Zanzibar Action Plan (ZAP) on Antimicrobial Resistance (2020-2024)

F A O 1 REVOLUTIONARY GOVERNMENT OF ZANZIBAR ZANZIBAR ACTION PLAN ON ANTIMICROBIAL RESISTANCE 2019 – 2024 September,2019 ii CONTENTS ABBREVIATION AND ACRONYMS ...................................................................................................... iv ACKNOWLEDGEMENTS .......................................................................................................................... vi FOREWORD ............................................................................................................................................... vii EXECUTIVE SUMMARY ......................................................................................................................... viii 1.0 INTRODUCTION ............................................................................................................................ 1 2.0 SITUATIONAL ANALYSIS AND ASSESSMENT ..................................................................... 3 3.0 GOVERNANCE ............................................................................................................................... 6 3.1 Antimicrobial Resistance Focal Point.............................................................................. 6 3.2 Zanzibar AMR Secretariat ............................................................................................. 6 Roles and Responsibilities of the Zanzibar AMR Secretariat ................................................ 6 3.3 Zanzibar Multi-Sectoral Coordinating Committee ............................................................ 7 Role and Responsibilities ................................................................................................ 7 3.4 Multisectoral Technical Working Groups ........................................................................ 7 The four established technical working groups are: .......................................................... 8 3.5 Membership to TWGs .................................................................................................. 8 Roles and Responsibilities of TWGs ................................................................................. 8 4.0 STRATEGIC OBJECTIVES ........................................................................................ 9 4.1 STRATEGIC OBJECTIVE ONE ........................................................................................ 9 PRIORITY ACTION1: AWARENESS-RAISING AND RISK COMMUNICATION ........ 10 PRIORITY ACTION 2: EDUCATION ......................................................................... 11 4.2 STRATEGIC OBJECTIVE TWO ..................................................................................... 12 PRIORITY ACTION 3: SURVEILLANCE SYSTEM ..................................................... 13 PRIORITY ACTION 4: LABORATORY CAPACITY .................................................... 14 PRIORITY ACTION 5: RESEARCH AND DEVELOPMENT .......................................... 15 4.3 STRATEGIC OBJECTIVE THREE .................................................................................. 16 PRIORITY ACTION 6: INFECTION PREVENTION AND CONTROL IN HEALTH CARE .................................................................................................................................. 17 PRIORITY ACTION 7: INFECTION PREVENTION IN AGRICULTURE (ANIMAL, FISHERIES& PLANT HEALTH) .................................................................................. 18 PRIORITY ACTION 8: HYGIENE AND SANITATION AT ALL LEVEL ......................... 19 iii 4.4 STRATEGIC OBJECTIVE FOUR .................................................................................... 20 PRIORITY ACTION 9: REGULATED ACCESS TO HIGH-QUALITY ANTIMICROBIAL MEDICINES .............................................................................................................. 21 PRIORITY ACTION 10: ANTIMICROBIAL STEWARDSHIP ...................................... 22 PRIORITY ACTION 11: USE OF ANTIMICROBIAL AGENTS IN ANIMAL HEALTH AND AGRICULTURE ................................................................................................. 22 4.5 STRATEGIC OBJECTIVE FIVE ..................................................................................... 23 PRIORITY ACTION 12: SUSTAINABILITY OF ANTIMICROBIAL RESISTANCE INTERVENTIONS ...................................................................................................... 24 5.0 OPERATIONAL PLAN ...................................................................................................................... 25 6.0 MONITORING AND EVALUATION PLAN ................................................................................. 56 ANNEX I: SWOT ANALYSIS ................................................................................................................. 72 ANNEX II: LIST OF CONTRIBUTORS ............................................................................................... 74 iv ABBREVIATION AND ACRONYMS AMR Antimicrobial Resistance AMU Antimicrobial Use AR Antimicrobial Residue CDC CHMT Center of Disease Control and Prevention Council Health Management Team CMS Central Medical Store CPD Continuous Professional Development CPO Chief Pharmacist Office DPs Development Partners IDSR Integrated Disease Surveillance and Responses EQA External Quality Assessment FAO Food and Agriculture Organization of the United Nations GARP Global Antimicrobial Resistance Partnership GHSA Global Health Security Agenda GLASS Global Antimicrobial Resistance Surveillance System GOZ Government of Zanzibar HCW Health Care Workers HIV Human Immunodeficiency Virus HMT Health Management Team IEC/BCC Information Education & communication/ Behavior Changes and Communication MANLF Ministry of Agriculture, Natural Resources, Livestock and Fisheries v MELD Monitoring Evaluation Learning and Documentation MoEVT Ministry of Education & Vocational Training MoH Ministry of Health MSD Medical Stores Department MTC Medicine Therapeutic Committee NAP National Action Plan NGO Non-Governmental Organization NHLQATC National Health Laboratory Quality Assurance and Training Centre OIE World Organization for Animal Health PC Pharmacy Council PHL-IdC Public Health Laboratory Ivo de Carneri PORALG President’s Office Regional Administration, Local Government and Special Departments QIT Quality Improvement Teams STG Standard Treatment Guideline TB Tuberculosis WHO World Health Organization ZAHRI Zanzibar Health Research Institute ZARI Zanzibar Agriculture Research Institute ZALIRI Zanzibar Livestock Research Institute ZAP Zanzibar Action Plan ZBC Zanzibar Broadcasting Cooperation ZEML Zanzibar Essential Medicines List ZFDA Zanzibar Food and Drugs Agency ZMCC Zanzibar Multi-sectoral Coordinating Committee OIE World Organization for Animal Health UNDP United Nation Development Program vi ACKNOWLEDGEMENTS The development of the Zanzibar Action Plan on Antimicrobial Resistance (2020-2024) is the result of extensive efforts involving broad consultation and collaboration of various key stakeholders in the public health, animal health and food production sectors, medicine manufacturers, importers, distributors, dealers/stockists, development partners, as well as interested groups and individuals. Special thanks are devoted to the World Health Organization and the Food and Agriculture Organization for their technical and financial support under the Fleming Fund supported Antimicrobial Resistance Project in Tanzania. We are highly indebted to the team of facilitators from WHO and FAO for their engagement and interest during the development process. The Ministry of Health and the Ministry of Agriculture Natural Resources Livestock and Fisheries in Zanzibar would like to acknowledge all those stakeholders who contributed towards successful development of this document, and would extend their sincere thanks to all institutions involved. Our sincere thanks are also expressed to AMR focal persons of both Ministries for their continued supervision and coordination role towards the realization of this plan. Director General Director Ministry of Health, Zanzibar Livestock development, MANRLF vii FOREWORD Antimicrobials, particularly antibiotics, have saved millions of lives since they were first discovered. However, antimicrobial resistance is increasingly becoming a serious public health threat for effective treatment of infections caused by bacteria, parasites, viruses and fungi. When infections can no longer be treated with currently available antibiotics, it leads to increasing suffering to individuals and cost to the government. All these impose a huge burden on health care systems and on the economy of Zanzibar. Antimicrobial resistance has been driven by misuse of antimicrobials without professional oversight. With few new antibiotics being developed to replace existing ones the world is heading towards a scenario in which common infections will not be easily treatable. With extensive travel and trade links throughout the world, no country is immune from antimicrobial resistant strains of microorganisms, which move freely in people, animals, plants and the environment, leading to their rapid spread worldwide. Resistance to common antibiotics is an issue that cuts across human and animal health, and food, environment and agriculture sectors. Single, isolated intervention has limited impact and therefore coordinated action is required to minimize the emergence and spread of antimicrobial resistance. The World Health Organization (WHO) and the Food and Agriculture Organization (FAO) have been working with Member States to secure commitment to develop and implement a national action plan on antimicrobial resistance. The Zanzibar Action Plan on Antimicrobial Resistance (2020 – 2024) was developed through consultative process engaging all relevant sectors and development partners. Zanzibar multi sectoral coordination committee, technical working groups and secretariats were formed to develop and facilitate this action plan. We are confident that this document will provide guidance for combating antimicrobial resistance, involving all stakeholders, with the common goal of minimizing the threat of antimicrobial resistance for a better quality of health and life in the years to come. We therefore request all relevant sectors to work together during implementation of this action plan. We need to act now, to make sure that our children and future generations continue to benefit from these life-saving medicines. Ms. Asha A. Abdulla Principal Secretary, Ministry of Health, Zanzibar Ms. Maryam J. Abdulla Principal Secretary, Ministry for Agriculture, Natural Resources Livestock and Fisheries, Zanzibar viii EXECUTIVE SUMMARY This Action Plan for Antimicrobial Resistance, has been developed in line with the Sixty-eighth World Health Assembly held on May, 2015 in Geneva that adopted the Global Action Plan on AMR with the objectives to reduce the incidence of infection through rational use of antimicrobial medicines in human and animal health. The main goal of the Zanzibar Action Plan on Antimicrobial Resistance is to promote and ensure the prudent and judicious use of antimicrobials in the human and agricultural sector with emphasis on the promotion of infection prevention and control in an endeavour to slow down the rate of development and spread of antimicrobial resistant microorganisms and to ensure that antimicrobials remain a viable option in the management of infectious diseases. The strategy is systematically arranged to facilitate better understanding of the actions needed in the process of day to day implementation of its activities to effectively achieve intended goals and objectives. It starts with the description of analysis of the situation of AMR in Zanzibar in the context of national AMR facilities, structures, policies, legal frameworks, surveillance undertakings, laboratory capacity and standards. Furthermore, an overview and analysis of data from surveillance, including the incidence and prevalence of AMR in different sub-groups of the population, morbidity, mortality and other health outcomes in relation to AMR, economic impact of AMR at both micro- and macroeconomic levels is highlighted. It also covers information awareness and knowledge, data from behavioural studies in different social and professional groups and any other evidence-based information on antimicrobial use and resistance in human health, animal health, agriculture and the environment. As part of “One Health Governance” the document entails the governance structure and functions of related technical working groups of which the Government has established a multi-sectoral coordinating committee that involve different MDAs and other stakeholders, to oversee and coordinate AMR-related activities in the Isles. The document further highlights the Strategic and Operational Plans in addressing 12 priority actions and 34 interventions in human and animal health, agriculture, food, and the environment with reference to Global Strategic objectives. The budget to cover all the interventions including cost of implementation and source of funds are covered in this section. With regards to Monitoring and evaluation the Plan draws a framework that comprises indicators and time frame for measuring strategic performance in the process of its implementation. 