Antimicrobial Resistance Prevention and Containment Strategic Plan - The One Health Approach - 2021-2025 Third Edition

AMR Prevention and Containment Strategic Plan: 2021–2025 NGE ANTIMICROBIAL RESISTANCE PREVENTION AND CONTAINMENT STRATEGIC PLAN THE ONE HEALTH APPROACH 2021–2025 THIRD EDITION May 2021 Addis Ababa ,Ethiopia AMR Prevention and Containment Strategic Plan: 2021–2025 AMR Prevention and Containment Strategic Plan: 2021–2025 TABLE OF CONTENT FOREWORD i MESSAGE FROM AMR PREVENTION AND CONTAINMENT ADVISORY COMMITTEE ii ACKNOWLEDGEMENTS iii ABBREVIATIONS iv EXECUTIVE SUMMARY v KEY CONCEPTS AND DEFINITIONS vii VISION, MISSION, GOAL AND SCOPE viii 1. BACKGROUND 1 1.1 Country profile 2 1.2 Antimicrobial resistance overview 4 2. RATIONALE FOR REVISIONS IN THIRD STRATEGIC PLAN 18 3. STRATEGIC PLAN 19 3.1 Objective one: Improve awareness and understanding of antimicrobial resistance through effective be haviour change communication, education and training 21 3.2 Objective two: Strengthen the knowledge and evidence on antimicrobial use and resistance through surveillance and research 23 3.3 Objective three: Enhance infection prevention and control through effective environmental health, infec tion prevention and bio-risk management in human, animal and plant health care 25 3.4 Objective four: Optimize the use of antimicrobials in human, animal and plant health care 27 3.5 Objective five: Strengthen and establish partnerships, alliances, governance and resource mobilization at all levels 30 4. OPERATIONAL PLAN 32 5. MONITORING AND EVALUATION FRAMEWORK 67 5.1 Monitoring and evaluation plan 70 5.2 Key performance indicators 71 6. RISKS AND MITIGATION 76 REFERENCES 78 ANNEX TERMS OF REFERENCES FOR ANTIMICROBIAL RESISTANCE MULTISECTOR GOVERNANCE STRUCTURE 81 AMR Prevention and Containment Strategic Plan: 2021–2025 TABLES Table 1 Analysis of the strengths, weaknesses, opportunities and threats regarding antimicrobial resistance prevention and control 9 Table 2 Stakeholder analysis for antimicrobial resistance prevention and containment 11 Table 3 Critical issues and core enablers related to antimicrobial resistance 17 Table 4 Initiatives and interventions for objective one Table 5 Initiatives and interventions for objective two 22 Table 5: Initiatives and interventions for objective two 24 Table 6 Initiatives and strategic interventions for objective three 26 Table 7 Initiatives and strategic interventions for objective four 28 Table 8 Initiatives and strategic interventions for objective five 31 Table 9 Detailed operational plan for objective one 33 Table 10 Detailed operational plan for objective two 39 Table 11 Detailed operational plan for objective three 48 Table 12 Detailed operational plan for objective four 56 Table 13 Detailed operational plan for objective five 64 Table 14 Monitoring and evaluation operation plan 70 Table 15 Key performance indicators 71 FIGURES Figure 1 Antimicrobial resistance governance framework 8 Figure 2. Strategic Objectives of National AMR Strategic Plan 20 Figure 3. Strategic Initiatives for Awarness and Education Strategic Objective 21 Figure 4. Strategic Initiatives for IPC and Hygiene Strategic Objective. 25 Figure 5. Core Elements of Anti-Microbial Stewardship 27 Figure 6 Logic model for the National Antimicrobial Resistance Prevention and Containment Strategic Plan 69 AMR Prevention and Containment Strategic Plan: 2021–2025 I FOREWORD There is global consensus on the profound threat that antimicrobial resistance poses to human and animal health. The global health community recognized the urgency of this crisis in 2015 when it adopted the World Health Organization’s Global Action Plan on Antimicrobial Resistance. After realizing widespread and emerging antimicrobial resistance and the grave consequences on the country’s health, economy and security, the Government of Ethiopia joined the global commu nity in seeking to better understand and disable the threat. The Government launched in 2011 a National Strategy for the Prevention and Containment of Antimicrobial Resistance, followed by a second strategy for 2015–2020 that integrated the One Health approach. Various efforts followed each edition. This third iteration of the national Antimicrobial Resistance Prevention and Containment Strategic Plan, for 2021–2025, sharpens the One Health approach to target the large amount of work still to be done. It integrates recent national and global updates and reflects the best available local evi dence, stakeholders’ concerns and inputs, the socioeconomic and sociocultural context of Ethiopia and the components of the country’s health system. This third strategic plan defines the role of all implementing stakeholders and shall be the focus for investments into antimicrobial resistance pre vention and containment efforts in Ethiopia. We want to express our sincere appreciation to all the stakeholders and development partners whose immense contribution and support made the development of this third strategic plan possi ble despite the COVID-19 pandemic situation. Because antimicrobial resistance is one of the challenges of our time, fighting this threat is a priority that requires a collaborative approach across sectors. We call upon all stakeholders for continued, coordinated and effective support for achieving the goals and priority objectives of the strategic plan. We would like to assure you of our commitment to promote, facilitate, finance and monitor the ef fective implementation of the national strategic plan and achievement of the strategic objectives. Dr Lia Tadesse Hon. Minister Ministry of Health Dr. Fikru Regasa Hon. State Minister Ministry of Agriculture Prof. Fekadu Beyene Hon. Commissioner Environment, Forest and Climate Change Commission II AMR Prevention and Containment Strategic Plan: 2021–2025 MESSAGE FROM AMR PREVENTION AND CONTAINMENT ADVISORY COMMITTEE One of the major breakthroughs in the history of humankind was the discovery of antimicrobials. Considered “miracle drugs”, they changed the health of human beings. Their use in animal hus bandry and veterinary medicine also has resulted in healthier and more productive farm animals, thus ensuring the welfare and health of both animals and humans. Unfortunately, from the first use of penicillin, resistance emerged. Sir Alexander Fleming recognized its deadly potential early on. Yet, antimicrobial resistance was denied proper attention until recent times. It gained concern over the past two decades, reaching public health crisis in the past few years for its impact on health as well as economies. The issue is multidimensional and requires col laboration among many stakeholders to overcome. Thus, Ethiopia created the multisector National Antimicrobial Resistance Advisory Committee in 2008. It has many appreciable results to its credit. But the country has a long way to go to prevent and contain the antimicrobial resistance threats. The Government has put in place a framework with this strategic plan to address the threats that antimicrobial resistance poses to the welfare of the people and livestock of Ethiopia. The strategic plan sets out a coordinated and collaborative One Health approach involving key stakeholders in government and other sectors. The National Antimicrobial Resistance Advisory Committee will continue to coordinate the work to be done and monitor the progress. The Government also will continue to work with other governments, international organizations and partners to counter this global public health crisis. The objectives of the strategic plan can only be successful through the continued political com mitment, collaboration and concerted effort of all stakeholders. I hope that our collaboration with communities, civil society organizations, development partners, donors, academics, associations and the private sector will continue to strengthen the antimicrobial resistance prevention and con tainment efforts. I am looking forward to working with you all towards the successful implementa tion of the Antimicrobial Resistance Prevention and Containment Strategic Plan and the realization of its vision. Yakob Seman Director General, Medical Services Ministry of Health, Ethiopia AMR Prevention and Containment Strategic Plan: 2021–2025 III ACKNOWLEDGEMENTS The development of the third strategic plan was possible through the contributions and support from the Ministry of Health, the Ministry of Agriculture, the Environment, Forest and Climate Change Commission and their agencies. The AMR secretariat would like to thank the World Health Organization, the Food and Agriculture Organization of the United Nations and the Medicines, Technologies and Pharmaceutical Services Programme of the United States Agency for International Development (USAID/MTaPS) for their generous financial and technical support in the drafting of this third strategic plan. We also acknowledge the National Antimicrobial Resistance Advisory Committee members and the USAID Global Health Supply Chain Program’s Procurement and Supply Management for their significant technical support throughout the process. Sincere appreciation is extended to the members of the third strategic plan revision task force, whose support was central during development of this strategic plan. The strategic plan through different revision processes that included drafting, reviewing and enrich ing through consultative and validation workshops comprising the Ministry of Health, the Ministry of Agriculture, the Environmental, Forest and Climate Change Commission, professional associations, academia, partner organizations and facilities. We heartily thank all the individuals and organiza tions who participated and contributed to this third strategic plan revision process.. IV AMR Prevention and Containment Strategic Plan: 2021–2025 ABBREVIATIONS AHRI Armauer Hansen Research Institute AISCO Agricultural Inputs Supply Corporation AMR antimicrobial resistance AWaRe access, watch and reserve BCC behaviour change communication CDC Africa Centres for Disease Control and Prevention EBI Ethiopian Biodiversity Institute EEFRI Ethiopian Environment and Forest Research Institute EFCCC Environment, Forest and Climate Change Commission EFDA Ethiopian Food and Drug Authority EIC Ethiopian Investment Commission EML Essential Medicines List EMLA Ethiopian Medical Laboratory Association EPHI Ethiopian Public Health Institute EPSA Ethiopian Pharmaceutical Supply Agency FAO Food and Agriculture Organization of the United Nations GDP gross domestic product GHSA Global Health Security Agenda GLASS Global Antimicrobial Surveillance System HIV human immunodeficiency virus HSTP Health Sector Transformation Plan MOA Ministry of Agriculture MOE Ministry of Education MOF Ministry of Finance MOH Ministry of Health MOSHE Ministry of Science and Higher Education MOTI Ministry of Technology and Innovation NAHDIC National Animal Health, Diagnostic and Investigation Centre NAMRAC National Antimicrobial Resistance Advisory Committee NAP national action plan NIMC National Interministerial Committee OIE World Organisation for Animal Health UNICEF United Nations Children’s Fund USAID United States Agency for International Development VDFACA Veterinary Drug and Feed Administration and Control Authority WHO World Health Organization AMR Prevention and Containment Strategic Plan: 2021–2025 V EXECUTIVE SUMMARY Antimicrobials are essential to medical care and public health. They are vital for reducing morbidity and mortality in individuals who present with microbial infections. Antimicrobials are also essential for the prevention and treatment of infectious diseases in veterinary practice and agriculture across the livestock industry, fisheries and crop production. Thus, they are important for the food produc tion chain and national economies. Antimicrobial medicines have saved millions of lives, substantially reduced the burden of diseases that were previously widespread, improved people’s quality of life and helped increase life ex pectancy. At the same time, the emergence and spread of antimicrobial resistance in several mi croorganisms has rendered the management of many infectious diseases difficult. Antimicrobial resistance has become a principal public health problem of the twenty-first century. It threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi that are no longer susceptible to the common medicines used to treat them. Over several decades, to varying degrees, bacteria causing common or severe infections have developed resistance to each new antibiotic coming to market. Faced with this reality, action to avert the evolving global crisis in health care is imperative. Globally, antimicrobial resistance causes an estimated 700 000 deaths every year. Failing to tackle antimicrobial resistance could, by 2050, cause an estimated 10 million deaths a year and cost up to $100 trillion. The highest impact likely will be in Asia and Africa, which likely will account for an estimated 4.7 million and 4.2 million deaths, respectively. In Ethiopia currently, misuse of antimicro bials is common among human and animal health care providers, unskilled and animal husbandry practitioners and drug users. Various studies reflect an alarming rate of antimicrobial resistance. The prevention and containment of antimicrobial resistance has a common approach and requires integrated and well-coordinated efforts at the global, national, institutional and individual levels. The global community recognizes the urgency of this crisis. The Government of Ethiopia has joined the global community in seeking to better understand and curb antimicrobial resistance. In 2006, the Government established the National Antimicrobial Resistance Advisory Committee, followed by the first national strategy framework in 2011. The second Strategy for the Prevention and Con tainment of Antimicrobial Resistance, for 2015–2020, was launched in October 2015. In that second strategy, Ethiopia embraced the One Health approach to overcome antimicrobial resistance through concerted, collaborative and integrated efforts across the human, animal, plant health, food, feed and environment sectors. The approaches primarily centre on water, sanitation, hygiene and wastewater management to prevent infection and contain pollution. In 2017, the Government developed and approved its National Antimicrobial Resistance Surveil lance Plan for laboratory-based antimicrobial resistance surveillance. The plan establishes a national surveillance network capable of detecting priority antimicrobial resistance pathogens, analysing and reporting data, characterizing resistance and generating evidence to inform the implementa tion of targeted prevention and control programmes. It is now (2019–2023) accompanied with an integrated National Antimicrobial Resistance and Residue Surveillance Plan for the animal health care, plant, food safety and environment sectors. Although Ethiopia initiated antimicrobial resistance prevention and containment practices early and has followed through considerably, the Government fears the country remains behind in controlling the antimicrobial resistance threats and risks. This lagging is attributed to an inadequate multisec tor approach, insufficient and poor-quality antimicrobial resistance and antimicrobial data and use, lack of sustainable financing, suboptimal practices, inadequate number of trained professionals and insufficient laboratories and supplies. To catch up with the threats and risks, the third national strategy on prevention and containment VI AMR Prevention and Containment Strategic Plan: 2021–2025 of antimicrobial resistance needed several revisions. In addition to aligning with the World Health Organization’s Global Action Plan on Antimicrobial Resistance, it must reflect the country’s Growth and Transformation Plan for the health, agriculture and environment sectors. The next strategy for Ethiopia needed a better-articulated vision for protecting the human, animal and plant pop ulations and the environment from the health as well as socioeconomic and environmental con sequences of antimicrobial resistance. Yet, it must ensure continuity of the successful approaches already practised for the prevention, control and treatment of infectious diseases in humans, animals and plants through multisector collaboration. The third edition of the national strategy responds to these requisites through the One Health approach and the following five strategic objectives. The third strategy is a product of a step-wise process, from development of the concept note and establishment of a task force to oversee the revision process to a series of reviews, consultations and validation and approval exercises. This third edition consists of 5 strategies, 22 initiatives, 66 interventions and 180 operational plans with costing and a monitoring and evaluation framework. The estimated budget amounts to $22 794 540. Nearly two thirds (66%) of the budget is allocated for objective two (research and surveillance), followed by 13.1% for objective four (prudent use of antimicrobials) and 11.6% for objective one (awareness and education). The National Antimicrobial Resistance Advisory Committee will coordinate implementation of this strategy and monitor the progress of interventions. Although its success will rely heavily on the Government’s commitment, the private sector, civil society organizations and the general public have significant contributions to make by supporting the government efforts or implementing some of the proposed interventions. 1. Improve awareness and understanding of antimicrobial resistance through effec tive behaviour change communication, education and training. 2. Strengthen the knowledge and evidence on antimicrobial use and resistance through surveillance and research. 3. Enhance infection prevention and control through effective environmental health, infection prevention and bio-risk measures in human, animal and plant health. 4. Optimize the use of antimicrobials in human, animal and plant health care. 5. Strengthen and establish partnerships, alliances, governance and resource mo bilization at all levels. AMR Prevention and Containment Strategic Plan: 2021–2025 VII KEY CONCEPTS AND DEFINITIONS One Health Is a “whole of society” approach that recognizes that the health of peo ple is connected to the health of animals and the environment. The goal of the One Health concept is to encourage multidisciplinary collabora tive efforts across different sectors, such as health, agriculture and the environment, to achieve the best health outcomes for people and ani mals. Health care associated infection Is acquired after contact with health care services. It most frequently oc curs due to treatment in hospital but can also happen after treatment in outpatient clinics, nursing homes and other health care settings. Health care-associated infections that are picked up in hospital are also known as “hospital-acquired infections”. Surgical site infection, pneumonia, uri nary tract infection, bloodstream infection and gastroenteritis are the five most common hospital-acquired infections Antimicrobial resistance occurs when an antimicrobial that was previously effective is no longer operative to treat an infection or disease caused by a microorganism. Antimicrobials are medicines used to treat infections or disease and are essential in both human and animal health. The development of resist ance is a natural phenomenon that will inevitably occur when antimicro bials are used to treat disease. The problem at present is that the sheer volume of antimicrobials being used globally in humans and animals is leading to significant increases in the rate of resistance, with the result that common infections are becoming more difficult to treat. And micro or-ganisms that are resistant to many antimicrobials are emerging as the so-called “superbugs”. Antimicrobial stewardship Is a systematic approach to optimizing antimicrobial therapy through a variety of structures and interventions. It includes limiting the inappro priate use of antibiotics and optimizing antimicrobial selection, dosing, route and duration of therapy to maximize clinical cure while limiting the unintended consequences, such as the emergence of resistance, ad verse drug events and costs. AWaRe list of antibiotics • ACCESS antibiotics that are first- and second-choice options for com mon infections and should be available in all countries and all facilities. • WATCH for antibiotics that only should be prescribed for specific indi cations because they are at higher risk of bacterial resistance. • RESERVE antibiotics, including last-resort options VIII AMR Prevention and Containment Strategic Plan: 2021–2025 VISION, MISSION, GOAL AND SCOPE Vision To protect human, animal and plant populations and the environment from the health, socioeco nomic and environmental consequences of antimicrobial resistance in Ethiopia. Mission To reduce the negative impacts of antimicrobial resistance through the generation and utilization of evidence, awareness and education on the prudent use of antimicrobials and the promotion of sectoral, national and global alliance and collaboration. Goal To ensure continuity of successful prevention, control and treatment of infectious diseases in the hu man, animal, plant and environment sectors through evidence-based prevention and containment of antimicrobial resistance following multisector collaboration through a One Health approach. Scope This third strategic plan covers improving awareness and understanding on antimicrobial resistance, preventing and controlling infections, strengthening the knowledge and evidence on antimicrobial resistance through surveillance and research, ensuring the prudent use of antimicrobials and the governance of antimicrobial resistance prevention and containment in human, animal and plant health care, food and feed production and the environment sectors at the national, regional and facility levels. The scope is also aligned with the Global Action Plan on Antimicrobial Resistance, the National Growth and Transformation Plan, the National Health Sector Transformation Plan II, the National Action Plan for Health Security and Animal Health Strategy, and the Vision for Ethiopia. This antimicrobial resistance strategy harmonizes with the National Healthcare Quality and Safety Strategy, the National Infection Prevention and Control Strategy and the standard treatment guide lines for general hospitals. In line with the Universal Declaration of Human Right, this strategic plan addresses vulnerable groups and the rights of people living with disabilities. AMR Prevention and Containment Strategic Plan: 2021–2025 1 Country Profile BACKGROUND 2 AMR Prevention and Containment Strategic Plan: 2021–2025 1.1 COUNTRY PROFILE Geography and climate Ethiopia is located in the north-eastern part of Africa, also known as the Horn of Africa. It is bor dered by Sudan and South Sudan to the west, Eritrea and Djibouti to the north-east, Somalia to the east