 7 3, 20 0, 00 0 G ov t/ Pa rt ne rs 5. 1. 2. 3. 3 Co nd uc t w or ks ho p on sl au gh te r pr ot oc ol s M LF / PO R AL G W or ks ho p (R eg io na l) 26 Su b na tio na l 20 23 2 02 8 W or ks ho p re po rt s 7 3, 20 0, 00 0 G ov t/ Pa rt ne rs 5. 1. 2. 3. 4 Co nd uc t re gu la r m en to rs hi p to e ns ur e co m pl ia nc e w ith sl au gh te r su ita bi lit y an d w ith dr aw al pe rio ds M LF / PO R AL G Vi si ts 20 Su b na tio na l 20 23 2 02 8 Vi si t re po rt s 6 1, 00 0, 00 0 G ov t/ Pa rt ne rs 5. 1. 2. 3. 5 Co nd uc t su rv ey s to m on ito r w ith dr aw al p er io d in E gg s an d M ilk s up pl y ch ai ns M LF / PO R AL G Su rv ey 20 Su b na tio na l 20 23 2 02 8 Su rv ey r ep or ts 3 9, 00 0, 00 0 G ov t/ Pa rt ne rs 78 National Action Plan on Antimicrobial Resistance 2023 - 2028 PRIORITY ACTION: ANTIMICROBIAL STEWARDSHIP PROGRAMS 79 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 O pe ra ti on al P la n fo r A nt im ic ro bi al S te w ar ds hi p P ro gr am s P R IO R IT Y A R EA : A N TI M IC R O B IA L ST EW A R D SH IP P R O G R A M O bj ec ti ve 5 .2 : To e ns ur e ap pr op ri at e us e of a nt im ic ro bi al a ge nt s In te rv en ti on 5 .2 .1 : Es ta bl is hm en t an ti m ic ro bi al s te w ar ds hi p pr og ra m m es in a ni m al s ec to r; a nd s tr en gt he ni ng o f A M S pr og ra m m es in h um an s ec to rs A ct iv it y 5. 2. 1. 1: E st ab lis h A M S pr og ra m m es in h os pi ta ls Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 2. 1. 1. 1 M ap A M S st ak eh ol de rs a t na tio na l l ev el M oH /M LF / PO R AL G / AM S M ap s 15 N at io na l l ev el Ja n 24 N um be r of lo ca l a nd in te rn at io na l o rg an i za tio ns ; te rt ia ry a nd re gi on al r ef er ra l h os pi ta ls im pl em en tin g AM S ac tiv iti es 13 ,6 00 ,0 00 G ov t/ Pa rt ne rs 5. 2. 1. 1. 2 Al lo ca te A M S st ak eh ol de rs t o sp ec ifi c he al th fa ci lit ie s M oH /M LF / PO R AL G AM S al lo ca tio ns 22 9 Su b na tio na l l ev el M ar 2 4 Te rt ia ry a nd R R H s lin ke d to s ta ke ho ld er s 10 ,0 20 ,0 00 G ov t/ Pa rt ne rs 5. 2. 1. 1. 3 Es ta bl is h Re gi on A M S te am s/ Co m m itt ee s un de r O ne H ea lth Ap pr oa ch M O H /M LF / PO R AL G N um be r of R eg io ns w ith A M S te am s un de r O ne H ea lth Ap pr oa ch 28 N at io nw id e 20 23 2 02 8 N um be r of R eg io ns w ith e st ab lis he d AM S Te am s/ Co m m itt ee s un de r O ne H ea lth Ap pr oa ch 3, 05 0, 00 0 G ov t/ Pa rt ne rs 5. 2. 1. 1. 4 Es ta bl is h Co un ci l A M S te am s/ Co m m itt ee s un de r O ne H ea lth Ap pr oa ch M O H /M LF / PO R AL G N um be r of AM S te am s in O H A pp ro ac h 18 7 N at io nw id e 20 23 2 02 8 N um be r of C ou nc ils w ith e st ab lis he d AM S Te am s/ Co m m itt ee s un de r O ne H ea lth Ap pr oa ch 1, 95 0, 00 0, 00 0 G ov t/ Pa rt ne rs A ct iv it y 5. 2. 1. 2: E st ab lis h A M S pr og ra m m es in a ni m al s ec to r Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 2. 1. 2. 1 Co nd uc t ne ed a ss es sm en t on AM S pr og ra m in v et er in ar y se ct or M LF / PO R AL G W or ks ho p 2 N at io nw id e Se p 23 AM S pr og ra m n ee d as se ss m en t in v et er in ar y se ct or id en tifi ed 20 ,4 00 ,0 00 G ov t/ Pa rt ne rs 5. 2. 1. 2. 2 Co nd uc t st ak eh ol de rs ' m ee t in g to r ev ie w S W O C fr om n ee ds a s se ss m en t M LF / PO R AL G M ee tin g 1 N at io nw id e O ct 2 3 M ee tin g re po rt s 9, 92 5, 00 0 G ov t/ Pa rt ne rs 80 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 5. 2. 1. 2. 3 Es ta bl is h AM S pr og ra m in ve te rin ar y se ct or M LF / PO R AL G N um be r of Es ta bl is he d AM S pr og ra m 18 7 N at io nw id e 2 02 4 2 02 8 N um be r of c ou nc ils w ith e st ab lis he d AM S Pr og ra m s 2, 50 0, 00 0 G ov t/ Pa rt ne rs A ct iv it y 5. 2. 1. 3: D ev el op a s ys te m t o m on it or p ro pe r us e of s ta nd ar d pr es cr ip ti on s in h um an , a ni m al a nd a qu at ic s ec to r Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 2. 1. 3. 1 To s ys te m at ic al ly a ss es s th e us e of s ta nd ar di ze d pr es cr ip tio n in h u m an h ea lth in p ub lic a nd p riv at e he al th fa ci lit ie s M oH /P O R AL G Fi el d su rv ey s 26 N at io nw id e Au g 23 St an da rd p re sc rip tio n in u se 62 ,4 00 ,0 00 G ov t/ Pa rt ne rs 5. 2. 1. 3. 1 To s ys te m at ic al ly a ss es s th e us e of s ta nd ar di ze d pr es cr ip tio n in an im al h ea lth M oH /P O R AL G Fi el d su rv ey s 26 N at io nw id e Au g 23 St an da rd p re sc rip tio n in u se 62 ,4 00 ,0 00 G ov t/ Pa rt ne rs A ct iv it y 5. 2. 1. 4: D ev el op , i m pl em en t an d m on it or h os pi ta l f or m ul ar y Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 2. 1. 4. 1 To d ev el op a nt ib io gr am b as ed on H os pi ta l A M R s ur ve ill an ce d at a M oH /P O R AL G Fa ci lit ie s 22 9 N at io nw id e 20 23 2 02 8 Fa ci lit ie s w ith d ev el op ed a nt ib io gr am s 69 ,2 00 ,0 00 G ov t/ Pa rt ne rs 5. 2. .1 .4 .2 T o de ve lo p ho sp ita l fo rm u la ry in te rt ia ry an d re gi on al re fe rr al ho sp ita ls ; w hi ch in co rp or at e AW aR e ca te go riz at io n of a nt ib io tic s M oH /P O R AL G Fa ci lit ie s 22 9 N at io nw id e 20 23 2 02 8 Fo rm ul ar y de ve lo pe d 69 ,2 00 ,0 00 G ov t/ Pa rt ne rs 5. 2. 1. 4. 3 Pi lo t de ve lo pm en t of h os pi ta l fo rm ul ar y in a f ew s el ec te d di st ric t co un ci ls M oH /P O R AL G Fa ci lit ie s 10 N at io nw id e 20 23 2 02 8 Fo rm ul ar y de ve lo pe d 69 ,2 00 ,0 00 G ov t/ Pa rt ne rs 5. 2. 1. 4. 4 To d ev el op a nt ib io gr am b as ed on H os pi ta l A M R s ur ve ill an ce d at a M oH /P O R AL G Fa ci lit ie s 22 9 N at io nw id e 20 23 2 02 8 Fa ci lit ie s w ith d ev el op ed a nt ib io gr am s 69 ,2 00 ,0 00 G ov t/ Pa rt ne rs 81 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 In te rv en tio n 5. 2. 2: M on ito r an tim ic ro bi al S te w ar ds hi p pr og ra m m es in H um an a nd A ni m al S ec to r A ct iv it y 5. 2. 2. .1 .: E st ab lis h m ed ic in es a nd t he ra pe ut ic C om m it te es in v et er in ar y se ct or Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 2. 2. 1. 1 Es ta bl is h na tio na l ve te rin ar y co m m itt ee t o m on ito r tr ea tm en t an d an tim ic ro bi al u se in v et er in ar y se ct or M LF Co m m itt ee 1 N at io nw id e Ap r 23 N at io na l v et er in ar y th er ap eu tic c om m itt ee es ta bl is he d 88 ,4 00 ,0 00 G ov t/ Pa rt ne rs 5. 2. 2. 1. 2 D ev el op g ui de lin es f or v et er in ar y co m m itt ee t o m on ito r tr ea tm en t an d AM U in V et er in ar y se ct or M LF /P O R AL G W or ks ho p 3 N at io nw id e D ec 2 3 Ve te rin ar y th er ap eu tic co m m itt ee g ui de lin es de ve lo pe d 10 ,3 00 ,0 00 G ov t/ Pa rt ne rs A ct iv it y 5. 2. 2. 2: S tr en gt he n M ed ic in es a nd T he ra pe ut ic C om m it te es a nd o th er r el at ed c om m it te es o n an ti m ic ro bi al S te w ar ds hi p pr og ra m s Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 2. 2. 2. 1 Co nd uc t ne ed s as se ss m en ts at N at io na l, Re gi on al a nd D is tr ic t l ev el s M oH / PO R AL G As se ss m en t 1 N at io nw id e 20 23 2 02 8 As se ss m en t re po rt s 5, 52 5, 00 0 G ov t/ Pa rt ne rs 5. 2. 2. 2. 2 D ev el op co m pr eh en si ve tr ai ni ng p ac ka ge s M oH /P O R AL G W or ks ho p 1 N at io nw id e 20 23 2 02 8 Tr ai ni ng p ac ka ge de ve lo pe d 27 ,1 00 ,0 00 G ov t/ Pa rt ne rs 5. 2. 2. 2. 3 Co nd uc t tr ai ni ng o f Tr ai ne rs (T O Ts ) fo r H M TC s M oH /P O R AL G W or ks ho p 1 N at io nw id e 20 23 2 02 8 W or ks ho p re po rt s 27 ,5 60 ,0 00 G ov t/ Pa rt ne rs 5. 2. 2. 3. 4 Co nd uc t t ra in in g to M ed ic in es an d Th er ap eu tic Co m m itt ee s/ ot he r Co m m itt ee s on A M S pr og ra m m es M oH /P O R AL G W or ks ho p 26 N at io nw id e 20 23 2 02 8 Tr ai ni ng r ep or ts 35 8, 08 0, 00 0 G ov t/ Pa rt ne rs A ct iv it y 5. 2. 2. 3: C on du ct s up po rt iv e su pe rv is io n to m on it or a nt im ic ro bi al S te w ar ds hi p pr og ra m s in h um an a nd a ni m al s ec to rs Su b ac ti vi ty Im pl em en ti ng en ti ty U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 5. 2. 2. 3. 1 D ev el op /r ev ie w su pe rv is io n ch ec kl is t an d SO Ps i n hu m an a nd a n im al s ec to rs M oH /M LF /M oA / PO R AL G Ch ec kl is t 2 N at io nw id e Ja n 23 Ch ec kl is t an d SO Ps de ve lo pe d 18 ,6 80 ,0 00 G ov t/ Pa rt ne rs 5. 2. 2. 3. 2 Co nd uc t bi an nu al s up po rt iv e su pe rv is io ns M oH /M LF /M oA / PO R AL G Fi el d Vi si ts 26 0 N at io nw id e 20 23 2 02 8 Vi si ts r ep or ts 12 4, 80 0, 00 0 G ov t/ Pa rt ne rs 82 National Action Plan on Antimicrobial Resistance 2023 - 2028 STRATEGIC OBJECTIVE SIX DEVELOP THE ECONOMY CASE FOR SUSTAINABLE INVESTMENT AMR has a significant negative impact on the economy due to increased mortality, prolongation of illness and reduced labour efficiency. The World Bank considers funding antimicrobial resistance as an exceptional economic and health investment for countries. The world Bank report 2017, estimates that, if we do not ad dress the problem of AMR, the world will lose 3.8 percent of its annual GDP by 2050, with an annual shortfall of $3.4 trillion by 203010. Without AMR containment, the Sustainable development goals relating to poverty, childhood survival, and development are less likely to be achieved. Low-income countries will be affected more due to high burden of infectious diseases and poor health system. Therefore, the return of economic and health investments in addressing antimicrobial resistance are needed to minimize the negative impact of antimicrobial resistance. Also, managing AMR requires a multidisciplinary collaborative and coordinated plan, including economic, scientific and political actors. 10 World Bank Report (March, 2017): Drug Resistance Infections: A Threat to our Economic Future. https://documents1.worldbank.org/curated/en/323311493396993758/pdf/final-report.pdf 83 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 O pe ra ti on al P la n fo r In ve st m en ts t o A dd re ss A nt im ic ro bi al R es is ta nc e P R IO R IT Y A C TI O N : IN V ES TM EN TS T O A D D R ES S A N TI M IC R O B IA L R ES IS TA N C E O bj ec ti ve 6 .1 : To e st ab lis h a su st ai na bl e in ve st m en ts m ec ha ni sm f or a nt im ic ro bi al r es is ta nc e in te rv en ti on s In te rv en ti on 6 .1 .1 D et er m in e ec on om ic im pa ct o f A M R in t he c ou nt ry A ct iv it y 6 .1 .1 .1 C on du ct e co no m ic e va lu at io n to d et er m in e ex pe nd it ur es f or t re at m en t of in fe ct io us d is ea se Su b ac ti vi ty Im pl em en ti ng e nt it y U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 6. 1. 1. 1. 1 D ev el op a p ro to co l M oH /M LF /M oA W or ks ho p 1 N at io na l 20 24 Pr ot oc ol in p la ce 17 ,1 70 ,0 00 G ov t/ Pa rt ne rs 6. 1. 1. 1. 2 Co lle ct d at a M oH /M LF /M oA Fi el d w or k 1 N at io nw id e 20 24 Fi el d w or k re po rt 36 ,6 02 ,4 00 G ov t/ Pa rt ne rs 6. 1. 1. 1. 3 Pe rf or m d at a an al ys is a nd re po rt w rit in g M oH /M LF /M oA W or ks ho p 1 N at io na l 20 24 Ev al ua tio n re po rt 10 ,7 06 ,0 00 G ov t/ Pa rt ne rs A ct iv it y : 6. 1. 1. 1. 2 C on du ct e co no m ic e va lu at io n to d et er m in e ex pe nd it ur es f or t re at m en t of p at ie nt s w it h A M R Su b ac ti vi ty Im pl em en ti ng e nt it y U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 6. 1. 1. 2. 1 D ev el op a p ro to co l M oH /M LF /M oA W or ks ho p 1 N at io na l 20 24 Pr ot oc ol in p la ce 0 G ov t/ Pa rt ne rs 6. 1. 1. 2. 2 Co lle ct d at a M oH /M LF /M oA Fi el d w or k 1 N at io nw id e 20 24 Fi el d w or k re po rt 36 ,6 02 ,4 00 G ov t/ Pa rt ne rs 6. 1. 1. 2. 3 Pe rf or m d at a an al ys is a nd re po rt w rit in g M oH /M LF /M oA W or ks ho p 1 N at io na l 20 24 Ev al ua tio n re po rt 9, 09 0, 00 0 G ov t/ Pa rt ne rs A ct iv it y : 6. 1. 1. 3 P re pa re a p ol ic y br ie f to a dd re ss t he im pa ct o f A M R b as ed o n th e fi nd in gs Su b ac ti vi ty Im pl em en ti ng e nt it y U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 6. 1. 1. 3. 1 Co nd uc t a w or ks ho p to de ve lo p a po lic y br ie f M oH /M LF /M oA W or ks ho p 4 N at io nw id e Ja n 24 Po lic y br ie f 18 ,6 98 ,4 43 G ov t/ Pa rt ne rs 6. 