1 1.0 INTRODUCTION The world is challenged with the rise and spread of antimicrobial resistant(AMR) microorganisms that cannot be treated with modern medicines. The impacts of AMR are wider in range which includes extreme cost, global health security, food sustainability and food security, environmental wellbeing, and socio-economic development. It has been reported worldwide that AMR related infections are estimated to cause about 700,000 deaths each year globally. This figure is expected to rise to 10 million deaths. On the other hand, the effect of AMR will make a cumulative cost of about $100 trillion, by 2050 if there will be no action taken as from today. Antimicrobial resistance is also threatening many of the Sustainable Development Goals (SDGs). The World Bank estimates that an extra 28 million people will be/ could be forced into extreme poverty by 2050 unless AMR is combated. In Zanzibar, like other African countries, the AMR situation is not promising. There is an increased misuse of antimicrobial agents that cause unwanted harmful effects that include medicine resistance that currently affect the management of several diseases. This situation is threatening our ability to treat common infectious diseases, resulting in prolonged illness, disability, and deaths. According to the situation analysis on the AMU, AMR and AR in food animals including fish farming (aquaculture) and crop production conducted in June 2017, use of antimicrobial agents as feed additives, and prescription of antimicrobial agents by non-veterinary professionals, are critical areas for considerations in animal related strategies for combating AMR in the isles. Apparently there is poor knowledge on AMR at household levels. Testing of AMR and AR in food of animal origin as well as in plants is inadequate/frequently performed. With regards to AMR in humans, both hospital and community acquired bacterial infections accounts for higher resistant trends, therefore making antimicrobial resistance a major threat in Zanzibar. According to report by Global Health Security Agenda (GHSA, 2016), cases of urinary tract infections (UTI), blood stream infections (BSI) and skin and soft tissues infections (SSTI) prevail. In addition, cases related food and water borne gastrointestinal infections, cholera outbreaks and respiratory infections, Mycobacterium tuberculosis (some of the strains are multi medicine resistance (TB-MDR) and other chronic respiratory tract infections are highly reported. This Strategic Plan addresses actions needed to be taken in order to combat AMR in Zanzibar. It might be mandatory to conduct a number of activities in the first two years since we ne need to raise people's awareness on antimicrobial resistance and promote 2 behavioural change through public communication programmes that targets human, animal and plant health. It has been also advised to include school health program and curricula, at all level the education on antimicrobial agents and resistance that will further promote better and or early understanding and awareness. The goal of the Global Action Plan for Antimicrobial Resistance (GAP-AMR) is: “To ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them”. Alignment with the GAP. The Zanzibar Action Plan on AMR has adopted the five GAP strategic objectives which are; Improve awareness and understanding of AMR through education and training, strengthen knowledge and evidence base through surveillance and research, Reduce the incidence of infection through effective hygiene and IPC measures, Optimize the use of antimicrobial medicines in human and animal health and Ensure sustainable investment through research and development. In particular, the ZAP should also reflect the following GAP guiding principles, which describes the role of all stakeholders to follow a common approach that requires integrated and well-coordinated efforts at the national, institutional and individual levels. Therefore, such actions are linked to regional and global efforts to combat AMR. The principles are: 1. Whole-of society engagement including “One Health” approach 2. Prevention first 3. Access 4. Sustainability 5. Incremental Targets for implementation 3 2.0 SITUATIONAL ANALYSIS AND ASSESSMENT The Zanzibar AMR Secretariat conducted an online database search and desk review of the sector specific studies that have been conducted in relation to AMR in human and animal health in order to understand the AMR situation and burden in the Island. This revealed presence of a limited number of studies carried out to address antimicrobial resistance especially focusing on antibiotics or antiprotozoal agents. No study has been carried so far to address resistance to antifungal agents in Zanzibar. The International Health Regulation (IHR) Joint External Evaluation (JEE) assessment report demonstrated that Zanzibar has insufficient capacity to detect, and also undertake surveillance on AMR. Currently there are only four laboratories; two (2) from human health, and two (2)-from animal health, which have potential for detection and reporting of antimicrobial resistance (WHO, 2017).The distribution of laboratories with such capacity is equal between the Islands. Despite these bottleneck, national plan for detection of AMR has been developed (WHO, 2017). The JEE report further indicated presence of high levels of irrational use of antimicrobials in human and animal health sectors (WHO 2017). In Zanzibar, Studies assessed antimicrobial resistance in humans, demonstrated that Escherichia coli and Klebsiella pneumoniae isolated from blood samples were resistant to antibiotics containing beta-lactam ring. It was further indicated that those organisms were either community or hospital acquired (Onken et al, 2015). Moreover, the study showed six out of 7 Salmonella typhi isolates detected were multidrug resistant(MDR) (Onken et al, 2015). These results are alarming, as they imply that some organisms already spread in the society are difficult to treat (Onken A et al.,2015). An earlier study conducted in Pemba to determine the burden of invasive bacterial infection showed an identical finding in which S. typhi isolated from blood samples were resistant to penicillin (beta-lactam ring containing antibiotic), chloramphenicol and co-trimoxazole and an MDR phenomenon was also observed (Thriemer et al, 2012). Many studies have assessed efficacy of anthelminthiasis, especially mebendazole and albendazole either alone or in combination with other drugs. Most of those studies have been carried out in Pemba and revealed reduced efficacy (egg reduction rate (ERR) or cure rate (CR)) for both albendazole and mebendazole against major soil transmitted helminths (STHs), Ascaris lumbricoide, Trichuris trichiura and hookworms. Although, this is more noticed for T.trichiura infection (Speich et al.,2014; 2015; 2016) (Moser et al., 2016; 2017)(Barda et al., 2018). Nevertheless, it should be noted the reduction in CR and/or ERR imposed by anthelminthic drug may not necessarily indicate failure of the 4 drug to combat the infection; as other factors play role. This might be true from the fact that despite observation of low efficacy of mebendazole and albendazole, studies have not shown occurrence of mutation of STH worms (Albonico et al., 1996) to these drugs. However, further studies are underway to explore this possibility. As for other malaria endemic countries, Zanzibar has experienced changing of anti malaria therapies as a result of emergence of anti-malaria resistance. Prior to that, for decades chloroquine was used as the first line drug for the treatment of uncomplicated malaria in Zanzibar but this was subsequently replaced by other drugs such sulphadoxine/pyrimethamine (Fansidar). The later (drug) also became resistant against malaria parasites and that has been, in principle, withdrawn in the treatment plan. Currently, due to low prevalence of malaria cases in Zanzibar, assessment of efficacy of other anti-malaria drugs including artemisinin is impeded. The study assessed E.coli in fish, diarrheic and healthy children showed that 100% of isolates from diarrheic children, 15% of isolates from health individuals and 55.2% , from fish were resistant to at least one antibiotic. However, all isolates [100%] from diarrheic children and 22.4% of isolates from fish were resistant to ampicillin. Other anti-microbials that were found to be resistant to various isolates from fish and humans were tetracycline, cefpodoxime, ciprofloxacin and Norfloxacin (Rabia et al., 2017). Moreover, MDR was observed from all three sources. In addition some of the isolates from fish were resistant to third generation cephalosporins and fluoroquinolones that area antibiotics of choice for treatment of Enterobacteriaceae infections in humans. It was suggested that use of antimicrobial agents when applied as feed additives, use and prescription of antimicrobial agents by non-veterinary professionals and factors leading to non-adherence to withdrawal periods are the most critical areas for considerations in animal related strategies for combating AMR in Tanzania (Bachana et al., 2017). Over 70% of medicines and animal feeds sold and used in Zanzibar are imported from Tanzania mainland; hence enforcement of regulation measures in the mainland will also have a positive impact in Zanzibar. There is poor knowledge on AMR at farm levels and inadequate testing of AMR and AR in food of animal’s origin as well as in plants. In support of this observation (Nonga et al., 2013) reported antimicrobial residues in 76.4% of 72 broiler meat samples from Zanzibar. MDR is threat to the control and treatment of mastitis since it reduces choice of medicine to be used. Most farmers in Zanzibar use penicillin, streptomycin and tetracycline or a combination of penicillin and neomycin, or kanamycin for intra-mammary infusion to treat their animals (Suleiman et al., 2018). Indeed, in this setting, it revealed that major bacterial pathogens isolated from a range samples were resistant to those common antibiotics 5 used to treat bovine mastitis and other bacterial diseases. In view of increased (87.6%) and spread of penicillin resistant pathogens, penicillin has been withdrawn in the treatment regimen for animal infection in Zanzibar (Suleiman et al., 2018). The occurrence of MDR in veterinary medicine raises a huge public health concern since the same medicines are used to treat infections in the human population. The threat may be by introducing antibiotic residue into the human food chain that may lead to the direct or indirect toxicity or allergic reaction; or by failure therapy to the common clinical diseases (Vishnuraj et al., 2016). The subject of AMR found to receive less attention where the current National policies and Acts do not clearly indicate the control of antimicrobials and AMR. There is lack of coordination mechanism that unite efforts of different stakeholders like through One health coordination desk that link every sectors concerning human health, animal health, plant and crop, food chain and environmental sector. Public awareness is critical in promoting behavioral change and ensures the prudent and judicious use of antimicrobials through AMR communication programmes targeting different audiences in human health, animal health and agricultural practices. Currently in Zanzibar the programmes are not in place. In Zanzibar, Limited research on AMR has been conducted for public consumption. The available AMR research data are sector specific, but there is no inter-sectorial and inter ministerial communication and information sharing of the findings.The existing human health, animal health and food safety laboratories are working in silos in Antibiotic Sensitivity Testing (AST). Hence, integrated AMR surveillance system is not in place. The country is lacking strategies and policies which should be taken into consideration in combating antimicrobial resistance. There is therefore a need for a coherent, comprehensive and integrated approach in reducing factors which lead to antimicrobial resistance challenges using the “One Health” approach. The situational analysis has been summarized in a SWOT Analysis (Annex I) 6 3.0 GOVERNANCE 3.1 Antimicrobial Resistance Focal Point The development of the Zanzibar Action Plan (ZAP) on AMR in a one health approach was/ be coordinated by the Ministry of Health and Ministry of Agriculture, Natural Resources Livestock and Fisheries Zanzibar, where by the two ministries are the AMR focal points. The Focal points will work in close collaboration with the AMR Secretariat. 3.2 Zanzibar AMR Secretariat The Zanzibar AMR Secretariat should be nominated and coordinated by the AMR Focal Points within the MoH and MANLF. Roles and Responsibilities of the Zanzibar AMR Secretariat 1. Preparation and circulation of documents (e.g. background papers, reports and advisory notes to ZMCC); 2. Storage and archiving of ZMCC works; 3. Build sustained partnerships and work nationally and internationally on containment of AMR; 4. Identify stakeholders and facilitate formation of an inclusive ZMCC; 5. Lead and coordinate drafting of a Zanzibar action plan for containment of AMR; 6. Facilitate and oversee implementation, M&E of the plan through the ZMCC; 7. Ensure regular data collection and information sharing by instituting effective communication and coordination among all stakeholders, the Members of ZMCC and their constituencies, sectors and disciplines; 8. Coordinate Zanzibar activities for establishment of AMR surveillance systems; and 9. Report on the prevalence of and trends in AMR to the global AMR surveillance system (GLASS). 7 3.3 Zanzibar Multi-Sectoral Coordinating Committee The Zanzibar Multi-Sectoral Coordinating Committee (ZMCC) on AMR is the central steering body and shall oversee and coordinate all AMR related activities in all sectors. The AMR Action plan operations shall be managed and implemented through the ZMCC under the chairmanship of the Director General of Ministry of Health and co-chaired by the Chief Veterinary Officer of Zanzibar. Members of the MCC include representatives from different sectors and disciplines specifically from the sectors responsible for human, animal, plant, environment health as well as livestock and food production. Membership to the Zanzibar Multi sectoral Coordinating Committee shall include the Director General Ministry of Health, Director of Livestock Development, Regulatory authority (ZFDA, Ministry of Health ( Epidemiology unit, curative services, preventive services, public health laboratories ), Chief Pharmacist, Director General Zanzibar Health Research Institute, Chief Veterinary Officer, Veterinary Laboratories, Department of Fisheries Development, Zanzibar Livestock Research Institute, Department of Agriculture, Zanzibar Environmental Management Authority, vice Second President's Office, State University of Zanzibar. Also involves the International Organizations such as WHO and FAO Zanzibar, OIE, CDC, UNDP, UNICEF. Role and Responsibilities 1. The ZMCC is expected to lead facilitation and, when appropriate, coordination of Zanzibar response to the threat of AMR. 2. Oversee the development of Zanzibar AMR Plan of Action (ZAP) and endorse it. 3. The ZMCC provides a structure for information-sharing to mutually reinforce activities among sectors. 4. The ZMCC should facilitate and, when appropriate and agreed, coordinate efforts to contain and reduce the threat of AMR at national, regional, district and shehia/community levels. 5. Collaboration with internal and external agencies and organizations is essential. ZMCC will interact with the health system and public health and disease-specific programmes. 