and south-east and Kenya to the south. Ethiopia has a national government system involving 10 regional states, 2 city administrations and 840 districts. The country occupies an area of 1.1 mil lion square kilometres and has diverse climate and landscapes. The climate is generally divided into three zones: the alpine vegetated cool zones (Dega), at more than 2600 metres above sea level, where temperatures range from near freezing to 16°C; the temperate zones (Woina Dega), where much of the country’s population is concentrated, with areas between 1500 and 2500 metres above sea level and temperatures ranging between 16°C and 30°C; and the hot zone (Qola), which en compasses both tropical and arid regions and has temperatures ranging between 27°C and 50°C. Demographic profile According to its Central Statistics Agency, Ethiopia is the second-most populous country in Africa and twelfth globally, with a population of about 104 million people in 2021. It is home to various ethnicities, with more than 80 spoken languages. The country is experiencing rapid population growth (at 2.6%), a young age structure and a high dependency ratio, with a high rural–urban differ ential. Ethiopia had one of the higher total fertility rates in Africa in 2016, at 4.6 births per woman (2.3 in urban areas and 5.2 in rural areas) and a corresponding crude birth rate of 32 per 1000 pop ulation. The average household size was 4.6 persons in 2013 (CSA, 2013). Ethiopia has the largest livestock population in Africa. The national herd comprises 57 million cat tle, 30 million sheep, 23 million goats and 57 million chickens as well as camels, horses and a small number of pigs (FAO, 2019). Socioeconomic situation Ethiopia is engaged in rapid and comprehensive development activities to transition from impov erished status to sustainable and reliable growth and prosperity. The country registered commend able achievements with the Millennium Development Goals, mainly in reducing the poverty head count, achieving universal primary education, narrowing gender disparities in primary education, reducing child and neonatal mortality and managing HIV, tuberculosis and malaria (FDRE, 2016). Since 1991, the Government has worked to achieve economic transformation from an agricultural economy to an industrial-led economy. The World Bank classifies Ethiopia as a low-income country, with a gross domestic product (GDP) per capita of $850 in 2019. The country has been one of the fastest-growing economies in Africa and aims to reach lower-middle-income status by 2025 (World Bank, 2019). As much as 70% of the population keeps livestock. Livestock contribute an estimated 10% of total export earnings. It also contributes 21% of the national GDP and 49% of the agricultural GDP (FAO, 2019). However, the contribution of the livestock sector to the national economy is minimal when compared with its potential. One of the main causes of this mismatch between population size and production output from livestock in Ethiopia is the widespread occurrence of many infectious and parasitic diseases, which drastically reduce the production of livestock due to morbidity, mortality and market restriction. The annual loss due to mortality ranges from 8% to 10% for cattle, 12% to 14% for sheep and 11% to 13% for goats. It is around AMR Prevention and Containment Strategic Plan: 2021–2025 3 56.9% for poultry. The direct and indirect losses from livestock disease have significant economic, food security and livelihood impacts on livestock keepers and the national economy (MOA, 2013). Cultivated crop area accounts for a relatively small share of the total area of Ethiopia because most land is not suited for cultivation. Cereals dominate Ethiopian crop production. As of 2011, cereals were grown on 73.4% of the total land area and cultivated by 11.2 million farmers (IFPRI, 2011). The human health system structure has three tiers, consisting of primary health care (primary care hospitals, health centres and health posts), secondary health care (general hospitals) and tertiary health care (comprehensive–specialized and subspecialized hospitals). According to the 2019–2020 Ethiopian health and health-related indicators, there are 400 public hospitals, 52 private hospitals, 3800 health centres, 18 000 health posts, 6500 other private health facilities and 6000 medicine retail outlets (MOH, 2020a). The Government delivers most animal health services. There are 743 public and 877 private veter inary clinics, 4760 veterinary health posts, 4 veterinary teaching hospitals and 1205 veterinary drug retail outlets. The number of primary, secondary and tertiary education facilities has increased dramatically in the country, and the number of students enrolled was an estimated 30 million in 2019–2020. Ethiopia has 44 public universities. Private higher education enrolled at least 15% of all undergraduate stu dents in 2015. In addition to public universities, there are 32 public teacher training colleges and 11 technical and vocational education and training institutes. And 14 universities provide training for veterinary and animal health professionals (MOE, 2020). 4 AMR Prevention and Containment Strategic Plan: 2021–2025 AMR Prevention and Containment Strategic Plan: 2021–2025 5 1.2 ANTIMICROBIAL RESISTANCE OVERVIEW Antimicrobial resistance poses a grave global threat to human, animal and plant health and the envi ronment. It causes an estimated 700 000 deaths every year. Failing to tackle antimicrobial resistance could, by 2050, cause an estimated 10 million deaths a year and cost up to $100 trillion. The highest impact likely will be in Asia and Africa, which likely will account for an estimated 4.7 million and 4.2 million deaths, respectively (O’Neil, 2014). In Ethiopia currently, misuse of antimicrobials is common among human and animal health care providers, unskilled and animal husbandry practitioners and drug users (MOH, 2020a). Various studies reflect an alarming rate of antimicrobial resistance. The Government of Ethiopia joined the global community in tackling the threat of antimicrobial resistance with a national strategic framework in 2011 (EFDA, 2011). It then followed with the first Strategy for the Prevention and Containment of Antimicrobial Resistance, in 2015 (EFDA, 2015). Ethiopia now embraces a concerted, collaborative and integrated One Health approach to man age the antimicrobial resistance threats appropriately and effectively across the human, animal and plant health, the food and feed production and the environment sectors. It works on better manag ing water, sanitation, hygiene and wastewater to prevent infections and contain pollution. Situation analysis and assessment The Government has undertaken various efforts to prevent and contain antimicrobial resistance. However, the previous human and animal health sector strategies as well as environmental sector strategies have not comprehensively addressed antimicrobial resistance prevention and contain ment. Various studies show an alarming rate of antimicrobial resistance in Ethiopia. A systematic review of Salmonella spp. (Tadesse, 2014) and Shigella spp. (Hussen, Mulatu and Yohannes Kassa, 2019) found high resistance for the commonly used antibiotics. Similarly, high E. coli resistance was seen not only for the commonly used antibiotics (access group) but also for third-generation cephalo sporins and fluoroquinolones (Sisay, Mengistu and Edessa, 2018; Tuem et al., 2018). The emergence and prevalence of resistant strains in agricultural food products also seriously com promise the public health. According to a systematic review of studies published from 2013 to 2018, out of the 556 E. coli isolates from different food sources in Ethiopia, resistance to ampicillin, eryth romycin and streptomycin have been reported, at 78.7%, 64.1% and 37.6%, respectively (NAHDIC, 2019). Similarly, among 205 Salmonella spp. isolated from food sources, resistance of 64.6% for Streptomycin, 45.1% for ampicillin and 39.1% for tetracycline were reported. Lower percentages of resistance were recorded for gentamycin, ceftriaxone and ciprofloxacin (NAHDIC, 2019, p. 8). Ethi opia has not yet taken action in avoiding or voluntarily phasing-out antimicrobial-growth promoters and non-therapeutic use of antimicrobials in animals, as promoted by research and evidence. An alarming magnitude of multidrug-resistant infections has been found in a few recent system atic reviews and meta-analyses. According to the 2020 systematic review and meta-analysis, the pooled proportion of extended spectrum beta-lactamase-producing gram-negative bacteria was 50% (Tufa et al., 2020). In addition, the pooled vancomycin-resistant Enterococci estimate account ed for 14.8% (Melese, Genet and Andualem, 2020). Out of 238 gram-negative bacilli isolates, nearly 2% were carbapenem-resistant (Beyene et al., 2019). The prevalence of multidrug-resistant tuberculosis among newly diagnosed patients has ranged from 2% to 2.7% (Girum et al., 2018; Eshetie et al., 2017; Kebede et al., 2014). Multidrug-resistant tuberculosis is mainly associated with history of previous treatment and to a lesser extent with con tact history. Meta-analyses have reported a prevalence of 15% (Eshetie et al., 2017) and 21% (Girum et al., 2018) among previously treated patients. The 2019 findings of the national antimicrobial resistance surveillance for the priority pathogens augment the evidence from previous reports for the different studies (EPHI, 2019). Although the 6 AMR Prevention and Containment Strategic Plan: 2021–2025 data were heterogenic, hospital-based and with less geographic representation, the findings cited here warn of the risks that antimicrobial resistance poses to public health. Despite the World Health Organization’s (WHO) recommendations, antimicrobials prescriptions are widespread in Ethiopia. The average percentage of prescriptions containing antibiotics is 57.6% (MOH, 2020a). Antimicrobial prescriptions are mainly driven by empiric decision (Gebretekle et al., 2020; Gutema et al., 2018). Antimicrobial prophylaxis is used in the majority of surgical procedures, including clean surgical procedures. It is found in wrong doses, duration and indication at levels above what is recommended (Alemkere, 2018). The irrational and overuse of antimicrobials is driven by poor availability and compliance with stand ard treatment guidelines, the functionality of the Drug and Therapeutic Committee and Drug Infor mation Services. (MOH, 2020b). Clients’ adherence to the prescribed antimicrobials and self-medi cation practice have been found to be major problems (Sisay, Mengistu and Edessa, 2018; Ayalew et al., 2017; Hailu et al., 2014). In general, improving evidence-based awareness is still an urgent agenda requiring surveillance on responsible antimicrobial use, residue and resistance trends in food and feed production and in the environment to prevent and contain antimicrobial resistance (O’Neil, 2016). One Health perspective In 2015, WHO developed the Global Action Plan on Antimicrobial Resistance, in collaboration with the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (OIE). It was then adopted by the World Health Assembly. The Global Action Plan highlights the One Health approach, which is a collaborative, multisector and transdisciplinary ap proach adopted as the global framework for streamlining collaboration among different sectors, in this case, to prevent and contain antimicrobial resistance (WHO, 2015). Ethiopia is fully committed to the collaborative, multisector and transdisciplinary approach, which is supported by the national One Health platform that involves the active participation of multiple stakeholders. Indeed, several policy documents recommend multi-stakeholder and multidiscipli nary approaches to better address complex public health issues. The Government endorsed the Public Health Policy of Ethiopia (1993), the Animal Diseases Prevention and Control Proclamation (No. 267/2002) and the National One Health Strategic Plan (2018–2022). All these policies support the adoption of the One Health approach. Although Ethiopia initiated antimicrobial resistance prevention and containment implementation early and has made much progress, the Government recognizes that the country lags behind the antimicrobial resistance threats and risks, which are still high due to inadequate multisector har monizing, insufficient and low-quality data on antimicrobial use and resistance, lack of sustainable financing, suboptimal practices, an inadequate number of trained professionals and insufficient laboratories and supplies. Country response In Ethiopia, antimicrobial resistance advocacy and containment efforts began back in 2006. The first antimicrobial resistance stakeholders meeting was conducted in March 2006, followed by the establishment of the National Antimicrobial Resistance Advisory Committee under leadership of the Drug Administration and Control Authority of Ethiopia (now the Ethiopian Food and Drug Au thority). The major initiative was capacity-building activities targeting the Drug and Therapeutic Committee as an entry point to support the antimicrobial resistance containment effort. A baseline survey on antimicrobial use, resistance and containment was conducted in 2008 and showed a high level of antimicrobial resistance (DACA, 2009). Following identification of gaps and targets, the first strategic framework for antimicrobial resistance prevention and containment was developed in 2011 (EFDA, 2011). The second strategy was released in October 2015, covering AMR Prevention and Containment Strategic Plan: 2021–2025 7 2015–2020 (EFDA, 2015). In April 2017, Ethiopia developed and approved the National Antimicrobial Resistance Surveillance Plan. It aimed at establishing a national surveillance network capable of detecting priority antimicro bial resistance pathogens, analysing and reporting data, characterizing resistance and generating evidence to inform the implementation of targeted prevention and control programmes. Three rounds of annual antimicrobial resistance surveillance reporting on priority pathogens from the sen tinel sites have been released so far (2018–2020). In addition, the integrated National Antimicrobial Resistance and Residue Surveillance Plan (2019–2023) for the animal health, plant, food safety and environment sectors. Led by the National Animal Health Diagnosis and Investigation Center, it offers great hope. Another baseline survey was conducted in 2018 on the awareness of veterinary drug retail outlets on the trends of antimicrobial resistance and its containment strategies. The survey revealed that pre-service and in-service training on antimicrobial use, resistance and contain ment are not well addressed in terms of dispensers, over-the-counter dispensing of antimicrobials when directly asked by animal owners and the traditional way of dispensing antimicrobials without evidence-based tools and aids (such as sensitivity test, veterinary standard treatment guidelines, the veterinary medicines formulary, prescription paper, etc.) (Zeru et al., 2019). Different antimicrobial resistance prevention and containment activities have been implemented. Including but not limited to: • Conducting advocacy and communication efforts through different forums and media capaci ty-enhancement activities in the human and animal health sectors; • Cascading the national antimicrobial resistance action plan to regions and establishment of re gional antimicrobial resistance advisory committees; • Implementing the antimicrobial stewardship programme in selected public and private hospitals; • Revising the infection prevention and control guidelines, development of an infection prevention and control policy and implementing infection prevention and control practices; • Revising the national veterinary drug list with restrictions of highest-priority critically important antibiotics for animal use; • Developing and implementing the rational medicine use directive, which restricts-over-the coun ter use of antimicrobials; • Revitalizing the antimicrobial resistance governance structure; • Revising standard treatment guidelines (human and animal health) and the essential medicines list, incorporating the who access, watch and reserve (aware) categorization of antibiotics; • Reporting annually the antimicrobial resistance surveillance findings to the who global antimicro bial surveillance and use system; • Providing national antimicrobial consumption surveillance training in two rounds; and • Commemorating national antimicrobial days. 8 AMR Prevention and Containment Strategic Plan: 2021–2025 Governance structure Since 2019, the governance framework of antimicrobial resistance prevention and containment transitioned from the Ethiopian Food and Drug Authority (the former Drug Administration and Con trol Authority) to the Ministry of Health. The current antimicrobial resistance governance mechanism comprises a high-level National Inter-ministerial Committee, the National Antimicrobial Resistance Advisory Committee, a national antimicrobial resistance focal point (AMR secretariat) and six multi sector technical working groups (on awareness and education; research and surveillance; infection prevention and control and hygiene; antimicrobial stewardship; regulations and pharmacovigilance; and partnership and resource mobilization) to address the strategic objectives of the national action plan (see the Annex for the terms of reference for the membership, duties and responsibilities of each governance body). National-level governance is responsible for formulating policies and reg ulations and providing technical guidance and assistance to regional-level antimicrobial resistance coordinating platforms. Regional antimicrobial resistance governance oversees and assists imple mentation of the antimicrobial resistance prevention and containment strategy at all levels. National Interministrial Committee National AMR Advisory Committee National AMR Advisory Secretariat(Focal Point) TWG Education and Awareness TWG surveillance and research TWG infection prevention and control and hygiene TWG antimicrobial stewardship TWG regulations and pharmacovigilance TWG partnership and resource mobilization for AMR Figure 1 Antimicrobial resistance governance framework AMR Prevention and Containment Strategic Plan: 2021–2025 9 SWOT ANALYSIS OF THE ANTIMICROBIAL RESISTANCE SITUATION IN ETHIOPIA Table 1. Analysis of the strengths, weaknesses, opportunities and threats regarding antimicrobial resistance prevention and control Strengths Weaknesses • Availability of legal provisions in human, agriculture and environment sectors • Weak collaboration system among major antimi crobial resistance stakeholders at all levels • Existence of regulatory bodies for medicine and med ical devices and professional conduct in the human and animal health and environment sectors • Inadequate antimicrobial resistance surveillance capacity and utilization of evidence generated for decision-making • Existence of antimicrobial resistance governance structure at national and regional levels (Advisory Committees and AMR secretariat) and a One Health Steering Committee • Inadequate sustainable financial, human and material resources • Existence of guidelines (Antimicrobial Stewardship I, standard treatment guidelines, infection prevention and control) and directives (Rational Medicine Use II) in the human and animal health sectors • Inadequate awareness and commitment on anti microbial resistance among policymakers and the general population. • Efforts undertaken to improve awareness on antimi crobial resistance • Inadequate ownership and cascading of a national strategy for antimicrobial resistance by key stake holders at national, regional and city administra tion and institution levels • Launching of the Antimicrobial Stewardship Pro gramme in selected public and private hospitals • Irrational antimicrobial prescribing, dispensing and use • Efforts underway to integrate infection prevention and control practices with antimicrobial stewardship, such as integrated training • Poor laboratory infrastructure and inadequate microbiology supplies • Established antimicrobial resistance surveillance sys tem in the human and animal health sectors • Lack of standards in existing food legislation on antibiotic residues • Presence of research and public health laboratory networks at national, regional and academic public health research laboratories • Inadequate regulation of antimicrobials, including market surveillance, inspection of antimicrobial use and enforcement and safe disposal of waste • Existence of accredited reference national bacteriolo gy laboratory in the human and animal health sectors • Inadequate institutionalized implementation of antimicrobial stewardship • Inadequate pre- and in-service training on proper use of antimicrobials and laboratory diagnostic testing capacity • Poor community and health facility infection pre vention and control programme • Poor animal husbandry practice and bio-risk management • Absence of a reporting, monitoring and evaluation system • Lack of interoperability database and reporting system among human, animal and environment surveillance 10 AMR Prevention and Containment Strategic Plan: 2021–2025 Opportunities Threats • Existence of health and agriculture extension pro grammes to reach communities and primary health care settings to strengthen awareness, appropriate prescribing and prevention efforts • Borderless transmission of resistant pathogens • Existence of ample international experience and research findings in the field • Emergence and re-emergence of infectious diseases • Commitment of international organization in com bating antimicrobial resistance including WHO, FAO, OIE, Africa Centres for Disease Prevention and Control (CDC), United States Agency for International Devel opment (USAID) and other partners • Inadequate number of new antimicrobials in the research and development pipeline • Availability of advanced technology • Competition of scarce resources and inflation • Availability of various print and electronic media • Circulation of substandard and falsified medical products due to porous borders • Availability of higher education institutions • Pressure from pharmaceutical companies • Improved primary and secondary education coverage AMR Prevention and Containment Strategic Plan: 2021–2025 11 STAKEHOLDER ANALYSIS The Government of Ethiopia has identified all relevant antimicrobial resistance stakeholders and presumes their engagement is essential for combating antimicrobial resistance. The majority of stakeholders are already members of the National Antimicrobial Resistance Advisory Committee. However, based on national and regional assessment findings, there is little coordinated engage ment and governance among these stakeholders (MOH, 2020a; 2020b; 2019). Table 2 Stakeholder analysis for antimicrobial resistance prevention and containment Stakeholders Level of involve ment Desired behav