1. 1. 3. 2 D is se m in at e a Po lic y br ie f to p ol ic y m ak er s an d ot he r ke y st ak eh ol de rs M oH /M LF /M oA W or ks ho p 2 N at io nw id e M ar 2 4 D is se m in at io n re po rt 73 ,2 43 ,1 80 G ov t/ Pa rt ne rs 84 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 In te rv en ti on : 6. 1. 2 M ob ili ze f un ds t o su pp or t A M R in te rv en ti on s A ct iv it y 6. 1. 2. 1. M ap t he A M R s ta ke ho ld er s in t he c ou nt ry Su b ac ti vi ty Im pl em en ti ng e nt it y U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 6. 1. 2. 1. 1 Id en tif y al l A M R s ta ke ho ld er s in t he c ou nt ry M CC S ec re ta ria t 1 5 N at io nw id e 20 23 2 02 8 N at io na l A W aR e Li st r ev ie w ed 33 ,3 00 ,0 00 G ov t/ Pa rt ne rs 6. 1. 2. 1. 2 D ev el op a d at a ba se fo r AM R s ta ke ho ld er s M CC S ec re ta ria t 1 5 N at io nw id e 20 23 2 02 8 N um be r of m ee tin gs 26 9, 33 3, 06 5 G ov t/ Pa rt ne rs A ct iv it y 6. 1. 2. 2: E ng ag e an d es ta bl is h lin ka ge w it h re le va nt s ta ke ho ld er s to s up po rt t he im pl em en ta ti on o f N A P A M R Su b ac ti vi ty Im pl em en ti ng e nt it y U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 6. 1. 2. 2. 1 En ga ge s ta ke ho ld er s to do cu m en t th ei r ar ea s of N AP A M R im pl em en ta tio n an d th ei r su pp or ts M CC S ec re ta ria t W or ks ho p 1 N at io nw id e 20 23 2 02 8 N um be r of m ee t in gs 1 46 ,4 93 ,6 12 G ov t/ Pa rt ne rs 6. 1. 2. 2. 2 Co nd uc t an nu al m ee tin g to sh ar e in fo rm at io n on t he im pl em en ta tio n of N AP A M R M CC S ec re ta ria t W or ks ho p 1 N at io nw id e 20 23 2 02 8 N um be r of m ee t in gs 2 20 ,3 63 ,4 16 G ov t/ Pa rt ne rs A ct iv it y 6. 1. 2. 3: E ng ag e P ol ic y m ak er s to s up po rt t he im pl em en ta ti on o f N A P A M R Su b ac ti vi ty Im pl em en ti ng e nt it y U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 6. 1. 2. 3. 1 Se ns iti ze M em be r of P ar lia m en t to s up po rt A M R in te rv en tio n M oH /M LF /M oA W or ks ho p 5 N at io na l 20 23 2 02 8 Se ns iti za tio n re po rt 40 0, 00 0 G ov /P ar tn er s 6. 1. 2. 3. 2 Se ns iti ze P ol ic y M ak er s at N at io na l, Re gi on al a nd C ou nc il le ve ls to s up po rt A M R in te rv en tio ns M oH /M LF /M oA /P O R AL G W or ks ho p 5 N at io nw id e 20 23 2 02 8 Se ns iti za tio n re po rt 50 0, 00 0 G v/ Pa rt ne rs In te rv en ti on 6 .1 .3 : Im pr ov e hu m an r es ou rc e ca pa ci ty f or A M R in te rv en ti on s A ct iv it y 6. 1. 3. 1: D ev el op a d at a ba se f or g ra du at es o n th e di sc ip lin e of A M R in v ar io us le ve ls Su b ac ti vi ty Im pl em en ti ng e nt it y U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 6. 1. 3. 1. 1 Id en tif y al l A M R g ra du at es fr om f el lo w sh ip o f ot he r pr og ra m M CC S ec re ta ria t 1 5 N at io nw id e 20 23 2 02 8 Av ai la bi lit y of D at ab as e 0 N o fu nd n ee de d 6. 1. 3. 1. 2 D oc um en t al l i n a da ta ba se a nd u pd at e th e lis t M CC S ec re ta ria t 1 5 N at io nw id e 20 23 2 02 8 An u pd at ed d at a ba se 0 N o fu nd n ee de d 85 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 6. 1. 3. 1. 3 D es ig n a sy st em t o us e th e qu al ifi ed e xp er ts in t he fi el d in t he im pl em en ta tio n of N AP A M R M CC S ec re ta ria t 1 5 N at io nw id e 20 23 2 02 8 An u pd at ed d at a ba se 18 ,3 56 ,7 50 N o fu nd n ee de d A ct iv it y 6. 1. 3. 2: I de nt if y A M R c ap ac it y ga ps a nd d ev el op a s us ta in ab le w or kf or ce o n A M R Su b ac ti vi ty Im pl em en ti ng e nt it y U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 6. 1. 3. 2. 1 Co nd uc t a w or ks ho p to id en tif y ga ps fo r a w or kf or ce in t he im pl em en ta tio n of N AP A M R M oH /M LF /M oA /P O R AL G W or ks ho p 1 N at io na l w id e 20 23 2 02 8 W or ks ho p re po rt 67 ,0 00 ,0 00 G ov /P ar tn er s 6. 1. 3. 2. 2 Lo ok fo r op po rt un iti es t o bu ild t he ir ca pa ci ty in c er tifi ca te , m as te rs a nd P H D le ve ls M oH /M LF /M oA /P O R AL G 1 5 N at io na l w id e 20 23 2 02 8 0 G ov /P ar tn er s In te rv en ti on 6 .1 .4 : St re ng th en in fr as tr uc tu re f or a s us ta in ab le A M R in te rv en ti on s A ct iv it y 6. 1. 4. 1: M ap la bo ra to ri es in h um an , a ni m al , f oo d sa fe ty a nd e nv ir on m en ta l s ec to rs t o de te rm in e th ei r ca pa ci ti es t o pe rf or m A M R 6. 1. 4. 1. 1 D ev el op a n as se ss m en t ch ec kl is t ba se d on in te rn at io na l st an da rd s M oH /M LF /V PO /T BS / PO R AL LG Fi el d w or k 1 N at io na l w id e 20 24 As se ss m en t re po rt 19 ,7 79 ,7 50 G ov /P ar tn er s 6. 1. 4. 1. 2 As se ss la bo ra to rie s ca pa ci ty in p er fo rm in g AM R M oH /M LF /V PO /T BS / PO R AL LG Fi el d w or k 1 N at io na l w id e 20 24 As se ss m en t re po rt 18 8, 34 4, 80 0 G ov /P ar tn er s 6. 1. 4. 1. 3 D ev el op a nd r ev ie w a d at a ba se in di ca tin g th ei r ca pa ci tie s M CC S ec re ta ria t D at a ba se 1 N at io na l 20 24 2 02 8 D at a ba se 12 ,9 28 ,0 00 N o fu nd n ee de d A ct iv it y 6. 1. 4. 2 P ri or it iz e an d st re ng th en la bo ra to ri es f or s us ta in ab le A M R in te rv en ti on s Su b ac ti vi ty Im pl em en ti ng e nt it y U ni t Q ua nt it y Im pl em en ta ti on le ve l (n at io na l/ fa ci lit y/ co m m un it y) Ti m e lin e O ut pu t In di ca to r C os t (C ur re nc y) So ur ce o f Fu nd in g 6. 1. 4. 2. 1 Co nd uc t a w or ks ho p to p ri or iti ze la bo ra to rie s to b e st re ng th en s M oH /M LF /V PO /T BS / PO R AL LG 1 4 N at io na l w id e 20 24 2 02 8 W or ks ho p re po rt 33 ,2 69 ,4 00 G ov /P ar tn er s 6. 1. 4. 2. 2 Se cu re f un ds t o re no va te pr io rit iz ed la bo ra to rie s M oH /M LF /V PO /T BS / PO R AL LG 1 4 N at io na l w id e 20 24 2 02 8 Fi na nc ia l r ep or ts 0 G ov /P ar tn er s 6. 1. 4. 2. 3 Re no va te p rio rit iz ed la bo ra to rie s M oH /M LF /V PO /T BS / PO R AL LG 1 4 N at io na l w id e 20 24 2 02 8 Li st o f re no va te d la bo ra to rie s 5, 10 0, 50 0, 00 0 G ov /P ar tn er s 86 National Action Plan on Antimicrobial Resistance 2023 - 2028 MONITOR AND EVALUATE THE NAP AMR The Monitoring and Evaluation (M&E) plan offers a framework for evaluating the National Action Plan for AMR's progress. The purpose of monitoring and evaluation is to establish a strategic connection with the appropriate stakeholders in order to guarantee that strategies are successful in addressing the threats posed by antimicrobial resistance in Tanzania. The M&E framework includes, activities/ process indicators, output indicators as well as a results assessment for outcomes and goals. The monitoring and evaluation plan is thus expected to provide an initial foundation to all stakeholders regarding pertinent and relevant indicators that can alert to successes and failures in the implementation of the NAP-AMR. It is therefore assumed that the implementation of antimicrobial resistance prevention and containment interventions be monitored and evaluated in order to gain a better understanding of the scope of the problem throughout the country and to measure any progress at the output, outcome, and impact levels. Such monitoring and requires the collection, collation, analysis and management of data from the human, animal, plant and environment sectors. Monitoring and evaluation help to extract relevant information from ongoing activities that can be used for program fine-tuning, reorientation and future planning. Indicators are developed by considering results framework from output, outcome and impact levels. Indicators at impact level were entirely adopted from WHO’s pre-determined Global Action Plan for AMR indicators. At outcome level, some of the indicators were adopted from the same framework however some more others were developed by conceptualization of output indicators achievement for an accrued period of time. On the other hand, output indicators were developed directly from planned interventions at activity level. The monitoring and evaluation framework of this National Action Plan for AMR will include: Standard reporting systems (reporting template, line of communication, frequency of reporting), routine and periodic monitoring mechanisms, such as supportive supervision and regular review meetings and midline and end line evaluation to assess achievement of envisioned outcomes and consequently impacts. The monitoring and evaluation TWG shall be established and regularly review the M&E framework for monitoring progress. The technical working group shall have an independent task of collection, aggregation, analysis and reporting of NAP data generated by AMR TWGs, civil society members, patient group representatives, non-governmental organizations and other AMR partner projects and evaluate the extent to which this is making an impact at the national and subnational levels. Also, the Tripartite AMR country self-assessment survey (TrACSS) indicators are integrated in the M & E framework. The monitoring and evaluation matrix summary (appendix X) adheres to the typical programmatic M&E structure, which includes the basic resources needed, the process or activities, the outputs, outcomes and their desired impact over the long term. Also, the key performance indicators are attached as appendix XI. 87National Action Plan on Antimicrobial Resistance 2023 - 2028 COSTED NAP-AMR OPERATIONAL PLAN The costing of the NAP-AMR was performed using the WHO tool for NAP-AMR. The costed document, comprises of 34 strategic interventions, and 85 activities. The total cost is Tanzania shillings 61,541,380,950. Activities were costed across six strategic areas: 1. Governance (TZS. 2,369,702,017/=) 2. Awareness and Education (TZS 4,580,344,679/=) 3. AMR/AMC/AMU Surveillance and Research (TZS 27,953,082,645/=) 4. Infection Prevention and Control (15,878,376,279/=) 5. Optimizie use of antimicrobials (TZS 4,814,203,124) 6. Sustainable investment (TZS 6,245,672,206/=) Governance Awareness and Educcation Surveillance and Research IPC Optimize Use Sustainability/Investment Figure 12: Distribution of costs across six key areas The costs for implementing activities are distributed across lead ministries and other implmenters including the ministry responsible for health, livestock and fisheries, agriculture and environments. The costed activities are attached as appendix XII and the costs of sub activities are included in the operational plan matrix. 