3.4 Multi sectoral Technical Working Groups The ZMCC has four Technical Working Groups (TWGs) which are based on the five global strategic objectives that have been identified to achieve the Zanzibar Action Plan on AMR main objectives. These TWGs are mandated with specific tasks including 8 providing technical inputs, conducting situational analyses and in collaboration with ZMCC development of Zanzibar Action Plan on AMR. The four established technical working groups are: I. Technical working group for Awareness, effective communication and Education II. Technical working group for AMR Knowledge, Surveillance, Research and sustainable investments III. Technical working group for sanitation, hygiene and infection prevention and control IV. Technical Working Groups for Antimicrobial use stewardship 3.5 Membership to TWGs Memberships of TWGs comprise relevant technical specialties and expertise. These include experts from infectious diseases, microbiology, infection prevention and control, social health, rational use of medicine, food safety, environmentalists, medicine regulation, surveillance, environmental health and health promotion and academia, fisheries, veterinarians, pharmacovigilance, plants pathologist and private sectors. Each TWG comprises of chairperson. Roles and Responsibilities of TWGs The ZMCC has established Terms of References (TORs) for each TWG stipulating specific scope, roles and responsibilities. The TWGs which are national groups interact with country representatives of the required sectors, as determined by their scope of work and report regularly to the ZMCC. Activities include but not limited to: (i) Collaborate with ZMCC Formulation of ZAP (ii) Operationalize Zanzibar Action plan on AMR under their respective strategic objectives. (iii) Prepare annual work plan as per Zanzibar Action Plan on AMR (iv) Report to ZMCC on the progress to the implementation of the respective strategic objective. (v) Proposal writing (vi) Provide updates on ongoing activities and provide technical advice to the ZMCC or Zanzibar AMR Focal Point. 9 4.0 STRATEGIC OBJECTIVES The five global strategic objectives are adopted and to be operationalized in order to achieve the desired results of this plan. In each strategic objective, the priority actions, specific objectives, interventions and key activities have been identified. STRATEGIC OBJECTIVES 1. Improve awareness and understanding of AMR through education and training 2. Strengthen knowledge and evidence base through surveillance and research 3. Reduce the incidence of infection through effective hygiene and IPC measures 4. Optimize the use of antimicrobial medicines in human and animal health 5. Ensure sustainable investment through research and development 4.1 STRATEGIC OBJECTIVE ONE Improve awareness and understanding of antimicrobial resistance through effective communication, education and training. Promotion of nation-wide behavioral change against antimicrobial resistance (AMR) in human and animal health and agricultural practices requires public awareness and understanding of AMR and antimicrobial use. The current level of public awareness is limited and AMR is not a core component of professional education, training or certification in both human and agricultural courses. Therefore, there is need for increased awareness for the general public and professionals to ensure appropriate use of antimicrobials, through conducting National Awareness campaigns targeting different audiences with emphasis to school children for better understanding and awareness from an early age However, it is important to develop AMR communication messages tailor made to suit different audiences and develop mechanisms to measure their effectiveness. There is need for creating awareness in relevant ministries to ensure concerted efforts in combating AMR. Combating AMR calls for commitment of government, private sectors and other development partners through resource mobilization and ensuring comprehensive sensitization at grassroots level. The priority actions in this strategic objective are as follows;  Awareness-raising and risk communication  Education 10 PRIORITY ACTION 1: AWARENESS-RAISING AND RISK COMMUNICATION Objective 1:Increase national awareness of AMR Strategic interventions Activities 1.1. Establish an evidence-based public communications programme targeting audiences in human health, animal health, fisheries, plant production and crops, food chain and environmental sectors practice. 1.1.1. To conduct Knowledge, Attitude and Practices (KAP) survey through behavioural studies in deferent social and health professional groups (human health, animal health, plant production and crops, food chain, fisheries and environmental sectors practice) 1.1.2. Develop communication awareness strategies and Standard Operating Procedures (SOP) targeting audience from different groups at all levels. 1.2. Strengthening of Public media and publication programmes targeting audiences in human health, animal health, fisheries, plant production and crops, food chain and environmental sectors practice. 1.2.1. To develop and disseminate IEC materials to target different groups including peoples with special needs (posters, brochures, papers, ads, etc.) 1.2.2. Develop and support the TV/Radio programs, village panorama and documentaries (Regular press briefings, question and answer sessions, video news releases, press statements, TV Public Service Announcements, Radio Public Service Announcements/live announcer scripts, news) 1.2.3. Facilitate the publications of news and articles (newspaper, publication of news and feature articles) 1.2.4. Improve existing web-based information system which is multi sectoral on information management system 1.3. Establishing and strengthening national festivals and dialogues 1.3.1. Establish and Support events for special days concerning with AMR 1.3.2. Annual commemoration on national festival and dialogues of AMR day and come up with annual special theme 1.3.3. Support Public private dialogues – (community leaders, religious leaders, NGOs). 11 PRIORITY ACTION 2: EDUCATION Objective 2: Improve knowledge of AMR and related topics Strategic interventions Activities 2.1. Establishing programmes on AMR and related topics as a core component of professional education, training, certification and development 2.1.1. Introduce and Support AMR and related topics in curricula for human health professionals, fisheries and animal health professionals and food industry and agriculture professionals. 2.2. capacity buildings on AMR programmes 2.2.1. Train staffs on AMR (tailor made and short courses) 2.2.2. Conducting workshop on AMR 2.3. Strengthening Policies, Acts and regulations on AMR awareness programmes 2.3.1. To review existing Policies, Acts and regulations (incorporate AMR awareness programme) 2.3.2. To establish new integrated policy on AMR 12 4.2 STRATEGIC OBJECTIVE TWO Strengthen the knowledge and evidence base through surveillance and research. Establishing a coordinated surveillance system to detect and report resistant pathogens in human health, animal health, agriculture and environmental settings, plays a critical role in developing evidence-based policies and guidelines to control/limit irrational use of antimicrobials which is a major driver of AMR. In Zanzibar, currently there is no AMR surveillance system in place and limited number of research have been conducted on AMR in academic institutions, health facilities in collaboration with international research partners. Moreover, those researches are limited to enteric pathogens and blood steaming pathogens which cause significant mortality and morbidity in children. In order to facilitate implementation of robust interventions the country needs to build capacity of National Reference Laboratory and designated laboratories for AMR surveillance and develop of multi-sectoral research agenda on AMR The priority actions in this strategic objective are as follows;  Surveillance system  Laboratory capacity  Research and development 13 PRIORITY ACTION 3: SURVEILLANCE SYSTEM Objective 3: Establish a national surveillance system for antimicrobial resistance Strategic interventions Activities 3.1. Develop a Zanzibar AMR surveillance framework 3.1.1 Review existing infectious disease surveillance systems 3.1.2 Conduct situation analysis to identify gaps relevant to AMR surveillance in all sectors 3.1.3 Define AMR priority pathogens for surveillance in all sectors 3.2. Develop AMR surveillance reporting system 3.2.1. Develop a multisectoral AMR surveillance reporting and information sharing system in human, fisheries, animals, plants, food and environment health 3.3 Review and develop multi sectoral antimicrobial agents consumption 3.3.1 Conduct a baseline survey on selected antimicrobial consumption 3.3.2 Conduct antimicrobial consumption surveillance down the supply chain towards consumers 3.3.3 Develop antimicrobial agents consumption guideline at all sectors 3.4 Establish antimicrobial residual testing program 3.4.1 Identify key antimicrobial agents for residual testing surveillance 3.4.2 Establish antimicrobial residual sentinel sites 3.4.3 Identify and support laboratories for testing antimicrobial residuals 3.4.4 Build human and infrastructural capacity in the identified laboratories for antimicrobial 14 PRIORITY ACTION 4: LABORATORY CAPACITY Objective 4: Build laboratory capacity to produce high-quality microbiological data for patient management and support surveillance activities in both human and animal sectors. Strategic interventions Activities 4.1. Designate laboratories for AMR surveillance 4.1.1. Assess the existing laboratories’ capacity and appoint two laboratories to be Zanzibar reference/designated laboratories for human and animal AMR surveillance 4.2. Capacity building for designated laboratories for AMR surveillance 4.2.1. Conduct training, mentorship and supportive supervision for personnel on diagnostics and antimicrobial susceptibility testing 4.3Strengthen supply chain system to support laboratory AMR surveillance 4.3.1 Develop the master list for the materials/ reagents/items required for AMR surveillance 4.3.2 Establish supply mechanism to ensure constant availability of equipment, reagents and supplies for AMR detection 4.4 Strengthen quality assurance system for AMR surveillance 4.4.1 Identify and support QA scheme to be used basing on WHO/OIE guidelines/ISO Standards 15 PRIORITY ACTION 5: RESEARCH AND DEVELOPMENT Objective 5: Identify operational research priorities for responsible use of antimicrobial agents and better practice in infection prevention in human and animal health Strategic interventions Activities 5.1. Incorporate multi sectoral research agenda on AMR in Zanzibar research agenda 5.1.1. Engage relevant stakeholders to identify current gaps in knowledge and potential research areas 5.1.2. Develop research guidelines on AMR Undertaken research related to AMR 5.2. Establish a mechanism for sharing AMR research findings 5.2.1. Participate in national multi sector AMR scientific symposiums 5.2.2 Establish an AMR data repository 5.2.3 Establish a bio bank/bio-repository centre 16 4.3 STRATEGIC OBJECTIVE THREE Reduce the incidence of infection through effective sanitation, hygiene and prevention measures. Good hygiene and infection prevention control are essential to limit the development and spread of antimicrobial-resistant infections and multidrug-resistant bacteria. Applied bio security measures, environmental and food sanitation and hygiene as well as vaccination must be core components for IPC for transmission of AMR infections. In all fields of livestock, farm-raised animals and pets, appropriate vaccination is important to prevent infectious diseases, in addition to thorough hygienic management. Promotion of Good Agricultural Practices, to reduce food contamination with antimicrobial resistant organisms and other microorganisms as well as to prevent food poisoning from occurring by promoting HACCP (Hazard Analysis and Critical Control Point). Additionally, prevention of water contamination from animal, human and manufacturing wastes containing active pharmaceutical ingredients which can result in soil, crops and water sources contamination and facilitate the development of antimicrobial resistance amongst the pathogens with which they interact creating environmental reservoirs of antimicrobial resistant bacteria. There is no IPC Policy in place, however guidelines and basic training courses are in place in health facilities at all levels. This ZAP will support the IPC implementation framework, development of integrated IPC policies and related guidelines and tools, Leverage IPC implementation through enhanced multi-sectoral collaborations, implementation of IPC practices in health facilities and congregated settings and Improve sanitation and waste management practices. The priority actions in this strategic objective are as follows;  Infection prevention and control in health care  Infection prevention in Agriculture (animal , fisheries& Plant health)  Hygiene and sanitation at all level 17 PRIORITY ACTION 6: INFECTION PREVENTION AND CONTROL IN HEALTH CARE Objective 6: Establish a national IPC programme with clear governance structure Strategic interventions Activities 6.1 Establish an integrated national and sub-national IPC implementation framework 6.1.1 Hold multi-stakeholders’ dialogue for development of an integrated IPC program for AMR prevention and control. 6.1.2 Develop a TOR for a multi-sectoral IPC coordinating unit. 6.1.3 Build capacity for IPC implementation. 6.2 Facilitate development of integrated IPC policies and related guidelines and tools 6.2.1 Develop national IPC policy and implementation guidelines and tools 6.3 Leverage IPC implementation through enhanced multi sectoral collaborations 6.3.1 Hold joint annual IPC planning sessions (work plan and budget). 6.3.2 Establish nationwide mechanism for multi-level monitoring of IPC program implementation. 6.3.3 Conduction of regular multi-sectoral IPC program implementation progress reviews 6.4 Strengthen implementation of IPC practices in health facilities and congregated settings. 6.4.1 Facilitate availability of IPC related equipment, supplies, SOP guidelines and improve related infrastructure 6.4.2 Conduct scheduled IPC supportive supervision, mentoring and monitoring in health facilities and congregated settings. 