iours Their needs Anticipat ed chal lenges Institutional response Ministry of Health (MOH) and its agencies (EPSA, EPHI), AHRI) and regional counter parts Ministry of Agri culture (MOA) and its agencies (NAH DIC) and regional counterparts Environment, Forest and Climate Change Com mission (EFCCC) and its agencies (Ethiopian En vironment and Forest Research Institute (EEFRI), Ethiopian Biodi versity Institute (EBI)) and regional counterparts High Advocacy and own ership of AMR Leadership and coor dination Develop and update polices and legal frameworks Plan and allocate resources Information exchange Collaboration Efficient utilization of resources Transparency of operations Accountability Technical and financial support Appropriate data for decision-making Information ex change Collaboration Inadequate collaboration information sharing leadership support Update continuously information and lobbying Review gaps and address swiftly Strengthen collabo ration Establish joint monitoring and evaluation Regulatory bodies EFDA, EFCCC VDFACA and regional counter parts High Advocacy and own ership of antimicrobi al resistance Plan and allocate resources Effective enforcement Transparency and accountability Technical and financial support Appropriate data for decision-making Information ex change Collaboration Inadequate enforcement information sharing leadership support Duplication of efforts Establish joint monitoring and evaluation Strengthen collabo ration Design mechanisms that avoid duplica tion of efforts 12 AMR Prevention and Containment Strategic Plan: 2021–2025 Stakeholders Level of involve ment Desired behav iours Their needs Anticipat ed chal lenges Institutional response Civil society Medium Promote ethical practices Lobby government to ensure availability and rational use of antimicrobials and personal protective equipment Antimicrobial resist ance advocacy Recognition Technical and financial support Supportive poli cies\y Lack of buy-in Expose un acceptable practices Identify the resist ance areas and respond based on the findings Engage and partic ipate in planning, monitoring and evaluation Professional asso ciations (relative to human, animal and plant health and the environment) High Antimicrobial resist ance advocacy Promote infection prevention and con trol and antimicrobial stewardship Provide continuing professional develop ment on antimicro bial resistance, use, consumption and stewardship, infec tion prevention and control, etc. Develop standards and protocols Research and devel opment Antimicrobial re sistance curriculum review Technical and financial support Exchange of infor mation Weak collab oration Loss of trust Engage in planning, implementation, monitoring and evaluations Communities and patients, animal owners, clients High Compliance and adherence to medi cations Avoid self-medication Participation, engage ment and ownership Avoid non-therapeu tic use of antimicro bials Safe, quality and effective medicines Safe water, sanita tion and hygiene facilities Up-to-date and reliable information Engagement and empowerment Non-compli ance Dissatisfac tion Opting for poor quality and unsafe alternatives Distrust Ensure sus tained access to good-quality and safe medical prod ucts Provide up-to-date, reliable and proper information Engagement and participation in planning, monitoring and evaluation AMR Prevention and Containment Strategic Plan: 2021–2025 13 Stakeholders Level of involve ment Desired behav iours Their needs Anticipat ed chal lenges Institutional response Public and private health facilities and diagnostic centres (animal and human) and pharmaceutical establishments High Ethical and rational use of medicines Institutionalize and integrate infection prevention and con trol and/or antimicro bial stewardship Participation in public awareness-raising efforts Empower their profes sionals on antimicrobial resistance Up-to-date infor mation, standard treatment guidelines and formularies Technical and finan cial support Supportive policy environment Unethical practices Refusal to follow stand ards Inappropri ate use of resources Measures on illegal practices Provision of infor mation Technical support Engagement and participation in planning, monitoring and evaluation Ministry of Science and Higher Edu cation (MOSHE), Ministry of Educa tion (MOE), Ministry of Information and Technology, aca demia and research institutions High Inclusion of antimi crobial resistance in curriculum and courses Technical assistance Evidence-generation and advocacy on an timicrobial resistance Serve as centre of excellence Innovations Technical and financial support and collaboration Engagement and participation Information ex change Poor attention to antimicrobial resistance Dissatisfac tion Poor infra structure or budgeting Transparency and collaboration Use of evidence and reports generated Up-to-date informa tion Engagement and participation in planning, monitoring and evaluation Media High Awareness-raising on antimicrobial resistance, sanitation, hygiene and infec tion prevention and control measures Broadcast achieve ments and best practices Provision of right information to the public on antimicrobi al resistance Lobby the Govern ment to combat anti microbial resistance Resources for generating up-to date and reliable information Transparency and participation Technical support Supportive policy Provision of reliable information Less atten tion Dissemi nation of unreliable information Broken trust Provide up-to-date and reliable infor mation Strengthen collabo ration and integrat ed works Create transparent and participatory platforms for the media 14 AMR Prevention and Containment Strategic Plan: 2021–2025 Stakeholders Level of involve ment Desired behav iours Their needs Anticipat ed chal lenges Institutional response Tripartite organ izations (World Health Organiza tion (WHO), Food and Agriculture Organization of the United Nations (FAO) and the World Organisa tion for Animal Health (OIE) High Technical and finan cial support Advocacy, harmoni zation and alignment of antimicrobial resistance, infec tion prevention and control, antimicrobial stewardship, food and feed safety and bios ecurity agendas with the global strategy Development and issuance of manuals, guidelines, policy documents Monitoring and evalu ation Efficient utilization of resources Timely reporting and feedback Reduced technical and financial support Low eval uation of performance reports Transparency Alignment and harmonization Engagement and collaboration International organizations and development part ners (CDC, United States Agency for International Development (USAID), UNICEF, United Nations Environment Programme, World Bank, European Union, etc.) High Technical and/or financial support Engagement on ad vocacy and promo tion of antimicrobial resistance prevention and containment activities, such as infection prevention and control practice, antimicrobial stew ardship implementa tion, research, surveil lance, awareness and education Harmonized and transparent system Participation in planning, monitor ing and evaluations Collaboration and engagement Denial of support or cooperation Transparency Efficient resource use Collaboration and engagement Provision of up-to date information AMR Prevention and Containment Strategic Plan: 2021–2025 15 Stakeholders Level of involve ment Desired behav iours Their needs Anticipat ed chal lenges Institutional response Health profession als (human and animal) High Compliance with good prescribing and good dispensing practices Compliance with standard treatment guidelines Refrain from dispens ing antimicrobials over the counter Ensuring quality-as sured laboratory results Compliance with infection prevention and control practice recommendations Availability of safe, effective and quali ty products Pre-service and in-service capaci ty-building Efficient and fair service and system from the regulatory enforcement Updated infor mation and legal framework Uncoopera tiveness Distrust Poor com pliance with standards and legal frameworks Poor com munication among pro fessionals Efficient and fare quality assurance system Updating laws and information Ministry of Finance High Recognition of anti microbial resistance as a social, economic and health threat re quiring a multisector approach Understand the benefit of investing in antimicrobial resist ance and value for money Allocate required resources for anti microbial resistance issues Justification among the competing government priori ties and economic benefit Efficient and effec tive utilization of budget Timely liquidation and reporting Hesitation or refusal of allocating and approv ing budget Inadequate information on economic impact of antimicrobial resistance Confidence on the deliv erables Budget shortage and competing priorities Utilize budget properly Demonstrate the results and benefits of investing in anti microbial resistance prevention Mobilize resource Develop convincing justifications in case of deviations in the implementation 16 AMR Prevention and Containment Strategic Plan: 2021–2025 Stakeholders Level of involve ment Desired behav iours Their needs Anticipat ed chal lenges Institutional response Parliamentarians, community lead ers and opinion leaders Medium Advocacy of rational medicine use laws and practices Cooperation Monitoring and follow-up Approval and moni toring of enforcement of the legal frame works Availability of safe and good-quality medicines Proper drafting legal frameworks Information ex change Timely perfor mance reporting Unac ceptance Deny coop eration Influence on budget allocation Embrace the ap proach and engage ment Review gaps and address them Embrace capaci ty-building mecha nisms Execute authority and responsibility properly Provide proper information AMR Prevention and Containment Strategic Plan: 2021–2025 17 CRITICAL ISSUES AND CORE ENABLERS RELATED TO ANTIMICROBIAL RESISTANCE Table 3 Critical issues and core enablers related to antimicrobial resistance Critical issues Core enablers • Inadequate multisector govern ance, collaboration, coordination and commitment at all levels • Resource constraints • Inadequate needs-based re search, diagnostic facilities and antimicrobial resistance, use and consumption surveillance for decision-making • Inadequate awareness on threats of antimicrobial resistance among policymakers, profes sionals and the general popula tion • Poor infection prevention and control practices and lack of in tegration of infection prevention and control with the Antimicrobi al Stewardship Programme • Irrational use of antimicrobials and circulation of substandard and falsified medical products • Strengthen the national and regional Antimicrobial Resistance Advisory Committees • Establish and strengthen AMR secretariat, team and focal persons • Strengthen the multisector antimicrobial resistance technical working groups • Mobilize aggressive and sustainable resources • Strengthen partnership and networking • Strengthen communication and coordination forums • Nominate goodwill ambassadors on antimicrobial resistance • Promote antimicrobial resistance knowledge and be haviour change among decision-makers, professionals and the general public through printed and electronic media • Strengthen sentinel surveillance sites and research to generate evidence to improve health care outcomes and decision-making • Access and ensure applicability of up-to-date treat ment guidelines • Institutionalize and integrate Antimicrobial Steward ship Programme and infection prevention and control programme into the human and animal health sectors • Improve regulatory enforcement of antimicrobial use, prescribing, dispensing and self-medication as well as prevention, detection and response to substandard and falsified medical products, including participation in WHO global surveillance and monitoring system and member State mechanisms regarding substand ard and falsified medical products • Establish and strengthen a monitoring and evaluation system • Strengthen innovation and adoption of technologies 18 AMR Prevention and Containment Strategic Plan: 2021–2025 2. RATIONALE FOR REVISIONS IN THE THIRD STRATEGIC PLAN The second edition of the National Antimicrobial Resistance Prevention and Containment Strategy 2015–2020 was well aligned with the WHO Global Action Plan on Antimicrobial Resistance. But the strategy needed revision, primarily for the following reasons. • It was not comprehensive enough to address the animal, fisheries, plant, food production and environment sectors. • The roles and responsibilities of key stakeholders, including private sector engagement, were not clearly articulated. • It lacked a robust operational plan; a clear line of reporting, monitoring and evaluation and ac countability, costing and required resources. • The strategy was overambitious, which had been difficult to implement in the specified period. • It needed to integrate recent global and national antimicrobial resistance-related updates. Completion of the implementation period became the right time to revise the national strategic plan to address these gaps and align with the country’s Growth and Transformation Plan for health, agri culture and the environment. AMR Prevention and Containment Strategic Plan: 2021–2025 19 3. STRATEGIC PLAN AMR Prevention and containment stratgic plan 5 Strategic Objectives 22 Initiatives 66 Interventions 180 opertational Plans Awareness and Education Research and Surviellance Infection Prevention and control Prudent use of Anti-Microbials Partnership, Alliance and Resource Mobilization 20 AMR Prevention and Containment Strategic Plan: 2021–2025 3. STRATEGIC PLAN In line with the World Health Organization’s Global Action Plan on Antimicrobial Resistance and country’s Growth and Transformation Plan for the health, agriculture and environment sectors, the third national strategic plan on prevention and containment of antimicrobial resistance is designed to ensure continuity of the successful approaches already practised for the prevention, control and treatment of infectious diseases in humans, animals and plants through multisector collaboration. Hence, the third AMR prevention and containment strategic plan consists of 5 strategic objectives with 22 initiatives, 66 interventions and 180 operational plans with costing and a monitoring and evaluation framework. 1. Improve awareness and understanding of antimicrobial resistance through effective behaviour change communication, education and training. 2. Strengthen the knowledge and evidence on antimicrobial use and resistance through surveillance and research. 3. Enhance infection prevention and control through effective environmental health, infection prevention and bio-risk measures in human, animal and plant health. 4. Optimize the use of antimicrobials in human, animal and plant health care. 5. Strengthen and establish partnerships, alliances, governance and resource mobilization at all levels. Figure 2. Strategic Objectives of National AMR Strategic Plan AMR Prevention and Containment Strategic Plan: 2021–2025 21 3.1 OBJECTIVE ONE: IMPROVE AWARENESS AND UNDERSTANDING OF ANTI MICROBIAL RESISTANCE THROUGH EFFECTIVE BEHAVIOUR CHANGE COMMUNICATION, EDUCATION AND TRAINING Description Antimicrobial resistance prevention and containment shall be seen as everyone’s responsibility. All human, animal and plant health professionals, environment professionals, public and private insti tutions, policymakers and communities shall understand the extent and the challenges posed by antimicrobial resistance. Some institutions had raised awareness and expanded knowledge on an timicrobial resistance. However, awareness, understanding of the problem and the attention given to antimicrobial resistance prevention and containment by communities, professionals and policy makers remain inadequate This strategic objective is designed to encourage a whole-of-society approach in tackling the issue of antimicrobial resistance and ensure that everyone is aware of the problem and challenges. It also seeks to ensure that individuals, communities and institutions understand their role in addressing antimicrobial resistance through effective behaviour change communication, education and train ing. The objective aims to improve behaviour change on antimicrobial use and resistance among the targeted groups. This objective involves 4 initiatives, 8 interventions and 18 activities, as explained in the operational plan. Improve awareness , understanding and empowerment of clients and communities Empower the media and engage civil society organizations Advocacy and communication on antimicrobial resistance Education and training on AMR for human, animal, plant and environmental professionals Awareness and education on AMR Figure 3. Strategic Initiatives for Awarness and Education Strategic Objective 22 AMR Prevention and Containment Strategic Plan: 2021–2025 Table 4: Initiatives and interventions for objective one Objective 1: Improve awareness and understanding of antimicrobial resistance through effective behaviour change communication, education and training Strategic initiatives Strategic intervention Improve awareness, understanding and empowerment of clients and communities 1. Design and promote sustainable whole-of-society engagement through effec tive communication platforms 2. Incorporate personal, public and food hygiene, sanitation, nutrition, good farm ing and environment health-control practices related to antimicrobial use and resistance into school curricula and extracurricular activities 3. Raise awareness of clients and the public on rational use of antimicrobials and adherence to treatment and professional advice through health education and training 4. Improve awareness of the risk of leftover antimicrobials, pesticides, insecti cides and heavy metals in the environment Education and training on antimicrobial resist ance for human, animal, plant and environmental professionals in public and private institutions 1. Incorporate antimicrobial resistance in course content of technical and voca tional education and training, undergraduate and post-graduate curricula 2. Develop and implement regular and needs-based pre-graduation and in-service training and continuous professional development programmes on antimicrobial use, resistance and stewardship and infection prevention and control, including for health and agriculture extension workers Empower the media (public and private) and engage civil society organizations on antimi crobial resistance 1. Capacitate media and civil society on antimicrobial resistance to ensure their engagement in educating the public Advocacy and commu nication with policymak ers and decision-makers 1. Advocate antimicrobial resistance as a national and global priority with pertinent policymakers and decision-makers to mainstream prevention and containment AMR Prevention and Containment Strategic Plan: 2021–2025 23 3.2 OBJECTIVE TWO: STRENGTHEN THE KNOWLEDGE AND EVIDENCE ON ANTI MICROBIAL USE AND RESISTANCE THROUGH SURVEILLANCE AND RESEARCH Description Surveillance and research on antimicrobial use, consumption and resistance, antimicrobial residues and market surveillance are essential in preventing and guiding the management of infectious dis eases. It is necessary for updating infection-control policies and practices. It is also critical to pro vide early warning of emerging and re-emerging human, animal and plant infectious diseases, to monitor changing patterns of resistance and to target and evaluate antimicrobial resistance preven tion and containment measures. Establishing and strengthening laboratory diagnostic testing through standardizing methods and procedures for surveillance and research on antimicrobial use, consumption and resistance can ensure and generate quality data to influence health care outcomes and policy and programme implementation. An effective network that generates and collates data on surveillance of antimicro bial use, consumption and resistance across the human, animal and environmental interface will be established. This objective focuses on strengthening and standardizing surveillance and research through the One Health approach. It involves 4 initiatives, 14 interventions and 47 activities, as explained in the operational plan. Hence, information and evidence will be generated for deci sion-making. 24 AMR Prevention and Containment Strategic Plan: 2021–2025 Table 5: Initiatives and interventions for objective two Objective two: Strengthen the knowledge and evidence on antimicrobial use and resist ance through surveillance and research Strategic initiatives Strategic interventions Establish and strengthen sur veillance of antimicrobial re sistance priority pathogens in human and animal health, feed and food safety, plants and the environment. 1. Establish and strengthen antimicrobial resistance surveillance sys tems to detect and report antimicrobial resistance and dissemi nate information to facilitate evidence-based decision-making at all levels in all sectors 2. Establish multi-institutional networks to collate and channel sur veillance reports and case studies on antimicrobial resistance and informed policymaking and decision-making 3. Establish real-time patient and population-based antimicrobial re sistance surveillance system 4. Strengthen and maintain a national bio-repository on antimicrobi al resistance priority organisms, strains and genes 5. Establish alert system on emerging and re-emerging antimicrobial resistance issues that do have public and animal health emergency importance Build up the capacity for a quality management system of laboratories for human, animal and plant health and for feed and food safety and environment testing at the national, regional and facility levels 1. Standardize microbiology laboratory methodologies and tech niques including advanced detection methods 2. Establish and strengthen laboratory facilities and equipment main tenance and calibration centres 3. Build up the capacity of human resources for specimen manage ment, for conducting culture, identification and antimicrobial sen sitivity tests and for reporting to the human, animal, environment, feed and food sectors using phenotypic and molecular methods 4. Strengthen the laboratory information management system Basic and operational re search 1. Conduct basic and operational research on antimicrobial use, consumption and resistance. 