88 National Action Plan on Antimicrobial Resistance 2023 - 2028 APPENDIX I: LIST OF CONTRIBUTORS Members of the National Multisectoral Coordinating Committee are mandated to oversee the development and implementation of the National Action Plan on Antimicrobial Resistance. Their names are listed for reference. S/N NAME INSTITUTION MEMBERSHIP 1 Prof. Tumaini Nagu MoH Chairperson 2 Prof. Hezron Emmanuel Nonga MLF Co- Chairperson 3 Mr. Daudi Msasi MoH Member 4 Prof. Said Aboud NIMR Member 5 Prof. Robinson Mdegela SUA Member 6 Prof. Stephen Mshana CUHAS Member 7 Mr. Longinus Tegulirwa MLF Member 8 Dr. Hamisi L. Nikuli MLF Member 9 Pharm. Rose Shija WHO Member 10 Dr. Mtebe Majigo MUHAS Member 11 Dr. John Rwegesha MNH Member 12 Ms. Jeniva Kamhabwa MoA Member 13 Prof. Jeremiah Seni CUHAS Member 14 Eng. Onesphory Kamukuru Vice President Office Member 15 Dr. Rogath Kishimba MoH Member 16 Dr. Elibariki Mwakapeje FAO Member 17 Mr. Jasson Joel Kyaruzi TBS Member 18 Ms. Valentina Sanga PMO Member 19 Dr. Doreen Mloka MUHAS Member 20 Dr. Joseph C. Hokororo MoH Member 21 Mr. Medard Beyanga NPHL Member 22 Dr. Zacharia Makondo CVL Member 23 Dr. Gibonce Kayuni MLF Secretariat 24 Pharm. Siana G.Mapunjo MoH Secretariat Team of experts who developed the NAP-AMR 2023-2028 are listed here for reference. S/N NAME INSTITUTION/TITLE 1 Pharm. Siana G. Mapunjo NIMR (MCC Secretariat) 2 Dr. Gibonce Kayuni MLF (MCC Secretariat) 3 Pharm. Emiliana Francis MoH (MCC Secretariat and Secretary Antimicrobial Stwardship TWG)) 4 Prof. Jeremiah Seni CUHAS (MCC Member and Chairperson Antimicrobial Stewardship TWG) 5 Prof. Robinson Mdegela MUHAS (MCC Member and Chairperson AMR Awareness and Education TWG) 6 Dr. Mtebe Majigo SUA (MCC Member and Chairperson AMR Surveillance TWG) 7 Mr. Akili Mawazo MUHAS (Member IPC TWG) 8 Pharm. Rose Shija WHO (MCC and AMR Awareness and Education TWG member) 9 Dr. Doreen Mloka MUHAS (MCC and AMR Awareness and Education TWG member) 10 Ms.Gaudensia Simwanza TMDA (Secretary AMR Awareness and Education TWG member) 11 Dr. Deodatus Kakoko MUHAS (AMR Awareness and Education TWG member) 12 Dr. Elibariki Mwakapeje FAO (MCC and AMR Surveillance TWG member) 13 Dr. Zachariah Makondo MUHAS (MCC and AMR Surveillance TWG member) 14 Mr. Reuben Abenego NPHL (AMR Surveillance TWG member and GLASS Focal Person for AMR) 15 Dr. Dr. Alexanda Mzula SUA (AMR Surveillance TWG member) 16 Dr. Nyambura Moremi NPHL (AMR Surveillance TWG member) 17 Mr. Emanuel Magembe NPHL (AMR Surveillance TWG member) 18 Dr. Siril Kullaya IDDS (AMR Surveillance TWG member) 19 Dr. Bachana Lubegwa IDDS (AMR Surveillance TWG member) 89National Action Plan on Antimicrobial Resistance 2023 - 2028 20 Dr. Ndekya Oriyo NIMR (AMR Surveillance TWG member) 21 Dr. Agricola Joachim MUHAS/ (AMR Surveillance TWG member) 22 Ms.Mwajuma Dukulai TBS (AMR Surveillance TWG member) 23 Dr. Justin Assenga MLF (AMR Surveillance TWG member) 24 Ms. Jeniva M. Kamuhabwa MoA (MCC and IPC TWG member) 25 Dr. Doris Lyutkam MTaPS (IPC TWG member) 26 Dr. Edwin Mkama CDE (IPC TWG member) 27 Dr. Stanford Ndibalema MLF (Member and Secretary IPC TWG) 28 Dr. Amour Selemani MoH (IPC TWG member) 29 Dr. Mwendwa Mwenesi IVD ( Immunization and Vaccine Development Programme) 30 Ms. Gladness Malisa NEMC (IPC TWG member) 31 Dr. Abubakar Hoza SUA (Antimicrobial Stewardship TWG member) 32 Dr. Obed Nyasebwa Veterinary Council of Tanzania (Member Antimicrobial Stewardship TWG) 33 Dr Romuald Mbwasi St. John’s University (Antimicrobial Stewardship TWG member) 34 Pharm. Samir Saitoti UDOM (UDOM with University of Dodoma) 35 Dr. Talhiya Yahya MTaPS (Antimicrobial Stewardship TWG member) 36 Pharm. Zuberi Abdalla PoRALG (Antimicrobial Stewardship TWG member) 37 Dr. Erick Komba TAHIRI and consultant ASM 38 Dr. Kunda John NIMR (Monitoring and Evaluation expert) 39 Mr. Martin Kidudu TAMIPA (Impact of AMR)- Monitoring and Evaluation expert 40 Mr. Godfrey Msonde NIMR (Monitoring and Evaluation experts) 41 Mr. Stephen Simba MTaPS (Monitoring and Evaluation expert) 42 Mr. Jackson Makoyola NACOPHA (Monitoring and Evaluation expert) 43 Mr Syabo M. Mwaisegela MoH (Monitoring and Evaluation expert) 44 Ms. Fiona Chilunda (Supply Chain Management HPSS Project) 45 Dr. Joseph Chilongani (NIMR and researcher) 46 Pharm. Aneth Wilbroad MoH (Pharmacist) 47 Mr. Matara Kalelema Ministry of Agriculture (Agriculture Field Officer) 48 Mr. Sigfrid Mtey TMDA (Communication officer) Team of experts contributed to the development of NAP-AMR during the stakeholders meeting, institutional and/or individual inputs S/N NAME INSTITUTION/TITLE 1 Dr. Niwael Mtui-Malamsha United Nations, Food and Agriculture Organization 2 Eng. Onesphory Kamukuru Vice President's Office 3 Ms. Valentina Sanga Prime Ministers’ Office (One Health desk) 4 Mr. Baltazar Lebar Prime Ministers’ Office (One Health desk) 5 Pharm. Mathew Mganga President’s Office’ Regional Administration and Local Government 6 Pharm. Suma Jairo Ministry of Health 7 Dr. Witness Mchwampaka Ministry of Health 8 Dr. Rogath Kishimba Ministry of Health 9 Dr. Elizabeth Shayo National Institute for Medical Research 10 Mr. Junior Shao American Society for Microbiology 11 Dr George Bwire Muhimbili University of Health and Allied Science 12 Dr. Joel Manyahi Muhimbili University of Health and Allied Science 13 Prof. Eva Prosper Muro Kilimanjaro Christian Medical Centre 14 Dr. Peter Mbelele Kibongoto Hospital 15 Dr. Ronald Benju Tanzania Veterinary Laboratory Agency, Mwanza 16 Pharm. Msafiri Reginald Ministry of Health 17 Pharm. Samwel Ibrahim Charles One Health Society 18 Pharm. Richard Charles Aga Khan hospital 19 Dr. Bernard Mbwele University of Dar es Salaam, Mbeya Campus 90 National Action Plan on Antimicrobial Resistance 2023 - 2028 20 Pharm. Gloria Matemu Tanzania Medicines and Medical Devices Authority 21 Pharm. Arapha Nshau Pharmacy Council 22 Pharm. Ambwene Mwakalobo National AIDS Control Programme 23 Pharm. Emilian Ngwandu HJFMRI 24 Prof. Shona Hilton UofG/SNAP-AMR 25 Dr. Tiziana Lembo UofG/SNAP-AMR 26 Dr. Alicia Davis UofG/SNAP-AMR 27 Dr. Emma Laurie UofG/SNAP-AMR 28 Prof. Louise Matthews UofG/SNAP-AMR 29 Dr. Jennika Virhia Postdoctoral Research Scientist; UofG/SNAP-AMR 30 Prof. Gabriel Shirima Nelson Mandela University 31 Dr. Bahati Fimbo APHFTA 32 Mr. Lameck B. Luwanda Ifakara Health Research Institute 33 Ms. Siha Mdemu Sokoine University of Agriculture 34 Dr. Vivian Wonanji TMDA 35 Mr. Ahmed Enock Amasha Sokoine University of Agriculture 36 Dr. Mbarouk Seif National Tuberculosis and Leprosy Program 37 Ms. Mary Mtui Laboratory Council (MoH) 38 Mr. Michael Mosha Rollback Antimicrobial Resisistance Initiatives 39 Dr. Happiness Kumburu Kilimanjaro Christian Research Institute 40 Mr. Frank Magwaza Ministry of Agriculture 41 Ms. Patricia Mbago CHAI 42 Mr. Jonas Gervas ARU 43 Ms. Faith P. Masia Sokoine University of Agriculture 44 Dr. Geofrey Omaroa Tanzania Veterinary Laboratory Agency, Dar es Salaam 45 Mr. Benedict Lugwishi HIASO 46 Dr. Michael J. Msolla LITA 47 Pharm. Paul Josephat Njige Tanzania Pharmaceutical Association 48 Pharm. Adam Mohamed Tanzania Pharmaceutical Association 49 Dr. Fares J. Biginagwa Sokoine University of Agriculture 50 Mr. Ambele Mwafulongo National Public Health Laboratory Prioritized activities were costed in the World Health Organization costing tool by Dr. Abubakar Hoza (SUA), Mr. Emmanuel Magembe (NPHL), Mr. Akili Mawazo (MUHAS) and Pharm. Siana G. Mapunjo (MCC Secretariat). The technical support for costing and analysis was provided by WHO Consultants (WHO-Geneva). Editing of the NAP-AMR (2023-2028) was accomplished by Prof. Jeremiah Seni (CUHAS), Prof. Robinson Mdegela (SUA), Pharm. Rose Shija (WHO) and Dr. Ndekya Oriyo (NIMR). 91National Action Plan on Antimicrobial Resistance 2023 - 2028 APPENDIX II: TERMS OF REFERENCE FOR THE NATIONAL AMR MULTI-SECTORAL COORDINATING COMMITTEE (MCC) Purpose The purpose of the national Multi-sectoral Coordinating Committee (MCC) is to oversee and, coordinate AMR related activities in all sectors including oversight and input into the development and implementation of the National AMR Plan of action. Scope The MCC shall address all AMR-related activities in the country. Role and responsibilities Leadership The MCC shall lead facilitation and coordination of a national response to the threat of AMR from a One Health Approach. Information sharing The MCC shall provide a structure for information-sharing to mutually reinforce activities among sectors. Facilitation and coordination The MCC shall facilitate and coordinate efforts to contain and reduce the threat of AMR at national and subnational levels. The MCC will build a collaborative, cooperative, supportive environment for sharing knowledge, information and experience. Each participating party should understand the scope and limits of its own contributions and also its inter-dependence with other parties and with the whole system in order to meet the defined goals. External interactions Collaboration with external partners, agencies and organizations is essential for the implementation of NAP AMR. The MCC will map, guide, encourage and work with all stakeholders implementing NAP-AMR 2023 2028. Internal interactions The MCC will interact and have clearly defined roles and responsibilities in existing health system, human health and disease-specific programmes, animal health, agriculture, the food sector and environmental initiatives. Membership The national MCC shall be composed of members representing the relevant sectors, notably human health, animal health, agriculture, food safety and environment sectors. Membership of the national MCC will consist of: 1. Chief Medical Officer (Chairperson) 2. Director, Veterinary Services (Co- Chair) 3. Chief Pharmacist (Member) 4. MCC Secretariat (Six focal persons representing the responsible ministries/institutions) 5. Representative World Health Organization (Member) 6. Representative Food and Agriculture Organization (Member) 7. Representative World Organisation for Animal Health (Member) 8. Representative United Nation Environmental Programme (Member) 92 National Action Plan on Antimicrobial Resistance 2023 - 2028 9. Representative Centre for Disease Control (Member) 10. Representative Ministry of Livestock and Fisheries- Fisheries (Member) 11. Representative Ministry of Agriculture (Member) 12. Representative Vice President’s office (Member) 13. Representative from PORALG (Member) 14. Representative TBS (Member) 15. Representative Tanzania Medicines and Medical Devices Authority (Member) 16. Representative National Medical Research Institution (Member) 17. Representative Livestock Research Institution (Member) 18. Representative Agriculture University (Member) 19. Representative Medical University (Member) 20. Representative National Public Health Laboratory (Member) 21. Representative Tanzania Veterinary Laboratory Agency (Member) 22. Representative Health Quality Inspectorate Unit (MOH) (Member) Schedule of the Meeting The regular meetings will be conducted on a quarterly basis or whenever the need arises and will be held as per government norms. MCC members will be required to attend the meeting in person. Minutes of the meetings should be recorded and filed by the Secretariat. Tenure of Office Tenure of office for nominated members shall be three years but renewable for some members. 93National Action Plan on Antimicrobial Resistance 2023 - 2028 APPENDIX III: TERMS OF REFERENCE FOR THE NATIONAL AMR MULTI-SECTORAL COORDINATING COMMITTEE – SECRETARIAT Purpose To coordinate the implementation of all AMR activities including the logistics for MCC meetings. Scope, roles and responsibilities The scope, roles and responsibilities of the focal point should: 1. Prepare and coordinate MCC meetings (e.g. background papers, reports and advisory notes to MCC); 2. Storage and archiving of MCC work; 3. Build sustained partnerships and work nationally and internationally on containment of AMR; 4. Lead and coordinate drafting of a national action plan and accompanying strategies for containment of AMR; 5. Facilitate and oversee implementation the NAP-AMR; 6. Ensure regular monitoring and evaluation of progress through data collection and information sharing by instituting effective communication, collaboroation and coordination among all stakeholders, the members of MCC and their constituencies, sectors and disciplines; 7. Coordinate national activities for establishment of AMR surveillance systems; 8. Report on the prevalence of and trends in AMR and AMC/AMU to GLASS and WOAH. Secretariat Members The Secretariat shall consist of members from responsible ministries/institutions including the Ministry of Health and Ministry of Livestock and Fisheries. It will comprise of at least six technical officers with at least five years of outstanding experience in AMR interventions. The Secretariat will be approved by the MCC. 94 National Action Plan on Antimicrobial Resistance 2023 - 2028 APPENDIX IV: TERMS OF REFERENCE AMR FOCAL POINTS FOR RELEVANT SECTORS Purpose AMR focal points should be designated to coordinate AMR activities and tasks in the relevant sectors. Scope, roles and responsibilities The focal point should: 1. Build sustained partnerships and work nationally and internationally on containment of AMR; 2. Identify stakeholders for NAP-AMR implementations; 3. Support the functionality of the MCC and AMR TWGs; 4. Lead and coordinate the review and implementation of the NAP-AMR in the responsible sector; 5. Ensure regular data collection and information sharing by instituting effective communication and coordination among all stakeholders, and their constituencies, sectors and disciplines; Note In view of the complexity of AMR, which requires a collaborative response, and in view of the importance of a comprehensive approach to addressing AMR at country level, the focal points should have good communication skills, convening power, resources and strong managerial skills. The focal point will be the primary contact for all issues related to AMR in the country (for the specific sectors). 