18 PRIORITY ACTION 7: INFECTION PREVENTION IN AGRICULTURE (ANIMAL, FISHERIES& PLANT HEALTH) Objective 7: Development of functional IPC programmes in the agriculture and livestock sectors Strategic interventions Activities 7.1 Diversify and improve IPC trainings beyond human health curricula 7.1.1 Include hygiene and infection prevention and control in training curricula for agriculture extension officers 7.1.2 Review existing IPC training contents to encompass and improve components of AMR prevention and control 7.2 To prevent and control occurrence of infectious disease in agriculture, fisheries and livestock 7.2.1 Improve the national mechanism for communicating, responding, reporting and recording animal, fish and plant disease occurrences. 7.2.2 Review existing regulations to accommodate the need for a mandatory vaccination program in animal health 7.2.3 Motivate farmers to use pesticides 7.2.4 Quarantine practices in animals and plants 7.3 Strengthen bio security system at farm level 7.3.1 Promote good agricultural, aquaculture and animal husbandry practice, improvement of animal hosting facilities and infrastructures. 7.4 Strengthen the national mechanism for regulation and control the use of antimicrobials in the agriculture, fisheries and livestock sector 7.4.1 Review and improve existing medicine policy to included handling and uses of microbial agents 7.4.2 Optimize use of antimicrobials and prevent the spread of pest in the agricultural sector 7.4.3 Training on integrated pest management through farmer field school 7.4.4 Review national pesticides, fisheries and national livestock policy to address AMR 19 PRIORITY ACTION 8: HYGIENE AND SANITATION AT ALLLEVEL Objective 8: Limit the development and spread of Infection in the community using infection prevention and control. Strategic interventions Activities 8.1 Promote hygiene practices in the communities 8.1.1 Engage the communities on implementation of personal hygiene in different social groups as a basis for the social mobilization campaigns 8.1.2 Undertake IPC advocacy, Awareness raising and community sensitization activities 8.2 Improve sanitation and waste management practices 8.2.1 Promote environmental sanitation in congregate settings 8.2.2 Promote sanitary inspectorate services in waste management for environment with a collective number of animals e.g. Zoos and parks. 8.2.3 Establish a national and sub national monitoring system in the field of waste management. 8.3 Strengthening National linkages and partnership for IPC 8.3.1 Enforce the use of International Health Regulations through Integrated Disease Surveillance and Response (IDSR) and existing bi-laws on prevention of outbreaks. 8.3.2 Promote food Chain Hygiene 20 4.4 STRATEGIC OBJECTIVE FOUR Optimize the use of antimicrobial medicines in human and animal health. Rational and Judicious Anti microbial Use (AMU) is vital to sustainable prevention and treatment of microbial diseases. Areas of focus in this strategic objective includes: development and implementation of guidelines, enhanced regulation, ensuring access to essential antimicrobials as well as establishing functional AMR stewardship program in order to ensure sustainable access to quality essential antimicrobials. Consumption of substandard or counterfeit antimicrobials containing less than the specified amount of the active ingredient, or consuming suboptimal dosage due to lack of supply or limited accessibility to antimicrobials contributes to the emergence of AMR. Strengthening the regulatory measures, tools and activities of the Zanzibar food and drug agency in ensuring the safety, efficacy and quality of medicines from market authorization to post-marketing surveillance will help combat AMR. Efforts must also focus on sustaining an efficient supply chain system towards ensuring the availability or accessibility of quality medicines to all patients at all times with emphasis on appropriate use by both patients and prescribers. The local demand for animal food products such as milk, meat, fish and eggs, is bound to increase. This increased demand for animal protein endangers complex intensive production systems that results to an increase in the use of antimicrobial agents. The OIE, Codex Alimentarius Commission and other international organizations have formulated guidelines concerning the use of veterinary Antimicrobials. The priority actions in this strategic objective are as follows;  Regulated access to high-quality antimicrobial medicines  Antimicrobial stewardship  Use of antimicrobial agents in animal health and agriculture 21 PRIORITY ACTION 9: REGULATED ACCESS TO HIGH-QUALITY ANTIMICROBIAL MEDICINES Objective 9: Ensure uninterrupted access to high-quality antimicrobial medicines in human, animal, plant and fisheries. Strategic interventions Activities 9.1 Strengthen the pharmaceutical supply chain for human medicine, including the procurement, supply, storage, and quality management system. 9.1.1 Build capacity for quality management system for the supply chain management of medicines, covering storage, transport, expiry date, etc. 9.1.2 Build capacity for ZFDA medicine regulation and enforcement on antimicrobial use. 9.1.3 Conduct Post marketing surveillance and Pharmaco-vigilance on microbial agents. 9.1.4 Revise and update STG and EML. 9.2 Establish the pharmaceutical supply chain for animal, plant and fisheries subsectors. 9.2.1 Develop antimicrobial policies, regulatory framework for supply chain management. 22 PRIORITY ACTION 10: ANTIMICROBIAL STEWARDSHIP Objective 10: Improve and measure appropriate use of antimicrobial agents in human, animal, plant and fisheries facilities. Strategic interventions Activities 10.1 Establish antimicrobial stewardship programmes inhuman, animal, plant and fisheries facilities. 10.1.1 Develop policies and guidelines for antimicrobial stewardship 10.1.2 Build capacity for prescribers, pharmacist, lab personnel and nurses about good antimicrobial prescribing, dispensing and diagnosis. 10.1.3 Establish and operationalize MTC and other related committees. 10.1.4 Conduct survey/assessment on antimicrobial consumption and use 10.2 Monitor and supervise antimicrobial Stewardship program. 10.2.1 Conduct supportive supervision to monitor antimicrobial stewardship programmes. 10.2.2 Introduce audit programs for antimicrobial prescribing. PRIORITY ACTION 11: USE OF ANTIMICROBIAL AGENTS IN ANIMAL HEALTH AND AGRICULTURE Objective 11:Ensure prudent use of antimicrobial agents Strategic interventions Activities 11.1 Establish national policies on use of antimicrobial agents in animal, plant and fisheries subsectors. 11.1.1 Develop policies and guidelines on prudent use of antimicrobial agents. 11.1.2 Develop essential medicine list and standard guideline for animal, plant and fisheries use. 11.1.3 Build capacity on practitioners on appropriate use of antimicrobial agent. 11.1.4 Support regulatory enforcement on antimicrobial use. 11.1.5 Support survey/assessment on antimicrobial consumption. 11.2 Establish monitoring, Evaluation, Learning and Documentation (MELD) system. 11.2.1 Develop comprehensive system for MELD. 11.2.2 Develop facility for documentation centre. 23 4.5 STRATEGIC OBJECTIVE FIVE Prepare the economic case for sustainable investment, and increase investment in new medicines, diagnostic tools, vaccines and other interventions. Research is required on trends in resistance, practices and attitudes driving resistance in Zanzibar to inform appropriate interventions. In addition to investment in the discovery and development of new anti microbials, diagnostic tools and vaccines is required. Research and investment in diagnostic tools and improved vaccines can contribute to the overall reduction in AMU. Veterinary antimicrobial consumption needs be further studied in order to determine the correlation of AMR/AR effects and impact in both animal and human health in the country. Researchers are needed to enhance the development of effective strategies and alternatives to combat AMR in food-producing animals. Developing a multi-sectoral research agenda on AMR and resources allocation for AMR researches, it is important not only to accumulate existing scientific evidence and incorporate it into public health measures, but also to create new scientific evidence in Zanzibar and share it with Tanzania Mainland and the international community for future investment and support for AMR interventions. The priority actions in this strategic objective are as follows;  Sustainability of antimicrobial resistance interventions. 24 PRIORITY ACTION 12: SUSTAINABILITY OF ANTIMICROBIAL RESISTANCE INTERVENTIONS Objective 12:To prepare the economic case for sustainable investment in new medicines, diagnostic tools, vaccines and other interventions. Strategic interventions Activities 12.1 Identify the investment required for the implementation of the Zanzibar action plan for AMR using one health approach 12.1.1 Engage the public, private sectors and development partners on the investment requirements for implementation of the AMR Zanzibar Action Plan 12.1.2 initiate and support research into pharmaceutical products quality and post marketing surveillance activities of antimicrobials 12.1.3 Support piloting and dissemination of innovative ideas on investment for new medicines, diagnostic tools, vaccines and other interventions 25 5.0 OPERATIONAL PLAN The operational plan consists of activities, sub-activities, unit measure, quantity, time frame, level of implementation, cost, source of fund and indicators. PRIORITY ACTION 1: AWARENESS-RAISING AND RISK COMMUNICATION Strategic intervention 1.1: Prepare an evidence-based public communication programme for people in human health practice. Activity 1.1.1.To conduct Knowledge, Attitude and Practices (KAP) survey through behavioural studies in deferent social and health professional groups (human health, animal health, plant production and crops, food chain and environmental sectors practice). Sub activity Unit Quantity Date/ Time Frame Level of implemen tation Responsible Entity Cost (USD) Source of funding Indicator Conduct KAP survey Survey 2 Aug 2020 Nation-wide MoH, MANRLF 20,000 Gov't / Partners surveys conducted and report/ data shared Conduct Disseminatio n meeting on KAP survey results Meeting 3 Oct 2020 Nation-wide MoH, MANRLF, 5,000 Gov't / Partners Activity 1.1.2. Develop communication awareness strategy and SOP on targeting audience from different groups. Sub activity Unit Quantity Date/ Time Frame Level of impleme ntation Responsib le Entity Cost (USD) Source of funding Indicator Develop communicati on awareness strategy Workshop 3 Nov 2020 Nation-wide MoH, MANRLF, SVPO, 10,000 Gov't / Partners AMR communicatio n strategy developed and shared Print communicati on strategy Copies 200 Dec 2020 Nation-wide MoH, MANRLF 10,000 Gov't / Partners Develop SOP on targeting audience from different groups Workshop 2 Dec 2020 Nation-wide MoH, MANRLF 5,000 Gov't / Partners SOP in place 26 Strategic intervention 1.2:Strengthening of Public media and publication programmes targeting audiences in human health, animal health, plant production and crops, food chain and environmental sectors practice. Activity 1.2.1 :To develop and disseminate IEC materials (posters, brochures, papers, ads) Sub activity Unit Quantity Date/ Time Frame Level of Impleme ntation Responsible Entity Cost (USD) Source of Funding Indicator Develop and disseminate AMR IEC materials Copies 600 Jan 2021 Jan 2025 National wide MoH, MANRLF 15,000 Gov't / Partners Number of AMR IEC disseminated Activity 1.2.2: Developing and supporting the TV/Radio programs and documentary (Regular press briefings, question and answer sessions, press statements, TV Public Service Announcements, Radio Public Service Announcements/live announcer scripts, news) Sub activity Unit Quantity Date/ Time Frame Level of impleme ntation Responsible Entity Cost (USD) Source of funding Indicator Developing and support media programmes program me 10 annually Feb 2021 (annual) Nation wide MoH, MANRLF 10,000 Gov't / Partners Media programmes records Activity 1.2.3 Facilitate the publications of news and articles (newspaper, publication of news and feature articles) e Sub activity Unit Quantity Date/ Time Frame Level of Impleme ntation Responsible Entity Cost (USD) Source of Funding Indicator Publications of news and articles publication 5 annually Jan - Dec 2021 Nationwide MoH, MANRLF, 5,000 Gov't / Partners Published News and articles Activity 1.2.4 Development and support of web-based information management system Sub-activity Unit Quantity Date/ Time Frame Level of Impleme ntation Responsible Entity Cost (USD) Source of Funding Indicator Develop and support of web-based information management system Web based system 1 Jan 2020 2025 Nationwide MoH, MANRLF, 10,000 Gov't / Partners AMR web based system online 27 PRIORITY ACTION 2: EDUCATION Strategic intervention 1.3: Conducting national AMR awareness campaign Activity 1.3.1 Conduct multimedia awareness campaigns on AMR Sub-activity Unit Quantity Date/ Time Frame Level of Impleme ntation Responsible Entity Cost (USD Source of Funding Indicator Disseminate AMR massages through social media and broadcasting programmes through radio/TV Massages /program mes 12 Jan 2021 Dec 2022 Nationwide MoH,MANRLF 30,000 Gov't / Partners Number of messages and aired programmes Promote AMR awareness campaign during national festival National festival 6 annual Jan 2021 Dec 2022 Nationwide MoH and MANRLF 10,000 Gov't / Partners Number of AMR campaign conducted Strategic intervention 2.1:Establishing programmes on AMR and related topics as a core component of professional education, training, certification and development Activity 2.1.1 Establish and Support development of AMR and related topics in Primary, Secondary and undergraduate curricula for human health professionals, animal health professionals and food industry and agriculture professionals. Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsibl e Entity Cost (USD) Source of Funding Indicator Conduct workshop to Introduce and Support AMR and related topics in Primary, Secondary and undergraduate curricula Meeting 3 Aug 2022 dec 2023 Nationwide MoH, MANRFL, MoE 10,000 Gov't / Partners AMR topics and curricula developed 28 PRIORITY ACTION 3: SURVEILLANCE SYSTEM Strategic intervention 2.2: Strengthening capacity buildings on AMR programmes Activity 2.2.1 Training and workshops on AMR (tailor made and short courses) Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsibl e Entity Cost (USD) Source of Funding Indicator Conduct training on AMR (tailor made and short courses) Training 1 annual Dec 2022 national MoH, MANRLF 10,000 Gov't / Partners Training reports Conducting workshop on AMR Workshop 1 annual Jan 2023 national MoH, MANRLF,. 