2. Research diagnostic and treatment alternatives for infections that can be treated with antimicrobials 3. Introduce innovative technologies and research on rapid diagnos tic tests and methods for infections and antimicrobial resistance 4. Develop an AMR index to communicate gaps in antimicrobial ef fectiveness and help aggregate data on resistance to assess trends over time and across locations Establish and strengthen surveillance and research of antimicrobial contaminants and residues and the drivers of antimicrobial resistance in the environment, plant, food and feed sectors 1. Establish and strengthen surveillance and research of anti microbial residues, effluent and waste in the environment, plant, food and feed sectors AMR Prevention and Containment Strategic Plan: 2021–2025 25 3.3 OBJECTIVE THREE: ENHANCE INFECTION PREVENTION AND CONTROL THROUGH EFFECTIVE ENVIRONMENTAL HEALTH, INFECTION PREVEN TION AND BIO-RISK MANAGEMENT IN HUMAN, ANIMAL AND PLANT HEALTH CARE Description Infection prevention and control along with water, sanitation and hygiene measures in human and animal health facilities and in communities reduces the risk of transmission of infections. It also min imizes the need for and use of antimicrobials and prevents the subsequent emergence of resistant strains. Infection prevention and control measures contain the spread of resistant microbes once resistance has emerged. These measures include personnel hygiene and environmental health, spe cifically water, sanitation and hygiene in communities and health care facilities; promoting vaccina tions; improving safety in risky areas of health facilities for humans and animals; safe wastewater and waste management practices; isolation of patients infected by highly contagious microorganisms; good animal husbandry practices; and biosafety and bio-risk management. This strategic objective is designed to reduce the occurrence of infections and contain the spread of the resistant strains in communities and in veterinary and human health care settings through im plementation of a range of recommendations and minimum requirements related to the existence of functional and effective infection prevention and control programmes to reduce the incidence of infection at the national and facility levels. This strategic objective involves 5 initiatives, 13 interventions and 37 activities, as explained in the operational plan. Strengthen IPC practices in public and veterinary health facilities Strengthen good animal husbandry practices Promote personal hygiene and strengthened WASH services at the community level Strengthen the information system for IPC management Strengthen and promote an IPC programme for human, animal and plant health care and for the environment IPC and Hygiene Figure 4. Strategic Initiatives for IPC and Hygiene Strategic Objective. 26 AMR Prevention and Containment Strategic Plan: 2021–2025 Table 6: Initiatives and strategic interventions for objective three Objective three: Enhance infection prevention and control through effective environmental health, infection prevention and bio-risk measures in human, animal and plant health care Strategic initiatives Strategic interventions Strengthen and promote an infection prevention and control programme for human, animal and plant health care and for the environment 1. Coordinate multisector collaboration to limit the emergence, re-emergence and spread of antimicrobial resistance and multiple drug-resistant organ isms in humans, animals, plants and the environment 2. Set and enforce standards on infection prevention and control as per the One Health approach 3. Develop protocols and guidelines for infection outbreak detection and case management due to antimicrobial resistance and multiple drug-resistant strains Strengthen infection pre vention and control prac tices in public and veteri nary health facilities 1. Ensure implementation of safe infection prevention and control practices in human and veterinary health facilities 2. Prevent and monitor health care-associated infections in human and veter inary health facilities 3. Strengthen prevention of zoonotic diseases Strengthen good animal husbandry practices 1. Promote bio-risk management and good husbandry practices 2. Integrate antimicrobial resistance prevention and containment activities with veterinary outreach services and vaccination access Promote personal hygiene and strengthened water, sanitation and hygiene services at the community level 1. Promote personal and environmental hygiene and sanitation 2. Promote, implement and enforce proper waste management at the com munity level 3. Encourage and promote safe water supply and sanitation services for humans and animals Strengthen the informa tion system for infection prevention and control management 1. Develop a multisector infection prevention and control information com munication management system (database) 2. Generate and disseminate evidence-based information to improve infection prevention and control practices and decision-making processes AMR Prevention and Containment Strategic Plan: 2021–2025 27 3.4 OBJECTIVE FOUR: OPTIMIZE THE USE OF ANTIMICROBIALS IN HUMAN, ANIMAL AND PLANT HEALTH CARE Description Countries, regions or human and veterinary health care facilities with high antimicrobial use and misuse are associated with high incidence of resistance. Inadequate capacity to diagnose and manage infectious diseases, poor prescribing and dispensing practices, poor adherence to treat ments, substandard and falsified medicines and outdated and biased medicine information, poor access to antimicrobials and wrong duration of therapy are all important contributors to antimi crobial resistance. Evidence-based policies, protocols and regulations that encourage more appropriate and ra tional use of antimicrobials are key interventions for the containment of antimicrobial resistance. This strategy involves strengthening and integrating antimicrobial stewardship into health care facilities. It also promotes using data on antimicrobial use, consumption and resistance to trigger changes in the behaviour of human and veterinary health care professionals, clients and other actors in the human and animal sectors. This objective involves 5 initiatives, 24 interventions and 50 activities, as explained in the opera tional plan. Leadership Commitment Accountability Drug Expertise Action Tracking Report Education Figure 5. Core Elements of Anti-Microbial Stewardship 28 AMR Prevention and Containment Strategic Plan: 2021–2025 Table 7: Initiatives and strategic interventions for objective four Objective four: Optimize the use of antimicrobials in human, animal and plant health care Strategic initiatives Strategic interventions Improve access to quality antimicrobials and labora tory supplies in the human and animal health sectors 1. Ensure effective supply chain management of quality essential antimicro bials and laboratory supplies 2. Promote local production of quality antimicrobials and laboratory supplies Ensure optimal prescribing, dispensing and use of anti microbials in human health care 1. Integrate antimicrobial stewardship into the Ethiopian Hospitals Services Transformation Guideline and the Ethiopian Health Centre Reform Imple mentation Guideline 2. Ensure implementation of antimicrobial stewardship in health care facili ties 3. Ensure the availability of and monitor compliance to updated and evidence-based guidelines, policies, manuals and formularies for the prescribing and dispensing practice 4. Strengthen antimicrobial use and consumption surveillance data for action to improve health care outcomes at health facilities and at the national level 5. Improve communication and team spirit among health care providers Ensure optimal prescribing, dispensing and use of anti microbials in animal health 1. Develop guidelines relevant to the prudent use of antimicrobials 2. Develop and promote implementation of antimicrobial stewardship in veterinary services 3. Strengthen the diagnostic capacity of veterinary health services to pro mote the rational antimicrobial use and consumption 4. Strengthen the antimicrobial use and consumption surveying for veteri nary health services 5. Strengthen professional and animal owner communication to optimize antimicrobial use and consumption Strengthen diagnostic stewardship at health care facility level 1. Establish, capacitate and standardize diagnostic laboratories 2. Ensure generation and utilization of antibiogram data at the health care facility level 3. Ensure prescribing practices of antimicrobials are based on laboratory diagnostic results AMR Prevention and Containment Strategic Plan: 2021–2025 29 Objective four: Optimize the use of antimicrobials in human, animal and plant health care Strategic initiatives Strategic interventions Strengthen the regulatory system in human, animal, food and feed production and the environment sec tors 1. Review, develop and enforce legislation on the prudent use of antimicro bials and laboratory supplies 2. Strengthen pre- and post-market surveillance and control of antimicrobi als as well as laboratory and infection prevention and control supplies 3. Capacitate regulatory bodies to ensure the availability and use of quality antimicrobial as well as laboratory and infection prevention and control supplies 4. Regulate food preparation and dispensary centres to enhance food hygiene and safety 5. Ensure proper disposal of unfit-for-use antimicrobials, laboratory supplies and residues 6. Establish standards for waste discharge and treatment from manufactur ing, food processing plants and human and animal health care settings 7. Establish predicted no-effect environmental concentration values for resistance selection 30 AMR Prevention and Containment Strategic Plan: 2021–2025 3.5 OBJECTIVE FIVE: STRENGTHEN AND ESTABLISH PARTNERSHIPS, ALLI ANCES, GOVERNANCE AND RESOURCE MOBILIZATION AT ALL LEVELS Description Antimicrobial resistance is a global and national threat that requires concerted and coordinated national and international efforts to bring together various stakeholders. This will influence opinion, obtain support, mobilize action, harness the expertise and resources available in different sectors and improve governance. All sectors must collaborate on innovations, resource mobilization and allocation, strengthen stew ardship practices and infection prevention and control, address the threats of antimicrobial resist ance, and move the issue of antimicrobial resistance to the political level. This objective is designed to strengthen and establish partnerships, alliances, governance and re source mobilization efforts for the effective implementation of the national strategic plan at all levels. The objective involves 3 initiatives, 6 interventions and 15 activities, as explained in the operational plan. AMR Prevention and Containment Strategic Plan: 2021–2025 31 Table 8: Initiatives and strategic interventions for objective five Objective five: Strengthen and establish partnerships, alliances, governance and resource mobilizations at all levels Strategic initiatives Strategic interventions Strengthen and establish governance, partnerships and alliances 1. Strengthen governance structures and collaboration of national and regional antimicrobial resistance stakeholders 2. Strengthen collaboration with multilateral and bilateral organizations engaging in antimicrobial resistance prevention and containment 3. Promote public–private partnerships on antimicrobial resistance preven tion and containment Strengthen leadership 1. Ensure leadership, ownership and commitment for the sustainable imple mentation of the antimicrobial resistance strategic plan across sectors Resource mobilization 1. Ensure the availability of sustainable resources 2. Ensure resource mobilization to encourage innovations in the develop ment of new antimicrobials, vaccines, diagnostics, novel therapies and/or alternatives 32 AMR Prevention and Containment Strategic Plan: 2021–2025 4. OPERATIONAL PLAN The national antimicrobial resistance prevention and containment strategic plan details an oper ational plan that describes activities to be implemented in line with the five strategic objectives. Priority area, interventions, detailed activity, indicator, time frame, frequency, lead implementer, collaborator and cost or budget have been identified. 5 Strategic Objectives 22 Initiatives 66 Interventions 180 Operational plans 2021 2022 2023 2024 2025 AMR Prevention and Containment Strategic Plan: 2021–2025 33 4. 1 O bj ec ti ve o ne : IM PR O V E A W A RE N ES S A N D U N D ER ST A N D IN G O F A N TI M IC RO B IA L RE SI ST A N C E TH RO U G H EF FE C TI V E B EH A V IO U R C H A N G E C O M M U N IC AT IO N , E D U C AT IO N A N D T RA IN IN G Ta bl e 9: D et ai le d op er at io na l p la n fo r ob je ct iv e on e In it ia ti ve 1 .1 : Im p ro ve a w ar e n e ss , u n d e rs ta n d in g a n d e m p o w e rm e n t o f cl ie n ts a n d c o m m u n it ie s S tr at e g ic in te rv e n ti o n s A ct iv it ie s In di ca to r Ti m e of im pl e m en ta ti on Fr e qu en cy (w ith in 5 ye ar s) Le ad im pl e m en te r C ol la bo ra to rs In di c at iv e bu dg et (U S$ ) D e si g n a n d p ro m o te su st ai n ab le w h o le o f so ci e ty e n g ag e m e n t th ro u g h e ff e ct iv e e n fo rc e m e n t o f th e O n e H e al th a p p ro ac h a n d co m m u n ic a ti o n p la tf o rm s D ev el op c om pr eh en siv e ev id en ce b as ed n at io na l c om m un ic at io n st ra te gi es fo r a nt im ic ro bi al re sis ta nc e in hu m an s, an im al s, pl an ts a nd th e en vi ro nm en t Co m m un ic at io n st ra te gy de ve lo pe d 20 21 – 20 22 1 M O H , M O A, EF CC C an d th ei r r eg io na l co un te rp ar ts Pr of es sio na l as so ci at io ns , ac ad em ia , m ed ia 94 50 .0 0 D ev el op a nd d is se m in at e in fo rm at io n an d ed uc at io n co m m un ic at io n an d be ha vi ou r c ha ng e co m m un ic at io n (p rin te d an d au di o vi su al ) m at er ia ls ta rg et in g di ve rs e be n ef ic ia rie s, in cl ud in g pe op le li vi ng w ith a d is ab ilit y N um be r o f i nf or m at io n an d ed uc at io n co m m un ic at io n an d be ha vi ou r c ha ng e co m m un ic at io n m at er ia ls de ve lo pe d 20 21 – 20 25 10 M O H , M O A, EF CC C an d th ei r r eg io na l co un te rp ar ts M ed ia , c iv il so ci et y 80 00 0. 00 Co nd uc t a nt im ic ro bi al re sis ta nc e aw ar en es s ca m pa ig ns re gu la rly (s uc h as W or ld A nt im ic ro bi al A w ar en es s W ee k, AM R D ay a nd o th er e ve nt s) a nd c ol la bo ra te w ith o th er ca m pa ig ns th at a re li nk ed to a nt im ic ro bi al re sis ta nc e to al ig n an d m ai ns tre am a nt im ic ro bi al re sis ta nc e m es sa g es (h an dw as hi ng d ay , E th io pi an g re at ru n, c ul tu re d ay , ch ild re n’s d ay , e tc .) N um be r o f c am pa ig ns co nd uc te d 20 21 – 20 25 10 M O H , M O A, EF CC C an d th ei r r e gi on al c ou nt er pa rts Ci vi l s oc ie ty , ac ad em ia , m ed ia , p ar t ne rs 12 5 00 0. 00 34 AMR Prevention and Containment Strategic Plan: 2021–2025 C o n t. .. . Co nd uc t s ur ve y (h ea lth p ro fe ss io na ls a nd c om m un ity ) to a ss es s kn ow le dg e, a tti tu de s an d be ha vi ou ra l p ra ct ic e ab ou t a nt im ic ro bi al s us e an d an tim ic ro bi al re sis ta nc e in hu m an h ea lth , a gr ic ul tu re a nd th e en vi ro nm en t N um be r o f s ur ve y re po rts 20 21 , 20 23 a nd 20 25 3 M O H , M O A, EF CC C an d th ei r r eg io na l co un te rp ar ts Ac ad em ia , pr of es sio na l as so ci at io ns , pa rtn er s 112 50 0. 00 U se m ul tim od al s tra te gi es fo r m as s co m m un ity p op ul ar iza tio n on a nt im ic ro bi al re sis ta nc e us in g ex is tin g co m m un ity pl at fo rm s ad ap te d to s pe ci fic s ta ke ho ld er g ro up s an d ta ilo re d to c ul tu ra l c on te xt s N um be r o f c om m un ity pl at fo rm s ut iliz ed 20 21 – 20 25 5 M O H , M O A, EF CC C an d th ei r r eg io na l co un te rp ar ts O pi ni on le ad er s, m ed ia , c iv il so ci et y 31 8 05 5. 56 Pr ov id e tra in in g fo r f oo d, a ni m al o w ne rs , h an dl er s an d pr oc es so rs a bo ut s af e fo od p ro du ct io n an d al te rn at iv es to an tim ic ro bi al s in p ub lic a nd p riv at e in st itu tio ns N um be r o f t ra in in g se ss io ns 20 21 – 20 25 25 M O A an d its re gi on al c ou n te rp ar ts M O H , E FC CC , EF D A, V D FA CA a nd th ei r r eg io na l co un te rp ar ts 39 0 00 0. 00 AMR Prevention and Containment Strategic Plan: 2021–2025 35 In co rp o ra te p e rs o n al , p u b lic a n d fo o d h yg ie n e an d s an it a ti o n , n u tr it io n , g o o d f ar m in g an d e n vi ro n m e n t h e al th co n tr o l p ra c ti ce s, r e la te d to t h e r at io n al m e d ic in e u se an d a n ti m ic ro b ia l r e si st an ce in t o s ch o o l cu rr ic u la a n d e xt ra cu rr ic u la r ac ti vi ti e s Ad vo ca cy fo r i nc lu sio n of a nt im ic ro bi al re sis ta nc e re la te d to pi cs in c ur ric ul ar a nd e xt ra cu rri cu la r a ct iv iti es N um be r o f a dv oc ac y se s sio ns 20 21 – 20 25 3 M O H , M O A, EF CC C an d th ei r r eg io na l co un te rp ar ts M O E an d th ei r r eg io na l co un te rp ar ts 32 40 0. 00 In cl us io n of a nt im ic ro bi al re sis ta nc e an d ra tio na l m ed ic in e us e to pi cs in e xt ra cu rri cu la r w or ks (s ch oo l h ea lth , n ut rit io n pr og ra m m e an d cl ub s) An tim ic ro bi al re sis ta nc e in co rp or at ed in to o ne o r m or e cl ub s in s el ec te d sc ho ol s 20 22 on w ar ds 1 M O E an d th ei r re gi on al c ou n te rp ar ts M O H , M O A, EF CC C an d th ei r r eg io na l co un te rp ar ts 45 60 0. 00 R ai se a w ar e n e ss o f cl ie n ts an d t h e p u b lic o n r at io n al u se o f an ti m i cr o b ia ls a n d ad h e re n ce to t re at m e n t an d p ro fe s si o n al a d vi ce th ro u g h h e al th e d u ca ti o n a n d tr ai n in g D ev el op jo b ai ds fo r p ro fe ss io na ls to im pr ov e ad he re nc e to co un se llin g in h um an a nd a ni m al h ea lth c ar e N um be r o f j ob a id s de ve l op ed 20 21 – 20 25 3 M O H , M O A Ac ad em ia 29 00 0. 00 In te gr at e an tim ic ro bi al re sis ta nc e an d ra tio na l m ed ic in e us e in to e xis tin g he al th e du ca tio n ac tiv iti es in w ai tin g ar ea s bo th in p ub lic a nd p riv at e fa ci lit ie s (e du ca tio n an d m en to rin g) Pe rc en ta ge o f f ac ilit ie s in te gr at in g ra tio na l m ed ic in e us e, a nt im ic ro bi al re sis ta nc e pr ev en tio n an d co nt ai nm en t in th ei r h ea lth e du ca tio n 20 21 – 20 25 80 % M O H , M O A H ea lth fa ci l iti es , h ea lth an d ag ric ul tu re e xt en sio n w or ke rs 10 5 00 0. 00 36 AMR Prevention and Containment Strategic Plan: 2021–2025 Im p ro ve aw ar e n e ss o n t h e r is k o f le ft o ve r an ti m ic ro b ia ls , p e st ic id e s, in se ct ic id e s an d h e av y m e ta l co n ta m in an ts in t h e e n vi ro n m e n t Ad vo ca te fo r t he im pl em en ta tio n of th e po lic y on s af e di s po sa l o f a nt im ic ro bi al s, pe st ic id es , in se ct ic id es a nd h ea vy m et al s at th e co m m un ity le ve l Im pl em en te d po lic y fra m e w or k an d gu id el in es o n sa fe di sp os al o f a nt im ic ro bi al s, pe st ic id es , in se ct ic id es a nd he av y m et al s at th e co m m un ity le ve l 20 22 1 EF CC C M O H , M O A, VD FA CA , EF D A 33 00 0. 00 D ev el op a nd d is se m in at e aw ar en es s ra isi ng m at er ia ls o n en vi ro nm en ta l w as te m an ag em en t f or fa rm er s, hu m an a nd an im al h ea lth fa ci lit ie s, fa rm s an d fo od h an dl er s N um be r o f a w ar en es s ra is in g m at er ia ls d ev el op ed 20 21 – 20 25 15 M O H , E FD A, M O A, V D FA CA , EF CC C Ci vi l s oc ie ty , ac ad em ia 27 20 0. 00 Im pr ov e ad he re nc e to p ro pe r d isp os al o f u nf it fo r-u se an tim ic ro bi al s fro m fa rm s, hu m an a nd a ni m al h ea lth fa ci lit ie s an d ot he r h az ar do us w as te s th ro ug h se ns iti za tio n w or ks ho ps N um be r o f e ve nt s or ga ni ze d 20 22 – 20 25 15 EF D A, V D FA CA , EF CC C Ci vi l s oc ie ty , ac ad em ia 15 7 50 0. 00 In it ia ti ve 1 .2 : E d u ca ti o n a n d t ra in in g o n a n ti m ic ro b ia l r e si st an ce f o r h u m an , an im al , p la n t an d e n vi ro n m e n ta l p ro fe ss io n al s at p u b lic a n d p ri va te in st it u ti o n s In co rp o ra te an ti m ic ro b ia l re si st an ce in c o u rs e co n te n ts o f te ch n ic al a n d vo ca ti o n al e d u ca ti o n an d t ra in in g (T V E T ), u n d e r g ra d u at e a n d p o st g ra d u at e cu rr ic u la Ad vo ca cy to in co rp or at e an tim ic ro bi al re sis ta nc e co ur se s in T VE T, un de rg ra du at e an d gr ad ua te c ur ric ul um N um be r o f a dv oc ac y se s sio ns c on du ct ed 20 21 – 20 23 5 M O H , M O A, EF CC C an d th ei r r eg io na l co un te rp ar ts M O SH E, M O E, ac ad em ia 54 50 0. 00 In co rp or at e an tim ic ro bi al re sis ta nc e in c ou rs e co nt en ts of T VE T, un de rg ra du at e an d po st gr ad ua te c ur ric ul um o f hu m an , a ni m al a nd e nv iro nm en t p ro fe ss io na ls An tim ic ro bi al re sis ta nc e in co rp or at ed in to th e cu r ric ul um 20 24 – 20 25 1 M O SH E, M O E M O H , M O A, EF CC C, ac ad em ia AMR Prevention and Containment Strategic Plan: 2021–2025 37 D e ve lo p a n d im p le m e n t re g u la r an d n e e d b as e d p re –g ra d u at io n a n d in s e rv ic e tr ai n in g a n d co n ti n u o u s p ro fe ss io n al d e ve lo p m e n t p ro g ra m m e s o n a n ti m i cr o b ia l u se , re si st an ce a n d st e w ar d sh ip an d in fe ct io n p re ve n ti o n an d c o n tr o l, in cl u d in g f o r h e al th a n d ag ri cu lt u re e xt e n si o n w o rk e rs Co nd uc t t ra in in g on re sp on sib le p re sc rib in g, d isp en sin g, us e, a nd a dm in is tra tio n pr ac tic es fo r h um an a nd a ni m al he al th c ar e pr of es sio na ls in cl ud in g fo r h ea lth a nd a gr ic ul tu re e xt en sio n w or ke rs N um be r o f t ra in in gs p ro vi d ed p er y ea r 20 21 – 20 25 15 p er se ct or M O H , M O A Ac ad em ia he al th fa ci li tie s, EF CC C 115 62 5. 00 Fa ci lit at e an d pr ov id e a pr e gr ad ua tio n tra in in g on a nt i m ic ro bi al u se , r es is ta nc e an d st ew ar ds hi p an d in fe ct io n pr ev en tio n an d co nt ro l f or h um an a nd a ni m al h ea lth pr of es sio na ls Pe rc en ta ge o f h ig he r e du ca tio n in st itu tio ns p ro vi di ng pr e gr ad ua tio n tra in in g on an tim ic ro bi al u se , r es is ta nc e an d st ew ar ds hi p an d in fe c tio n pr ev en tio n an d co nt ro l 20 22 – 20 25 10 0% Ac ad em ia , M O H , M O A, EF CC C, M O SH E M O E, p ro fe s sio na l a ss oc i at io ns 1 0 00 00 0. 00 In co rp or at e an tim ic ro bi al u se , r es is ta nc e an d st ew ar ds hi p an d in fe ct io n pr ev en tio n an d co nt ro l m od ul es a nd tr ai n in gs fo r h um an a nd v et er in ar y pr of es sio na ls , in cl ud in g fo r he al th a nd a gr ic ul tu re e xt en sio n w or ke rs N um be r o f p ro fe ss io na l as so ci at io ns th at h av e in co rp or at ed a nt im ic ro bi al re sis ta nc e pr ev en tio n an d co nt ai nm en t i n th ei r c on tin ue d pr of es sio na l d ev el op m en t t ra in in g 20 21 – 20 22 1 p er pr of es sio na l as so ci a tio n M O H , M O A, pr of es sio na l as so ci at io ns Ac ad em ia 27 12 5. 