95National Action Plan on Antimicrobial Resistance 2023 - 2028 APPENDIX V: TERMS OF REFERENCE FOR AMR AWARENESS AND EDUCATION TECHNICAL WORKING GROUP Purpose Improve awareness and understanding of AMR through effective communication, education and training Scope Provide technical support during the development and implementation of the AMR national action plan Roles and Responsibilities The AMR Awareness and Education TWG is a national group that will advise the MCC on issues of awareness creation and education on AMR to all stakeholders through the One Health Approach. The TWG is also responsible for technical guidance on implementation of the NAP with regards to the following areas: 1. National awareness of antimicrobial resistance through public communication programmes that target the different audiences in human health, animal health and agricultural practice, including participation in national antibiotic awareness campaigns. 2. Establishment of antimicrobial resistance as a core component of professional education, training, certification and development for the health and veterinary sectors and agricultural practice. 3. Inclusion of antimicrobial use and resistance in school curricula in order to promote better understanding and awareness, and provide the public media with accurate and relevant information so that public information and reporting reinforce key messages 4. Recognition of antimicrobial resistance as a priority need for action across all government ministries through inclusion in national risk registers or other effective mechanisms for cross-government commitment 5. Promotion and support establishment of multi-sectoral (one-health) coalitions to address antimicrobial resistance at local and national levels. 6. Facilitate in conducting operational research on the area of AMR awareness and education for the informed decision making. Membership The TWG will consist of the following members SN ORGANIZATION RESPONSIBILITY 1 Among the MCC members Chairperson 2 Representative from TMDA Member 3 Representative from Pharmaceutical Services Unit (MoH) Member 4 Representative MLF (Livestock) Member 5 Representative MLF (Fisheries) Member 6 Representative MoA Member 7 Representative Ministry of Education Member 8 Representative PORALG Member 9 Representative environmental sector Member 10 Representative training Institution (Public) Member 11 Representative training institution (Animal) Member 12 Representative Research Institution Secretariat 13 Representative MoH- Health promotion Member 14 Representatives Local NGOs Member 15 Representative students associations Member 16 Any other co-opted members Member Schedule of Meeting The regular meeting will be conducted on quarterly basis or whenever the need arises and will be held as per government norms. Minutes of the meetings should be recorded and shared with the National Multi-sectoral AMR Coordinating Committee. 96 National Action Plan on Antimicrobial Resistance 2023 - 2028 APPENDIXES VI: TERMS OF REFERENCE FOR AMR SURVEILLANCE TECHNICAL WORKING GROUP Purpose Strengthen the knowledge and evidence base through surveillance and research Scope Provide technical support during the development and implementation of the AMR national action plan Roles and Responsibilities The AMR Surveillance and Research TWG is a national group that will advise the MCC on issues of AMR Surveillance and Research to all stakeholders through the One Health Approach. The TWG is also responsible for technical guidance on the implementation of the NAP regarding the following areas: 1. Strengthening the National surveillance system for antimicrobial resistance 2. Collection, storage, and analysis of data on antimicrobial resistance in human health, animal health, food safety, aquaculture, agriculture, and environment 3. Strengthening surveillance of antimicrobial residual in foods of animal and plant origin and environment. 4. Collection, storage, and analysis of data on antimicrobial residual surveillance in food of animal and plant origin and environment 5. Reporting antimicrobial resistance data to GLASS and other international platforms 6. Building Laboratory capacity and support of AMR surveillance activities in human, animal agriculture, aquaculture, food safety and the environment 7. Implementation of public health research agenda on antimicrobial resistance 8. Collection, storage, dissemination and sharing of AMR research findings 9. Supporting national biobank for storage of AMR priority pathogens Membership The TWG will consist of the following members SN ORGANIZATION/INSTITUTION RESPONSIBILITY 1 Among MCC Members Chairperson 2 Representative National Public Health Laboratory Member 3 Representative Central Veterinary Laboratory Member 4 Representative TBS (Food safety) Member 5 Representative NEMC Member 6 Representative MLF (Livestock) Member 7 Representative MoH (Diagnostics) Member 97National Action Plan on Antimicrobial Resistance 2023 - 2028 8 Representative MLF (National Fisheries Quality Control Laboratory) Member 9 Representative PORALG Member 10 Representative MOH (Epidemiology) Member 11 Representative Tanzania Plant Health and Pesticide Authority (TPHPA) Member 12 Representative academic institution (Health) Member 13 Representative academic institution (animal) Member 14 Representative from research institution Member 15 Any other Co opted members Member Schedule of Meeting The regular meeting will be conducted on quarterly basis or whenever the need arises and will be held as per government norms. Minutes of the meetings should be recorded and shared with the National Multi-sectoral AMR Coordinating Committee. 98 National Action Plan on Antimicrobial Resistance 2023 - 2028 APPENDIX VII: TERMS OF REFERENCE FOR HYGIENE, INFECTION PREVENTION AND CONTROL - TECHNICAL WORKING GROUP Purpose Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures Scope Provide technical support during the development and implementation of the AMR national action plan Roles and Responsibilities The Hygiene, Infection Prevention and Control TWG is a national group that will advise the MCC on issues of Hygiene, Infection Prevention and Control on AMR to all stakeholders through the One Health Approach. The TWG is also responsible for technical guidance on implementation of the NAP with regards to the following areas: 1. Plan, implement and strengthen hygiene and infection prevention and control; 2. Develop and strengthen national policies and standards of practice regarding infection prevention and control in health facilities; 3. Strengthen animal health and agricultural practices through implementation of the standards published in the WOAH Terrestrial and Aquatic Animal Health Codes 22 and FAO/WHO Codex Alimentarius Code of Practice to Minimize and Contain antimicrobial resistance. 4. Facilitate in conducting operational research on the area of antimicrobial stewardship for the informed decision making. 5. Facilitate in conducting operational research on the area of hygiene and IPC for the informed decision making. Membership The TWG will consist of the following members SN ORGANIZATION RESPONSIBILITY 1 Among the MCC members Chairperson 2 Representative MoH (Health Quality Assurance) Member 3 Representative MoH (WASH) Member 4 Ministry of Agriculture Member 5 Ministry of Livestock and Fisheries (Livestock) Member 6 Ministry of Livestock and Fisheries (Fisheries) Member 7 Representative MoH (Nursing) Member 8 Representative MoH (Director Curative) Member 9 Representative MoH (PSU) Member 10 Representative PORALG Member 11 Representative NEMC Member 12 Representative training institution (health) Member 13 Representative training institution (animal) Member 14 Representative Research Institution Member 15 Any other co-opted member Schedule of Meeting The regular meeting will be conducted on quartely basis or whenever the need arises and will be held as per government norms. Minutes of the meetings should be recorded and shared with the National Multi-sectoral AMR Coordinating Committee. 99National Action Plan on Antimicrobial Resistance 2023 - 2028 APPENDIX VIII: TERMS OF REFERENCE FOR ANTIMICROBIAL STEWARDSHIP - TECHNICAL WORKING GROUP Purpose Optimize the use of antimicrobial medicines in human and animal health, crops production and in the environment. Scope Provide technical support during the development and implementation of the AMR national action plan. Roles and Responsibilities The Antimicrobial Use Stewardship TWG is a national group that will advise the MCC on issues of Antimicrobial Use Stewardship to all stakeholders through the One Health Approach. The TWG is also responsible for technical guidance on implementation of the NAP with regards the following areas: 1. Strengthening regulation, their distribution, quality and use of antibiotics. 2. Monitoring antibiotic consumption; 3. Strengthening stewardship for antibiotic use in health facilities; Evidence-based prescribing and dispensing should be the standard of care. 4. Strengthen patient and health care provider compliance, the prevalence of substandard medicines for both human and veterinary use, and inappropriate or unregulated use of antimicrobial agents in agriculture. 5. Collected and reported data on consumption and use of antimicrobial agents in human and animal health and agriculture so that trends can be monitored and the impact of action plans assessed; 6. Facilitate in conducting operational research on the area of antimicrobial stewardship for the informed decision making. Membership The TWG will consist of the following members SN ORGANIZATION/INSTITUTION RESPONSIBILITY 1 Among the MCC members Chairperson 2 Representative Pharmacy Council Member 3 Representative Tanzania Veterinary Council Member 4 Representative Medical Council of Tanzania Member 5 Representative Laboratory Council Member 6 Representative PST Member 7 Representative Wholesaler Member 8 Representative MoH (PSU) Member 9 Representative MLF (Livestock) Member 100 National Action Plan on Antimicrobial Resistance 2023 - 2028 10 Representative MLF (Fisheries) Member 11 Representative Ministry of Agriculture Member 12 Representative PORALG Member 13 Representative training institution (Health) Member 14 Representative Training institution (Animal) Member 15 Representative training institutions Member Schedule of Meeting The regular meeting will be conducted on quartely basis or whenever the need arises and will be held as per government norms. Minutes of the meetings should be recorded and shared with the National Multi-sectoral AMR Coordinating Committee. 101National Action Plan on Antimicrobial Resistance 2023 - 2028 APPENDIX IX: TERMS OF REFERENCE FOR MONITORING AND EVALUATION TECHNICAL WORKING GROUPS Purpose Monitor the progress for the implementation of NAP-AMR activities. Scope Provide technical support during the development and implementation of the AMR national action plan Roles and Responsibilities The AMR monitoring and evaluation technical working group shall have an independent task of collection, aggregation, analysis and reporting of NAP data generated by other AMR TWGs, implementers and other AMR partner projects: 1. Oversight over development of an M&E system/plan to track and monitor progress and performance of NAP implementation and provide feedback on adjustments or corrective measures required to achieve NAP’s outcomes and goals. 2. Evaluate appropriateness, efficiency, effectiveness, impact and sustainability of NAP implementation at the times required and provide recommendations on the way forward based on lessons picked from NAP implementation M&E results chain. 3. Advise and develop policies and procedures on data management, data privacy and linkages. 