5,000 Gov't / Partners Workshop reports Strategic intervention 3.1:Develop guideline on Zanzibar AMR surveillance framework for all sectors. Activity 3.1.1. Operationalize AMR surveillance systems Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsible Entity Cost (USD) Source of Funding Indicator Collect information on the pre-existing surveillance system on AMR Surveillance System 1 Jan 2020 Nationa MoH, MANRLF, 5000 Gov't / Partners Availability of Information of on AMR Review and harmonize collected information on existing surveillance system on AMR Workshop 1 Mar 2020 National MoH , MANRLF … Gov/ Partners Surveillance System on AMR in place Prepare and disseminate AMR Guideline/ SOP for AMR surveillance in human, animals/fisherie s, plant and environment Number SOP disseminated 1 May 2020 National MoH, MANRLF 4000 Gov/ Partners Guideline/ SOP in place 29 Activity 3.1.2. Conduct situation analysis to identify gaps relevant to AMR surveillance in all sectors Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsible Entity Cost (USD) Source of funding Indicator Develop terms of reference for conducting AMR Surveillance in human, animals/ fisheries, plant and environment List of ToR 1 June 2020 National MoH, MANRLF 10,000 Gov' t/ Partners Terms of reference in place Conduct Need assessment to identify existing gaps on relevant AMR surveillance in human, animals/ fisheries, plant and environment Assessed gaps 1 July 2020 National MoH, MANRLF, SVPO 2000 Gov't / Partners Needs assessment /gaps Identificatio n report Conduct capacity Building for AMR Surveillance in human, animals/ fisheries, plant and environment Human resource 4 Sept 2020 National MoH, MANRLF, SVPO 10,000 Gov't / Partners Skilled human personnel Establishment of AMR Surveillance database based on one health Database 1 Jan 2021 National MoH, MANRLF 5,000 Gov't / Partners Functional Database in place 30 PRIORITY ACTION 4: LABORATORY CAPACITY Activity 3.1.3. Develop multi sector AMR surveillance reporting system(data collection, management, analysis and dissemination) 1 e Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsible Entity Cost (USD) Source of Funding Indicator Collect and identify the existing reporting system on AMR in human, animals/fisherie s, plant and environment List of existing Reporting system 1 Oct 2020 National MoH, MANRLF 6000 Gov't / Partners Availability of functional AMR reporting system Conduct stakeholder meeting to review and harmonize collected information on reporting system Meeting 1 Nov 2020 National MoH, MANRLF 3000 Gov't / Partners Availability of functional AMR reporting system Conduct specific training for AMR surveillance reporting system in human, animals/fisherie s, plant and environment Training 2 Dec 2020 Jan 2021 National MoH, MANRLF 2500 Gov't/ Partners Availability of functional AMR reporting system Strategic intervention 4.1: Selection of designate laboratories for AMR surveillance Activity 4.1.1. Assess the existing laboratories’ capacity and appoint two laboratories to be Zanzibar reference/designated laboratories for AMR surveillance Sub-activity Unit Quantity Date/ Time Frame Level of Implemen tation Responsibl e Entity Cost (USD) Source of Funding Indicator Develop terms of reference for selection of reference laboratories for AMR Terms of reference tools 1 June 2020 National MoH, MANRLF 10,000 Gov't / Partners Zanzibar reference laboratory terms of reference ready for approval 31 detection and surveillance. Conduct assessment of existing laboratory capacity on AMR detection and surveillance (human resource, reagents, equipment and consumables) Laboratory 1 July 2020 National MoH, MANRLF 2000 Gov't / Partners AMR reference laboratories Conduct training on AMR detection /surveillance in reference laboratories training 4 September 2020 National Reference laboratories 10,000 Gov't / Partners Skilled human personnel Procure reagents, equipment and consumables (for detection of AMR in reference laboratories) Equipment, reagents and other consumables 10 January June Every year National MoH, MANRLF 200,000 Gov't / Partners Qualified laboratories for AMR detection Conduct surveillance and detection of AMR pathogens in human, animals/ fisheries, plant and environment Surveillance Ongoing 2020 National MoH, MANRLF 30,000 Gov't / Partners Surveillance system in place Dissemination of annual report on AMR surveillance in human, animals/ fisheries, plant and environment Report 4 2021 National MoH, MANRLF 5000 Gov't / Partners Annual Report delivery 32 Strategic intervention 4.2: Capacity building for designated laboratories for AMR surveillance Activity 4.2.1. Conduct training, mentorship and supportive supervision for personnel on diagnostics and antimicrobial susceptibility testing Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsibl e Entity Cost (USD) Source of Funding Indicator Enhance supervision, mentorship, and supportive supervision on AMR detection in selected laboratories Reference laboratory Ongoing 2020 National MoH, MANRLF 5000 Gov't / Partners Competent laboratory personnel Strategic intervention 4.3:Strengthensupplychainsystem to support laboratory AMR surveillance Activity 4.3.1. Procurements of materials/ reagents/items required for AMR surveillance Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsibl e Entity Cost (USD) Source of Funding Indicator Development of master list of materials and reagents required for AMR surveillance in all sectors List of material and reagents 2 Jan 2020 Jan 2023 Nationwide MoH, MANRLF 0 Gov't / Partners Master list ready for use Procurement and Supply of materials and reagents for AMR surveillance in human, animals/fisherie s, plant and environment Materials and reagents 10 January June Each year Nationwide MoH, MANRLF 100,000 Gov't / Partners Percentage of diagnostic and reagents available for AMR 33 Activity 4.3.2. Establish supply mechanism to ensure constant availability of equipment, reagents and supplies for AMR detection Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsibl e Entity Cost (USD) Source of funding Indicator Establishment of one health supply mechanism on equipment, reagents and supplies for AMR surveillance based on one health approach. Supply mechanism 1 Jan 2021 Nation wide Procurement unit 12 000 Gov't / Partners Supply mechanism in place Strategic intervention 4.4: Strengthen quality assurance system for AMR surveillance Activity 4.4.1. Identify and support QA scheme to be used based on WHO/OIE guidelines/ISO Standards Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsibl e Entity Cost (USD) Source of Funding Indicator Institute EQA AMR program basing on the WHO/OIE guidelines/ISO Standards to the participating laboratories. Laboratory 10 March 2021 National MoHMANRLF 5000 Gov't / Partners AMR surveillance test performed as per WHO/ISO standard. AMR Train laboratory personnel on AMR Quality assurance program in all sectors Training session 4 Once per year National MoH,MANRLF 10000 Gov't / Partners Support implementation of Quality assurance on AMR schemes for appointed laboratories in all sectors (responsible Laboratories 4 May 2021 National MoH, MANRLF 20,000 Gov't / Partners 34 PRIORITY ACTION 5: RESEARCH AND DEVELOPMENT sectors) Establish Quality Assurance system on AMR in all selected laboratories Reference laboratory Ongoing 2020 National MoH, MANRLF 7000 Gov't / Partners Number of laboratories implementing QMS Strategic intervention 5.1: Incorporate multi-sectoral research agenda on AMR in Zanzibar Research agenda 2021-2025 Activity 5.1.1. Engage relevant stakeholders to identify gaps in knowledge and potential research areas on AMR Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Conduct stakeholders workshop to identify gaps and potential research areas on AMR Workshop 1 April 2020 National wide MoH, MANRLF 6000 Gov't / Partners AMR gaps and potential research areas identified Conduct epidemiology study in order to identify gaps related to AMR surveillance in all sectors Survey 6 June 2020 National wide MoH, MANRLF 30000 Gov't / Partners Report on AMR gaps identified Incorporate identified AMR gaps into Zanzibar research agenda workshop 1 Sept 2020 Unguja MoH, MANRLF, SVPO 4000 Gov't / Partners AMR components on Research agenda 2021 2025 Activity 5.1.2. Develop research guidelines on AMR Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsib le Entity Cost (USD) Source of funding Indicator 35 Conduct stakeholders meeting to develop TOR on AMR research meeting 1 Oct 2020 Nationwide MoH, MANRLF 4000 Gov't / Partners TOR of AMR research availability Conduct a workshop to develop guideline on AMR Research. workshop 1 Nov 2020 Nationwide MoH, MANRLF 4000 Gov't / Partners AMR guideline available Print and disseminate AMR research guideline in all sectors Copies 50 Jan 2021 National wide MoH, MANRLF 2000 Gov't / Partners Zanzibar AMR research guideline Activity 5.1.3. Conduct research activities related to AMR in all sectors Sub-activity Unit Quantity Date/ Time Frame /Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Develop AMR related research proposals with one health approach Proposals TBD April 2021 National wide MoH, MANRLF 4000 Gov't / Partners Number of AMR research proposal developed Conduct research activities Papers TBD June 2022 National wide MoH, MANRLF 20,000 Gov't / Partners Number of AMR research conducted Strategic intervention 5.2: Establish a mechanism for sharing AMR research findings Activity 5.2.1. Conduct Zanzibar multi sector AMR scientific symposium Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator 36 Establish and support the organizing scientific conference meetings on AMR meeting 2 June 2023 National wide MoH, MANRLF, SVPO 2000 Gov't / Partners AMR Symposium/ conference conducted Conduct AMR scientific symposium or roundtable discussions annually Symposium 1 Sept 2023 National wide MoH, MANRLF, SVPO 12,000 Gov't / Partners AMR Symposium/ conference Activity 5.2.2. Establish an AMR data repository Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsi ble Entity Cost (USD) Source of funding Indicator Establish Zanzibar AMR bulletin Bulletin 1 Dec 2023 National level MoH, MANRLF 5000 Gov't / Partners Zanzibar AMR data repository established Establish an electronic system for AMR data repository Repository 1 Dec 2018 National level MoH, MANRLF 25,000 Gov't / Partners Zanzibar AMR data repository established Activity 5.2.3. Establish a bio-bank/bio-repository canter Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsi ble Entity Cost (USD) Source of Funding Indicator Establish and Equip the Zanzibar Reference laboratory with equipment for bio-bank/bio repository Bio-bank/ bio repository equipment 1 May 2023 National MOH, MANRLF, SVPO 2500 Gov't / Partners Assessment report available Source and train personnel on use of a web-based bio-repository in all sectors Training Quarterly Sept 2023 National MOH, MANRLF, SVPO 5000 Gov't / Partners Zanzibar bio bank/ bio repository centre established 37 PRIORITY ACTION 6: INFECTION PREVENTION AND CONTROL IN HEALTH CARE Strategic intervention 6.1: Establish a national and sub-national IPC implementation framework in human health Activity 6.1.1 : Hold multi-stakeholders’ dialogue for development of IPC program for AMR prevention and control Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsibl e Entity Cost (USD) Source of Funding Indicator Conduct stake holder meetings on development of IPC program Meetings 3 meetings 03/2020 – 06/2020 Nation wide MoH, MANRLF 10,000 $ Gov't / Partners National IPC program created Develop a draft for national IPC program for AMR Draft of IPC 30 08/2020 – 10/2020 Nation wide MoH, MANRLF 200,000$ Gov't / Partners Activity 6.1.2. Build capacity for IPC implementation in human health Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsibl e Entity Cost (USD) Source of funding Indicator Conduct training for one health stakeholders on IPC program Workshop and training 10 trainings 01/2021 Nation wide MoH, MANRLF, SVPO, 6000 Gov't / Partners No. of trainings and reports done Monitoring and supervision of implementation on IPC program Monitoring and supervision Semi annual 07/2021 Nation wide MoH, MANRLF, SVPO 50,000 Gov't / Partners No. of Monitoring and Supervision s Strategic intervention 6.2: Facilitate development of IPC policies and related guidelines and tools. Activity 6.2.1 Develop national IPC policy and implementation guidelines and tools Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsibl e Entity Cost (USD) Source of Funding Indicator 38 Meeting with stake holders on the community level for policy development Community stake holders’ meeting 3 12/2020 Community MoH, MANRLF, SVPO, 60,000 MoF, MANRLF, SVPO,MoH Developed national IPC guidelines and policies Meeting with development partners, NGOs and public institutions for policy and guidelines development Stake holders’ meeting 1 12/2020 Organizational levels MoH, MANRLF, SVPO, 20,000 MoF, MANRLF, SVPO,MoH Develop drafts of national IPC policy and guidelines National IPC policy and guidelines 1 05/2021 Responsible ministries MoH, MANRLF, SVPO, 300,000 MoF, MANRLF, SVPO,MoH Activity 6.2.2: Facilitate availability of IPC related equipment, supplies and guidelines. Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsibl e Entity Cost (USD) Source of funding Indicator Conduct needs assessment for related equipment and supplies Quantified items To be known 09/2022 Nation wide MoH, MANRLF, SVPO, To be known MoF, MANRLF, SVPO,MoH IPC equipment, supplies and guidelines available in health facilities Procure and distribute IPC materials IPC materials To be known 10/2022 Nation wide MoH, MANRLF, SVPO, To be Known Gov't Distribute IPC guidelines Guideline documents 2,000 12/2022 Nation wide MoH, MANRLF, SVPO, 30,000 Gov't Develop and support of web based information management system Web based system 1 Jan 2020 2025 Nationwide MoH, MANRLF. 