00 38 AMR Prevention and Containment Strategic Plan: 2021–2025 In it ia ti ve 1 .3 : E m p o w e r th e m e d ia (p u b lic a n d p ri va te ) a n d e n g ag e c iv il so ci e ty o rg an iz at io n s o n a n ti m ic ro b ia l r e si st an ce p re ve n ti o n a n d c o n ta in m e n t C ap ac it at e m e d ia a n d ci vi l s o ci e ty o n a n ti m ic ro b ia l r e si st an ce to e n su re t h e ir e n g ag e m e n t in e d u ca ti n g th e p u b lic Pr ov id e tra in in gs o n an tim ic ro bi al re sis ta nc e fo r m ed ia pr of es sio na ls (p rin t a nd e le ct ro ni c) N um be r o f t ra in in gs p ro vi d ed p er y ea r 20 21 – 20 25 10 M O H , M O A, EF CC C an d th ei r r eg io na l co un te rp ar ts M ed ia , c iv il so ci et y 40 62 5. 00 Co nd uc t a dv oc ac y w or ks ho ps o n an tim ic ro bi al re sis ta nc e fo r c iv il so ci et y gr ou ps N um be r o f w or ks ho ps pr ov id ed 20 21 – 20 22 , 20 23 – 20 24 2 M O H , M O A, EF CC C M ed ia , c iv il so ci et y 15 00 0. 00 D is se m in at e in fo rm at io n on a nt im ic ro bi al re sis ta nc e to th e ge ne ra l p ub lic th ro ug h m ed ia a nd c iv il so ci et y N um be r o f m ed ia a nd c iv il so ci et y se ss io ns o n an tim i cr ob ia l r es is ta nc e 20 21 – 20 25 50 M ed ia , c iv il so ci et y M O H , M O A, EF CC C, Et hi op ia n Br oa dc as tin g Co rp or at io n 14 75 0. 00 In it ia ti ve 1 .4 : A d vo ca cy a n d c o m m u n ic at io n o n a n ti m ic ro b ia l r e si st an ce w it h p o lic ym ak e rs a n d d e ci si o n m ak e rs A d vo ca te an ti m ic ro b ia l re si st an ce a s a n at io n al a n d g lo b al p ri o ri ty w it h p e rt in e n t p o lic ym ak e rs an d d e ci si o n m ak e rs to m ai n st re am an ti m ic ro b ia l re si st an ce p re ve n ti o n an d c o n ta in m e n t Co nd uc t a dv oc ac y w or ks ho ps N um be r o f a dv oc ac y w or k sh op s 20 21 – 20 25 3 N at io na l a nd re gi on al A dv i so ry C om m it te es M O H , M O A, EF CC C 18 90 0. 00 D ev el op p ol ic y br ie fin g an d di ss em in at e th em N um be r o f p ol ic y br ie fs di ss em in at ed 20 21 – 20 25 3 N at io na l a nd re gi on al A dv i so ry C om m it te es M O H , M O A, EF CC C 6 75 0. 00 To ta l 2 64 2 35 5. 56 AMR Prevention and Containment Strategic Plan: 2021–2025 39 4. 2 O B JE C TI V E TW O : S TR EN G TH EN T H E K N O W LE D G E A N D E V ID EN C E O N A N TI M IC RO B IA L U SE A N D R ES IS TA N C E TH RO U G H S U RV EI LL A N C E A N D R ES EA RC H Ta bl e 10 D et ai le d op er at io na l p la n fo r ob je ct iv e tw o St ra te gi c in te rv en ti on s A ct iv it ie s In di ca to r Ti m e of im pl e m en ta ti on Fr e qu en cy (w ith in 5 ye ar s) Le ad im pl em en t er C ol la bo ra to rs In di ca ti ve bu dg et (U S$ ) n it ia ti ve 2 .1 : E st ab lis h a n d s tr e n g th e n s u rv e ill an ce o n a n ti m ic ro b ia l r e si st an ce p ri o ri ty p at h o g e n s in h u m an a n d a n im al h e al th , fe e d a n d f o o d s af e ty , p la n t an d t h e e n vi ro n m e n t E st ab lis h a n d st re n g th e n a nt im i cr ob ia l r es is ta nc e su rv ei lla nc e sy s te m s to d et ec t an d re po rt a nt im ic ro bi al r es is ta nc e an d di ss em in at e in fo r m at io n to f ac ili ta te ev id en ce b as ed de ci si on m ak in g at a ll le ve ls in a ll se ct or s. D ev el op jo in t p la n to e st ab lis h su rv ei lla nc e sy st em o n an tim i cr ob ia l r es is ta nc e Av ai la bi lit y of jo in t p la n 20 21 1 EP H I, N at io na l A ni m al H ea lth , D ia gn os tic a nd In ve st ig at io n Ce nt er (N AH D IC ), EE FR I VD FA CA M O H , M O A AH RI , E FD A, EF CC C, N at io na l V et er i na ry In st itu te (N VI ), st ak e ho ld er s in th e re gi on al st at e, p riv at e di ag no st ic la bs 12 00 .0 0 Es ta bl ish a nd e xp an d an tim ic ro bi al re sis ta nc e se nt in el s ite s N um be r o f a nt im ic ro bi al re sis ta nc e se nt in el si te s 20 21 –2 02 5 30 EP H I, N AH D IC , E EF RI EP SA , p riv at e ph ar m ac eu tic al s up pl ie rs 3 29 9 70 0. 00 Es ta bl ish a nd s tre ng th en pr og ra m m at ic a nt im ic ro bi al re sis ta nc e su rv ei lla nc e sy st em fo r h um an a nd a ni m al h ea lth N um be r o f p ro gr am m at ic a nt im ic ro bi al re sis ta nc e su rv ei lla nc e sy st em s 20 21 –2 02 5 5 EP H I, N AH D IC M O H , W H O 4 92 4 00 0. 00 O rg an ize a n an tim ic ro bi al re sis ta nc e da ta a nd in fo rm at io n di ss em in at io n pl at fo rm a nd re vi ew m ee tin g An nu al re vi ew m ee tin g co nd uc te d 20 21 –2 02 5 5 M O H , M O A, E FC CC an d th ei r a ge nc ie s Re se ar ch in st itu te s, de ve l op m en t p ar tn er s, m ed ia 27 0 00 0. 00 Es ta bl ish a n an tim ic ro bi al re sis ta nc e da ta ba se a nd g en er at e re po rts a m on g th e hu m an , an im al a nd p la nt h ea lth , fo od sa fe ty a nd e nv iro nm en t s ec to rs Es ta bl ish ed n at io na l an tim ic ro bi al re sis ta nc e da ta ba se 20 21 –2 02 2 1 M O H , M O A, E FC CC D ev el op m en t p ar tn er s 50 0 00 0. 00 40 AMR Prevention and Containment Strategic Plan: 2021–2025 St ra te gi c in te rv en ti on s A ct iv it ie s In di ca to r Ti m e of im pl e m en ta ti on Fr e qu en cy (w ith in 5 ye ar s) Le ad im pl em en t er C ol la bo ra to rs In di ca ti ve bu dg et (U S$ ) Es ta bl is h m ul ti in st it ut io na l n et w or ks to c ol la te a nd ch an ne l s ur ve il la nc e re po rt s an d ca se s tu di es o n an ti m ic ro bi al r es is t an ce a nd in fo rm ed po lic ym ak in g an d de ci si on m ak in g Cr ea te O ne H ea lth a nt im ic ro bi al re sis ta nc e su rv ei lla nc e an d re se ar ch p la tfo rm s Pl at fo rm c re at ed 20 21 1 EP H I, N AH D IC , A H RI , EE FR I M O H , M O A, E FC CC , de ve lo pm en t p ar tn er s, ac ad em ia 81 0 00 .0 0 N um be r o f p la tfo rm m ee tin gs c on du ct ed 20 22 –2 02 5 5 G en er at e an d di ss em in at e in te gr at ed a nt im ic ro bi al re sis ta nc e su rv ei lla nc e re po rts fr om a ll se ct or s N um be r o f j oi nt re po rts an d re se ar ch a rti cl es di ss em in at ed 20 21 –2 02 5 5 EP H I, N AH D IC , A H RI , EE FR I M O H , M O A, E FC CC , d ev el op m en t p ar tn er s 65 0 00 .0 0 Pr ep ar e po lic y br ie fs W rit te n po lic y br ie fs 20 21 –2 02 5 2 EP H I, N AH D IC , A H RI , EE FR I M O H , M O A, E FC CC , d ev el op m en t p ar tn er s 27 00 .0 0 Es ta bl is h a re al t im e pa ti en t a nd p op u la ti on b as ed a nt i m ic ro bi al r es is ta nc e su rv ei lla nc e sy st em Co nd uc t r ea l-t im e pa tie nt ( hu m an a nd a ni m al ) a nd p op ul at io n ba se d an tim ic ro bi al re sis ta nc e su rv ei lla nc e N um be r o f r ea l-t im e su rv ei lla nc e re po rts pr od uc ed 20 21 –2 02 5 2 EP H I, N AH D IC , E EF RI M O H , M O A, E FC CC 10 8 00 0. 00 M on ito r a nt im ic ro bi al re sis t an ce tr en ds to d em on st ra te th e ex te nt o f t he p ro bl em in h um an , an im al a nd p la nt h ea lth , fo od sa fe ty a nd th e en vi ro nm en t N um be r o f s ur ve y re po rts c on du ct ed 20 21 –2 02 5 5 EP H I, N AH D IC , E EF RI M O H , M O A, E FC CC 27 0 00 .0 0 AMR Prevention and Containment Strategic Plan: 2021–2025 41 St ra te gi c in te rv en ti on s A ct iv it ie s In di ca to r Ti m e of im pl e m en ta ti on Fr e qu en cy (w ith in 5 ye ar s) Le ad im pl em en t er C ol la bo ra to rs In di ca ti ve bu dg et (U S$ ) St re ng th en a nd m ai nt ai n a na ti on al bi o re po si to ry o n an ti m ic ro bi al r es is t an ce p ri or it y or ga n is m s, s tr ai ns a nd ge ne s D ev el op a nd d is se m in at e a na tio na l b io re po si to ry g ui de lin es D ev el op ed a nd d is se m in at ed b io re po si to ry gu id el in es 20 22 –2 02 3 1 EB I, E PH I, N AH D IC , EE FR I A H RI , A ni m al Pr od uc ts , V et er in ar y D ru g an d Fe ed Q ua l ity A ss es sm en t Ce nt er (A PV D F Q AC ) M O H , M O A, E FC CC , d ev el op m en t p ar tn er s, W H O 13 5 00 .0 0 St re ng th en th e ex is tin g na tio na l bi o re po si to ry (b io b an k) c en tre Ce nt er s tre ng th en ed 20 23 –2 02 5 1 EB I, E PH I, N AH D IC , EE FR I, A H RI , A PV D F Q AC M O H , M O A, E FC CC , d ev el op m en t p ar tn er s W H O 2 00 0 00 0. 00 Es ta bl is h an a le rt sy st em o n em er g in g an d re e m er g in g an ti m ic ro bi al re si st an ce is su es th at h av e pu bl ic an d an im al h ea lt h em er ge nc y im po r ta nc e D ev el op p ro to co ls a nd g ui de lin es fo r n ot ify in g of a n an ti m ic ro bi al re sis ta nc e in fe ct io n ou tb re ak Pr ot oc ol a nd g ui de lin es de ve lo pe d 20 22 1 EP H I, N AH D IC M O H , M O A, E FC CC 60 00 .0 0 G en er at e al er t r ep or t G en er at ed a le rt re po rts 20 21 –2 02 5 Co nt in uo us EP H I, N AH D IC , A H RI , AP VD F Q AC M O H , M O A, E FC CC 42 AMR Prevention and Containment Strategic Plan: 2021–2025 St ra te gi c in te rv en ti on s A ct iv it ie s In di ca to r Ti m e of im pl e m en ta ti on Fr e qu en cy (w ith in 5 ye ar s) Le ad im pl em en t er C ol la bo ra to rs In di ca ti ve bu dg et (U S$ ) In it ia ti ve 2 .2 : B u ild u p t h e c ap ac it y fo r a q u al it y m an ag e m e n t sy st e m o f la b o ra to ri e s fo r h u m an , an im al a n d p la n t h e al th , fe e d a n d f o o d s af e ty a n d e n vi ro n m e n t te st in g a t n at io n al , re g io n al a n d f ac ili ty le ve ls St an da rd iz e m ic ro bi ol og y la bo ra to ry m et ho do lo gi es an d te ch ni qu es , in cl ud in g ad va nc ed de te ct io n m et ho ds Co nd uc t a ss es sm en t o f g ap s in sa m pl e co lle ct io n, s hi pm en t, bi os af et y, bi os ec ur ity a nd la bo ra to ry sk ills a nd k no w le dg e As se ss m en t r ep or ts 20 21 –2 02 3 2 EP H I, N AH D IC , E EF RI M O H , M O A, E FC CC , d ia gn os tic la bo ra to rie s, ac ad em ia , pa rtn er s 63 0 00 .0 0 Pr ep ar e a la bo ra to ry im pl em en ta tio n pl an b as ed o n th e id en tif ie d ga ps (s am pl e co lle ct io n, tr an sp or t, su bm is sio n, p ro ce ss in g an d co n fir m at or y te st in g, tr ai ni ng , c on su m ab le s an d eq ui pm en t) Im pl em en ta tio n pl an ex ec ut ed 20 22 1 EP H I, N AH D IC , E EF RI M O H , M O A, E FC CC , d ev el op m en t p ar tn er s D ev el op a nd re vi ew a la bo ra to ry sa m pl e re fe rra l s ys te m N um be r o f n et w or ke d la bo ra to rie s 20 22 1 EP H I, N AH D IC , E EF RI M O H , M O A, E FC CC , d ev el op m en t p ar tn er s 12 18 0. 00 D ev el op a nd d is se m in at e a na tio n al h ar m on ize d re fe re nc e m an ua l or g ui de lin es o n an tim ic ro bi al re sis ta nc e re la te d te st s Av ai la bi lit y of h ar m on ize d m an ua l 20 21 –2 02 2 1 EP H I, N AH D IC , E EF RI M O H , M O A, E FC CC , E th io pi an S ta nd ar ds A ge nc y (E SA ), he al th fa ci lit ie s, la bo ra to rie s de ve lo pm en t p ar tn er s 21 12 0. 00 D ev el op a nd c on du ct in te rn al qu al ity c on tro l N um be r o f a nt im ic ro bi al re sis ta nc e si te s im pl e m en tin g in te rn al q ua lit y co nt ro l 20 21 –2 02 5 30 EP H I, N AH D IC , E EF RI M O H , M O A, E FC CC , d ev el op m en t p ar tn er s N A In vo lv e an tim ic ro bi al re sis ta nc e su rv ei lla nc e si te s in e xt er na l q ua lit y as su ra nc e sc he m es N um be r o f a nt im ic ro bi al re sis ta nc e si te s pa rti ci pa tin g in e xt er na l q ua lit y as su ra nc e sc he m es (t hr ee tim es p er y ea r) 20 21 –2 02 4 30 EP H I, N AH D IC , E EF RI M O H , M O A, E FC CC , d ev el op m en t p ar tn er s 50 6 25 0. 00 Fa ci lit at e ex te rn al q ua lit y as su r an ce s ch em es p ro fic ie nc y te st in g pa ne l p ro du ct io n N um be r o f e xt er na l q ua l ity a ss ur an ce s ch em es pa ne l p ro du ct io n 20 25 2 EP H I, N AH D IC M O H , M O A, d ev el op m en t pa rtn er s 1 2 97 6 62 .0 0 Pr oc ur e Am er ic an ty pe c ul tu re co lle ct io n st ra in s Un in te rru pt ed in te rn al qu al ity c on tro l a nd c on fir m at or y te st s 20 21 –2 02 5 Co nt in u ou s EP H I, N AH D IC , E th i op ia n En vi ro nm en t an d Fo re st R es ea rc h In st itu te (E EF RI ) M O H , M O A, E FC CC , d ev el op m en t p ar tn er s 50 1 0 00 .0 0 AMR Prevention and Containment Strategic Plan: 2021–2025 43 St ra te gi c in te rv en ti on s A ct iv it ie s In di ca to r Ti m e of im pl e m en ta ti on Fr e qu en cy (w ith in 5 ye ar s) Le ad im pl em en t er C ol la bo ra to rs In di ca ti ve bu dg et (U S$ ) Es ta bl ish a m ic ro bi ol og y m ed ia pr ep ar at io n ce nt re Ce nt re e st ab lis he d 20 22 –2 02 5 3 EP H I, N AD H IC , A H RI , EE FR I, r eg io na l l ab o ra to rie s M O H , M O A, E FC CC , d ev el op m en t p ar tn er s 50 0 00 0. 00 Im pl em en t a q ua lit y m an ag e m en t s ys te m N um be r o f a nt im ic ro bi al re sis ta nc e si te s im pl em en tin g a la bo ra to ry qu al ity m an ag em en t sy st em 20 21 –2 02 5 30 Su rv ei lla nc e si te s, EP H I, N AH D IC , EF CC C, E EF RI M O H , M O A, E FC CC , d ev el op m en t p ar tn er s 13 5 00 0. 00 En su re in vo lv em en t o f a nt im i cr ob ia l r es is ta nc e su rv ei lla nc e la bo ra to rie s in a n ac cr ed ita tio n sy st em N um be r o f a cc re di te d la bo ra to rie s 20 21 –2 02 5 10 Su rv ei lla nc e si te s, EP H I, N AH D IC , EF CC C, E EF RI M O H , M O A, E FC CC , d ev el op m en t p ar tn er s Es ta bl is h an d st re ng th en la bo ra to ry f ac ili ti es a nd eq ui pm en t m ai nt e na nc e an d ca lib ra ti on c en tr e Co nd uc t a fe as ib ilit y st ud y fo r st re ng th en in g th e na tio na l c al i br at io n an d m et ro lo gy c en tre Fe as ib ilit y st ud y co n du ct ed 20 22 1 EP H I, N AH D IC , E EF RI , N at io na l M et ro lo gy In st itu te o f E th io pi a M O H , M O A, E FC CC , d ev el op m en t p ar tn er s 30 00 .0 0 St re ng th en in c ou nt ry e qu ip m en t m ai nt en an ce a nd c al i br at io n se rv ic es a t t he n at io na l le ve l Av ai l o f m ai nt en an ce an d ca lib ra tio n se rv ic es at th e na tio na l l ev el 20 21 –2 02 5 5 EP H I, N AH D IC , E EF RI M O H , M O A, E FC CC , d ev el op m en t p ar tn er s 90 0 00 .0 0 44 AMR Prevention and Containment Strategic Plan: 2021–2025 St ra te gi c in te rv en ti on s A ct iv it ie s In di ca to r Ti m e of im pl e m en ta ti on Fr e qu en cy (w ith in 5 ye ar s) Le ad im pl em en t er C ol la bo ra to rs In di ca ti ve bu dg et (U S$ ) B ui ld u p th e ca pa ci ty o f hu m an re so ur ce s fo r sp ec im en m an ag em en t, co nd uc ti ng c ul tu re , id en ti fic at io n an d an ti m ic ro bi al s en si ti vi ty t es ts a nd re po rt in g in r el at io n to h um an s, a ni m al s, th e en vi ro nm en t an d fe ed a nd f oo d pr oc es si ng , u si ng ph en ot yp ic a nd m o le cu la r m et ho ds D ev el op tr ai ni ng m at er ia ls a nd pr ov id e tra in in g fo r p ro fe ss io n al s w or ki ng a t s en tin el s ite s Tr ai ni ng p ro vi de d 20 21 –2 02 5 2 EP H I, N AH D IC , E EF RI Su rv ei lla nc e si te s, de ve l op m en t p ar tn er s 45 0 00 .0 0 St re ng th en t he la bo ra to ry in fo rm a ti on m an ag em en t sy st em s As se ss th e ex is tin g la bo ra to ry in fo rm at io n sy st em As se ss m en t r ep or t 20 22 1 EP H I, N AH D IC , E EF RI , he al th fa ci lit ie s, la bo ra to rie s M O H , M O A, E FC CC , d ev el op m en t p ar tn er s 6 30 0. 00 Es ta bl ish a s ta nd ar di ze d la bo ra to ry in fo rm at io n sy st em N um be r o f f ac ilit ie s w ith s ta nd ar di ze d la bo ra to ry in fo rm at io n sy st em 20 21 –2 02 5 15 21 0 00 .0 0 AMR Prevention and Containment Strategic Plan: 2021–2025 45 In it ia ti ve 2 .3 : B as ic a n d o p e ra ti o n al r e se ar ch C on du ct b as ic an d op er at io na l re se ar ch o n an ti m ic ro bi al u se , co ns um pt io n an d re si st an ce Id en tif y pr io rit y op er at io na l r es ea rc h ar ea s Id en tif ie d op er at io na l re se ar ch a re as 20 22 a nd 20 24 2 M O H , M O A, E PH I, AH RI , N AH D IC , EF CC C, E EF RI , ac ad em ia Pr of es sio na l as so ci at io ns , EF D A, V D FA CA Co nd uc t r es ea rc h on p rio rit ize d ar ea s (in cl ud in g bu rd en a nd im pa ct o f a nt im i cr ob ia l r es is ta nc e) a nd d et er m in in g ris k fa ct or s an d dr iv er s of re sis ta nc e N um be r o f r es ea rc h st ud ie s co nd uc te d 20 22 –2 02 5 11 EP H I, N AH D IC , EE FR I, A H RI , ac ad em ia , A PV D F Q AC , p ro fe ss io na l as so ci at io ns M O H , M O A, EF CC C 21 2 52 0. 00 Co nd uc t s ys te m at ic re vi ew a nd m e ta a na ly sis o f n at io na l s tu di es o n an ti m ic ro bi al u se , r es is ta nc e an d co ns um p tio n an d an tim ic ro bi al re sid ue le ve ls Sy st em at ic re vi ew an d m et a an al ys is co nd uc te d 20 23 –2 02 4 1 EP H I, A H RI , N AH D IC , E FD A, V D FA CA , E EF RI M O H , M O A, EF CC C, de ve lo pm en t pa rtn er s 75 00 .0 0 In tr od uc e in no va ti ve t ec hn ol og ie s an d re se ar ch f or in fe ct io n an d an ti m ic ro bi al r es is t an ce r ap id d ia g no st ic t es ts a nd m et ho ds As se ss in no va tiv e te ch no lo gi es a nd m et ho ds to in tro du ce in no va tiv e ra pi d di ag no st ic te ch ni qu es As se ss m en t r ep or t 20 22 O nc e Su rv ei lla nc e si te s, EP H I, N AH D IC , AH RI , E EF RI , a ca de m ia M O H , M O A, EF CC C, de ve lo pm en t pa rtn er s 30 0 00 .0 0 Ad op t n ew d ia gn os tic to ol s, eq ui pm en t, ki ts a nd p oi nt o f-c ar e de vi ce s an d te ch ni qu es (f ie ld a pp lic ab le ra pi d te st s) N um be r o f p oi nt o f ca re te st s in tro du ce d 20 21 –2 02 5 Co nt in uo us 72 0 00 0. 00 46 AMR Prevention and Containment Strategic Plan: 2021–2025 Re se ar ch o n di ag no st ic s an d tr ea t m en t al te rn at iv es fo r in fe ct io ns t ha t ca n be t re at ed w it h an ti m ic ro bi al s Co nd uc t r es ea rc h to in tro du ce n ew an d im pr ov ed v ac ci ne s fo r h um an s an d an im al s (p ne um oc oc ca l v ac ci ne ) N um be r r es ea rc h st ud ie s pr od uc ed 20 21 –2 02 5 2 EP H I, N AH D IC , EE FR I, N VI A H RI , ac ad em ia , A PV D F Q AC M O H , M O A, EF CC C, p ro fe s sio na l a ss oc ia tio ns 23 5 00 .0 0 Co nd uc t r es ea rc h to id en tif y ra pi d or be st d ia gn os tic m et ho ds a nd /o r m et ric s to im pr ov e ra tio na l u se o f a nt im i cr ob ia ls N um be r o f r es ea rc h st ud ie s pr od uc ed 20 21 –2 02 5 6 EP H I, N AH D IC , AH RI , a ca de m ia a f fil ia te d w ith re fe rra l ho sp ita ls M O H , M O A, EP H I, N AH D IC , EF CC C, A H RI , AP VD F Q AC pr of es sio na l as so ci at io ns 10 0 00 0. 00 Un de rta ke jo in t v ac ci na tio n as se ss m en t to id en tif y ga ps o n se le ct ed h um an a nd an im al d is ea se s Jo in t v ac ci na tio n co ve ra ge a ss es s m en t u nd er ta ke n 20 23 1 M O A, E PH I, A H RI M O H , N VI , N AH D IC , t he ir re gi on al a nd ci ty a dm in is tra tio n co un te rp ar ts , h ea lth fa ci lit ie s 75 00 .0 0 D ev el op a n A M R in de x to c om m un i ca te g ap s in a n ti m ic ro bi al e ff ec ti ve ne ss a nd h el p ag gr eg at e da ta on r es is ta nc e to as se ss t re nd s ov er ti m e an d ac ro ss lo ca ti on s Id en tif y ke y st ak eh ol de rs St ak eh ol de rs id en tif ie d 20 21 –2 02 5 1 M O H , M O A, E FC CC EE FR I, p ro fe s sio na l a ss oc i at io ns , E PH I, N AH D IC , A H RI , AP VD F Q AC , ac ad em ia N A G at he r a nd d is se m in at e AM R in de x AM R in de x av ai la bl e 20 21 –2 02 5 1 EP H I, N AH D IC , EF CC C M O H , M O A 45 00 .0 0 AMR Prevention and Containment Strategic Plan: 2021–2025 47 In it ia ti ve 2 .4 : E st ab lis h a n d s tr e n g th e n s u rv e ill an ce a n d r e se ar ch o n a n ti m ic ro b ia l c o n ta m in an ts a n d r e si d u e s an d t h e d ri ve rs o f an ti m ic ro b ia l r e si st an ce in t h e e n vi ro n m e n t, p la n t, f o o d a n d f e e d s e ct o rs Es ta bl ish a nd s tre ng th en s ur ve illa nc e an d re se ar ch o f a nt im ic ro bi al re sid ue s, eff lu en ts a nd w as te in th e en vi ro n m en t, pl an t a nd fo od se ct or s Es ta bl ish n at io na l a nt im ic ro bi al re sid ue su rv ei lla nc e sy st em fo r e nv iro nm en t, pl an t a nd fo od s af et y Sy st em e st ab lis he d 20 22 1 EF D A, V D FA CA , EE FR I M O H , M O A, EF CC C, E PH I, N AH D IC , A H RI 75 00 .0 0 Co nd uc t r es ea rc h an d su rv ei lla nc e on an tim ic ro bi al re sid ue s in fo od , e ffl ue nt s an d w as te N um be r o f r es ea rc h re po rt pr od uc ed 20 21 –2 02 5 5 VD FA CA , E FD A ac ad em ia A H RI , EE FR I M O H , M O A, EF CC C, E PH I 45 0 00 .0 0 M on ito r t he le ve l o f a nt im ic ro bi al re s id ue s, ba se d on th e su rv ei lla nc e an d re se ar ch fi nd in gs in fo od , m an uf ac tu rin g pl an ts , h ea lth fa ci lit ie s, ot he r i ns tit u tio ns , in di vi du al h ou se ho ld s, w as te fr om an im al s an d sla ug ht er h ou se s N um be r o f m on ito rin g ac tiv iti es pe rfo rm ed 20 23 –2 02 5 3 VD FA CA , E FD A, AH RI , E EF RI M O H , M O A, EF CC C, E PH I, ac ad em ia 22 5 00 .0 0 Id en tif y pr io rit y fo od bo rn e pa th og en ic in di ca to r b ac te ria l s pe ci es in a ni m al , pl an t a nd a qu at ic o rig in s D at a ge ne ra te d an d re po rte d 20 22 –2 02 3 1 AH RI , E PH I, N AH D IC , E EF RI M O H , M O A, EF CC C 20 0 00 .0 0 To ta l 15 0 34 13 2. 00 48 AMR Prevention and Containment Strategic Plan: 2021–2025 4. 