4. Document best practices, challenges, lessons, gaps to best forge the way forward in NAP implementation 5. Review TrACSS data and submit to the MCC for endorsement before its submission to the WHO by the MCC Secretariat or any other appointed personnel. Membership The TWG will consist of the following members SN ORGANIZATION RESPONSIBILITY 1 Among MCC member Chairperson 2 Representative from research institutions Member 3 Representative from AMR implementing partners Member 4 Representative from MoH Member 5 Representative from MLF Member 6 Any other co-opted members Schedule of Meeting The regular meeting will be conducted on quartely basis or whenever the need arises and will be held as per government norms. Minutes of the meetings should be recorded and shared with the National Multi-sectoral AMR Coordinating Committee. 10 2 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 A P P EN D IX X : M O N IT O R IN G A N D E V A LU A TI O N M A TR IX Pl an ni ng In pu t Pr oc es s/ Ac tiv iti es O ut pu t O ut co m e Im pa ct s/ Go al Re so ur ce s Ac tiv iti es Re su lts a t a le ve l o f p ro gr am Re su lts a t l ev el o f po pu la tio n Ul tim at e ef fe ct in th e lo ng te rm St re ng th en co or di na tio n, co lla bo ra tio n an d go ve rn an ce fo r t he im pl em en ta tio n of AM R Fu nd s fo r co or di na tio n, co lla bo ra tio n an d go ve rn an ce co m m un ic at io n st ra te gi es fo r AM R co or di na tio n St re ng th en A M R Go ve rn an ce S tr uc tu re at N at io na l L ev el Fu nc tio na l A M R go ve rn an ce st ru ct ur e at na tio na l a nd su bn at io na l le ve ls de ve lo pe d Im pr ov ed go ve rn an ce o f AM R Re du ce d im pa ct o f i nf ec tio us di se as es o n hu m an a nd a ni m al he al th Co nt in ue d ab ili ty to tr ea t a nd pr ev en t i nf ec tio us d ise as es w ith e ffe ct iv e an d sa fe m ed ic in es Sl ow er d ev el op m en t o f re sis ta nc e (r ed uc ed em er ge nc e an d sp re ad o f re sis ta nc e or re du ce d le ve ls) Es ta bl ish A M R Go ve rn an ce S tr uc tu re a t Su b Na tio na l L ev el Co nd uc t t ra in in g on A M R, O ne H ea lth , go ve rn an ce a nd c oo rd in at io n De ve lo p a w eb b as ed p or ta l t o sh ar e AM R su rv ei lla nc e pu bl ic at io n an d ot he r in fo rm at io n St re ng th en co m m un ic at io n an d co lla bo ra tio ns on A M R Ad vo ca te fo r s tr at eg ie s to in cr ea se th e na tio na l b ud ge t c on tr ib ut io n to O ne He al th A M R in te rv en tio ns M on ito rin g an d Ev al ua tio n to e ns ur e th at s tr at eg ie s ar e ef fe ct iv e in re sp on di ng to th e an tim ic ro bi al re sis ta nc e th re at s in th e co un tr y Fu nd s fo r M on ito rin g an d Ev al ua tio n M on ito rin g an d Ev al ua tio n Gu id el in es Da ta fr om th e hu m an , an im al , p la nt an d en vi ro nm en t se ct or s Co nd uc t b as el in e su rv ey o f N AP AM R 20 23 2 02 8 NA P AM R 20 23 – 20 28 m on ito re d an d ev al ua te d NA P AM R 20 23 – 20 28 m on ito re d an d ev al ua te d en su rin g st ra te gi es a re ef fe ct iv e in re sp on di ng to th e AM R th re at s Co nd uc t m on ito rin g fo r A M R an nu al op er at io na l p la n Co nd uc t e va lu at io n of N AP A M R AM R 20 23 2 02 8 D oc um en t b es t p ra ct ic es o f N AP – AM R De ve lo p TO R fo r M &E T W G fu nc tio ns O rg an ize m ee tin gs fo r m on ito rin g an d ev al ua tio n re po rt s sh ar in g 10 3 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 A P P EN D IX X : M O N IT O R IN G A N D E V A LU A TI O N M A TR IX Pl an ni ng In pu t Pr oc es s/ Ac tiv iti es Ou tp ut Ou tc om e Im pa ct s/ Go al Re so ur ce s Ac tiv iti es Re su lts a t a le ve l o f p ro gr am Re su lts a t l ev el o f po pu la tio n Ul tim at e ef fe ct in th e lo ng te rm Cr ea te A w ar en es s an d Un de rs ta nd in g of An tim icr ob ia l Re sis ta nc e th ro ug h Ef fe ct ive In fo rm at io n, Ed uc at io n an d Co m m un ica tio n Co m m un ica tio n st ra te gy fo r a ll st ak eh ol de rs Fu nd in g fo r co m m un ica tio n to th e pu bl ic an d th e pr of es sio na ls se cu re d Co nd uc t a s ys te m at ic re vie w o f K AP B st ud ie s to d et er m in e th e co un try s ta tu s in h um an Ca m pa ig ns to ra ise a w ar en es s an d un de rs ta nd in g of A M R ris ks a nd re sp on se in hu m an h ea lth Im pr ov ed aw ar en es s of AM R an d be ha vio ur c ha ng e am on g po lic y m ak er s, fa rm er s, ve te rin ar ia ns a nd he al th w or ke rs , fo od in du st ry a nd th e pu bl ic T ra ns la te a nd d iss em in at e a co m m un ica tio n st ra te gy fo r A M R (M ul tis ec to ra l A nt im icr ob ia l R es ist an ce Co m m un ica tio n St ra te gy : M ov in g fro m Aw ar en es s to A ct io n 20 20 – 2 02 5) Co nd uc t c om m em or at io n of th e W or ld An tim icr ob ia l a w ar en es s w ee k Co nd uc t T ra in in g of T ra in er s (T OT s) a t Na tio na l, Re gi on al a nd C ou nc il le ve l o n AM R C on du ct s en sit iza tio n m ee tin gs to pr iva te a nd p ub lic s ta ke ho ld er s at Na tio na l, Re gi on al a nd C ou nc il le ve ls on A M R Co nd uc t m ul tim ed ia a w ar en es s ca m pa ig ns o n AM R Es ta bl ish A M R kn ow le dg e m an ag em en t an d sh ar in g m ec ha ni sm a t a ll le ve ls Es ta bl ish A M R kn ow le dg e m an ag em en t an d sh ar in g m ec ha ni sm a t a ll le ve ls 10 4 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 Pl an ni ng In pu t Pr oc es s/ Ac tiv iti es Ou tp ut Ou tc om e Im pa ct s/ Go al Re so ur ce s Ac tiv iti es Re su lts a t a le ve l o f p ro gr am Re su lts a t l ev el o f po pu la tio n Ul tim at e ef fe ct in th e lo ng te rm Co nd uc t a s ys te m at ic re vie w o f K AP B st ud ie s to d et er m in e th e co un try s ta tu s in a ni m al h ea lth , p la nt h ea lth , f oo d pr od uc tio n, fo od s af et y, a nd en vir on m en t Ca m pa ig ns to ra ise a w ar en es s an d un de rs ta nd in g of A M R ris ks a nd re sp on se in an im al h ea lth , pl an t h ea lth , fo od p ro du ct io n, fo od s af et y an d th e en vir on m en t Tr an sla te a nd d iss em in at e a co m m un ica tio n st ra te gy fo r A M R (M ul tis ec to ra l A nt im icr ob ia l R es ist an ce Co m m un ica tio n St ra te gy : M ov in g fro m Aw ar en es s to A ct io n 20 20 – 2 02 5) C on du ct c om m em or at io n of th e W or ld An tim icr ob ia l a w ar en es s w ee k C on du ct T ra in in g of T ra in er s (T OT s) at Na tio na l, Re gi on al a nd C ou nc il le ve l o n AM R Co nd uc t s en sit iza tio n m ee tin gs to pr iva te a nd p ub lic s ta ke ho ld er s at Na tio na l, Re gi on al a nd C ou nc il le ve ls on A M R Co nd uc t m ul tim ed ia a w ar en es s ca m pa ig ns o n AM R Es ta bl ish A M R kn ow le dg e m an ag em en t an d sh ar in g m ec ha ni sm a t a ll le ve ls Es ta bl ish A M R kn ow le dg e m an ag em en t an d sh ar in g m ec ha ni sm a t a ll le ve ls 10 5 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 Pl an ni ng In pu t Pr oc es s/ Ac tiv iti es Ou tp ut Ou tc om e Im pa ct s/ Go al Re so ur ce s Ac tiv iti es Re su lts a t a le ve l o f p ro gr am Re su lts a t l ev el o f po pu la tio n Ul tim at e ef fe ct in th e lo ng te rm Re vie w , u pd at e an d di ss em in at e th e ex ist in g ed uc at io n cu rri cu la in h um an Tr ai ni ng a nd pr of es sio na l ed uc at io n on AM R in th e hu m an h ea lth se ct or Re vie w , u pd at e an d di ss em in at e th e ex ist in g CP D gu id el in es fo r h um an Re vie w , u pd at e an d di ss em in at e th e ex ist in g ed uc at io n cu rri cu la in ve te rin ar y se ct or Tr ai ni ng a nd pr of es sio na l ed uc at io n on AM R in th e ve te rin ar y se ct or R ev ie w , u pd at e an d di ss em in at e th e ex ist in g CP D gu id el in es fo r v et er in ar y se ct or Re vie w , u pd at e an d di ss em in at e th e ex ist in g ed uc at io n cu rri cu la o n AM R in fa rm in g (a ni m al a nd p la nt ), fo od pr od uc tio n, fo od s af et y an d th e en vir on m en t Tr ai ni ng a nd pr of es sio na l ed uc at io n on AM R in fa rm in g (a ni m al a nd pl an t), fo od pr od uc tio n, fo od sa fe ty a nd th e en vir on m en t Re vie w , u pd at e an d di ss em in at e th e ex ist in g CP D gu id el in es fo r A M R in fa rm in g (a ni m al a nd p la nt ), fo od pr od uc tio n, fo od s af et y an d th e en vir on m en t St re ng th en th e Kn ow le dg e an d Ev id en ce B as ed th ro ug h Su rv ei lla nc e an d Re se ar ch M an ua l o f pr oc ed ur es fo r Su rv ei lla nc e of AM R M an ua l o f Co nd uc t s ur ve illa nc e on a nt im icr ob ia l co ns um pt io n an d us e at N at io na l a nd Su b na tio na l l ev el s in h um an h ea lth M on ito rin g sy st em fo r co ns um pt io n an d ap pr op ria te us e of an tim icr ob ia ls in hu m an h ea lth St re ng th en ed kn ow le dg e an d ev id en ce b as e us ed fo r p ol icy an d pr ac tic al de cis io ns 10 6 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 Pl an ni ng In pu t Pr oc es s/ Ac tiv iti es Ou tp ut Ou tc om e Im pa ct s/ Go al Re so ur ce s Ac tiv iti es Re su lts a t a le ve l o f p ro gr am Re su lts a t l ev el o f po pu la tio n Ul tim at e ef fe ct in th e lo ng te rm pr oc ed ur es fo r Su rv ei lla nc e of an tim icr ob ia l us e M an ua l o f a nd fo r Su rv ei lla nc e of an tim icr ob ia l re sid ue s in fo od s Fu nd s fo r A M R su rv ei lla nc e Fu nd in g fo r IP C m at er ia ls Co nd uc t s ur ve illa nc e on a nt im icr ob ia l co ns um pt io n an d us e at N at io na l a nd Su b na tio na l l ev el s in a ni m al s (te rre st ria l, aq ua tic ) a nd p la nt pr od uc tio n M on ito rin g sy st em fo r A M U in a ni m al s (te rre st ria l, aq ua tic ) a nd pl an t p ro du ct io n Co nd uc t s ur ve illa nc e on a nt im icr ob ia l co ns um pt io n an d us e at N at io na l a nd Su b na tio na l l ev el s in p la nt p ro du ct io n Na tio na l m on ito rin g sy st em fo r A M U in p la nt pr od uc tio n Re vie w th e ex ist in g Na tio na l A M R su rv ei lla nc e fra m ew or k Su rv ei lla nc e sy st em fo r A M R in h um an s De ve lo p pr ot oc ol s an d st an da rd op er at in g pr oc ed ur es (S OP s) fo r A M R su rv ei lla nc e in h um an C ol le ct s am pl es fo r A M R su rv ei lla nc e Pa ck ag e an d tra ns po rt co lle ct ed sa m pl es to d es ig na te d la bo ra to rie s fo r AM R su rv ei lla nc e Co nd uc t t ra in in g, m en to rs hi p, a nd su pp or tiv e su pe rv isi on fo r p er so nn el on d ia gn os tic s an d an tim icr ob ia l su sc ep tib ilit y te st in g Su pp or t t ra ns po rta tio n of p rio rit y iso la te s to re fe re nc e la bo ra to rie s an d bi or ep os ito rie s 10 7 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 Pl an ni ng In pu t Pr oc es s/ Ac tiv iti es O ut pu t O ut co m e Im pa ct s/ Go al Re so ur ce s Ac tiv iti es Re su lts a t a le ve l o f p ro gr am Re su lts a t l ev el o f po pu la tio n Ul tim at e ef fe ct in th e lo ng te rm Re vi ew a nd u pd at e th e m as te r l ist fo r th e m at er ia ls/ re ag en ts / i te m s re qu ire d fo r A M R su rv ei lla nc e an d su pp ly m ec ha ni sm to e ns ur e co ns ta nt av ai la bi lit y B ui ld in g ca pa cit y of s ta ff at th e de sig na te d la bo ra to ry fo r A M R su rv ei lla nc e on s up pl y ch ai n m an ag em en t As se ss a nd e nr ol l d es ig na te d la bo ra to rie s fo r A M R su rv ei lla nc e on th e EQ A pr og ra m Su pp or t r ef er en ce la bo ra to rie s to co or di na te a nd d ist rib ut e EQ A m at er ia ls fo r A M R su rv ei lla nc e Su pp or t a cc re di ta tio n pr oc es s to de sig na te d la bo ra to rie s fo r A M R su rv ei lla nc e De ve lo p pr ot oc ol s an d st an da rd op er at in g pr oc ed ur es (S O Ps ) f or A M R su rv ei lla nc e in a ni m al , f oo d, ag ric ul tu re , a qu ac ul tu re , a nd en vi ro nm en t De ve lo p pr ot oc ol s an d st an da rd op er at in g pr oc ed ur es (S O Ps ) f or A M R su rv ei lla nc e in h um an Su rv ei lla nc e sy st em fo r A M R in a ni m al s (t er re st ria l, aq ua tic ), pl an ts , Co lle ct s am pl es fo r A M R su rv ei lla nc e 10 8 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 Pl an ni ng In pu t Pr oc es s/ Ac tiv iti es Ou tp ut Ou tc om e Im pa ct s/ Go al Re so ur ce s Ac tiv iti es Re su lts a t a le ve l o f p ro gr am Re su lts a t l ev el o f po pu la tio n Ul tim at e ef fe ct in th