10,000 Gov't / Partners AMR web based system online Strategic intervention 6.3: Strengthen implementation of IPC practices in health facilities and congregated settings. Activity 6.3.1: Facilitate availability of IPC related equipment, supplies, SOP guidelines and improve related infrastructure Sub-activity Unit Quantity Date/ Time Level of Implement Responsibl e Entity Cost Source of Indicator 39 Frame ation (USD) Funding Assess availability of IPC related equipment and supplies Quantified items To be known 01/2020 Nation wide MoH To be known Gov't / Partners IPC related equipment, supplies, SOP guidelines and improved related infrastructur e are readily available Procure and distribute IPC related equipment and supplies Quantified items To be known 04/2020 Nation wide MoH To be known Gov't / Partners Provide adequate and appropriately maintained water and sanitation as well as waste management facilities Sanitation and waste management facilities 100 10/2020 Nation wide MoH 10,000 Gov't / Partners Activity 6.3.2: Conduct scheduled IPC supportive supervision, mentoring and monitoring in health facilities and congregated settings Sub-activity Unit Quantity Date/ Time Frame Level of implementa tion Responsibl e Entity Cost (USD) Source of funding Indicator Conduct supportive supervisions and mentoring in health facilities and congregate setting visits Quarterly Ongoing Nationwide MoH 7,000 Gov't Supportive supervision and mentoring report is available Activity 6.3.3: Strengthen the functioning vaccination programs available for human health e Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsibl e Entity Cost (USD) Source of Funding Indicator Procurement of required vaccines Vaccines To be known 01/2023 National level MoH 200,000 Gov't Strong & Functional 40 Distribution of vaccine Route To be known 02/2023 National level MoH 80,000 Gov't vaccination programs for human health Provide capacity building Work shop 12/2022 National level MoH 7,000 Gov't Conduct inspection Visits Semi annual Ongoing National level MoH 10,000 Gov't Strategic intervention 6.4: Diversify and improve IPC trainings beyond human health curricula Activity 6.4.1 : Review existing IPC training contents to encompass and improve components of AMR prevention and control Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Conduct a stake holders meeting to reviewing existing IPC training contents meetings 2 02/2023 National level MoH, MANRLF, SVPO, 8000 Gov't / Partners AMR prevention and control components are improved and added into IPC programs Activity 6.4.2: Include hygiene and infection prevention and control in training curricula for agriculture extension officers Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsib le Entity Cost (USD) Source of funding Indicator Review of curricula for agriculture to incorporate IPC components Curricula 1 08/2023 Education sector, MoH, MANRLF, SVPO MoH, MANRLF 50,000 Gov't A revised curricula and TOT manual on IPC are available Develop TOT manual on IPC for health professionals (human, animals, Plants, environmental health and extension officers) TOT Manual 1 08/2023 Education sector, MoH, MANRLF, SVPO 80,000 Gov't 41 PRIORITY ACTION 7: INFECTION PREVENTION IN AGRICUTURE (ANIMAL AND PLANT HEALTH) Strategic intervention 7.1: To prevent and control occurrence of infectious disease in agriculture and livestock sector Activity 7.1.1 :Improve the national mechanism for communicating, responding, reporting and recording animal and plant disease occurrences. Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Procure relevant virtual networking equipment Set of equipment 1 09/2022 National level MANRLF 10,000 MoF, MANRLF, SVPO Virtual networking platform on communicating, responding, reporting and recording animal and plant disease occurrences is available Establish a central database on communicating, responding, reporting and recording Disease occurrences Database 1 11/2022 National level MANRLF 20,000 Gov't Conduct training to designated officers of the use of the virtual equipment Training workshop 3 2021 2022 National level MANRLF 25,000 Gov't Operationalize and monitor the database Report quarterly 07/2023 National level MANRLF 25,000 Gov't Activity 7.1.2: Review existing regulations to accommodate the need for a mandatory vaccination programs in animal health Sub-activity Unit Quantity Date/ Time Level of implement Responsib le Entity Cost (USD) Source of Indicator 42 Frame ation funding Review regulations for vaccinations Meeting 2 04/2022 National level MANRLF 30,000 MoF, MANRLF, SVPO,MoH Regulations on mandatory vaccination on animal health are reviewed Conduct stakeholders meeting to share the revised draft of regulations Workshop 1 05/2022 National level MANRLF 25,000 Gov't Approval and dissemination of the regulations Meetings 2 07/2022 National level MANRLF 30,000 Gov't Strategic intervention 7.2: Strengthen bio security system in animal health, plants and environment. Activity 7.2.1 : Promote good agricultural/animal husbandry practice to enhance bio security practices and improvement of animal hosting facilities and infrastructures Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Training farmers, livestock keepers and fisher folks on bio security practices. training 6 Jul - Aug 2020 National wide M.N.L.F SVPO USD 70000 MoF MANRLF Training Report Support farmers, livestock keepers and fisher folks on bio security facilities and infrastructures. Facilities and infrastructures 200 Sept 2020 National wide MANRLF SVPO USD. 500000 MoF MANRLF Facilities and infrastructure 43 PRIORITY ACTION 8: HYGIENE AND SANITATION AT COMMUNITY LEVEL Strategic intervention 7.3: Strengthen the national mechanism for regulation and control the use of antimicrobials in the agriculture and livestock sector Activity 7.3.1:Strengthen policies and guidelines on handling and uses of microbial agents Sub-activity Unit Quantity Date/T ime Frame Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Review the current Policies and guidelines on microbial agent usage and handling Work shop 2 12/2020 Nation wide MoH, MANRLF 3,000 Gov't Reviewed guidelines and policies Activity 7.3.2: Training on integrated pest management through farmer field school Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsib le Entity Cost (USD) Source of funding Indicator Conduct assessment on integrated pest management among farmers visits 1 07/2022 National level MANRLF 5,000 MoF, MANRLF. Integrated pest management is practised by farmers Prepare and conduct trainings on integrated pest management Work shop 5 08/2022 National level MANRLF 45,000 Gov't Strategic intervention 8.1: Promote hygiene practices in the communities. Activity 8.1.1 : Undertake IPC advocacy, Awareness raising and community sensitization activities Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Develop Information, Education and communication (IEC) & behavioral change communication materials 200,000 04/2021 Nation wide MoH, MANRLF, SVPO, MoF, MANRLF, SVPO, MoH IPC sensitization sessions conducted 44 Sensitization, orientation & training stake holders at all levels People 300 05/2021 Country wide MoH, MANRLF, SVPO, Gov't Strategic intervention 8.2:Improve sanitation and waste management practices Activity 8.2.1: Promote environmental sanitation in congregate settings Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Review infectious outbreak (IOB) guidelines to include concepts of hygiene and sanitation Meeting 4 03/2020 National level MoH, SVPO 25,000 Gov't IOB guideline reviewed Activity 8.2.2: Promote sanitary inspectorate services in waste management for environment with a collective number of animals e.g. Zoos and parks. Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Equip targeted areas with necessary facilities Sanitary facilities To be known 2021 National MANRLF, SVPO To be known MoF, Municipal council, SVPO, MANRLF Sanitary environment in collective animal settings improved. Conduct capacity building to respective inspectors Meeting 5 2021 National level MANRLF, SVPO 15,000 Gov't Activity 8.2.3: Establish a national and sub national monitoring system in the field of waste management Sub-activity Unit Quantity Date/T ime Frame Level of Implement ation Responsi ble Entity Cost (USD) Source of Funding Indicator Conduct supportive supervision Visits Semi annually 04/2023 National level MANRLF, SVPO. MoH 6,000 Gov't Functional system for monitoring waste 45 Prepare report of the monitor Reports Semi annually 04/2023 National level MANRLF, SVPO, MoH 4,000 Gov't management Activity 8.2.4: Procure waste management equipment Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsi ble Entity Cost (USD) Source of funding Indicator Assess health facilities and communities to determine equipment needs Visit 1 04/2024 National level MoH, MANRLF, SVPO, 15,000 Gov't Waste management equipment available Procure and distribute incinerators and other waste management equipment Incinerators and other waste management equipment To be known 06/2024 National level MoH, MANRLF, SVPO, To be known Gov't Strategic intervention 8.3: Strengthening National linkages and partnership for IPC Activity 8.3.1 : Promote food Chain Hygiene Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Conduct sensitization meeting on IPC meeting 6 09/2022 National wide MANRLF, MoH, 60,000 Gov't Available reports on supervisions, training and awareness meeting Conduct regular supervision to ensure compliance with slaughter suitability and withdrawal periods No of copies annual 2022 National level MoH, MANRLF, 20000 Gov't Conduct awareness on slaughter protocols to abattoirs Mentoring sessions 2 2022 District wise MoH MANRLF, 15000 Gov't 46 PRIORITY ACTION 9: REGULATED ACCESS TO HIGH QUALITY ANTIMICROBIAL MEDICINES Conduct regular inspections Large scale and small scale processing industries Visits Semi annual 2022 National wide SVPO 10,000 Gov't Activity 8.3.2: Encourage use of medias for educating and Promoting IPC Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsib le Entity Cost (USD) Source of funding Indicator Training with journalist and stakeholders on IPC meeting 8 May 2021 2023 National wide MANRLF MOH SVPO 80,000 Gov't Education and IPC promotion through the use of media is achieved. Develop sensitization material on IEC (Information Education and Communication) for behavioural changes. IEC materials 20000 June 2021 Zanzibar MANRLF MOH SVPO 700000 Gov't Strategic intervention 9.1:Strengthen the pharmaceutical supply chain for human medicine, including the procurement, supply and management system. Activity 9.1.1 : Build capacity for quality management system for the supply chain management of medicines, covering storage, transport, expiry date, etc. Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsi ble Entity Cost (USD) Source of Funding Indicator Conduct Train to human medicines supply chain actors on appropriate handling procedures during purchasing, storage, distribution and disposal Training 12 (1 national 11 districts) 2020 2022 Zanzibar MoH 50,000 MoH Number of supply chain actors trained 47 Develop and provide standard operating procedure manuals on purchasing, storage, distribution and disposal Document 2500 2020 Zanzibar MoH 15,000 MoH Number of Manual developed and distributed Expand Central Medical Stores to accommodate xxx tons of medicine Premises 2 2021 2024 Unguja and Pemba MoH 800,000 MoH Number and capacity of Central Medical Store Rehabilitate and equip primary health storage facilities Premises 80 2021 2024 Unguja and Pemba MoH 500,000 MoH Number of primary health storage facilities rehabilitated Activity 9.1.2: Build capacity for ZFDA medicine regulation and enforcement on antimicrobial use. Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsi ble Entity Cost (USD) Source of funding Indicator Train ZFDA inspectors on modern inspection and surveillance of antimicrobial agents at port of entries Training 5 2020 2024 Unguja and Pemba MoH 10,000 MoH Number of inspectors trained Equip ZFDA laboratories with modern facilities and materials (Centrifuges, HPLC machine, gas chromatograph machine, reagents) Set 5 2020 2024 Unguja MoH 200,000 MoH Number of lab facilities equipped Rehabilitate and equip Pemba ZFDA laboratory Building 1 2021 2024 Pemba MoH 150,000 MoH Pemba ZFDA Laboratory rehabilitated and equipped 48 Conduct regular inspections and surveillance in medicine outlets Inspections 5 2020 2024 Unguja and Pemba MoH 120,000 MoH Number of outlets inspected Activity 9.1.3: Conduct Post marketing surveillance and Pharma covigilance on microbial agents. e Sub-activity Unit Quantity Date/ Time Frame /Level of Implement ation Responsi ble Entity Cost (USD) Source of Funding Indicator Conduct AMR Post marketing surveillance on microbial agents Surveillance 5 2020 2024 Unguja and Pemba MoH 70,000 MoH Number of AMR PMS reports Disseminate PMS findings to stakeholders Workshops 5 2020 2024 Unguja and Pemba MoH 20,000 MoH Number of PMS findings reports Train health workers on Pharma covigilance on microbial agents Training 5 2020 2024 Unguja and Pemba MoH 30,000 MoH Number of health workers trained Activity 9.1.4 Revise and update STG and EML Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsi ble Entity Cost (USD) Source of Funding Indicator Conduct stakeholder meeting on STG and EML Meeting 4 2020 2024 Unguja and Pemba MoH 16,000 MoH Number of meeting conducted Review STG and EML Event 2 2020 2024 Unguja MoH 12,000 MoH Reviewed STG and EML Distribute new STG and EML Event 1 2020 2024 Unguja MoH 5,000 MoH Number of STG and EML distributed 49 PRIORITY ACTION 10: ANTIMICROBIAL STEWARDSHIP. Strategic intervention 10.1: Establish antimicrobial stewardship programmes in human, animal, plant and fisheries facilities. Activity 10.1.1 : Develop policies and guidelines for antimicrobial stewardship Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Conduct stakeholder meeting on antimicrobial stewardship Meeting 4 2020 2024 Unguja and Pemba MoH, MANRLF 12,000 MoH&MAN RLF Number of meeting conducted Develop policies and guideline on antimicrobial stewardship Consultant 1 2020 2024 Unguja and Pemba MoH, MANRLF 70,000 MoH Policies and guidelines on antimicrobia l stewardship Operationalize anti microbial stewardship policies and guideline Event 5 2020 2024 Unguja and Pemba MoH, MANRLF 60,000 MoH& MANRLF Number of Operational reports Monitor and supervise anti microbial stewardship policies and guideline Event 5 2020 2024 Unguja and Pemba MoH, MANRLF 45,000 MoH& MANRLF Monitoring and supervision reports Activity 10.1.2: Build capacity for prescribers, pharmacist, lab personnel and nurses about good antimicrobial prescribing, dispensing and diagnosis. Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsib le Entity Cost (USD) Source of funding Indicator Conduct training need assessment (TNA) for prescribers, pharmacist, lab personnel and nurses Assessment 1 2020 Unguja and Pemba MoH, MANRLF 10,000 MoH & MANRLF TNA report 50 Training prescribers, pharmacist, lab personnel and nurses good antimicrobial management Training 2 2021 2024 Unguja and Pemba MoH 30,000 MoH & MANRLF Number of Trainees Activity 10.1.3: Establish and operationalize to MTC and other related committees Sub-activity Unit Quantity Date/ Time Frame /Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Conduct Stakeholders meeting for MTC and other related committees Meeting 1 2021 Unguja and Pemba MoH 2,000 MoH & MANRLF Number of meeting conducted Operationalize to MTC and other related committees Event 4 2021 2024 Unguja and Pemba MoH 12,000 MoH & MANRLF Number of meeting and reports Activity 10.1.4:Supervise antimicrobial use and consumption to human, animal, plant and fisheries sub-sector Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Conduct assessment on antimicrobial use and consumption Assessment 4 2021 2022 Unguja and Pemba MoH & MANRLF 20,000 MoH & MANRLF/ Partners Number of assessment report Disseminate assessment findings on antimicrobial use and consumption to stakeholders Event 1 2023 Unguja and Pemba MoH & MANRLF 15,000 MoH & MANRLF/ Partners Disseminati on reports Develop guideline on proper antimicrobial use and consumption Guideline 1 2020 Unguja and Pemba MoH & MANRLF 10,000 MoH & MANRLF/ Partners Antimicrobia l use and consumptio n guidelines Orient practitioners on antimicrobial use and consumption guideline Event 1 2021 Unguja and Pemba MoH & MANRLF 25,000 MoH & MANRLF/ Partners Orientation reports 51 Strategic intervention 10.2: Monitor and supervise antimicrobial Stewardship program. Activity 10.2.1 : Conduct supportive supervision to monitor antimicrobial stewardship programmes Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Develop M&E Tool to monitor antimicrobial stewardship programmes M&E Tool 1 2020 Unguja and Pemba MoH& MANRLF 5,000 MoH & MANRLF M&E Tool in place Supervise and monitor antimicrobial stewardship programmes Event 5 2020 2024 Unguja and Pemba MoH& MANRLF 25,000 MoH & MANRLF Supervision and monitoring reports Activity 10.2.2: Introduce audit programs of antimicrobial prescribing Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsib le Entity Cost (USD) Source of funding Indicator Conduct auditing training to prescribers of antimicrobial agents Training 1 2021 2024 Unguja and Pemba MoH & MANRLF 5,000 MoH & MANRLF Number of prescribers trained Operationalize audit programs of antimicrobial prescribing Event 4 2021 2024 Unguja and Pemba MoH & MANRLF 15,000 MoH & MANRLF Prescribing audit reports Monitor and supervise audit programs of antimicrobial prescribing Event 4 2021 2024 Unguja and Pemba MoH & MANRLF 10,000 MoH & MANRLF Monitoring and supervision reports Strategic intervention 10.3: Establish national policies on use of antimicrobial agents in animal, plant and fisheries subsectors. 52 Activity 10.3.1 : Develop policies and guidelines on prudent use of antimicrobial agents in animal, plant and fisheries subsectors Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsi ble Entity Cost (USD) Source of Funding Indicator Conduct stakeholder meeting on prudent use of antimicrobial agents Meeting 2 2020 Unguja and Pemba MoH & MANRLF 10,000 MANRLF Number of meeting conducted Develop policies and guideline on prudent use of antimicrobial agents Consultant 1 2020 2024 Unguja and Pemba MoH& MANRLF 70,000 MANRLF Policies and guidelines on anti microbial stewardship Operationalize antimicrobial use policies and guidelines Event 5 2020 2024 Unguja and Pemba MoH & MANRLF 80,000 MoH & MANRLF Monitor and supervise policies and guideline implementation Event 4 2021 2024 Unguja and Pemba MoH & MANRLF 15,000 MoH& MANRLF Monitoring and supervision reports Activity 10.3.2: Develop essential medicine list and standard guideline for animal, plant and fisheries Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsi ble Entity Cost (USD) Source of funding Indicator Develop EML and standard guideline Meeting 3 2021 Unguja and Pemba MoH & MANRLF 30,000 MANRLF EML and standard guidelines Operationalize EML and standard guidelines Event 4 2021 2024 Unguja and Pemba MoH & MANRLF 80,000 MoH & MANRLF Disseminati on and Operational reports Monitor and supervise EML and standard guidelines operations Event 4 2021 2024 Unguja and Pemba MoH& MANRLF 10,000 MoH& MANRLF Monitoring and supervision reports Activity 10.3.3: Build capacity on practitioners on appropriate use of antimicrobial agent. Sub-activity Unit Quantity Date/ Time Level of Implement Responsi ble Entity Cost Source of Indicator 53 Frame ation (USD) Funding Conduct training need assessment (TNA) appropriate use of antimicrobial agent Assessment 1 2020 Unguja and Pemba MoH ,MANRLF 10,000 MoH & MANRLF TNA report Develop Training Programmes on appropriate use of antimicrobial agent Training programmes 1 2021 2024 Unguja and Pemba MoH, MANRLF 20,000 MoH & MANRLF Number of training programme s developed Conduct training of trainers appropriate use of antimicrobial agent ToT 2 2021 2024 Unguja and Pemba MoH, MANRLF 20,000 MoH & MANRLF Number of ToT Trained Conduct training to practitioners on appropriate use of antimicrobial agent Training 8 2021 2024 Unguja and Pemba MoH, MNARLF 20,000 MoH & MANRLF Number of practitioner s trained Strategic intervention 10.4: Establish Monitoring, Evaluation, Learning and Documentation (MELD) system. Activity 10.4.1 : Develop comprehensive system for MELD Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsib le Entity Cost (USD) Source of Funding Indicator Establish MELD section Section 1 2020 Unguja and Pemba MoH, MANRLF 15,000 MoH& MANRLF MELD section in place Develop MELD tool MELD tool package 1 2020 Unguja and Pemba MoH, MANRLF 10,000 MoH& MANRLF MELD tool package in place Conduct training on MELD for practitioners Training 5 2020 Unguja and Pemba MoH, MANRLF 60,000 MoH& MANRLF Number of practitioners trained Operationalize the MELD system Event 5 2020 Unguja and Pemba MoH, MNARLF 100,000 MoH& MANRLF MELD reports 54 PRIORITY ACTION 12: USE OF ANTI-MICROBIAL AGENTS IN ANIMAL HEALTH AND AGRICULTURE Activity 10.4.2: Develop facility for AMR documentation centre Sub-activity Unit Quantity Date/ Time Frame Level of implement ation Responsib le Entity Cost (USD) Source of funding Indicator Extend and equip Central Medical Stores to accommodate documentation centre for AMR resources AMR DC 2 2021 Unguja and Pemba MoH 500,000 MoH Number of AMR DC in place Link AMR DC with service delivery points Linkage 4 2020 Unguja and Pemba MoH 120,000 MoH Number of delivery points linked to AMR DC Strategic intervention 12.1: Identify the investment required for the implementation of the Zanzibar action plan on AMR using one health approach Activity 12.1.1 : Incorporate the public, private sectors and development partners on the investment requirements for implementation of the AMR Zanzibar Action Plan Sub-activity Unit Quantity Date/ Time Frame Level of Implement ation Responsi ble Entity Cost (USD) Source of Funding Indicator Conduct assessment investment requirements for implementation of the ZAP on AMR Meeting/ Workshop 1 Oct 2023 National level MoH MANRLF MoFP SVPO 25 000 SVPO, MoH, MANRLF Assessment report available Integrates the ZAP on AMR into the sectoral plan Meeting 1 Nov 2023 National level MoH MANRLF MoFP SVPO 1,000 SVPO, MoH, MANRLF ZAP on AMR integrated into sectoral plan Engage local and international development partners on implementation of the ZAP AMR Meeting 1 Nov 2023 National level MoH, MANRLF MoFP SVPO 3,000 SVPO, MoH, MANRLF Proportion of targeted AMR stakeholders engaged in ZAP 55 Review and priorities areas for investment in new medicines, diagnostic tools, vaccines and other interventions Workshop 1 Dec 2023 National wide MoH, MoFP 1000 SVPO , MoH, MANRLF Priority areas for investment in new medicines, diagnostic tools, vaccines and other interventions reviewed Activity 12.1.2: Conduct research related to development of new antimicrobials agents, vaccines and sera Sub-activity Unit Quantity Date/Ti me Frame Level of implement ation Responsi ble Entity Cost (USD) Source of funding Indicator Conduct research with objectives of development of new antimicrobials agents, vaccines and other interventions Research TBD April 2021 National wide Stakeholders 24000 MoH, MoF, MANRLF Number of AMR research reports available Activity 12.1.3: Support piloting and dissemination of innovative ideas on investment for new medicines, diagnostic tools, vaccines and other interventions Sub-activity Unit Quantity Date/ Time Frame /Level of Implement ation Responsibl e Entity Cost (USD) Source of Funding Indica tor Support the implementation of the selected innovative ideas Workshop 4 January 2024 National wide Stakeholders 25 000 MoH, MoFP, MANRLF Innovati ve products available Support dissemination of the appropriate innovative ideas Workshop 1 July 2024 National wide Stakeholders 5,000 MoH, MoFP, MANRLF Dissemi nated innovati ve products available 56 6.0 MONITORING AND EVALUATION PLAN Monitoring and Evaluation of AMR Zanzibar Action Plan is critical in measuring the implementation of the designed interventions. The main objectives of this is to track implementation progress and demonstrate results of the Zanzibar Action Plan on AMR in Zanzibar, assess the p l an in accordance with the agreed objectives and goals using performance indicators to support management for results (evidence-based planning and decision making), improve accountability and constructive engagement with stakeholders (policy dialogue) and facilitate the documentation of achievements, challenges and lessons learned during the implementation of the ZAP AMR and share with relevant stakeholders. A set of indicators will be developed and used to determine whether the interventions are on the right track or not, aiming at achieving its desired objectives and goals of the AMR - AP. They will be measured at all levels starting from input, output, outcome and impact. Conceptual framework Data collection will be done on monthly, quarterly and annual basis depending on its type using the available sources such as surveillance report, laboratory analysis and 57 research findings. New data sources will be established when required. These data will be generated from designated AMR laboratories then sent to data repository of the National reference laboratory for analysis and compilation, the national AMR data will be disseminated to the National Focal Points. Quarterly progress reports and annual progress report will be produced and shared to all relevant stakeholders for planning and decision making. Apart from that there will also be a mid-term review which will be done in the middle of the of the implementation period of the Action Plan. End of term evaluation will be conducted by the end of the implementation period. The following matrix show the basic indicators to monitor the implementation of the plan. 58 Monitoring & Evaluation Plan Matrix Planning element (activity linked to the strategic plan) Indicator Type Definition Value (Calculation /Formula) Frequency of data collection Data source Baseline 2018/19 Target 2023/2024 Responsible body Strategic Objectives 1: Improve awareness and understanding of AMR through education and training Develop AMR communication awareness strategy Availability/pres ence and uses of a communication strategy for AMR Process A comprehensive document that will be used as guide for creating AMR education and awareness to all implementers and other relevant stakeholders Yes/No Once Annual AMR Progress Report No Yes MOH, MANLF Number of higher learning institutions that have incorporated AMR educational modules in their core curricula Output Number of higher learning institutions in health, environment, animal, agriculture and fisheries that have incorporated AMR educational modules in their core curricula aiming at creating awareness on AMR to graduates Number of higher learning institutions that have incorporated AMR in their core curricula Annually Higher learning institution s’ Curricula Annual Report 0 4 (SUZA, ZSHS, ZU, KIST) MANLF MOH Number of AMR cases reported Process This is the total number of cases of AMR reported from the animal and human health facilities This is the total number of cases of AMR reported from the animal and human health facilities Quarterly /Annually Quarterl y/Annual AMR Progress Report MOH MANLF Conduct training Number of Output Number of stakeholders Number of Quarterly/A Quarterly/ 0 2,000 MCC 59 Planning element (activity linked to the strategic plan) Indicator Type Definition Value (Calculation /Formula) Frequency of data collection Data source Baseline 2018/19 Target 2023/2024 Responsible body and workshops on AMR stakeholders trained ON AMR (farmers/ veterinarians/agricultural workers, agro – vet dealers, human drug dealers, health practitioners, policy makers, journalists, oriented on AMR stakeholders (farmers/ veterinarians/ agricultural workers, agro – vet dealers, human drug dealers, health practitioners, policy makers, journalists, oriented on AMR nnually Annual AMR Progress Report SECRETARIAT Strengthen policies, acts and regulations on AMR awareness program Availability of reviewed policies, acts and regulations Outputs Availability of reviewed policies, acts and regulations on AMR for agriculture, fisheries, vetenaries and public health programs Yes/No Annually MOH Annual Progress report MANLF progress report 0 9 (Agricultural Policy, 2003 Fisheries Policy,2014 Fisheries Act, 2010 Livestock Policy,2012 Health Policy, 2011 Medicine Management MOH MANLF SOVP 60 Planning element (activity linked to the strategic plan) Indicator Type Definition Value (Calculation /Formula) Frequency of data collection Data source Baseline 2018/19 Target 2023/2024 Responsible body Act, 2015 Public and Environment al Health Act, 2012 ZFDA Act, 2016)Policy, 2014 Zanzibar Environment al Strategic Objectives 2: Strengthen knowledge and evidence based through surveillance and research Develop policy guideline on Zanzibar AMR surveillance and research framework for all sectors Presence of policy guidelines on AMR research and surveillance for all sectors Process Policy guidelines on AMR research and surveillance in place in agriculture, livestock, human, environment and fisheries Yes/No Once MOH Annual Progress report MANLF progress report 1 (MOH) Availability of research guideline and surveillance guideline in place MOH, MANLF Conduct Zanzibar Multi sector AMR scientific symposium Number of Multi-sectoral Scientific Symposium conducted Output Number of Multi-sectoral Scientific Symposium conducted in a year Annually AMR Annual Report Meeting Report MOH Annual Progress report MANLF progress 0 No MOH, MANLF 61 Planning element (activity linked to the strategic plan) Indicator Type Definition Value (Calculation /Formula) Frequency of data collection Data source Baseline 2018/19 Target 2023/2024 Responsible body report Establish an AMR data repository Presence of a functional data repository Output Presence of a functional data repository for storing AMR surveillance information Once Annually MOH Annual Progress report MANLF progress report No Presence of a functional AMR data repository MCC SECRETARIAT Availability of a National reference laboratory for AMR surveillance in human health, animal health and environment Output Availability of a national reference laboratory for AMR surveillance in human health, animal health and environment designated and participating in an external quality assurance scheme Yes/No Once AMR Quarterly/ Annual report 0 1 MOH, MANLF Establish a bio bank/bio repository center Number of a bio-repository center Process Presence of a functional bio-repository Centre in a national reference laboratories for storing biological materials Yes/no Once AMR Quarterly/ Annual report 0 1 MOH, MANLF 62 Planning element (activity linked to the strategic plan) Indicator Type Definition Value (Calculation /Formula) Frequency of data collection Data source Baseline 2018/19 Target 2023/2024 Responsible body Establish AM residual program Number of laboratories with capacity to test AM residues Process Number of laboratories with the appropriate infrastructure, equipment, reagents and skills to test AM residues in food animal origin (milk, egg, meat) Number of laboratories with the appropriate infrastructure , equipment, reagents and skills to test AM residues in food animal origin (milk, egg, meat) Quarterly ZFDA Quarterly Progress Report Veterinary Investigati on Centre Quarterly Progress Report 2 2 MOH, MANLF Number of samples tested Output Number of food animal samples tested by designated laboratories Number of food animal samples tested by designated laboratories Quarterly ZFDA Quarterly Progress Report Veterinary Investigati on Centre Quarterly Progress Report 1,648 TBD MOH, MANLF Develop Zanzibar AMR multi-sectoral research Presence of a multi-sectoral AMR research agendas Process Presence of a multi sectoral one health AMR research agendas developed, disseminated Presence of a multi-sectoral AMR research agendas Five Years AMR research Agendas Document No AMR research Agendas Document in Place ZAHRI ZALIRI ZARI Institute of 63 Planning element (activity linked to the strategic plan) Indicator Type Definition Value (Calculation /Formula) Frequency of data collection Data source Baseline 2018/19 Target 2023/2024 Responsible body agendas to stakeholders and used for conducting research in line with the requirements developed, disseminated to stakeholders and used for conducting research in line with the requirements Fisheries Research Zanzibar ( IFRZ) ZEMA Number of AMR research conducted and disseminated Output Number of AMR research conducted and disseminated Number of AMR research conducted and disseminated Annually Research Reports and Publication s 4 TBD ZAHRI ZALIRI ZARI Institute of Fisheries Research Zanzibar ( IFRZ) ZEMA Strategic Objectives 3: Reduce the incidence of infection through effective hygiene and IPC measures Develop AMR IPC guidelines and promotion programs Presence of AMR IPC guidelines Process Presence of AMR IPC guideline for human in clinical setting which incorporate AMR component (presence of coordinating unit, planning sessions, Presence of AMR IPC guideline for human in clinical setting Once Quarterly/ Annual AMR Progress Report No Presence of AMR IPC guideline for human in clinical setting MOH, MANLF 64 Planning element (activity linked to the strategic plan) Indicator Type Definition Value (Calculation /Formula) Frequency of data collection Data source Baseline 2018/19 Target 2023/2024 Responsible body supervision, mentoring and monitoring) Establish baseline data to understand the percentage of health facilities adhered with AMR IPC guidelines Outcome Percentage of health facilities adhered with AMR IPC guidelines (presence of coordinating unit, planning sessions, supervision, mentoring, monitoring, etc). Number of health facilities adhered with IPC guidelines/To tal number of health facilities assessed x 100 Annually Annual AMR IPC Assessme nt Report TSPA Report TBD TBD MOH 65 Planning element (activity linked to the strategic plan) Indicator Type Definition Value (Calculation /Formula) Frequency of data collection Data source Baseline 2018/19 Target 2023/2024 Responsible body Promotion of hygiene and sanitation at community level Proportion of household and congregate settings with access to basic sanitation facilities (water) Outcome Population using a basic drinking-water source (piped water into dwelling, yard or plot; public taps or standpipes; boreholes or tube wells; protected dug wells; protected springs and rainwater) which is located on premises and available when needed; free of fecal (and priority chemical) contamination and/or regulated by a competent authority. Population using safely managed drinking water services/Total population x 100 Three years TDHS – MIS 98% (2015/ 16) OCGS 66 Planning element (activity linked to the strategic plan) Indicator Type Definition Value (Calculation /Formula) Frequency of data collection Data source Baseline 2018/19 Target 2023/2024 Responsible body Proportion of household and congregate settings with access to basic sanitation facilities (latrine/toilet) Outcome Population using a basic sanitation facility (flush or pour-flush toilets to sewer systems, septic tanks or pit latrines, ventilated improved pit latrines, pit latrines with a slab, and composting toilets) which is not shared with other households and where excreta are safely disposed in situ (e.g. in a sealed latrine pit until they are safe to handle and re-use, such as an agricultural input ) or transported to a designated place for safe disposal or treatment (e.g. treatment facility or hygienically collected from septic tanks or pit latrines by a suction truck or similar Population using safely managed sanitation services/ Total population x 100 Three years TDHS MIS 58.7% (2015/ 2016) 89 (2023/24) OCGS 67 Planning element (activity linked to the strategic plan) Indicator Type Definition Value (Calculation /Formula) Frequency of data collection Data source Baseline 2018/19 Target 2023/2024 Responsible body equipment that limits human contact and thereafter transported to a designated location such as a treatment facility or solid waste collection site). Number of new cases of infectious diseases Outcome Number of new cases of top infectious diseases such pneomonia, typhoid, UTI, Diarrhea and skin diseases reported Quarterly Quarterly/A nnual infectious diseases Progress Report DHIS 2 Annual Health Bulletin Quarterly/ Annual infectious diseases Progress Report DHIS 2 Annual Health Bulletin Pneumon ia(65580) Typhoid (5679) UTI(9840 4) Diarrhea( 94976) Skin disease(1 0554 Pneumonia (30500) Typhoid (2500) UTI(5300) Diarrhea (4200 00) 50000 MOH Strategic Objectives 4: Optimize the use of antimicrobial medicines in human and animal health 68 Planning element (activity linked to the strategic plan) Indicator Type Definition Value (Calculation /Formula) Frequency of data collection Data source Baseline 2018/19 Target 2023/2024 Responsible body Establishing functional AMR stewardship program Percentage of new products registered Output Percentage of food, animal feed, human and veterinary medicines, cosmetics, medical devices and Herbal drugs registered Number of new products registered/To tal number of products targeted x 100 Quarterly Annually Quarterly/ Annual Health sector Performan ce Report ZFDA Quarterly/ Annual Report 66 (2017/ 18) 96 ZFDA Percentage of premises inspected Output Percentage of premises such as land, buildings, structures, basements and vessels in relation to the storage of food, medicine & cosmetics Number of registered premises inspected/Tot al number of registered premises x100 Quarterly Annually Quarterly/ Annual Health sector Performan ce Report ZFDA Quarterly/ Annual Report 57 (2017/ 18) 87 ZFDA Percentage of samples analyzed Output A set composed of one or several items Food, Animal Feed, Human and Veterinary Medicines, Cosmetics, Medical Devices and Herbal drugs analyzed for quality assurance in Number of samples analyzed/Tot al number of samples planned x 100 Quarterly Annually Quarterly/ Annual Health sector Performan ce Report ZFDA Quarterly/ 62 (2017/ 18) 92 ZFDA 69 Planning element (activity linked to the strategic plan) Indicator Type Definition Value (Calculation /Formula) Frequency of data collection Data source Baseline 2018/19 Target 2023/2024 Responsible body the ZFDA laboratory. Annual Report Presence of a national policy/guideline on the use of Antimicrobial Output Presence of a national policy/ guidelines on the use of Antimicrobial for animal, plants and fisheries Presence of a national policy on the use of Antimicrobial Once Existing MOH&MA NLF Policies No Presence of a national policy on the use of Antimicrobial MOH MANLF Establish baseline data to understand the total consumption of antibiotics for human use Output Total consumption of antibiotics for human and animal use including critical importance, highly important and important antibiotics Total consumption of antibiotics consumed /Number of antibiotics imported Annually Assessme nt Report and Survey Report Unknown TBD MOH (ZFDA) Strategic Objectives 5: To prepare the economic case for sustainable investment in new medicines, diagnostic tools, vaccines and other interventions Investment of innovation of new medicine, diagnostic tools and vaccine Presence of new diagnostic tools Output Presence of a new diagnostic tools for laboratory surveillance of pathogens such as PCR MaldiTof Presence of a new diagnostic tools for laboratory surveillance of pathogens Once Reference Lab progress Report Pathology Lab 0 1 (PCR MaldiTof) MOH MANLF 70 Planning element (activity linked to the strategic plan) Indicator Type Definition Value (Calculation /Formula) Frequency of data collection Data source Baseline 2018/19 Target 2023/2024 Responsible body such as PCR MaldiTof Report Veterinary Lab Report Presence of a new vaccines Output Presence of a new vaccines for infectious diseases (Hepatitis B, TB, diarrhea, pneumonia) introduced Presence of a new vaccines for infectious diseases (Hepatitis B, TB, diarrhea, pneumonia) introduced When needed MOH Annual Report No Hepatitis B birth dose MOH Presence of new medicine Output Presence of a new and WHO prequalified medicine introduced for combating infectious diseases Presence of a new and WHO prequalified medicine introduced for combating infectious diseases When needed MOH Annual Report MANLF Annual Report No Primaquine MOH 71 Planning element (activity linked to the strategic plan) Indicator Type Definition Value (Calculation /Formula) Frequency of data collection Data source Baseline 2018/19 Target 2023/2024 Responsible body Percentage of Zanzibar AMR Action Plan activities and budget implemented Output Percentage of Zanzibar AMR Action Plan activities and budget implemented in a given year Number of planned activities implemented/ Total number of activities planned in a given year x 100 Annually AMR Progress Report 0 80 MCC secretariat 72 ANNEX I: SWOT ANALYSIS STRENGHTHS WEAKNESSES  Presence of health promotion unit under the Ministry of Health  Availability of medicine policy 2014, standard treatment guideline and essential medicine list  Existence of Regulatory authorities (Zanzibar Food and Drug Agency, Zanzibar Traditional Medicine Council) and their operating Act, regulation and guidelines  Availability of human and animal health and agriculture research institutions (ZAHRI, ZALIRI, ZARI and ZRFI)  There is integrated disease surveillance system and response (IDSR/IDWE) in human health sector  Existence of IPC unit at Mnazi Mmoja hospital  Presence several acts on sanitation and hygiene, such as public and environmental health act no 11 of 2012  Lack of public awareness and understanding of AMR and antimicrobial use.  In necessary prescription of antimicrobials by health care providers and veterinarians  Lack of One health AMR surveillance system and guideline  Limited number of equipped laboratories for detection and reporting of resistance pathogens in human, animal health and agriculture.  Limited number of skilled personnel to conduct surveillance and research on AMR.  Inexistence of IPC guideline and national programs  Limited IPC related facilities and supplies, such as hand wash and hospital waste disposal pits/incinerator  Lack of policies that describe the control the use of antimicrobial agents in veterinary medicine and agriculture.  Lack of well-defined veterinary medicine supply chain.  Lack of regulatory framework for preservation of new antimicrobial agents.  Lack of investment in modern technology and tools for diagnostic, analysis and intervention.  In adequate legal enforcement on antimicrobial consumption.  Inadequate skilled, professional and expert in AMR. 73 OPPORTUNITIES  Existence of public Medias such as TV, radio stations, newspapers.  Availability of professional staff  Presence of higher learning institutions that can provide in-service and pre-service training on AMR  Existence of selected health surveillance system in humans (TB, HIV/AIDS, malaria,)  There is a global and regional AMR frame work.  Willingness of international organization to support AMR intervention THREATS  Limited resources human and financial  Competition of Ministerial priorities  Increase of emerging and re-emerging infectious diseases  Accessibility of antimicrobial without prescription.  Presence of multiple unofficial entry points that allows movement of human, animal, fisheries and crop products.  Use and dispensing of antimicrobial agents by nonprofessional individual.  Off label use of antimicrobial agents on animals and plants growth 74 ANNEX II: LIST OF CONTRIBUTORS s/n Participants Position 1 Dr. Jamala Ismail Chair person 2 Dr. Mayasa Salim Ally Vice chair person 3 Ms. Hidaya Juma Hamad Member 4 Dr Salma Yussuf Masauni Member 5 Mr. Habib Ali Sharif Member 6 Dr. Shaali Ame Member 7 Dr Talib Saleh Suleiman Member 8 Dr. Aron Edmond Ringo Member 9 Mr. Burhani Mussa Hassan Member 10 Dr Warid Abdallah Mussa Member 11 Mr. Ahmed Haji Member 12 Mr. Saida Issa Omar Member 13 Dr Salum Seif Salum Member 14 Mr. Muhiddin Hamada Omar Member 15 Dr Khadja Noor Omar Member 16 Dr Ghirmay Andemichael Member 17 Mr. Ali Haji Ramadhan Member 18 Ms. Rose Shija WHO 19 Dr. Rubegwa Bachana FAO