3 O B JE C TI V E TH RE E: E N H A N C E IN FE C TI O N P RE V EN TI O N A N D C O N TR O L TH RO U G H E FF EC TI V E EN V IR O N M EN TA L H EA LT H , I N FE C TI O N P RE V EN TI O N A N D B IO R IS K M A N A G EM EN T IN H U M A N , A N IM A L A N D P LA N T H EA LT H C A RE Ta bl e 11 : D et ai le d op er at io na l p la n fo r ob je ct iv e th re e In it ia ti ve 3 .1 : S tr e n g th e n a n d p ro m o te in fe ct io n p re ve n ti o n a n d c o n tr o l p ro g ra m m e s fo r h u m an , an im al a n d p la n t h e al th a n d t h e e n vi ro n m e n t St ra te gi c in te r ve nt io ns A ct iv it ie s In di ca to r Ti m e of im pl em en ta ti on Fr e qu en cy (w ith in 5 ye ar s) Le ad im pl e m en te r C ol la bo ra to rs In di ca ti ve bu dg et (U S$ ) C oo rd in at e m ul ti se ct or c ol la b or at io n to li m it th e em er ge nc e, re e m er ge nc e an d sp re ad o f an ti m ic ro bi al re si st an ce a nd m ul ti pl e dr ug re si st an t or ga n is m s in h um an s, an im al s, p la nt s an d th e en vi ro n m en t Es ta bl ish a nd s tre ng th en m ul tis ec to r ta sk fo rc e on in fe ct io n pr ev en tio n an d co nt ro l a nd h yg ie ne M ul tis ec to r t as k fo rc e es ta bl ish ed a t ea ch le ve l 20 21 –2 02 2 13 M O H , M O A, EF CC C Fa ci lit ie s, ac ad em ia , de ve lo pm en t p ar t ne rs 65 0 00 .0 0 D ev el op g ui de lin es fo r h er d he al th pa ck ag es , s uc h as d is ea se p re ve nt io n an d co nt ro l, g oo d hu sb an dr y pr ac tic es , bi o ris k m an ag em en t, eff lu en ts a nd m an ur e, a nd w as te d isp os al m an ag e m en t G ui de lin es d ev el op ed 20 22 3 M O H , M O A, EF CC C H ea lth , a gr ic ul tu re an d en vi ro nm en t bu re au s, un iv er si tie s, fa ci lit ie s, de ve lo p m en t p ar tn er s 68 4 00 .0 0 O rg an ize p la tfo rm s to id en tif y, sh ar e an d re w ar d be st p ra ct ic es o n in fe ct io n pr ev en tio n an d co nt ro l N um be r o f e ve nt s or ga ni ze d to s ha re a nd re w ar d be st pr ac tic es o n in fe ct io n pr ev en tio n an d co nt ro l 20 21 –2 02 5 5 M O H , M O A, EF CC C Ac ad em ia , r es ea rc h in st itu te s, pr of es sio n al a ss oc ia tio ns 35 0 00 .0 0 AMR Prevention and Containment Strategic Plan: 2021–2025 49 Se t an d en fo rc e st an da rd s on in fe ct io n pr ev en ti on a nd c on tr ol pr ac ti ce s as pe r O ne H ea lt h ap pr oa ch D ev el op in st itu tio na l i nf ec tio n pr ev en tio n an d co nt ro l p ol ic ie s an d st an da rd pr ot oc ol s an d m on ito rin g to ol s, in cl ud in g he rd d is ea se p re ve nt io n an d co n tro l, g oo d hu sb an dr y pr ac tic es , b io r isk m an ag em en t a nd e ffl ue nt s, m an ur e an d w as te d isp os al m an ag em en t D ev el op ed in fe ct io n pr e ve nt io n an d co nt ro l p ol ic ie s, pr ot oc ol s an d to ol s 20 21 –2 02 2 3 M O H , M O A, EF CC C H ea lth , a gr ic ul tu re an d en vi ro nm en t bu re au s, fa ci lit ie s 68 4 00 .0 0 En fo rc e ad he re nc e to in fe ct io n pr ev en tio n an d co nt ro l p ol ic ie s an d st an da rd s Pe rc en ta ge o f f ac ilit ie s ad he r in g to th e st an da rd s 20 22 –2 02 5 80 % M O H , M O A an d th ei r r eg io na l co un te rp ar ts Fa ci lit ie s 75 00 .0 0 D ev el op p ro to co ls a nd gu id el in es f or in fe ct io n ou t br ea k de te ct io n an d ca se m an ag em en t du e to a nt im ic ro bi al re si st an ce a nd m ul ti pl e dr ug re si st an t st ra in s D ev el op c as e m an ag em en t p ro to co ls an d gu id el in es fo r i nf ec tio n ou tb re ak s du e to a nt im ic ro bi al re sis ta nc e an d m ul tip le d ru g re sis ta nt s tra in s D ev el op ed p ro to co ls a nd gu id el in es 20 21 1 M O H , M O A an d th ei r r eg io na l co un te rp ar ts EF CC C, fa ci lit ie s 65 00 .0 0 Pr in t, di ss em in at e an d di st rib ut e ou t br ea k de te ct io n an d ca se m an ag em en t pr ot oc ol s an d gu id el in es Pr in te d an d di ss em in at ed pr ot oc ol s an d gu id el in es 20 22 1 M O H , M O A, a nd th ei r r eg io na l co un te rp ar ts EF CC C, fa ci lit ie s 50 00 .0 0 50 AMR Prevention and Containment Strategic Plan: 2021–2025 In it ia ti ve 3 .2 : S tr e n g th e n in fe ct io n p re ve n ti o n a n d c o n tr o l p ra ct ic e s in p u b lic a n d v e te ri n ar y h e al th f ac ili ti e s E n su re im p le m en ta ti on o f sa fe in fe ct io n pr ev en ti on a nd co nt ro l p ra c ti ce s in h um an an d ve te ri na ry he al th f ac ili ti es Es ta bl ish a nd s tre ng th en a fu nc tio na l in fe ct io n pr ev en tio n an d co nt ro l c om m itt ee a t t he h um an a nd a ni m al h ea lth fa ci lit y le ve l Pe rc en ta ge o f f ac ilit ie s w ith fu nc tio na l i nf ec tio n pr ev en tio n an d co nt ro l c om m itt ee 20 21 –2 02 5 10 0% Re gi on al b ur ea us , hu m an a nd an im al h ea lth fa ci lit ie s M O H , M O A, d ev el op m en t p ar tn er s 10 0 00 0. 00 Pr om ot e th e av ai la bi lit y of in fe ct io n pr ev en tio n an d co nt ro l m at er ia ls , su pp lie s an d eq ui pm en t, in cl ud in g sa fe an d ad eq ua te w at er s up pl y in h ea lth fa ci lit ie s Pe rc en ta ge o f f ac ilit ie s w ith re qu ire d in fe ct io n pr ev en tio n an d co nt ro l s up pl ie s 20 21 –2 02 5 80 % H ea lth fa ci lit ie s, M O H , M O A an d th ei r r eg io na l co un te rp ar ts M in is try o f W at er Irr ig at io n an d En er gy , su pp lie rs 50 0 00 .0 0 M on ito r t he in fe ct io n pr ev en tio n an d co nt ro l p ra ct ic es a t t ar ge te d fa ci lit ie s N um be r o f f ac ilit ie s m on i to re d 20 21 –2 02 5 20 0 M O H , M O A an d th ei r r eg io na l co un te rp ar ts EF CC C, h ea lth fa ci l iti es , d ev el op m en t pa rtn er s 25 0 00 .0 0 Co nd uc t i n se rv ic e tra in in gs o n in fe c tio n pr ev en tio n an d co nt ro l N um be r o f t ra in in gs p ro vi de d 20 21 –2 02 5 15 M O H , M O A, a nd th ei r r eg io na l co un te r p ar ts , ac ad em ia , p ro fe ss io na l a ss oc i at io ns EF CC C, h ea lth fa ci l iti es , d ev el op m en t pa rtn er s 20 0 00 0. 00 AMR Prevention and Containment Strategic Plan: 2021–2025 51 Pr ev en t an d m on it or h ea lt h ca re a ss oc ia te d in fe ct io ns a t hu m an a nd v et er in ar y he al th fa ci lit ie s Co nd uc t h ea lth c ar e as so ci at ed in fe c tio ns s ur ve y at th e he al th fa ci lit y le ve l N um be r o f s ur ve ys c on du ct ed 20 21 1 M O H , M O A an d th ei r r eg io na l co un te rp ar ts H ea lth fa ci lit ie s, de ve lo pm en t p ar tn er s 12 2 50 .0 0 Im pl em en t h ea lth c ar e as so ci at ed in fe ct io n pr ev en tio n m ea su re s Pe rc en ta ge o f h ea lth fa ci lit ie s w ith h ea lth c ar e as so ci at ed in fe ct io n pr ev en tio n m ea s ur es 20 21 –2 02 5 10 0% H ea lth fa ci lit ie s M O H a nd re gi on al co un te rp ar ts , W H O , de ve lo pm en t p ar t ne rs 87 5 00 .0 0 Pe rc en ta ge re du ct io n of he al th c ar e as so ci at ed in fe ct io ns 20 24 10 % re du ct io n fro m ba se lin e H ea lth fa ci lit ie s M O H a nd re gi on al co un te rp ar ts , W H O , de ve lo pm en t p ar t ne rs 12 2 50 .0 0 Im pl em en t c lin ic a cq ui re d in fe ct io n pr ev en tio n m ea su re s in a ni m al h ea lth fa ci lit ie s Pe rc en ta ge o f h ea lth fa ci lit ie s w ith h ea lth c ar e as so ci at ed in fe ct io ns p re ve nt io n pl an 20 21 –2 02 5 50 % M O A, re gi on al a gr ic ul tu re bu re au s, an im al he al th fa ci lit ie s D ev el op m en t p ar t ne rs St re ng th en pr ev en ti on o f zo on ot ic d is ea s es As se ss p re va le nc e an d ris k fa ct or s of zo on ot ic d is ea se s Su rv ey s co nd uc te d 20 21 1 M O H , M O A, EF CC C H ea lth , a gr ic ul tu re an d en vi ro nm en t bu re au s, un iv er si tie s 34 2 00 .0 0 D ev el op in te gr at ed z oo no tic d is ea se pr ev en tio n an d co nt ro l a ct io n pl an Ac tio n pl an d ev el op ed 20 22 1 M O H , M O A, EF CC C H ea lth , a gr ic ul tu re an d en vi ro nm en t bu re au s, un iv er si tie s 11 40 0. 00 D es ig n an d im pl em en t c ol la bo ra tiv e ev id en ce b as ed in te rv en tio ns N um be r o f i nt er ve nt io ns 20 22 –2 02 3 4 M O H , M O A, EF CC C H ea lth , a gr ic ul tu re an d en vi ro nm en t bu re au s, un iv er si tie s 22 8 00 .0 0 In te gr at e zo on ot ic d is ea se p re ve nt io n th ro ug h th e O ne H ea lth a pp ro ac h at re gi on a nd fa ci lit y le ve ls Pe rc en ta ge o f f ac ilit ie s an d re gi on s pr ac tis in g th e O ne H ea lth a pp ro ac h 20 21 –2 02 5 10 0% M O H , M O A, EF CC C H ea lth , a gr ic ul tu re an d en vi ro nm en t bu re au s, un iv er si tie s 45 0 00 .0 0 52 AMR Prevention and Containment Strategic Plan: 2021–2025 In it ia ti ve 3 .3 : S tr e n g th e n g o o d a n im al h u sb an d ry p ra ct ic e s P ro m o te b io r is k m an ag em en t an d go od h us ba nd ry p ra ct ic e s Pr ep ar e ne ce ss ar y re gu la tio ns a nd le gi sla tio n re la te d to in te ns iv e an d ex te ns iv e fa rm s Le gi sla tio n pr ep ar ed a nd en do rs ed 20 21 –2 02 3 1 M O A Re gi on al c ou nt er pa rts , fa ci lit ie s, de ve l op m en t p ar tn er s 15 0 00 .0 0 Co nd uc t s itu at io n an al ys is in th e fo od va lu e ch ai n (m ea t, m ilk , h on ey ) f or pr io rit ize d fiv e sp ec ie s, ag ro e co lo gy (lo w , m id a nd h ig h la nd ) Si tu at io n an al ys is c on du ct ed 20 21 1 M O A Re gi on al c ou nt er pa rts , fa ci lit ie s, de ve l op m en t p ar tn er s 34 2 00 .0 0 Co nd uc t a ss es sm en t o f k no w le dg e, at tit ud es , b eh av io ur a nd p ra ct ic es o n go od h us ba nd ry p ra ct ic e As se ss m en t d on e on k no w l ed ge , a tti tu de s, be ha vi ou r a nd pr ac tic es 20 21 1 M O A, p riv at e se ct or , in di vi du al fa rm er s Re gi on al a gr ic ul tu re bu re au s, fa ci lit ie s, de ve lo pm en t p ar tn er s 34 2 00 .0 0 D ev el op b io r isk g ui de lin es fo r a ni m al fe ed p ro ce ss in g an d po ul try , d ai ry a nd be ef p ro du ct io n, fo od h an dl er s an d tra de rs G ui de lin es d ev el op ed 20 22 1 M O A, E FD A Re gi on s, fa ci lit ie s, de ve lo pm en t p ar t ne rs , p riv at e se ct or , fa rm er s 22 8 00 .0 0 Im pl em en t b io se cu rit y gu id el in es in se le ct ed fa rm p ro du ct io n sy st em s N um be r o f p ro du ct io n sy s te m s im pl em en tin g bi os ec ur i ty g ui de lin es 20 22 –2 02 5 3 M O A Re gi on s, fa ci lit ie s, de ve lo pm en t p ar t ne rs , p riv at e se ct or , fa rm er s 35 6 00 .0 0 Im pr ov e aw ar en es s on g oo d an im al fe ed p ro du ct io n (h ar ve st in g, d is tri bu tio n an d st or ag e) a nd c le an lin es s of th e ya rd N um be r o f t ra in in g se ss io ns 20 21 –2 02 5 5 M O A Re gi on s, fa ci lit ie s, de ve lo pm en t p ar t ne rs , p riv at e se ct or , fa rm er s 87 5 00 .0 0 Pr om ot e in te gr at ed le ga l o bl ig at io ns re ga rd in g an im al w el fa re in th e an nu al ac tio n pl an In te gr at ed le ga l o bl ig at io n re ga rd in g an im al w el fa re in th e an nu al a ct io n pl an 20 21 –2 02 5 5 M O A Re gi on s, fa ci lit ie s, de ve lo pm en t p ar t ne rs , p riv at e se ct or , fa rm er s 34 7 00 .0 0 Pr om ot e an d di ss em in at e se le ct iv e br ee di ng (d is ea se re sis ta nt b re ed s) Ty pe s of d is ea se re sis ta nt br ee ds d is se m in at ed 20 21 –2 02 5 5 M O A Re gi on s, fa ci lit ie s, de ve lo pm en t p ar t ne rs , p riv at e se ct or , fa rm er s 84 9 00 .0 0 AMR Prevention and Containment Strategic Plan: 2021–2025 53 In te g ra te a nt i m ic ro bi al r es is t an ce p re ve nt io n an d co nt ai n m en t ac ti vi ti es w it h ve te ri na ry ou tr ea ch s er vi c es a nd v ac ci na ti on a cc e ss Im pr ov e va cc in at io n se rv ic e co ve ra ge , su pp ly a nd c ol d ch ai n m an ag em en t Pe rc en ta ge c ov er ag e 20 21 –2 02 5 80 % M O A Re gi on s, fa ci lit ie s, de ve lo pm en t p ar tn er s 42 4 00 .0 0 Im pr ov e ou tre ac h se rv ic es Pe rc en ta ge c ov er ag e 20 21 –2 02 5 80 % An im al h ea lth w or ke rs , c om m un ity a ni m al he al th w or ke rs Re gi on s, fa ci lit ie s, de ve lo pm en t p ar tn er s 30 3 00 .0 0 Co nd uc t s ta ff ca pa ci ty b ui ld in g N um be r o f t ra in ed tr ai ne rs 20 21 –2 02 5 20 0 M O A Re gi on s, fa ci lit ie s, de ve lo pm en t p ar tn er s 49 0 00 .0 0 In it ia ti ve 3 .4 : P ro m o te p e rs o n al h yg ie n e a n d s tr e n g th e n w at e r, sa n it at io n a n d h yg ie n e (W A S H ) s e rv ic e s at t h e c o m m u n it y le ve l P ro m o te p e rs o n al a nd e nv iro n m en ta l h yg ie ne an d sa ni ta ti o n Su pp or t a nd e nf or ce h um an a nd a ni m al h ea lth fa ci lit ie s to p ro vi de fu nc tio n al h an dw as hi ng a nd b at hi ng fa ci lit y fo r st aff a nd p at ie nt s Pe rc en ta ge o f h ea lth fa ci lit ie s ha vi ng fu nc tio na l b at hi ng fa ci lit y fo r s ta ff an d pa tie nt s 20 21 –2 02 5 10 0% H ea lth fa ci lit ie s M O H , r eg io na l h ea lth bu re au s, W H O 10 5 00 .0 0 Su pp or t f ac ilit ie s to p re pa re a nd d is pe ns e al co ho l-b as ed h an d sa ni tiz er Pe rc en ta ge o f f ac ilit ie s su p po rte d 20 21 –2 02 5 10 0% M O H , M O A, EF CC C an d th ei r re gi on al c ou nt er pa rts H ea lth fa ci lit ie s, de ve lo pm en t p ar tn er s 10 5 00 .0 0 54 AMR Prevention and Containment Strategic Plan: 2021–2025 P ro m o te , im p le m e n t an d en fo rc e pr op er w as te m an ag e m en t at t he co m m un it y le ve l Pr om ot e an d en fo rc e sa fe h um an e x cr et a di sp os al a nd fu nc tio na l i m pr ov ed la tri ne s in c om m un iti es Pe rc en ta ge o f c om m un ity se tti ng s w ith fu nc tio na l im pr ov ed to ile ts w ith h an d w as hi ng p ro vi sio n 20 21 –2 02 5 60 % M O H , M O A, EF CC C an d th ei r re gi on al c ou nt er pa rts U N IC EF , F AO , W H O , he al th fa ci lit ie s, co m m un ity le ad er s 15 5 00 .0 0 Pr om ot e an d en fo rc e fu nc tio na l s ee p ag e pi ts , s ep tic ta nk s an d ox id at io n po nd c on ne ct ed w ith a s ew er li ne in he al th fa ci lit ie s Pe rc en ta ge o f h ea lth fa ci lit ie s w ith fu nc tio na l a nd p ro pe r liq ui d w as te m an ag em en t 20 21 –2 02 5 10 0% M O H , M in is try o f W at er Ir rig at io n an d En er gy Re gi on al h ea lth bu re au s, W om en Su pp or t A ss oc ia tio n, W H O , h ea lth fa ci lit ie s 10 5 00 .0 0 Pr om ot e an d en fo rc e to h av e fu nc tio na l i nc in er at or , r ef us e pi ts a nd s ol id w as te c ol le ct io n bi ns Pe rc en ta ge o f h ea lth fa ci lit ie s w ith fu nc tio na l a nd p ro pe r so lid w as te m an ag em en t 20 21 –2 02 5 10 0% M O H , M in is try of U rb an D e ve lo pm en t a nd H ou sin g Re gi on al h ea lth b u re au s, W H O , h ea lth fa ci lit ie s 10 5 00 .0 0 Pr om ot e an d en fo rc e ha za rd ou s w as te m an ag em en t i n he al th fa ci lit ie s Pe rc en ta ge o f h ea lth fa ci lit ie s w ith fu nc tio na l a nd p ro pe r ha za rd ou s w as te m an ag e m en t 20 21 –2 02 5 10 0% M O H , M in is try of U rb an D e ve lo pm en t a nd H ou sin g Re gi on al h ea lth b u re au s, W H O , h ea lth fa ci lit ie s 10 5 00 .0 0 E n co u ra g e a n d p ro m o te s af e w at er s up pl y an d sa ni ta ti on se rv ic es f or hu m an s an d an im al s Bu ild u p th e ca pa ci ty o f h ea lth a nd ag ric ul tu ra l e xt en sio n w or ke rs to en co ur ag e an d pr om ot e cl ea n ho m e en vi ro nm en ts , s ch oo l c om po un ds a nd an im al h ou sin g N um be r o f c ap ac ity e n ha nc em en ts p ro vi de d fo r he al th a nd a gr ic ul tu ra l e xt en sio n w or ke rs 20 21 –2 02 5 10 M O H , M O A EF CC C, re gi on al he al th b ur ea us , re gi on al a gr ic ul tu re bu re au s, W H O , F AO 31 5 00 .0 0 AMR Prevention and Containment Strategic Plan: 2021–2025 55 In it ia ti ve 3 .5 : S tr e n g th e n in fo rm at io n s ys te m f o r in fe ct io n p re ve n ti o n a n d c o n tr o l m an ag e m e n t D ev el op a m ul ti se ct or in fe c ti on p re ve nt io n an d co nt ro l in fo rm at io n an d co m m un ic at io n m an ag em en t sy st em D ev el op a nd a do pt a n in fe ct io n pr e ve nt io n an d co nt ro l i nf or m at io n co m m un ic at io n an d m an ag em en t d at ab as e D at ab as e in p la ce 20 21 –2 02 2 1 M O H , M O A, EF CC C Re gi on al la bs , re gi on al h ea lth bu re au s, he al th fa ci lit ie s, de ve lo pm en t pa rtn er s 28 9 00 .0 0 In te gr at e no tif ic at io n of a nt im ic ro bi al re sis ta nc e an d m ul tip le d ru g re sis t an t i nf ec tio ns in to e xis tin g re po rti ng sy st em s N um be r o f r ep or ts p ro du ce d 20 21 –2 02 5 5 M O H (E PH I, AH RI ), M O A (N AH D IC , V D FA CA ) Re gi on al la bs , h ea lth fa ci lit ie s, de ve lo p m en t p ar tn er s 12 6 00 .0 0 G en er at e an d di ss em in at e ev id en ce b as ed in fo rm at io n to im pr ov e in fe c ti on p re ve nt io n an d co nt ro l pr ac ti ce s an d de ci si on m ak in g pr oc es se s Co nd uc t a nd d is se m in at e op er at io na l re se ar ch o n in fe ct io n pr ev en tio n an d co nt ro l p ra ct ic es N um be r o pe ra tio na l r es ea rc h st ud ie s co nd uc te d 20 21 –2 02 5 3 M O H (E PH I an d AH RI ) M O A (N AH D IC ) Re gi on al la bs , re gi on al h ea lth bu re au s, he al th fa ci lit ie s, de ve lo pm en t pa rtn er s 37 5 00 .0 0 D is se m in at e an d us e th e in fo rm at io n fo r d ec isi on m ak in g N um be r o f c om pi le d in fo rm a tio n re po rts d is se m in at ed 20 21 –2 02 5 5 M O H , M O A, EF CC C H ea lth , a gr ic ul tu re an d en vi ro nm en t bu re au s To ta l 1 52 6 0 23 .3 0 56 AMR Prevention and Containment Strategic Plan: 2021–2025 4. 4 O B JE C TI V E FO U R: O PT IM IZ E TH E U SE O F A N TI M IC RO B IA LS IN H U M A N , A N IM A L A N D P LA N T H EA LT H C A RE Ta bl e 12 : D et ai le d op er at io na l p la n fo r ob je ct iv e fo ur In it ia ti ve 4 .1 : Im p ro ve a cc e ss t o q u al it y an ti m ic ro b ia ls a n d la b o ra to ry s u p p lie s in t h e h u m an a n d a n im al h e al th s e ct o rs St ra te gi c in te rv en ti on s A ct iv it ie s In di ca to r Ti m e of im pl em en ta ti on Fr e qu en cy (w ith in 5 ye ar s) Le ad im pl e m en te r C ol la bo ra to rs In di c at iv e bu dg et (U S$ ) En su re a n ef fe ct iv e su pp ly c ha in m an ag em en t of q ua lit y es se nt ia l a nt im ic ro bi al s an d la bo ra to ry su pp lie s As se ss p rio rit iza tio n of e ss en tia l a nt i m ic ro bi al s an d la bo ra to ry s up pl ie s in th e go ve rn m en t a nd n on g ov er nm en t pr oc ur em en t l is t f or h um an a nd a ni m al he al th s ec to rs As se ss m en t r ep or ts 20 21 a nd 20 24 2 M O H , M O A, E PS A, EP H I, N AH D IC , EH IA , A IS CO D ev el op m en t pa rtn er s, EF D A, VD FA CA 25 0 00 .0 0 Ad vo ca te in cl us io n of p rio rit y an tim i cr ob ia ls a nd la bo ra to ry s up pl ie s in th e Et hi op ia n Ph ar m ac eu tic al s Su pp ly Ag en cy (E PS A) a nd th e Ag ric ul tu re In pu ts S up pl y Co rp or at io n (A IS CO ) lo ng te rm p ro cu re m en t a gr ee m en ts an d/ or n on g ov er nm en t s up pl ie rs An tim ic ro bi al a nd la bo ra to ry s up pl ie s in cl ud ed in s up pl ie rs ’ lo ng te rm pr oc ur em en t a gr ee m en ts 20 21 –2 02 5 Co nt in uo us M O H , M O A, E PS A, AI SC O Pr iv at e m an uf ac tu re rs , im po rte rs , di st rib ut or s 17 5 00 .0 0 Pr om ot e lo ca l p ro du ct io n of q ua lit y an ti m ic ro bi al s an d la bo ra to ry s up pl ie s fo r hu m an a nd a ni m al Un de rta ke a b as el in e as se ss m en t o f lo ca l m an uf ac tu rin g ca pa ci ty As se ss m en t r ep or t 20 21 1 M O H , M O A, M O TI , Et hi op ia n In ve st m en t C om m is sio n (E IC ) EF D A, V D FA CA 52 50 .0 0 Ad vo ca te c ap ac ity e nh an ce m en t o f lo ca l m an uf ac tu re rs N um be r o f a dv oc ac y ca m pa ig ns c on du ct ed 20 21 –2 02 5 3 M O TI , M O H , M O A, EI C 72 00 .0 0 AMR Prevention and Containment Strategic Plan: 2021–2025 57 In it ia ti ve 4 .2 : E n su re o p ti m al p re sc ri b in g , d is p e n si n g a n d u se o f an ti m ic ro b ia ls in t h e h u m an h e al th s e ct o r In te gr at e an ti m i cr ob ia l s te w ar ds hi p in to t he H os pi ta ls Se rv ic es T ra ns fo rm a ti on G ui de lin e an d th e Et hi op ia n H ea lt h C en te r Re fo rm Im pl e m en ta ti on G ui de lin e Co nd uc t w or ks ho p fo r p ol ic ym ak er s an d de ci sio n m ak er s at a ll le ve ls N um be r o f a dv oc ac y ca m pa ig ns c on du ct ed 20 21 2 M O H , r eg io na l he al th b ur ea us H ea lth fa ci lit ie s, de ve lo pm en t pa rtn er s 14 0 00 .0 0 In cl us io n of a nt im ic ro bi al s te w ar ds hi p in to th e H os pi ta ls S er vi ce s Tr an sf or m at io n G ui de lin e an d th e Et hi op ia n H ea lth C en te r R ef or m Im pl em en ta tio n G ui de lin e An tim ic ro bi al s te w ar ds hi p in cl ud ed in th e H os pi ta ls Se rv ic es T ra ns fo rm at io n G ui de lin e an d th e Et hi op i an H ea lth C en te r R ef or m Im pl em en ta tio n G ui de lin e 20 22 1 M O H , r eg io na l he al th b ur ea us H ea lth fa ci lit ie s 62 50 .0 0 E n su re im p le m e n ta ti o n o f an ti m ic ro bi al st ew ar ds hi p in h ea lt h ca re f ac ili ti es En su re a nt im ic ro bi al s te w ar ds hi p as o ne of h ea lth c ar e fa ci lit y m an ag em en ts ’ qu al ity im pr ov em en t p ar am et er s N um be r o f f ac ilit ie s w ith pl an , d ed ic at ed b ud ge t an d pe rs on ne l f or a nt im i cr ob ia l s te w ar ds hi p 20 21 –2 02 5 15 0 W H O , d ev el op m en t p ar tn er s 33 0 00 .0 0 St re am lin e an tim ic ro bi al s te w ar ds hi p in to th e ex is tin g ph ar m ac y se rv ic es (c lin ic al p ha rm ac y an d th e D ru g In fo r m at io n Se rv ic es ) N um be r o f f ac ilit ie s w ith in te gr at ed A nt im ic ro bi al St ew ar ds hi p Pr og ra m m e w ith c lin ic al p ha rm ac y se rv ic es a nd th e D ru g In fo rm at io n Se rv ic es 20 21 – 20 25 15 0 H ea lth c ar e fa ci l iti es M O H , r eg io na l he al th b ur ea us , de ve lo pm en t pa rtn er s, W H O N A Pr ov id e tra in in g on a nt im ic ro bi al s te w ar ds hi p fo r t he A nt im ic ro bi al S te w ar d sh ip a nd th e D ru g an d Th er ap eu tic Co m m itt ee s an d ot he r p ro fe ss io na ls N um be r o f t ra in in g se ss io ns 20 21 –2 02 5 17 M O H , r eg io na l he al th b ur ea us , EP H I, E FD A H ea lth c ar e fa ci l iti es , a ca de m ia , W H O , d ev el op m en t p ar tn er s, pr of es sio na l as so ci at io ns 21 0 00 0. 00 M on ito r i m pl em en ta tio n of fu nc tio na l an tim ic ro bi al s te w ar ds hi p at h ea lth c ar e fa ci lit ie s N um be r o f h ea lth fa ci lit ie s th at h av e im pl em en te d fu nc tio na l a nt im ic ro bi al st ew ar ds hi p 20 21 –2 02 5 15 0 M O H , r eg io na l he al th b ur ea us 50 0 00 .0 0 58 AMR Prevention and Containment Strategic Plan: 2021–2025 E n su re t h e a va ila b ili ty an d m on it or c om pl i an ce w it h up da te d an d ev id en ce b as ed gu id el in es , p ol ic ie s, m an u al s an d f o rm u la r ie s fo r p re sc ri b in g a n d d is p e n si n g p ra ct ic e s Re vi ew e xis tin g an tim ic ro bi al s te w ar ds hi p gu id el in es , p re sc rib in g an d di sp en sin g m an ua ls , fo rm ul ar ie s an d st an da rd tr ea tm en t g ui de lin es a nd th e W H O E ss en tia l M ed ic in es L is t w ith th e AW aR e cl as si fic at io n of a nt ib io tic s Av ai la bi lit y of u pd at ed ev id en ce b as ed s ta nd ar d tre at m en t g ui de lin es , an tim ic ro bi al s te w ar d sh ip p ol ic y, pr es cr ib in g an d di sp en sin g m an ua ls , fo rm ul ar ie s an d th e W H O Es se nt ia l M ed ic in es L is t 20 21 1 M O H , r eg io na l he al th b ur ea us , EF D A, h ea lth fa ci lit ie s W H O , d ev el op m en t p ar tn er s, ac ad em ia , pr of es sio na l as so ci at io ns 18 0 00 .0 0 Av ai l o f a nd m on ito r c om pl ia nc e w ith ev id en ce b as ed s ta nd ar d tre at m en t gu id el in es a nd a nt im ic ro bi al s te w ar ds hi p gu id el in es , p re sc rib in g an d di sp en sin g m an ua ls , fo rm ul ar ie s an d th e W H O E ss en tia l M ed ic in es L is t w ith th e aw ar e cl as si fic at io n of a nt ib io tic s 20 21 –2 02 5 Co nt in uo us M O H , r eg io na l he al th b ur ea us , EF D A, h ea lth fa ci lit ie s W H O , d ev el op m en t p ar tn er s, ac ad em ia , pr of es sio na l as so ci at io ns 80 0 00 .0 0 St re ng th en a nt im ic ro bi al u se a nd c on su m pt io n su rv ei lla nc e fo r ac ti on t o im pr ov e he al th c ar e ou tc om e at t he h ea lt h fa ci lit y an d na ti on al le ve ls Co nd uc t r eg ul ar a nt im ic ro bi al u se a nd co ns um pt io n su rv ei lla nc e at th e he al th fa ci lit y le ve l Pe rc en ta ge o f h ea lth fa ci lit ie s co nd uc tin g an tim ic ro bi al u se a nd co ns um pt io n su rv ei lla nc e 20 21 –2 02 5 Ye ar ly pe r he al th fa ci lit y le ve l H ea lth fa ci lit ie s M O H , r eg io na l he al th b ur ea us , W H O , d ev el op m en t p ar tn er s 63 0 00 .0 0 Co nd uc t a nt im ic ro bi al u se a nd c on su m pt io n su rv ei lla nc e at th e na tio na l le ve l N um be r o f a nt im ic ro bi al us e an d co ns um pt io n su rv ei lla nc e re po rts 20 21 –2 02 5 5 M O H , r eg io na l he al th b ur ea us Fa ci lit ie s, W H O , de ve lo pm en t pa rtn er s 12 5 00 0. 