e lo ng te rm Pa ck ag e an d tra ns po rt co lle ct ed sa m pl es to d es ig na te d la bo ra to rie s fo od a nd th e en vir on m en t De ve lo p an d op er at io na liz e a m ul tis ec to ra l A M R su rv ei lla nc e re po rti ng s ys te m Re vie w a nt im icr ob ia l a ge nt s fo r re sid ua l s ur ve illa nc e in fo od s of a ni m al an d pl an t o rig in a nd e nv iro nm en t. Id en tif y, a ss es s, a nd s up po rt la bo ra to rie s fo r t es tin g an tim icr ob ia l re sid ua ls in fo od , a qu ac ul tu re , a nd th e en vir on m en t De ve lo p an d ha rm on ize S OP a nd m et ho ds o f t es tin g th e an tim icr ob ia l re sid ua l. Co lle ct a nd tr an sp or t s am pl es fo r an tim icr ob ia l r es id ua l s ur ve illa nc e As se ss th e ex ist in g la bo ra to ry c ap ac ity an d ap po in t o ne la bo ra to ry to b e a na tio na l r ef er en ce la bo ra to ry a nd se le ct la bo ra to rie s to c ar ry o ut A M R su rv ei lla nc e in a gr icu ltu re , f oo ds , aq ua cu ltu re , a nd e nv iro nm en ta l 10 9 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 Pl an ni ng In pu t Pr oc es s/ Ac tiv iti es O ut pu t O ut co m e Im pa ct s/ Go al Re so ur ce s Ac tiv iti es Re su lts a t a le ve l o f p ro gr am Re su lts a t l ev el o f po pu la tio n Ul tim at e ef fe ct in th e lo ng te rm Co nd uc t t ra in in g, m en to rs hi p, a nd su pp or tiv e su pe rv isi on fo r p er so nn el on d ia gn os tic s an d an tim icr ob ia l su sc ep tib ilit y te st in g Su pp or t t ra ns po rta tio n of p rio rit y iso la te s to re fe re nc e la bo ra to rie s an d bi or ep os ito rie s Re vi ew a nd u pd at e th e m as te r l ist fo r th e m at er ia ls/ re ag en ts / i te m s re qu ire d fo r A M R su rv ei lla nc e an d su pp ly m ec ha ni sm to e ns ur e co ns ta nt av ai la bi lit y B ui ld in g ca pa cit y of s ta ff at th e de sig na te d la bo ra to ry fo r A M R su rv ei lla nc e on s up pl y ch ai n m an ag em en t As se ss a nd e nr ol l d es ig na te d la bo ra to rie s fo r A M R su rv ei lla nc e on th e EQ A pr og ra m Su pp or t r ef er en ce la bo ra to rie s to co or di na te a nd d ist rib ut e EQ A m at er ia ls fo r A M R su rv ei lla nc e S up po rt ac cr ed ita tio n pr oc es s to de sig na te d la bo ra to rie s fo r A M R su rv ei lla nc e Re du ce th e In cid en ce of In fe ct io n th ro ug h M on ito rin g IP C in h ea lth fa cil iti es IP C in h um an he al th c ar e Re du ce d in cid en ce o f 11 0 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 Pl an ni ng In pu t Pr oc es s/ Ac tiv iti es Ou tp ut Ou tc om e Im pa ct s/ Go al Re so ur ce s Ac tiv iti es Re su lts a t a le ve l o f p ro gr am Re su lts a t l ev el o f po pu la tio n Ul tim at e ef fe ct in th e lo ng te rm ad eq ua te W at er su pp ly, S an ita tio n, Hy gi en e an d In fe ct io n Pr ev en tio n M ea su re s Fu nd in g fo r IP C m at er ia ls In fe ct io ns a nd Co nt ro l Gu id el in es Fu nd in g fo r IP C se cu re d Co nd uc t a dv oc ac y an d se ns iti za tio n on IP C in fe ct io n in h ea lth fa cil iti es , f ar m s an d co m m un iti es as w el l a s re du ce d en vir on m en ta l co nt am in at io n, du e to e ffe ct ive pr ev en tio n Fa cil ita te a va ila bi lit y of IP C re la te d eq ui pm en t, su pp lie s, u til iti es (w at er su pp ly) a nd g ui de lin es St re ng th en in g va cc in at io n fo r h um an he al th De sig n an d in tro du ce IP C in te rv en tio ns ac ro ss a ni m al h ea lth c ar e se tti ng Go od h ea lth , m an ag em en t, an d hy gi en e pr ac tic es to pr ev en t in fe ct io ns a nd re du ce th e us e of a nt im icr ob ia ls in a ni m al a nd pl an t p ro du ct io n an d AM R tra ns m iss io n in fo od p ro du ct io n St re ng th en in g va cc in at io n an d ve ct or co nt ro l p ro gr am m es fo r a ni m al h ea lth En fo rc e us e of in te rn at io na l h ea lth re gu la tio n (I HR ) t hr ou gh in te gr at ed di se as e su rv ei lla nc e an d re sp on se (I DS R) a nd e xis tin g la w s on o ut br ea k pr ev en tio n Pr om ot e Fo od C ha in H yg ie ne Pr om ot e ac ce ss to s af e w at er a t ho us eh ol d le ve l a nd c on gr eg at io ns Sc al ed u p w at er su pp lie s, sa ni ta tio n, hy gi en e an d im m un iza tio n to re du ce th e sp re ad o f in fe ct io ns in co m m un iti es an d he al th fa cil iti es P ro m ot e en vir on m en ta l s an ita tio n an d w as te m an ag em en t Pr om ot e Zo o sa ni ta ry a nd ph yt os an ita ry e nv iro nm en ta l s et tin gs St re ng th en m on ito rin g sy st em fo r w as te m an ag em en t 11 1 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 Pl an ni ng In pu t Pr oc es s/ Ac tiv iti es Ou tp ut Ou tc om e Im pa ct s/ Go al Re so ur ce s Ac tiv iti es Re su lts a t a le ve l o f p ro gr am Re su lts a t l ev el o f po pu la tio n Ul tim at e ef fe ct in th e lo ng te rm Pr om ot e m an ag em en t o f e m er gi ng po llu ta nt s in te rr es tri al e nv iro nm en t e. g. , a nt im icr ob ia l r es id ue s M on ito r d isp os al o f a nt im icr ob ia l i n th e en vi ro nm en t P re pa re a nd d iss em in at e po lic y br ie f Op tim ize th e Us e of An tim icr ob ia l A ge nt s in Hu m an a nd A ni m al He al th / S te w ar ds hi p An tim icr ob ia l st ew ar ds hi p Gu id el in es Pr es cr ip tio n an d Tr ea tm en t Gu id el in es De ve lo p gu id el in es fo r h an dl in g an d pr es er va tio n of a nt im icr ob ia l a ge nt s in hu m an h ea lth Op tim ize d AM U in h um an h ea lth Op tim ize d us e of an tim icr ob ia ls in hu m an a nd an im al h ea lth ; ph as ed o ut an im al u se fo r gr ow th p ro m ot io n Re vi ew N at io na l M ed ici ne s Po lic y to ad dr es s AM R Re vi ew a nd D iss em in at e Na tio na l AW aR e Li st o f a nt ib io tic s in h um an he al th R ev ie w a nd d iss em in at e ST G/ NE M LI T fo r h um an h ea lth , i nc lu di ng A W aR e ca te go riz at io n of a nt im icr ob ia ls Re vi ew a nd d iss em in at e M ed ici ne s an d Th er ap eu tic C om m itt ee G ui de lin es fo r Hu m an H ea lth Co nd uc t r eg ul ar in sp ec tio n on ph ar m ac eu tic al m an uf ac tu re rs Es ta bl ish a p la tfo rm a m on g th e re gu la to ry a ut ho rit ie s to m on ito r a nd co nt ro l o f a nt im icr ob ia l a ge nt s 11 2 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 Pl an ni ng In pu t Pr oc es s/ Ac tiv iti es O ut pu t O ut co m e Im pa ct s/ Go al Re so ur ce s Ac tiv iti es Re su lts a t a le ve l o f p ro gr am Re su lts a t l ev el o f po pu la tio n Ul tim at e ef fe ct in th e lo ng te rm Es ta bl ish A M S pr og ra m m es in h ea lth ca re fa cil iti es De ve lo p, im pl em en t a nd m on ito r ho sp ita l f or m ul ar y De ve lo p a sy st em to m on ito r p ro pe r us e of s ta nd ar d pr es cr ip tio ns M on ito r f un ct io na lit y of m ed ici ne s an d th er ap eu tic C om m itt ee s an d ot he r re la te d co m m itt ee s Pr ov id e ca pa cit y bu ild in g to M ed ici ne s an d Th er ap eu tic C om m itt ee s an d ot he r re la te d co m m itt ee s on a nt im icr ob ia l st ew ar ds hi p pr og ra m s Co nd uc t s up po rt iv e su pe rv isi on to m on ito r a nt im icr ob ia l s te w ar ds hi p pr og ra m s De ve lo p gu id el in es fo r h an dl in g an d pr es er va tio n of a nt im icr ob ia l a ge nt s in an im al s’ he al th a nd a qu at ic an im al s O pt im ize d AM U in a ni m al h ea lth De ve lo p/ re vi ew a nd d iss em in at e ST G an d NE M LI T in v et er in ar y pr ac tic e, liv es to ck p ro du ct io n, p la nt h ea lth a nd fis he rie s; a nd in clu de A to D ca te go riz at io n of a nt ib io tic s fo r u se in an im al s C on du ct re gu la r i ns pe ct io n on ph ar m ac eu tic al a nd a gr o ch em ica l ou tle ts 11 3 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 Pl an ni ng In pu t Pr oc es s/ Ac tiv iti es Ou tp ut Ou tc om e Im pa ct s/ Go al Re so ur ce s Ac tiv iti es Re su lts a t a le ve l o f p ro gr am Re su lts a t l ev el o f po pu la tio n Ul tim at e ef fe ct in th e lo ng te rm E st ab lis h jo in t s tra te gy a m on g th e re gu la to ry a ut ho rit ie s to m on ito r pr op er u se o f a nt im icr ob ia l a ge nt s in hu m an , a ni m al s, a qu at ic, p la nt a nd en vir on m en ta l h ea lth Co nd uc t m en to rs hi p in s la ug ht er ho us es a ba tto irs , s la ug ht er s la bs a nd aq ua tic fa rm s to c he ck c om pl ia nc e of w ith dr aw p er io ds a nd s la ug ht er su ita bi lit y Es ta bl ish a v irt ua l n et w or kin g pl at fo rm on th e us e of p re se rv ed a nt im icr ob ia ls ag en ts De ve lo p a sy st em to m on ito r p ro pe r us e of s ta nd ar d pr es cr ip tio ns De ve lo p gu id el in es fo r h an dl in g an d pr es er va tio n of a nt im icr ob ia l a ge nt s in pl an t h ea lth Op tim ize d AM U in p la nt h ea lth De ve lo p gu id el in es fo r h an dl in g an d pr es er va tio n of a nt im icr ob ia l a ge nt s in en vir on m en ta l h ea lth Le gi sla tio n an d/ or re gu la tio ns to pr ev en t co nt am in at io n of th e en vir on m en t w ith an tim icr ob ia ls 11 4 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 Pl an ni ng In pu t Pr oc es s/ Ac tiv iti es Ou tp ut Ou tc om e Im pa ct s/ Go al Re so ur ce s Ac tiv iti es Re su lts a t a le ve l o f p ro gr am Re su lts a t l ev el o f po pu la tio n Ul tim at e ef fe ct in th e lo ng te rm Re se ar ch a nd De ve lo pm en t Fu nd s fo r re se ar ch En ga ge re le va nt s ta ke ho ld er s to id en tif y cu rre nt g ap s in k no w le dg e an d po te nt ia l r es ea rc h to pi cs . Co or di na te d ef fo rts , w ith de fin ed p rio rit ie s an d es ta bl ish ed m ec ha ni sm s to in ce nt ivi ze re le va nt R &D In cr ea se d R& D on ne w m ed ici ne s, di ag no st ics , va cc in es a nd ot he r in te rv en tio ns re la te d to p rio rit y pa th og en s De ve lo p na tio na l r es ea rc h gu id el in es on A M R. Es ta bl ish p ol icy g ui de lin es to a dd re ss AM R da ta s ec ur ity a nd s ha rin g in th e co un try Co nd uc t A M R re se ar ch a ct ivi tie s In cr ea se d in ve st m en t i n R& D to a dd re ss AM R an d pr ev en t in fe ct io n Es ta bl ish a nd o pe ra tio na liz e th e na tio na l b io b an k as s ou rc e of is ol at es fo r A M R re se ar ch in th e co un try Id en tif y an d ut iliz e di ffe re nt ap pr oa ch es fo r d iss em in at io n of A M R re se ar ch fi nd in gs Es ta bl ish a nd s us ta in a n at io na l A M R da ta re po sit or y 11 5 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 A pp en di x X I: K ey P er fo rm an ce I nd ic at or s N ot e Ba se lin e in fo rm at io n is m is si ng fo r so m e in di ca to rs h en ce , t he T ec hn ic al W or ki ng G ro up r es po ns ib le fo r m on ito rin g an d ev al ua tio n w ill c ol le ct b as el in e da ta a nd s et t ar ge ts fo r 20 23 2 02 8. St ra te gi c O bj ec ti ve s In di ca to r Ty pe o f In di ca to r D at a So ur ce Fr eq ue n cy M ea ns o f V er ifi ca ti on B as e lin e Y ea r Ta rg et ( 20 23 20 28 ) 1 2 3 4 5 1. St re ng th en c oo rd in at io n, co lla bo ra tio n an d go ve rn an ce f or N AP o n AM R im pl em en ta tio n 1. 1 . A M R m ul ti se ct or al g ov er na nc e st re ng th en ed a t na tio na l l ev el O ut pu t M CC r ep or ts Q ua rt er ly M in ut es o f m ee tin gs 1. 2. A M R m ul ti se ct or al g ov er na nc e es ta bl is he d an d st re ng th en ed at su bn at io na l l ev el O ut pu t M CC r ep or ts Bi a nn ua l M in ut es o f m ee tin gs / w or ks ho ps 2. c re at e aw ar en es s an d un de rs ta nd in g of a nt im ic ro bi al re si st an ce t hr ou gh e ffe ct iv e in fo rm at io n, e du ca tio n an d co m m un ic at io n 2. 1. In cr ea se d nu m be r of AM R aw ar en es s ca m pa ig ns ta rg et in g pr i or ity s ta ke ho ld er g ro up s (h um an , an im al & p la nt h ea lth , f oo d pr od uc tio n, fo od s af et y an d en vi ro nm en t) O ut pu t M CC r e po rt s Ro ut in e AM R a w ar e ne ss r ep or ts 2. 2. In cr ea se d nu m be r of Po lic y M ak er s w ho u nd er st an d an d su p po rt A M R in te rv en tio ns O ut pu t M CC R e po rt s Ro ut in e AM R a w ar e ne ss r ep or ts 2. 3. In cr ea se d pr op or tio n of he al th , an im al , ag ric ul tu re an d en vi ro nm en ta l pr of es si on al s de m on st ra tin g AM R c om pe te nc ie s O ut co m e W or ks ho p / CP D / in te r vi ew s Ro ut in e W or ks ho p/ tr ai ni ng / as se ss m en t re po rt s 2. 4 In cr ea se d nu m be r of m in is tr ie s/ in st itu tio ns /o rg an iz at io ns co m m em or at e W AA W O ut pu t M ed ia a nd in st itu tio ns / or ga ni za tio ns An nu al ly W AA W r ep or t 11 6 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 2. 5 Pr op or tio n of hu m an , liv e st oc k, ag ric ul tu re an d en vi ro n m en ta l he al th t ra in in g in st itu tio ns in co rp or at ed A M R in t he ir cu rr ic ul ar O ut pu t In st itu tio n tr ai ni ng cu rr ic ul um An nu al ly D oc um en t re vi ew 2. 6 Ta ilo r m ad e cu rr ic ul a on A M R de ve lo pe d fo r pr e pr im ar y, p rim ar y, se co nd ar y sc ho ol s O ut pu t Pr im ar y, se co nd ar y sc ho ol s tr ai ni ng cu rr ic ul a An nu al ly D oc um en t re vi ew 3. S tr en gt he n th e kn ow le dg e an d ev id en ce b as ed t hr ou gh s ur ve ill an ce an d re se ar ch 3. 1 N um be r of l ab or at or ie s in cl ud ed in t he n at io na l A M R s ur ve ill an ce sy st em i n th e hu m an s ec to r w ith th e ca pa ci ty t o pe rf or m a nt im ic ro bi al su sc ep tib ili ty te st in g an d/ or ba ct er ia l i so la tio n O ut pu t N PH L da ta ba se An nu al ly O bs er va tio n/ D oc um en t re vi ew 3. 2 Pe rc en ta ge in cr ea se in AM R da ta s ub m itt ed t o W H O G LA SS O ut pu t N PH L D at ab as e / M CC r ep or ts An nu al ly O bs er va tio n/ D oc um en t re vi ew 3. 3. N um be r of la bo ra to rie s in cl ud ed in t he n at io na l A M R s ur ve ill an ce sy st em i n th e an im al s ec to r w ith ca pa ci ty to pe rf or m an tim ic ro bi al su sc ep tib ili ty t es tin g an d/ or b ac te ria l i so la tio n O ut pu t CV L da ta ba se An nu al ly O bs er va tio n/ D oc um en t re vi ew 3. 4. N um be r of A M R s ur ve ill an ce La bo ra to rie s in ag ric ul tu re , aq ua cu ltu re , f oo ds , a nd th e en vi ro nm en t st re ng th en ed O ut pu t M oA /T BS / N EM C da ta ba se An nu al ly O bs er va tio n/ D oc um en t re vi ew 11 7 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 3. 5. N um be r of la bs se rv in g th e na tio na l A M R s ur ve ill an ce s ite s co v er ed b y ex te rn al q ua lit y as su ra nc e O ut pu t N PH L/ C VL da ta ba se An nu al ly O bs er va tio n/ D oc um en t re vi ew 3. 6. N at io na l s ys te m o f A M R s ur ve il la nc e es ta bl is he d an d st re ng th en ed fo r pr io rit y fo od bo rn e pa th og en s O ut pu t Su rv ei lla nc e re po rt An nu al ly O bs er va tio n/ D oc um en t re vi ew 3. 7. A s ys te m f or m on ito rin g (p as si ve su rv ei lla nc e) of an tim ic ro bi al co m po un ds a nd t he ir m et ab ol ite s (o r re si du es ) an d re si st an t ba ct er ia or an tim ic ro bi al re si st an ce ge ne s (A R G s) in w at er q ua lit y es ta bl is he d O ut pu t M CC a nd TW G s re po rt An nu al ly O bs er va tio n/ D oc um en t re vi ew 3. 8. N at io na l hu m an c on su m pt io n of a nt ib io tic s fo r sy st em ic u se ( AT C cl as si fic at io n) in D efi ne d D ai ly D os es p er 1 00 0 po pu la tio n (o r in ha bi ta nt s) p er d ay d et er m in ed , d is se m i na te d an d re po rt s ub m itt ed to W H O G LA SS O ut pu t TM D A/ M SD / Lo ca l M an u fa ct ur er s An nu al ly O bs er va tio n/ D oc um en t re vi ew 3. 9. S ur ve ill an ce s ys te m f or a nt im i cr ob ia l us e in s el ec te d he al th f ac il iti es e st ab lis he d (u si ng P PS m et h od ol og y) , di ss em in at ed a nd r ep or t su bm itt ed t o W H O G LA SS O ut pu t M oA / H os pi ta ls An nu al ly O bs er va tio n/ D oc um en t re vi ew 3. 10 T ot al v ol um e of a nt im ic ro bi al sa le s/ im po rt s (o r us e) , in m g/ kg bi om as s, in f oo d pr od uc in g an im al s de te rm in ed , re po rt ed , di ss em in at ed , a nd s ub m itt ed t o W O AH . O ut pu t TM D A da ta ba se An nu al ly O bs er va tio n/ D oc um en t re vi ew 11 8 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 3. 11 . T ot al q ua nt ity o f an tim ic ro bi al us e in c ro p pr od uc tio n, b y an tim i cr ob ia l c la ss c ol le ct ed a nd r ep or te d O ut pu t M CC r ep or t/ M oA An nu al ly O bs er va tio n/ D oc um en t re vi ew 3. 12 . P ro po rt io n of h ea lth c ar e an d ve te rin ar y fa ci lit ie s ut ili zi ng AS T da ta t o in fo rm t he ir de ci si on o f ch oi ce o f an tim ic ro bi al s O ut pu t Fa ci lit ie s re po rt An nu al ly O bs er va tio n/ D oc um en t re vi ew 4. R ed uc e th e in ci de nc e of in fe ct io n th ro ug h ef fe ct iv e sa ni ta tio n, hy gi en e, a nd in fe ct io n pr ev en tio n, an d on f ar m b io se cu rit y 4. 1 Pr op or tio n of h ea lth ca re fa ci li tie s w ith e st ab lis he d IP C pr og ra m s ad dr es se s th e co re c om po ne nt s de fin ed b y M oH O ut co m e D H IS 2/ Re se ar ch fin di ng s Q ua rt er ly D oc um en t re vi ew 4. 2. P ro po rt io n o f he al th c ar e fa ci lit ie s w ith q ua lit y w at er s up pl y an d in p re m is e sa ni ta tio n fa ci lit ie s O ut co m e D H IS 2/ Re se ar ch fin di ng s An nu al ly Su rv ey r e po rt s 4. 3. R ed uc tio n of in ci de nc e of su rg ic al s ite in fe ct io n in h ea lth fa ci lit ie s O ut co m e D H IS 2/ Re se ar ch fin di ng s An nu al ly D oc um en t re vi ew 4. 4. R ed uc tio n of in ci de nc e of N eo na ta l s ep si s in h ea lth fa ci lit ie s O ut pu t D H IS 2/ Re se ar ch fin di ng s An nu al ly O bs er va tio n/ D oc um en t re vi ew 4. 5. N um be r of I PC p ro gr am s in an im al , A qu at ic , p la nt h ea lth s er vi ce s an d En vi ro nm en ta l M an ag e m en t es ta bl is he d O ut pu t Su rv ey Re po rt s An nu al ly O bs er va tio n/ D oc um en t re vi ew 4. 6. R ed uc ed r es id ue s of a nt im ic ro bi al c om po un ds a nd a nt im ic ro bi al re si st an t pa th og en s in t he e nv iro n m en t O ut co m e Re se ar ch fin di ng s An nu al ly D oc um en t re vi ew 11 9 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 5. O pt im iz e th e us e of a nt im ic ro bi al ag en ts in h um an a nd a ni m al h ea lth 5. 1 N um be r of h ea lth f ac ili tie s w ith fu nc tio na l A M S pr og ra m m e O ut pu t H ea lth Fa ci lit ie s AM S Co re el em en ts as se ss m en t re po rt An nu al ly O bs er va tio n/ D oc um en t re vi ew 5. 2. N um be r of A M S pr og ra m s in an im al s ec to r Es ta bl is he d O ut co m e Su pe rv is io n/ in sp ec tio ns / re se ar ch fin di ng s An nu al ly O bs er va tio n/ D oc um en t re vi ew 5. 3. P er ce nt ag e of h os pi ta l p at ie nt s re ce iv in g an a nt ib io tic a cc or di ng t o AW aR e ca te go rie s O ut co m e Su pe rv is io n/ in sp ec tio ns / re se ar ch fin di ng s An nu al ly O bs er va tio n/ D oc um en t re vi ew 5. 4. P er ce nt ag e of in pa tie nt s ur gi ca l pr oc ed ur es w ith a pp ro pr ia te t im in g an d du ra tio n of s ur gi ca l an tib io tic pr op hy la xi s O ut pu t Su pe rv is io n/ in sp ec tio ns / re se ar ch fin di ng s An nu al ly O bs er va tio n/ D oc um en t re vi ew 5. 5. N um be r of N at io na l A BC D L is t of a nt ib io tic s in v et er in ar y se ct o re vi ew ed a nd d is se m in at ed O ut pu t Su pe rv is io n/ in sp ec tio ns / re se ar ch fin di ng s An nu al ly O bs er va tio n/ D oc um en t re vi ew 5. 6. N um be r of p os t m ar ke t su rv ey on a nt im ic ro bi al s co nd uc te d in h u m an s ec to r O ut co m e TM D A da ta ba se An nu al ly O bs er va tio n/ D oc um en t re vi ew 5. 7. N um be r of p os t m ar ke t su rv ey on a nt im ic ro bi al s co nd uc te d in a ni m al s ec to r (t er re st ria l, aq ua tic ) O ut pu t TM D A da ta ba se An nu al ly O bs er va tio n/ D oc um en t re vi ew 12 0 N at io na l A ct io n Pl an o n A nt im ic ro bi al R es is ta nc e 20 23 2 0 28 5. 8. In cr ea se d ev i de nc e ba se d de ci si on s on an tim ic ro bi al u se O ut co m e Re se ar ch fin di ng s/ po lic y do cu m en ts /p ol i cy b rie fs An nu al ly O bs er va tio n/ D oc um en t re vi ew 6. s us ta in ab le in ve st m en ts f or a nt i m ic ro bi al r es is ta nc e in te rv en tio ns 6. 1. A m ou nt o f fu nd s al lo ca te d an d re le as ed in t he n at io na l b ud ge ts fo r im pl em en ta tio n of th e N at io na l A M R ac tio n pl an fo r re sp on si bl e se ct or s O ut pu t Re sp on si bl e m in is tr ie s/ in st itu tio ns an nu al bu dg et An nu al ly O bs er va tio n/ D oc um en t re vi ew 6. 2. I nc re as ed h um an r es ou rc e ca pa ci ty in v ar io us A M R r el at ed fi el ds (f el lo w sh ip s, m as te rs & P hD s) O ut co m e M CC S ec re ta ria t da ta ba se An nu al ly O bs er va tio n/ D oc um en t re vi ew 6. 3. A va ila bi lit y of n at io na l d at a th at es tim at es t he e co no m ic i m pa ct o f an tim ic ro bi al r es is ta nc e at n at io na l le ve l i n al l r el ev an t se ct or s O ut pu t Re se ar ch fin di ng s An nu al ly O bs er va tio n/ D oc um en t re vi ew 121National Action Plan on Antimicrobial Resistance 2023 - 2028 APPENDIX XII: THE NAP-AMR 2023-2028 COSTED ACTIVITIES (TZS) Total costs is Tanzania shillings 61,541,380,950/= distributed in the fillowing six strategic areas Strategic Objective 1 1 Governance 2,369,702,017 Objective 2 1.1 Strengthen coordination, collaboration and governance for the implementation of AMR 2,369,702,017 Intervention 3 1.1.1 Establish and strengthen governance structures to tackle AMR 1,797,547,395 Activity 4 1.1.1.1 Strengthen an AMR governance structure at national level. 944,885,109 Activity 4 1.1.1.2 Establish an AMR governance structure at Sub na tional level 530,023,720 Activity 4 1.1.1.3 Conduct training on AMR, One Health, governance and coordination 322,638,566 Intervention 3 1.1.2 Strengthen communication and collaborations on AMR 27,340,750 Activity 4 1.1.2.1 Develop a web-based portal to share AMR surveil lance publication and other information 27,340,750 Activity 4 1.1.2.2 Advocate for strategies to increase the national bud get contribution to One Health AMR interventions 0 Intervention 3 1.1.3 Monitor and evaluate NAP-AMR 2023 - 2028 544,813,872 Activity 4 1.1.3.1 Conduct baseline survey of NAP - AMR 2023-2028 63,125,000 Activity 4 1.1.3.2 Conduct monitoring of NAP - AMR 2023-2028 388,561,613 Activity 4 1.1.3.3 Document best practices of NAP – AMR 93,127,259 Strategic Objective 1 2 Awareness and Education 4,580,344,679 Objective 2 2.1 Increase national awareness on AMR 4,206,929,619 Intervention 3 2.1.1 Establish evidence-based public communications on AMR targeting human, animal and plant including food chain. 