00 D is se m in at e an d en su re u se o f t he e v id en ce g en er at ed fo r i m pr ov in g he al th ca re o ut co m es , p ol ic ym ak in g an d de ci sio n m ak in g pr oc es s N um be r o f h ea lth c ar e fa ci lit ie s ut iliz ed th e an tim ic ro bi al u se a nd co ns um pt io n su rv ei lla nc e da ta fo r a ct io n 20 21 –2 02 5 Co nt in uo us M O H , r eg io na l he al th b ur ea us , he al th fa ci lit ie s W H O , d ev el op m en t p ar tn er s AMR Prevention and Containment Strategic Plan: 2021–2025 59 Im pr ov e co m m un ic a ti on a nd t ea m p ra c ti ce s am on g he al th ca re p ro vi de rs O rg an ize m ul tid is ci pl in ar y ev en ts (s em in ar s, tra in in gs , c on su lta tiv e m ee tin gs , m or ni ng s es sio ns ) o n an tim ic ro bi al u se an d re sis ta nc e N um be r o f e ve nt s pe r ye ar 20 22 –2 02 5 6 H ea lth fa ci lit ie s M O H , r eg io na l he al th b ur ea us , ac ad em ia 24 0 00 0. 00 D ev el op a nd d is se m in at e up to d at e an d un bi as ed s ci en tif ic in fo rm at io n on an tim ic ro bi al u se a nd re sis ta nc e N um be r o f m at er ia ls di ss em in at ed (i nf or m at io n an d ed uc at io n co m m un i ca tio n m at er ia ls , jo ur na l cl ub s, et c. ) p er y ea r 20 21 –2 02 5 6 H ea lth fa ci lit ie s M O H , r eg io na l he al th b ur ea us , ac ad em ia 15 0 00 .0 0 In it ia ti ve 4 .3 : E n su re o p ti m al p re sc ri b in g , d is p e n si n g a n d u se o f an ti m ic ro b ia ls in t h e a n im al h e al th s e ct o r D ev el op g ui de lin es re le va nt t o th e pr u de nt u se o f an ti m i cr ob ia ls D ev el op p re sc rip tio n gu id el in es D ev el op ed g ui de lin e 20 21 1 M O A, V D FA CA a nd its c ou nt er pa rts FA O , O IE , v et er in ar ia n as so ci a tio ns 20 0 00 .0 0 Re vi ew v et er in ar y dr ug fo rm ul ar y Up da te d fo rm ul ar y 20 21 1 M O A, V D FA CA a nd its c ou nt er pa rts FA O , O IE , a ss oc i at io ns 18 0 00 .0 0 D is se m in at io n of p re sc rip tio n gu id el in es , ve te rin ar y st an da rd tr ea tm en t g ui de lin es a nd fo rm ul ar y Pe rc en ta ge a va ila bi lit y of p re sc rip tio n gu id e lin e, v et er in ar y st an da rd tre at m en t g ui de lin es a nd fo rm ul ar ie s at v et er in ar y fa ci lit ie s 20 21 –2 02 5 90 % M O A, V D FA CA a nd its c ou nt er pa rts FA O , O IE , a ss oc i at io ns 20 00 .0 0 D ev el op a nd p ro m ot e im pl em en ta ti on of a nt im ic ro bi al s te w ar ds hi p in v et er in ar y se rv ic es D ev el op a nt im ic ro bi al s te w ar ds hi p gu id el in es fo r a ni m al h ea lth fa ci lit ie s D ev el op ed g ui de lin es 20 21 1 M O A, re gi on al ag ric ul tu re b ur ea us , ve te rin ar y cl in ic s N AH D IC , V D FA CA , a ca de m ia 20 0 00 .0 0 Im pl em en t a nt im ic ro bi al s te w ar ds hi p in se le ct ed a ni m al h ea lth fa ci lit ie s N um be r o f h ea lth fa ci lit ie s im pl em en tin g an tim ic ro bi al s te w ar ds hi p 20 21 –2 02 5 15 M O A, re gi on al ag ric ul tu re b ur ea us , ve te rin ar y cl in ic s N AH D IC , V D FA CA , a ca de m ia 21 0 00 .0 0 60 AMR Prevention and Containment Strategic Plan: 2021–2025 St re ng th en t he di ag no st ic c ap ac it y of v et er in ar y he al th se rv ic es t o pr om ot e ra ti on al a nt im ic ro bi al us e Eq ui p th e la bo ra to ry d ia gn os tic te st in g in a ni m al h ea lth fa ci lit ie s w ith m at er ia ls an d pr oc ed ur es N um be r o f l ab or at or y fa ci lit ie s eq ui pp ed w ith di ag no st ic te st in g m at er i al s an d pr oc ed ur es 20 21 –2 02 5 50 M O A, re gi on al ag ric ul tu re b ur ea us , ve te rin ar y cl in ic s, VD FA CA , N AH D IC Ac ad em ia , F AO , O IE 1 2 50 00 0. 00 Bu ild u p th e ca pa ci ty o f h um an re so ur ce s fo r q ua lit y la bo ra to ry d ia gn os tic te st in g N um be r o f p ro fe ss io na ls tra in ed 20 21 –2 02 5 15 0 M O A, re gi on al ag ric ul tu re b ur ea us , Ve te rin ar y cl in ic s, VD FA CA , N AH D IC Ac ad em ia , F AO , O IE 10 0 00 0. 00 St re ng th en a nt im ic ro bi al us e an d co ns um pt io n su r ve yi ng fo r v et er in ar y he al th se rv ic es Co nd uc t r eg ul ar a nt im ic ro bi al u se a nd co ns um pt io n su rv ey s at n at io na l a nd an im al h ea lth fa ci lit y le ve ls N um be r o f s ur ve ys c on du ct ed 20 21 –2 02 5 5 M O A, re gi on al ag ric ul tu re b ur ea us , VD FA CA , N AH D IC Ve te rin ar y cl in ic s 75 0 00 .0 0 U se a nd d is se m in at e su rv ey d at a on an tim ic ro bi al u se a nd c on su m pt io n fo r po lic ym ak in g an d de ci sio n m ak in g N um be r o f p ol ic y br ie fs di ss em in at ed 20 21 –2 02 5 3 M O A, re gi on al ag ric ul tu re b ur ea us , VD FA CA N AH D IC , v et er i na ry c lin ic s St re ng th en p ro fe ss io na l, fa rm er s fie ld s ch oo l a nd an im al o w ne r c om m un ic a tio ns to o pt im ize a nt im ic ro bi al u se a nd c on su m pt io n O rg an ize m ul tid is ci pl in ar y ev en ts (t ra in in gs , fa rm er s m on th ly m ee tin gs , v ac ci ne ca m pa ig ns , e tc .) to e m po w er a ni m al ow ne rs o n re co rd in g of a ni m al h is to ry , di se as e tre nd s an d an tim ic ro bi al u se an d co ns um pt io n N um be r o f e ve nt s 20 21 –2 02 5 5 pe r re gi on M O A, re gi on al ag ric ul tu re b ur ea us , VD FA CA , p ro fe s sio na l a ss oc ia tio ns Fa rm er s as so ci at io ns , u ni on s, co m m un ity an im al h ea lth w or ke rs 96 0 00 .0 0 En su re c ou ns el lin g of c lie nt s (a ni m al ow ne rs ) o n ad he re nc e, w ith dr aw al p e rio d of a nt im ic ro bi al s an d an tim ic ro bi al re sis ta nc e N um be r o f c ou ns el le d an im al o w ne rs 20 21 –2 02 5 Co nt in uo us Ve te rin ar y cl in ic s M O A, re gi on al ag ric ul tu re b u re au s, VD FA CA 12 00 .0 0 AMR Prevention and Containment Strategic Plan: 2021–2025 61 In it ia ti ve 4 .4 : S tr e n g th e n d ia g n o st ic s te w ar d sh ip a t th e h e al th c ar e f ac ili ty le ve l B ui ld u p ca pa ci ty a nd st an da rd iz e di ag no s ti c la bo ra to ri es Un de rta ke b as el in e as se ss m en t o n m ic ro bi ol og y la bo ra to ry s er vi ce s As se ss m en t r ep or t 20 21 1 EP H I, M O H , M O A, re gi on al h ea lth bu re au s, re gi on al ag ric ul tu re b ur ea us H ea lth fa ci lit ie s 31 5 00 .0 0 D ev el op d ia gn os tic s te w ar ds hi p gu id e lin es G ui de lin es d ev el op ed 20 22 1 EP H I, M O H , M O A Re gi on al h ea lth bu re au s, re gi on al a gr ic ul tu re bu re au s, he al th fa ci lit ie s, W H O , FA O , O IE , C D C, Un ite d N at io ns En vi ro nm en t Pr og ra m m e, de ve lo pm en t pa rtn er s 65 00 .0 0 Pr ov id e tra in in gs o n di ag no st ic s te w ar d sh ip fo r h ea lth c ar e pr of es sio na ls N um be r o f t ra in in g se s sio ns c on du ct ed 20 22 –2 02 5 5 EP H I, M O H , M O A, re gi on al h ea lth bu re au s, re gi on al ag ric ul tu re b ur ea us W H O , F AO , O IE , CD C, U N EP D ev el op m en t pa rtn er s 60 0 00 .0 0 O rg an ize e xp er ie nc e sh ar in g vi si ts lo ca l an d ab ro ad a m on g la bo ra to rie s N um be r o f e xp er i en ce s ha rin g vi si ts co nd uc te d 20 22 –2 02 5 5 38 0 00 .0 0 En su re g en er at io n an d ut ili za ti on o f an ti bi og ra m d at a at t he hu m an h ea lt h ca re fa ci lit y le ve l G en er at e, re vi ew a nd d is se m in at e fa ci li ty s pe ci fic a nt ib io gr am d at a N um be r o f h ea lth fa ci lit ie s ge ne ra tin g an tib io gr am da ta 20 21 –2 02 5 30 H ea lth fa ci lit ie s, M O H , r eg io na l he al th b ur ea us W H O , d ev el op m en t pa rtn er s En su re u se o f a nt ib io gr am d at a at th e he al th c ar e fa ci lit y le ve l o n a re gu la r ba sis N um be r o f f ac ilit ie s us in g an tib io gr am d at a 20 21 –2 02 5 30 H ea lth fa ci lit ie s, M O H , r eg io na l he al th b ur ea us En su re p re sc ri bi ng pr ac ti ce s of a nt im i cr ob ia ls b as ed o n la bo ra to ry d ia gn os ti c re su lt s Pr om ot e re al ti m e ut iliz at io n of m ic ro bi ol og i ca l a nd o th er d ia gn os tic re su lts fo r p re sc rib in g pr ac tic es N um be r o f c on su lta tiv e m ee tin gs c on du ct ed 20 21 –2 02 5 2 ev en ts pe r fa ci lit y pe r y ea r M O H , r eg io na l h ea lth bu re au s, he al th fa ci lit ie s 0 62 AMR Prevention and Containment Strategic Plan: 2021–2025 In it ia ti ve 4 .5 : S tr e n g th e n t h e r e g u la to ry s ys te m in t h e h u m an , an im al , fo o d a n d f e e d p ro d u ct io n a n d t h e e n vi ro n m e n t se ct o rs Re vi ew , d ev el op a nd en fo rc e le gi sl at io n on t he p ru de nt u se of a nt im ic ro bi al s an d la bo ra to ry s up pl ie s D ev el op , u pd at e an d en fo rc e le ga l f ra m e w or ks fo r a nt im ic ro bi al s an d la bo ra to ry su pp ly u se D ev el op ed a nd u pd at ed hu m an a nd a ni m al h ea lth le ga l f ra m ew or ks 20 21 a nd 2 02 2 1 EF D A, V D FA CA a nd th ei r c ou nt er pa rts M O H , M O A, re gi on al h ea lth bu re au s, re gi on al a gr ic ul tu re bu re au s 15 3 00 .0 0 Re st ric t a nd b an n on th er ap eu tic u se o f an tim ic ro bi al s in a ni m al p ro du ct io n an d fo od p ro du ct io n Li st o f r es tri ct ed a nd b an ne d an tim ic ro bi al s 20 21 –2 02 2 1 M O A, V D FA CA a nd th ei r c ou nt er pa rts FA O , O IE 10 5 00 .0 0 St re ng th en p re a nd po st m ar ke t su rv ei l la nc e an d co nt ro l o f an ti m ic ro bi al s an d la bo ra to ry a nd in fe c ti on p re ve nt io n an d co nt ro l s up pl ie s Re vi ew a nd d ev el op s ys te m s an d gu id el in es fo r m ar ke t s ur ve illa nc e an d co nt ro l D ev el op ed s ys te m fo r m ar ke t s ur ve illa nc e 20 21 a nd 2 02 2 2 EF D A, V D FA CA a nd th ei r c ou nt er pa rts FA O , O IE , W H O , de ve lo pm en t pa rtn er s 14 0 00 .0 0 Co nd uc t m ar ke t s ur ve illa nc e an d co nt ro l N um be r o f m ar ke t s ur ve il la nc e re po rt 20 21 –2 02 5 4 EF D A, V D FA CA , a nd th ei r c ou nt er pa rts FA O , O IE 92 7 50 .0 0 B ui ld u p ca pa ci ty o f re gu la to ry b od ie s to en su re a va ila bi lit y an d us e of q ua lit y an ti m ic ro bi al s, la bo ra to ry a nd in fe ct io n pr ev en ti on a nd c on tr ol s up pl ie s As se ss th e ex is tin g ca pa ci ty o f t he re gu la to ry b od ie s to w ar ds e ns ur in g th e av ai la bi lit y an d ut iliz at io n of q ua lit y as su re d an tim ic ro bi al s, la bo ra to ry c om m od iti es a nd in fe ct io n pr ev en tio n an d co nt ro l s up pl ie s As se ss m en t r ep or ts 20 21 2 EF D A, V D FA CA Re gi on al c ou n te rp ar ts o f E FD A, VD FA CA 31 5 00 .0 0 En ha nc e ca pa ci ty o f h um an re so ur ce s th ro ug h ne ed s ba se d tra in in g N um be r o f t ra in in gs p ro vi de d 20 21 –2 02 5 5 EF D A, V D FA CA a nd th ei r r eg io na l c ou n te rp ar ts D ev el op m en t pa rtn er s 52 5 00 .0 0 Re gu la te f oo d an d fe ed p re pa ra ti on p ro ce ss in g an d di sp en sa ry c en tr es t o en ha nc e fo od a nd f ee d hy gi en e an d sa fe ty Co nd uc t r eg ul ar in sp ec tio n at a ll le ve ls Re gu la r i ns pe ct io ns co nd uc te d 20 21 –2 02 5 Co nt in uo us EF D A, V D FA CA an d th ei r r eg io na l co un te rp ar ts D ev el op m en t pa rtn er s 15 0 00 0. 00 Co nd uc t h az ar d an al ys is o f c rit ic al co nt ro l p oi nt s N um be r o f f ac ilit ie s co n du ct in g ha za rd a na ly sis o f cr iti ca l c on tro l p oi nt s 20 21 –2 02 5 5 EF D A, V D FA CA , M O A, M O H , E PH I D ev el op m en t pa rtn er s AMR Prevention and Containment Strategic Plan: 2021–2025 63 En su re p ro pe r di s po sa l o f un fit f or u se an ti m ic ro bi al s an d la bo ra to ry s up pl ie s Es ta bl ish a nd s tre ng th en d isp os al fa ci lit ie s N um be r o f d isp os al fa ci lit ie s 20 21 –2 02 5 12 M O H , M O A, E FD A, VD FA CA , E FC CC , EP SA a nd th ei r co un te rp ar ts H ea lth fa ci lit ie s N A En su re p ro pe r d isp os al o f u nf it fo r-u se an tim ic ro bi al s an d la bo ra to ry s up pl ie s Pe rc en ta ge o f u nf it fo r-u se a nt im ic ro bi al s an d re sid ue s pr op er ly di sp os ed 20 21 –2 02 5 Co nt in uo us M O H , M O A, E FD A, VD FA CA a nd th ei r co un te rp ar ts , he al th fa ci lit ie s H ea lth fa ci lit ie s N A Es ta bl is h st an da rd s fo r w as te d is ch ar ge an d tr ea tm en t fr om m an uf ac tu ri ng a nd fo od p ro ce ss in g pl an ts a nd h um an an d an im al h ea lt h ca re s et ti ng s D ev el op a nd p ro m ot e gu id el in es fo r w as te d isp os al , d is ch ar ge a nd tr ea tm en t G ui de lin e av ai la bl e 20 22 1 M O H , M O A, E FC CC D ev el op m en t pa rtn er s 18 0 00 .0 0 M on ito r w as te d isp os al a nd d is ch ar ge pr ac tic es a t m an uf ac tu rin g an d fo od pr oc es sin g pl an ts a nd h um an a nd an im al h ea lth c ar e se tti ng s Im pr ov ed p ra ct ic e of w as te d isp os al , d is ch ar ge an d tre at m en t 20 22 –2 02 5 Co nt in uo us EF D A, V D FA CA , EF CC C D ev el op m en t pa rtn er s 0 Es ta bl is h pr ed ic te d no e ff ec t en vi ro n m en ta l c on ce nt ra ti on va lu es f or r es is ta nc e se le ct io n Es ta bl ish s ta nd ar d fo r m in im um se le ct iv e co nc en tra tio n an d pr ed ic te d no e ffe ct c on ce nt ra tio n va lu es Av ai la bi lit y of th e pr ed ic t ed n o eff ec t c on ce nt ra tio n st an da rd s 20 23 1 M O H , M O A, E FC CC D ev el op m en t pa rtn er s 0 Pr om ot e an d m on ito r t he e st ab lis he d pr ed ic te d no e ffe ct c on ce nt ra tio n va lu es Lo w le ve l o f e nv iro nm en ta l h ea lth ri sk s 20 24 –2 02 5 Co nt in uo us M O H , M O A, E FC CC D ev el op m en t pa rtn er s 0 To ta l 2 98 0 45 0. 00 64 AMR Prevention and Containment Strategic Plan: 2021–2025 4. 5 O B JE C TI V E FI V E: S TR EN G TH EN A N D E ST A B LI SH P A RT N ER SH IP S, A LL IA N C ES , G O V ER N A N C E A N D R ES O U RC E M O B IL IZ AT IO N A T A LL L EV EL S Ta bl e 13 : D et ai le d op er at io na l p la n fo r ob je ct iv e fiv e In it ia ti ve : 5 .1 : S tr e n g th e n a n d e st ab lis h p ar tn e rs h ip s, a lli an ce s, g o ve rn an ce a n d r e so u rc e m o b ili za ti o n s at a ll le ve ls St ra te gi c in te r ve nt io ns A ct iv it ie s In di ca to r Ti m e of im pl e m en ta ti on Fr e qu en cy (w ith in 5 ye ar s) Le ad im pl e m en te r C ol la bo ra to rs In di c at iv e bu dg et (U S$ ) S tr e n g th e n t h e g o ve rn an ce st ru ct ur e an d co lla bo ra ti on of n at io na l a n d re g io n al a n ti m i cr o b ia l r e si st an ce st ak e h o ld e rs Es ta bl ish a nd s tre ng th en a m ul ti in st itu tio n an d m ul tid is ci pl in ar y in te r-m in is te ria l c om m itt ee s, AM R Ad vi so ry C om m itt ee s an d th em at ic w or ki ng g ro up s at n at io na l a nd re gi on al le ve ls N um be r o f f un ct io na l in te r-m in is te ria l c om m itt ee s, AM R Ad vi so ry C om m itt ee s an d th em at ic w or ki ng g ro up s 20 21 a nd 2 02 2 92 M O H , M O A, EF CC C an d th ei r r eg io na l co un te rp ar ts , in st itu tio ns D ev el op m en t pa rtn er s, ac a de m ia , a ss oc ia tio ns 17 0 00 .0 0 St re ng th en A M R se cr et ar ia t a t t he na tio na l l ev el (h um an re so ur ce s, m at er ia ls , fi na nc es , s tru ct ur es , e tc .) Fu nc tio na l a nd m ul tid is ci pl i na ry A M R se cr et ar ia t p ut in pl ac e 20 21 –2 02 5 1 M O H , M O A, EF CC C D ev el op m en t pa rtn er s, W H O Es ta bl ish a nd s tre ng th en A M R te am an d fo ca l p oi nt s fo r h um an , a ni m al , pl an t, w at er , s an ita tio n, h yg ie ne a nd w as te w at er m an ag em en t a t d iff er en t le ve ls N um be r o f A M R te am s or fo ca l p oi nt s pu t i n pl ac e 20 21 –2 02 2 39 M O H , M O A, EF CC C an d th ei r r eg io na l co un te rp ar ts , in st itu tio ns U N IC EF , W H O , CD C, d ev el op m en t p ar tn er s, ac ad em ia , as so ci at io ns 10 0 00 .0 0 O rg an ize a nn ua l j oi nt re vi ew m ee t in gs o n th e im pl em en ta tio n of th e na tio na l a nt im ic ro bi al re sis ta nc e op er at io na l p la n N um be r o f r ev ie w m ee tin gs co nd uc te d 20 21 –2 02 5 65 M O H , M O A, EF CC C, A dv is o ry C om m itt ee s, th em at ic w or k in g gr ou ps D ev el op m en t pa rtn er s, ac a de m ia , a ss oc ia tio ns 52 5 00 .0 0 AMR Prevention and Containment Strategic Plan: 2021–2025 65 St re ng th en c ol la bo ra ti on w it h m ul ti la te ra l a nd bi la te ra l o rg an iz at io ns e ng ag in g in a nt im ic ro bi al r es is ta nc e pr ev en ti on a nd co nt ai nm en t Cr ea te p la tfo rm s (n et w or ki ng , c oo rd in a tio n, in fo rm at io n an d re so ur ce e xc ha ng e m ec ha ni sm ) w ith a ll m ul til at er al a nd bi la te ra l a nt im ic ro bi al re sis ta nc e st ak e ho ld er s N um be r o f c oo rd in at io n m ee t in gs c on du ct ed 20 21 –2 02 5 5 M O H , M O A, EF CC C D ev el op m en t pa rtn er s, Ad vi so ry C om m itt ee s, th em at ic w or ki ng gr ou ps , a ca de m ia , a ss oc ia tio ns 10 0 00 .0 0 Sh ar e in fo rm at io n, k no w le dg e an d re po rts o n an tim ic ro bi al re sis ta nc e w ith in te rn at io na l c ol la bo ra to rs N um be r o f a nt im ic ro bi al re sis t an ce re se ar ch o ut pu ts , g ui de lin es a nd s ur ve illa nc e, in cl ud in g Tr ip ar tit e AM R Co un try S el f-A s se ss m en t S ur ve y re po rts s ha re d 20 21 –2 02 5 5 AM R se cr et ar ia t, M O H , M O A, EF CC C, E PH I, N AH D IC , E FR I D ev el op m en t pa rtn er s, ac a de m ia , a ss oc ia tio ns 0 Pr om ot e pu b lic –p ri va te pa rt ne rs hi ps on a nt im ic ro bi al r es is ta nc e pr ev en ti on a nd co nt ai nm en t D ev el op p ub lic –p riv at e pa rtn er sh ip fra m ew or k on a nt im ic ro bi al re sis ta nc e pr ev en tio n an d co nt ai nm en t Fr am ew or k de ve lo pe d 20 21 /2 2 1 M O H , M O A, EF CC C, M O F D ev el op m en t pa rtn er s, ac a de m ia , a ss oc ia tio ns 15 4 00 .0 0 Co nd uc t r eg ul ar a dv oc ac y pl at fo rm s to en ga ge th e pr iv at e se ct or o n an tim ic ro bi al re sis ta nc e pr ev en tio n an d co nt ai nm en t N um be r o f a dv oc ac y pl at fo rm s co nd uc te d 20 21 –2 02 5 10 M O H , M O A, EF CC C an d ag en ci es u nd er th em , p riv at e or ga ni za tio ns in th e he al th s ec to r D ev el op m en t pa rtn er s, ac a de m ia , a ss oc ia tio ns 38 5 00 .0 0 In it ia ti ve 5 .2 : S tr e n g th e n le ad e rs h ip E n su re le ad e r sh ip , o w n e rs h ip an d c o m m it m e n t fo r su st ai na bl e im pl em en ta ti on of a nt im ic ro bi al re si st an ce s tr a te gi c pl an a t al l se ct or s In co rp or at e an tim ic ro bi al re sis ta nc e pr ev en tio n an d co nt ai nm en t a ct iv iti es in th e an nu al in st itu tio na l p la n an d na tio na l s tra te gi c he al th pl an N um be r o f i ns tit ut io ns th at h av e in co rp or at ed a nt im ic ro bi al re sis ta nc e in to th ei r a nn ua l p la n 20 21 –2 02 5 18 9 M O H , M O A, EF CC C an d th ei r re gi on al c ou nt er pa rts , a ll st ak e ho ld er s N at io na l P la nn in g Co m m is sio n, d ev el op m en t p ar tn er s Al lo ca te re so ur ce s fo r t he s us ta in ab le im pl e m en ta tio n of a nt im ic ro bi al re sis ta nc e ac tiv iti es N um be r o f i ns tit ut io ns th at h av e al lo ca te d re so ur ce s 20 21 –2 02 5 18 9 M O H , M O A, EF CC C an d th ei r re gi on al c ou nt er pa rts , a ll st ak e ho ld er s M in is try o f F in an ce an d re gi on al c ou n te rp ar ts , d ev el op m en t p ar tn er s 0 Co nd uc t a nn ua l i ns tit ut io na l a nt im ic ro bi al re sis ta nc e pe rfo rm an ce re vi ew m ee tin gs a t th e na tio na l l ev el N um be r o f s ec to rs th at h av e co n du ct ed p er fo rm an ce re vi ew s 20 21 –2 02 5 15 M O H , M O A, EF CC C, a ll st ak e ho ld er s D ev el op m en t pa rtn er s 63 0 00 .0 0 66 AMR Prevention and Containment Strategic Plan: 2021–2025 In it ia ti ve 5 .3 : R e so u rc e m o b ili za ti o n En su re a va ila bi l it y of s us ta in a bl e re so ur ce s D ev el op re so ur ce m ob iliz at io n st ra te gi es Re so ur ce m ob iliz at io n st ra te gy d ev el op ed 20 21 1 AM R se cr et ar ia t M O H , M O A, EF CC C D ev el op m en t pa rtn er s, M O F, ac a de m ia , a ss oc ia tio ns 15 0 80 .0 0 G en er at e ev id en ce o n th e re tu rn o f in ve st m en t i n an tim ic ro bi al re sis t an ce p re ve nt io n an d co nt ai nm en t N um be r o f e vi de nc e re po rts g en er at ed 20 24 1 M O H , M O A, EF CC C D ev el op m en t pa rtn er s, ac ad em ia , as so ci at io ns 20 0 00 .0 0 En su re r es ou rc e m ob ili za ti on t o en co ur ag e in no va ti on s on t he de ve lo pm en t of ne w a nt im ic ro bi al s, v ac ci ne s, di ag no st ic s, no ve l t he ra pi es an d/ or a lt er na ti ve s M ob iliz e re so ur ce s fo r t he d ev el op m en t o f n ew a nt im ic ro bi al s, va c ci ne s, di ag no st ic s, no ve l t he ra pi es an d/ or a lte rn at iv es Am ou nt o f r es ou rc es m ob iliz ed a nd a llo ca te d fo r i nn ov at io ns 20 21 –2 02 5 10 0% M O H , M O A EF CC C, d ev el op m en t p ar tn er s, ac a de m ia , a ss oc ia tio ns 12 10 0. 00 D es ig n in ce nt iv e ba se d m ec ha ni sm s to m ot iv at e se ct or s in th e de ve lo p m en t o f n ew a nt im ic ro bi al s, va c ci ne s, di ag no st ic s, no ve l t he ra pi es an d/ or a lte rn at iv es In ce nt iv e m ec ha ni sm s in p la ce 20 21 –2 02 5 1 M O H M O A EF CC C D ev el op m en t pa rtn er s, ac ad em ia as so ci at io ns , p riv at e se ct or 10 0 00 .0 0 To ta l 24 6 58 0. 00 G ra nd t ot al f or o bj ec ti ve s on e– fiv e in U S$ 2 2 42 9 54 0. 86 AMR Prevention and Containment Strategic Plan: 2021–2025 67 5. MONITORING AND EVALUATION FRAMEWORK Goals Objectives Activities/ Inputs Outputs Outcomes Impacts 2021 2022 2023 2024 2025 68 AMR Prevention and Containment Strategic Plan: 2021–2025 5. MONITORING AND EVALUATION FRAMEWORK Implementation of the antimicrobial resistance prevention and containment interventions must be monitored regularly to enable a better understanding of the scope of the problem throughout the country as well as to measure any progress. Such monitoring requires the collection, collation, anal ysis and management of data from the human, animal, plant and environment sectors. Monitoring and evaluation help to extract relevant information from ongoing activities that can be used for pro gramme fine-tuning, reorientation and future planning. The role of monitoring and evaluation is to provide a strategic link with the relevant stakeholders to ensure that strategies are effective in responding to the antimicrobial resistance threats in the coun try. Additionally, it enables problems to be detected early, thereby reducing the likelihood of major cost overruns or time delays and related health outcomes. A monitoring and evaluation system needs to be in place to ensure that results are reported in a timely and efficient manner. In addition, the system supports the establishment of transparent feed back loops with implementing agencies, stakeholders and the public. The monitoring and evaluation framework of the third strategic plan will include: Standard reporting systems (reporting template, line of communication, frequency of reporting). Routine and periodic monitoring mechanisms, such as supportive supervision and regular review meetings. Baseline, midterm and terminal evaluations (based on the key performance indicators stipulated in table 15). The logic model for the antimicrobial resistance prevention and containment monitoring and evalu ation framework is presented in figure 2. AMR Prevention and Containment Strategic Plan: 2021–2025 69 5. 