556,759,169 Activity 4 2.1.1.1 Conduct a systematic review of KAPB studies to determine the country status in all sectors 321,494,019 Activity 4 2.1.1.2 Translate and disseminate a communication strategy for AMR and other relevant AMR documents 235,263,150 Intervention 3 2.1.2 Advocate for AMR and Conduct campaigns 3,604,432,450 Activity 4 2.1.2.1 Conduct commemoration of the World Antimicrobial Awareness Week and other relevant national and international ceremonies/exibitions 1,029,145,514 Activity 4 2.1.2.2 Conduct Training of Trainers (TOTs) at National, Regional and Council level on AMR 1,073,045,513 Activity 4 2.1.2.3 Conduct sensitization meetings to private and public stakeholders at National, Regional and Council levels on AMR 800,524,953 Activity 4 2.1.2.4 Conduct multimedia awareness campaigns on AMR 701,716,490 Intervention 3 2.1.3 Develop knowledge sharing mechanism at all levels (web portal, social media handles and mobile apps) 45,740,000 Activity 4 2.1.3.1 Establish AMR knowledge Management and sharing mechanism at all levels 45,740,000 Objective 2 2.2 Improve knowledge on AMR 373,415,060 Intervention 3 2.2.1 Include AMR as a core component of professional education, training, certification, and development 283,929,060 122 National Action Plan on Antimicrobial Resistance 2023 - 2028 Activity 4 2.2.1.1 Develop and integrate tailor-made curricula learning outcomes on AMR for pre-primary, primary and secondary schools 283,929,060 Intervention 3 2.2.2 Include AMR as a core component of Continuing Professional development (CPD) 89,486,000 Activity 4 2.2.2.1 Advocate that CPD/short courses on AMR and one health become mandatory courses for actors of all respective sectors 89,486,000 Strategic Objective 1 3 AMR Surveillance and Research 27,953,082,645 Objective 2 3.1 Strengthen National Surveillance System for Antimicrobial Resistance 8,524,310,138 Intervention 3 3.1.1 Develop or review guiding documents for AMR Surveillance 1,021,521,600 Activity 4 3.1.1.1 Review the existing National AMR surveillance framework 683,671,600 Activity 4 3.1.1.2 Develop protocols and standard operating procedures (SOPs) for AMR surveillance in human, animal, food, agriculture, aquaculture, and environment 337,850000 Intervention 3 3.1.2 Conduct AMR surveillance in human, animal, food, agriculture, aquaculture, and environment 4,018,271,796 Activity 4 3.1.2.1 Collect samples for AMR surveillance 4017,047,566 Activity 4 3.1.2.2 Package and transport collected samples to designated laboratories for AMR surveillance 1,224,240 Intervention 3 3.1.3 Develop a multisectoral AMR surveillance reporting system 155,462,855 Activity 4 3.1.3.1 Develop and operationalize a multisectoral AMR surveillance reporting system 155,462,855 Intervention 3 3.1.4 Strengthen AMC and AMU surveillance in human, animal, aquaculture, and agriculture 1,536,893,776 Activity 4 3.1.4.1 Conduct regular AMC/AMU surveys and surveillance on selected antimicrobial agents in human and animal sectors 1,536,893,776 Intervention 3 3.1.5 Strengthen surveillance of antimicrobial residual 1,792,160,111 Activity 4 3.1.5.1 Review antimicrobial agents for residual surveillance in foods of animal and nplant origin and environment 50,045,500 Activity 4 3.1.5.2 Identify, assess, and support laboratories for testing antimicrobial residuals in food, aquaculture, and environment 17,170,000 Activity 4 3.1.5.3 Develop and harmonize SOP and methods of testing the antimicrobial residual 48,379,000 Activity 4 3.1.5.4 Build technical and infrastructural capacity in the identified laboratories for antimicrobial residual testing 1,109,742,955 Activity 4 3.1.5.5 Collect and transport of samples for antimicrobial residual surveillance 566,822,656 Objective 2 3.2 Strengthen Laboratory capacity to produce high-quality microbiological 16,754,573,307 Intervention 3 3.2.1 Designate and strengthen Laboratories for AMR sur veillance in agriculture, aquaculture, foods, and the environment 2,645,707,115 Activity 4 3.2.1.1 Assess the existing laboratories' capacity and select one laboratory to be a national reference laboratory for AMR surveillance in agriculture, food, aquaculture, and the environment 2,645,707,115 Intervention 3 3.2.2 Capacity building for designated laboratories for AMR surveillance in human, animal, food, agriculture, aquaculture, and environment. 1,335,119,299 123National Action Plan on Antimicrobial Resistance 2023 - 2028 Activity 4 3.2.2.1 Conduct training, mentorship, and supportive supervision for personnel on diagnostics and antimicrobial susceptibility testing 617,917,289 Activity 4 3.2.2.2 Support transportation of priority isolates to reference laboratories and biorepositories 717,202,010 Intervention 3 3.2.3 Strengthen the supply chain system to support laboratory AMR surveillance 9,339,332,277 Activity 4 3.2.3.1 Review and update the master list for the materials/ reagents/ items required for AMR surveillance and supply mechanism to ensure constant availability 35,093,177 Activity 4 3.2.3.2 Building capacity of staff at the designated laboratory for AMR surveillance on supply chain management 10,304,229,100 Intervention 3 3.2.4 Strengthen quality management system for designat ed laboratories for AMR surveillance 3,434,424,616 Activity 4 3.2.4.1 Assess and enroll designated laboratories for AMR surveillance on the EQA program 1,034,038,002 Activity 4 3.2.4.2 Support reference laboratories to coordinate and distribute EQA materials for AMR surveillance 2,055,653,004 Activity 4 3.2.4.3 Support accreditation process to designated laboratories for AMR surveillance 344,733,610 Objective 2 3.3 Strengthen research and development in addressing antimicrobial resistance 2,674,199,200 Intervention 3 3.3.1 Integrate AMR in respective sectoral research agenda 905,449,200 Activity 4 3.3.1.1 Engage relevant stakeholders to identify current gaps in knowledge and potential research topics 72,300,000 Activity 4 3.3.1.2 Develop national research guidelines on AMR 270,189,200 Activity 4 3.3.1.3 Conduct AMR research activities 204,580,000 Activity 4 3.3.1.4 Establish and operationalize the national bio-bank as source of isolates for AMR research in the country 358,380,000 Intervention 3 3.3.2 Establish and support a framework for dissemination, storage and sharing of AMR research findings 1,768,750,000 Activity 4 3.3.2.1 Identify and utilize different approaches for dissemination of AMR research findings 900,400,000 Activity 4 3.3.2.2 Establish policy guidelines to address AMR data security and sharing in the country 53,150,000 Activity 4 3.3.2.3 Establish and sustain a national AMR data repository 815,200,000 Strategic Objective 1 4 IPC 15,578,376,279 Objective 2 4.1 Strengthen infection prevention and control Programs 11,353,692,945 Intervention 3 4.1.1 Promoting IPC programmes in all human health care settings 5,860,013,488 Activity 4 4.1.1.1 Conduct scheduled supportive supervision to all health facilities by quality assurance teams (Ministry level, RHMT, CHMT) 2,088,208,947 Activity 4 4.1.1.2 Conduct advocacy and sensitization on IPC 1,328,647,164 Activity 4 4.1.1.3 Facilitate availability of IPC related equipment, supplies, utilities (water supply) and guidelines 2,443,157,377 Intervention 3 4.1.2 Strengthen vaccination Programme in human 1,683,632,655 Activity 4 4.1.2.1 Strengthening vaccination and vector control programmes in human 1,683,632,655 Intervention 3 4.1.3 Establish and design IPC programmes in animal, aquatic, plant health services and Environmental Management 2,645,961,005 Activity 4 4.1.3.1 Design and introduce IPC interventions across animal health care setting 2,645,961,005 Intervention 3 4.1.4 Strengthen vaccination Programme in human and animal health 480,832,233 124 National Action Plan on Antimicrobial Resistance 2023 - 2028 Activity 4 4.1.4.1 Strengthening vaccination and vector control programmes for animal health 480,832,233 Intervention 3 4.1.5 Strengthening community IPC, linkages and Partnership for IPC 683,253,564 Activity 4 4.1.5.1 Engage communities on implementation of personal hygiene and environmental sanitation 417,958,200 Activity 4 4.1.5.2 Promote Food Chain Hygiene 265,295,364 Objective 2 4.2 Strengthen health waste management at all levels 4,524,683,334 Intervention 3 4.2.1 Develop and strengthen system for health waste management in the public sector 3,952,374,966 Activity 4 4.2.1.1 Promote environmental sanitation and waste management 1,547,192,726 Activity 4 4.2.1.2 Promote Zoosanitary and phytosanitary environmental settings 1,033,236,490 Activity 4 4.2.1.3 Strengthen national and subnational monitoring system in the field of waste management 1,040,147,920 Activity 4 4.2.1.4 Promote management of emerging pollutants in terrestrial environment e.g., antimicrobial residues and others 114,681,000 Activity 4 4.2.1.5 Monitor disposal of antimicrobial in the environment 212,116,830 Intervention 3 4.2.2 Establish evidence-based policies to guide management of antimicrobial residues in the environment 572,308,368 Activity 4 4.2.2.1 Conduct Systematic Review on antimicrobial residue in aquatic and terrestrial environment in all sectors to identify gaps 572,308,368 Strategic Objective 1 5 Optimize use 4,814,203,124 Objective 2 5.1 Strengthen regulatory system for produc tion, supply and prudent use of antimicrobial agents 3,898,313,124 Intervention 3 5.1.1 Review Policies, Laws, Regulations and Develop Guidelines on prescriptions and use of antimicrobi al agents in human, animals, plant, environmental health and aquatic animals 2,980,873,502 Activity 4 5.1.1.1 Develop guidelines for handling and preservation of antimicrobial agents in animals, plant, environmental health and aquatic animals 717,220,360 Activity 4 5.1.1.2 Develop operational guidelines for implementation of AMS at National, Sub-national level and Private sectors in human health 106,163,054 Activity 4 5.1.1.3 Develop/review and disseminate STG and NEMLIT in veterinary practice, livestock production, plant health and fisheries; and include A to D categorization of antibiotics for use in animals 196,657,100 Activity 4 5.1.1.4 Review and Disseminate National AWaRe List of antibiotics in human health 381,904,028 Activity 4 5.1.1.5 Review and disseminate STG/NEMLIT for human health, including AWaRe categorization of antimicrobials 354,726,140 Activity 4 5.1.1.6 Review and Disseminate Medicines and Therapeutic Committee Guidelines for Human health sector 1,224,202,820 Intervention 3 5.1.2 Monitor proper use of antimicrobial agents 917,439,622 Activity 4 5.1.2.1 Conduct regular inspection on pharmaceutical and agro chemical outlets 618,514,622 125National Action Plan on Antimicrobial Resistance 2023 - 2028 Activity 4 5.1.2.2 Establish a platform among the regulatory authorities to monitor proper use of antimicrobial agents in human, animals, aquatic, plant and environmental health 257,425,000 Activity 4 5.1.2.3 Conduct mentorship in slaughter houses, abattoirs, slaughter slabs and aquatic farms to check compliance of withdraw periods and slaughter suitability 41,50,000 Objective 2 5.2 Ensure appropriate use of antimicrobial agents 915,890,000 Intervention 3 5.2.1 Establishment antimicrobial stewardship programmes in animal sector; and strengthening of AMS programmes in human sectors 235,445,000 Activity 4 5.2.1.1 Establish AMS programmes in hospitals 28,620,000 Activity 4 5.2.1.2 Establish AMS programmes in animal sector 32,825,000 Activity 4 5.2.1.3 Develop a system to monitor proper use of standard prescriptions in human, animal and aquatic sector 124,800,000 Activity 4 5.2.1.4 Develop, implement and monitor hospital formulary 69,200,000 Intervention 3 5.2.2 Monitor antimicrobial Stewardship programmes in Human and Animal Sector 66,445,000 Activity 4 5.2.2.1 Establish medicines and therapeutic Committees in veterinary sector 98,700,000 Activity 4 5.2.2.2 Strengthen Medicines and Therapeutic Committees and other related committees on antimicrobial Stewardship programs 418,480,000 Activity 4 5.2.2.3 Conduct supportive supervision to monitor antimi crobial Stewardship programs in human and animal sectors 143,480,000 Strategic Objective 1 6 Sustainable investment 6,245,672,206 Objective 2 6.1 Establish a sustainable investments mecha nism for antimicrobial resistance interventions 6,245,672,206 Intervention 3 6.1.1 Determine economic impact of AMR 202,112,413 Activity 4 6.1.1.1 Conduct economic evaluation to determine expenditures for treatment of infectious disease 64,478,400 Activity 4 6.1.1.2 Conduct economic evaluation to determine expenditures for treatment of patients with AMR 45,692,400 Activity 4 6.1.1.3 Prepare a policy brief to address the impact of AMR based on the findings 91,941,613 Intervention 3 6.1.2 Mobilize funds to support AMR interventions 670,390,093 Activity 4 6.1.2.1 Map the AMR stakeholders in the country 302,633,065 Activity 4 6.1.2.2 Engage and establish linkage with relevant stakeholders to support the implementation of NAP AMR 366,857,028 Activity 4 6.1.2.3 Engage Policy makers to support the implementation of NAP-AMR 900,000 Intervention 3 6.1.3 Improve human resource capacity for AMR interventions 18,356,750 Activity 4 6.1.3.1 Develop a data base for competent workforce on AMRiscipline of AMR in various levels 18,356,750 Activity 4 6.1.3.2 Identify AMR capacity gaps and develop a sustainable workforce on AMR 0 Intervention 3 6.1.4 Strengthen infrastructure for a sustainable AMR intervention 5,133,769,400 Activity 4 6.1.4.1 Map laboratories in human, animal, food safety and environmental sectors to determine their capacities to perform AMR 221,043,550 Activity 4 6.1.4.2 Prioritize and strengthen laboratories for sustainable AMR interventions 5,133,769,400