1 LO G IC M O D EL F O R TH E N AT IO N A L A N TI M IC RO B IA L RE SI ST A N C E PR EV EN TI O N A N D C O N TA IN M EN T ST RA TE G IC P LA N Fi gu re 2 L og ic m od el f or t he N at io na l A nt im ic ro bi al R es is ta nc e Pr ev en ti on a nd C on ta in m en t St ra te gi c Pl an Im pa ct R ed uc ti o n an d co nt ai nm en t o f an ti m ic ro bi al r es is ta nc e Household- and facili ty-based assessments, population-based surveys Regular review at different platforms and National and Regional AMR Advisory Committee meetings, midterm and final evaluations and global reporting through the Global Antimicrobial Surveillance System  Ef fe c ti ve ne ss O ut co m e Im pr o ve d aw ar en es s & un de rs ta nd in g o f an ti m ic ro bi al u se & r es is t an ce in t ar ge t gr o up s St ro ng m ul ti se ct o r co lla b o ra ti o n R ed uc ed in ci de nc e o f in fe ct io n O pt im iz ed u se o f an ti m ic ro bi al s  Q ua lit y O ut p ut Su rv ey & re se ar ch re po rt A va ila bi li ty o f m i cr o b io lo gy & q ua lit y co nt ro l l ab A va ila bi lit y o f ad vo ca cy m at er ia ls Tr ai ne d pe rs o n ne l A M R d at a ba se A M R in c ur ri cu lu m Document reviews, surveys, surveillance reports, administrative reports  Le ad er sh ip & go ve rn an ce In pu t & pr o ce ss B ud ge t Fa ci lit ie s, pr em is es D ev el o pm en t o f in fo rm at io n & ed uc at io n co m m un ic at io n & be ha vi o ur c ha ng e co m m un ic at io n m at er ia ls A w ar e ne ss & tr ai ni ng Le ga l i ns tr u m en ts & gu id el in es H um an r es o ur ce s, le ad er sh ip & po lit ic al c o m m it m en t G o ve rn an ce , m ul ti se ct o r co lla bo ra ti o n D ri ve r D o m ai n M o ni to ri ng & e va lu at io n fr am ew o rk fo r an ti m ic ro bi al r es is ta nc e D at a so ur ce A na ly si s & u se F ig u re 6 : Lo g ic m o d e l f o r th e N at io n al A n ti m ic ro b ia l R e si st an ce P re ve n ti o n a n d C o n ta in m e n t S tr at e g ic P la n 70 AMR Prevention and Containment Strategic Plan: 2021–2025 5.2 MONITORING AND EVALUATION PLAN Table 14 Monitoring and evaluation operation plan Strategic interven tions Activities Indicator Time of imple menta tion Fre quency (within 5 years) Lead imple menter Collabo rators Indic ative budget (US$) Develop and implement monitoring and evalua tion (M&E) guidelines Develop M&E guide lines with standard reporting template M&E guide lines devel oped 2021 1 AMR secretariat MOA, EFCCC 15 000.00 Submit reg ular imple mentation reports at all levels Number of timely reports 2021– 2025 Quarterly MOH, MOA, EFCCC and their regional counter parts Devel opment partners NA Provide feedback Timely feed back 2021– 2025 Quarterly AMR secretariat MOH, MOA, EFCCC and their regional counter parts, de velopment partners NA Establish and strengthen routine and periodic monitoring mechanisms Organize integrated supportive supervision at all levels Number of supervision report 2021– 2025 Biannual MOH, MOA, EFCCC and their regional counter parts Devel opment partners 120 000.00 Conduct an annual review meeting Number of re view meetings conducted 2021– 2025 Annual MOH, MOA, EFCCC and their regional counter parts Devel opment partners 150 000.00 Evaluation Baseline assessment Assessment report 2021 1 MOH, MOA, EFCCC, partners Respective regional counter parts 15 000.00 Midterm evaluation Evaluation report 2023 1 MOH, MOA, EFCCC and their regional counter parts, partners Academia 25 000.00 Terminal evaluation Evaluation report 2025 1 Academia 40 000.00 Total 365 000.00 AMR Prevention and Containment Strategic Plan: 2021–2025 71 5.3 KEY PERFORMANCE INDICATORS Core indicators have been selected to evaluate whether activities in the coming years are executed as planned and outcomes achieved as anticipated. They will also provide learning on how to im prove future activities. Using the following guiding principles, 36 key performance indicators were selected for the monitoring and evaluation of the National Antimicrobial Resistance Prevention and Containment Strategic Plan. • Relevance: significance of the indicators that measure each component of the plan. • Feasibility: in terms of cost, time, data collection and capturing the burden. • Sensitivity: change over two to three years of the reporting period. • Consistency with international standards. Table 15 Key performance indicators Indicator Type Baseline 2020 Yearly target (2021–2025) Data source Peri odic ity Level of data col lection Y1 Y2 Y3 Y4 Y5 Objective one: Improve awareness and understanding of antimicrobial resistance through effective behaviour change communication, education and training Number of dissemination events for IEC and BCC materi als in the human, animal and envi ronment sectors (1.1) Out put 2 4 6 8 10 12 Institutional activities and event reports Annu al Institution (three sectors) Awareness and understanding level increased on antimicrobial resistance among humans, animals and environment health profes sionals (1.1) Out come NA 5% from the base line 10% Surveys 2–3 years Population Number of media spots dis seminated to the public (1.1) Out put 2 4 6 8 10 12 Institution al reports Annu al Institution (three sectors) Number of anti microbial train ings for media professionals (1.3) Out put 1 4 6 8 10 12 Institutional reports Annu al Institution (three sectors) 72 AMR Prevention and Containment Strategic Plan: 2021–2025 Indicator Type Baseline 2020 Yearly target (2021–2025) Data source Peri odic ity Level of data col lection Y1 Y2 Y3 Y4 Y5 Number of advo cacy workshops created on anti microbial resist ance for policy makers (1.4) Out put 0 1 2 3 4 5 Institutional reports Annu al Institution (three sectors) Objective two: Strengthen the knowledge and evidence on antimicrobial use and resistance through surveillance and research Number of anti microbial resist ance surveillance sentinel sites em ployed to detect and report anti microbial resist ance, in human and animal health sectors (2.1) Out put H–9 A–1 H–12 A–1 H–16 A–2 H–19 A–3 H–22 A–4 H–25 A–5 Admin reports Rou tine Institution Percentage of bloodstream infections due to methicillin-resist ant staphylococ cus aureus and extended spec trum beta-lacta mase E. coli among patients seeking care and blood sampled (2.1) Out come 32.5% for methicil lin-resist ant staph ylococcus aureus, 50% extended spectrum be ta-lacta mase E. coli 10% Published surveil lance reports 5 years Institution Number of hu man, animal and environment labs with a standard quality manage ment system (2.2) Out come H–2 A–1 E–0 9 – – 12 – – 16 – – 19 – – H–25 A–2 E–1 Admin reports Rou tine Institution Number of re search studies conducted on prioritized antimi crobial resistance areas (2.3) Out put NA 2 4 7 10 Published literature Annu al NA AMR Prevention and Containment Strategic Plan: 2021–2025 73 Indicator Type Baseline 2020 Yearly target (2021–2025) Data source Peri odic ity Level of data col lection Y1 Y2 Y3 Y4 Y5 Objective three: Enhance infection prevention and control through effective environmental health, infection prevention and bio-risk management in human, animal and plant health care Percentage of facilities adhered with updated infection preven tion and control policies, standard protocols and guidelines in hu man and animal health care (3.1) Out come NA 5% 20% 40% 60% 80% Survey reports Annu al Institution Decreased rate of health care-as sociated infec tions (3.2) Out come 39.6% 5% 10% Survey reports 3–5 years Institution Percentage of fa cilities having bi osecurity guide lines for animal feed processing, poultry, dairy and beef production (3.3) Out put 0 30% 50% Survey reports 2–3 years Institution Objective four: Optimize the use of antimicrobials in human, animal and plant health care Percentage of essential antimi crobials and lab supplies included in the Govern ment’s long-term procurement list (4.1) Out put – 100% 100% 100% 100% Survey reports 2–3 years Institution Number of hazard analysis critical control point inspections conducted on food preparation and dispensing centres (4.4) Out put – 1 2 3 4 5 Inspection reports Rou tine Institution 74 AMR Prevention and Containment Strategic Plan: 2021–2025 Indicator Type Baseline 2020 Yearly target (2021–2025) Data source Peri odic ity Level of data col lection Y1 Y2 Y3 Y4 Y5 Number of health care facilities implementing an timicrobial stew ardship (4.2) Out put 30 60 75 90 100 150 Facilities reports Rou tine Institution Availability of updated veter inary standard treatment guide lines at veterinary health facilities (4.3) Out put 0 25% 50% 80% 90% 100% Admin reports Rou tine Institution Percentage of adherence to standard treat ment guidelines in hospitals (4.2) Out come NA 32 60 Survey reports 2–3 years Health facilities Number of hos pitals conducting hazard analysis critical control point prevalence survey (4.2) Out put 0 10 20 40 60 90 Survey reports Annu al Health facilities Number of guide lines on prudent use of antimicro bials in animal health sector and food production (4.3) Out put 0 2 Admin reports Annu al Institution Number of hospi tals that generate antibiogram data (4.4) Out put 9 12 15 20 25 30 Survey reports Rou tine Health facilities Percentage of health facilities complying with the Rational Med icine Use Direc tive (4.5) Out come NA 60 75 Survey reports 3–5 years Health facilities AMR Prevention and Containment Strategic Plan: 2021–2025 75 Indicator Type Baseline 2020 Yearly target (2021–2025) Data source Peri odic ity Level of data col lection Y1 Y2 Y3 Y4 Y5 Percentage of ad herence to waste management standards in man ufacturing and food processing plants (4.5) Out come 50 70 Survey reports 3–5 years Manufac turers Number of train ings provided for animal owners on withdrawal peri od and maximum residue limit Out put NA 5 10 15 20 25 Admin reports Annu al Institution Objective five: Strengthen and establish partnerships, alliances, governance and resource mobilizations at all levels Number of advo cacy workshops conducted to en gage the private sector on antimi crobial resistance prevention and containment (5.1) Out put 0 2 4 6 8 10 Admin reports Annu al Institution Number of insti tutions that have incorporated an timicrobial resist ance prevention and containment into their ap proved annual plan (5.2) Input 7 17 25 189 Survey reports Annu al Institution Number of iden tified innovative financing mecha nisms for antimi crobial resistance prevention and containment (5.3) Out come 0 1 2 Document reviews 2–3 years Institution Generated evi dence that shows return on invest ment in antimi crobial resistance prevention and containment in selected institu tions (5.3) Out put 0 1 2 Study reports 2–3 years Institution 76 AMR Prevention and Containment Strategic Plan: 2021–2025 6. RISKS AND MITIGATION 2021 2022 2023 2024 2025 AMR Prevention and Containment Strategic Plan: 2021–2025 77 6. RISKS AND MITIGATION During the implementation of the National Antimicrobial Resistance Prevention and Containment Strategy, the sectors may encounter risks that impede achievement of results. The following table articulates the risks identified through the SWOT analysis and stakeholder analysis and strategies to address or mitigate them. S. No Risk Mitigation strategy 1 COVID-19 and its impacts on the health system (human and animal) and the environment The MOH, MOA and EFCCC in close collaboration with the Government and different ministries will actively work on the pre vention and control of COVID-19. As a priority public health concern, its control will be enhanced through implementa tion of appropriate and effective public health measures. In line with the COVID-19 controls, the MOH, the MOA, the EFCCC and other stakeholders will implement the National Antimicrobial Resistance Prevention and Containment strategy by integrating it into COVID-19 activities. 2 Occurrence of emerging and re-emerging microbial diseases (human and animal) The MOH and MOA will strengthen the public health (human and animal) emergency management system by improving the capacity for emergency preparedness, prevention, early detec tion and response of emerging and re-emerging diseases. 3 Inadequate financial resources and sudden reduction of donor funds (low predictability of external funding due to world economic recession) The antimicrobial prevention and containment strategy will follow efforts to address the financial gaps. Implementation of innovative domestic financing strategies to mobilize adequate finance domestically will be implemented. Public–private partnerships are to be strengthened. 4 Weak intersectional collaboration The MOH, MOA and EFCCC will work closely with the Gov ernment and other stakeholders to collaborate in addressing the implementation of antimicrobial resistance prevention and containment. 5 Inadequate private sector involve ment The MOH, MOA and EFCCC will work with other govern ment ministries and agencies, civil society organizations and the private sector to attract investment on antimicrobial resistance prevention and containment and strengthen pub lic–private partnerships. 78 AMR Prevention and Containment Strategic Plan: 2021–2025 REFERENCES • Alemkere, G (2018). Antibiotic usage in surgical prophylaxis: a prospective observational study in the surgical ward of Nekemte referral hospital. PLoS ONE. doi: 10.1371/journal.pone.0203523. • Ayalew MB (2017). Self-medication practice in Ethiopia: a systematic review. Patient Prefer Ad herence. 11:401-413. doi: 10.2147/PPA.S131496. 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(https://wellcomecollection.org/works/rdpck35v). • O’Neill J (2016). Tackling drug-resistant infections globally: final report and recommendations. 80 AMR Prevention and Containment Strategic Plan: 2021–2025 May 2016. (https://amr-review.org/sites/default/files/160518 Final% 20paper with%20cover. pdf). • Sisay M et al. (2018). Resistance profile of clinically relevant bacterial isolates against fluoro quinolone in Ethiopia: a systematic review and meta-analysis. BMC Pharmacol Toxicol. 19(1):86. doi: 10.1186/s40360-018-0274-6. PMID: 30541613; PMCID: PMC6292079. • Sisay M, Mengistu G, Edessa D (2018). Epidemiology of self-medication in Ethiopia: a system atic review and meta-analysis of observational studies. BMC Pharmacol Toxicol. 19:56. (https:// doi.org/10.1186/s40360-018-0248-8). • Tadesse G (2014). A meta-analysis of the proportion of antimicrobial resistant human salmonel la isolates in Ethiopia. BMC Pharmacol Toxicol. 15:51. doi: 10.1186/2050-6511-15-51. 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AMR Prevention and Containment Strategic Plan: 2021–2025 81 ANNEX TERMS OF REFERENCES FOR ANTIMICROBIAL RESISTANCE MULTISECTOR GOVERNANCE STRUCTURE 1.TERMS OF REFERENCE NATIONAL INTERMINISTERIAL COMMITTEE FORANTIMICROBIAL RESISTANCE PREVENTION AND CONTAINMENT Introduction Antimicrobials include antibiotics, antifungals, antivirals and anti-protozoal. They are critical to hu man, animal and plant health and the environment and to a country’s development and security. De spite the innovation of many antimicrobials in the world, the emergence of drug-resistant bacterial strains has become a top global public health agenda priority. Antimicrobials used and misused for human and animal health care can be found in food as residues and also are excreted unchanged into the environment (water and soil) as contaminants creating selection pressure on microorgan isms. Antimicrobial resistance occurs when microorganisms change in a way that reduces or eliminates the effectiveness of antimicrobials that were used to cure or prevent infections. By so doing, the microorganisms continue to survive and multiply, with their presence causing more harm. In human and animal health, it implies that life-threatening infections that were previously manageable are poised to be untreatable because of antimicrobial resistance. This will lead to high morbidity and mortality in human diseases, reduction in agricultural output and related livelihood and econo my-wide impacts. It will increase poverty and render achievement of the Sustainable Development Goals difficult if not impossible. If nothing is done to stem these threats, it could force up to 24 million people into extreme poverty by 2030. By 2050 the global economy may lose more than $100 trillion dollars annually because of antimicrobial resistance and the reduction in GDP by an estimated global average of 3.8% high for low-income countries. More people will go into poverty due to antimicrobial resistance. Resistant microorganisms have no borders, making it truly a global problem that requires One Health solutions. Coordinated action is required to minimize the emergence and spread of antimi crobial resistance. Members of the public, of the scientific and medical communities, of the national and regional authorities as well as the international community can and should contribute to the solutions. One of the major objectives of the Global Health Security Agenda is to accelerate progress towards a world safe and secure from infectious disease threats. The Global Health Security Agenda has developed 11 “action packages” that are implemented under three titles: Prevent, Detect and Re spond. The action packages concept was developed to facilitate regional and global collaboration towards specific Global Health Security Agenda objectives and targets. Antimicrobial resistance is one of the 11 action packages requiring national multisector and international collaboration. Tackling the global spread of antimicrobial resistance is also a high priority agenda for the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (OIE) and their member countries. WHO, FAO and OIE launched a Global Strategy and Plan of Action for Containment of Antimicrobial Resistance that follows the One-Health approach. Countries have developed national strategies and action plans so that they can prevent and manage antimicrobial resistance across multiple sectors. 82 AMR Prevention and Containment Strategic Plan: 2021–2025 In line with the WHO Global Strategy and Plan of Action, Ethiopia has committed to develop a National Action Plan on Antimicrobial Resistance and mobilize the necessary resources. Under the coordination and leadership of the Ethiopian Food and Drug Authority, a National Antimicrobial Re sistance Advisory Committee composed of multiple stakeholders has been established to oversee the country’s antimicrobial resistance prevention and containment activities. Recognizing that bringing antimicrobial resistance under control requires consolidated, concerted action by multiple stakeholders, the Ministry of Health, in collaboration with the Ministry of Agricul ture and the Ethiopian Forestry, Environment and Climate change Commission, has taken the initi ative leveraging on the gains already made by strengthening and restructuring the country’s efforts to contain and prevent antimicrobial resistance. A federal multisector governance mechanism is to be established to serve as the central intervention around which all the antimicrobial resistance-re lated activities can be effectively coordinated in each of the relevant sectors. This will ensure a systematic and comprehensive approach that would be broad enough to address all five strategic objectives of the antimicrobial resistance action plan, prioritizing activities in a step-wise approach. The antimicrobial resistance governance mechanism for Ethiopia will comprise a high-level National Inter-Ministerial Committee, the national antimicrobial resistance focal point (AMR secretariat), the National Antimicrobial Resistance Advisory Committee and multisector technical working groups that will address the objectives of the national action plan. Given the ultimate goal of antimicrobial resistance containment efforts that are geared to improve health outcomes, the National Interministerial Committee will be formed to provide necessary po litical commitment and support and avail of financial and human resources for national antimicrobial resistance containment and prevention efforts. Objective The main objective of the National Interministerial Committee is to provide necessary political com mitment and authority for the coordination and implementation of country’s antimicrobial resistance containment and prevention efforts. Roles and responsibilities • Political support: As antimicrobial resistance has an impact on all human and veterinary medical activ ities as well as on the environment, which justifies a multisector approach based on the One Health con cept, advocacy on the risk of antibiotic resistance and to the proper use of antibiotics as a public health priority, the National Interministerial Committee will sustain political decisions and support to control antimicrobial resistance. • Leadership: The National Interministerial Committee will set joint leadership with other relevant min istries that might require oversight from a specified authority. • Policy direction: The National Interministerial Committee will set strategic and policy directions that support implementation of the antimicrobial resistance prevention and containment activities. • Dedicated funds: The availability of dedicated funds will increase the operational effectiveness of the program. Hence, the National Interministerial Committee will solicit and secure funds to ensure political “ownership” and increase the likelihood of programme sustainability. • Authority to act: The National Interministerial Committee will give sufficient authority to ensure that its decisions and plans are implemented. • Coordination and collaboration: Addressing the growing threat of antimicrobial resistance is a shared responsibility that requires multisector collaboration. The National Interministerial Committee will: AMR Prevention and Containment Strategic Plan: 2021–2025 83 • Work with other government offices, domestic and international partners on reducing the public • health risks and impacts of antimicrobial resistance. • Support and collaboratively evaluate the performance of regional state and city administrations in cascaded implementation of the national strategy and plan of action on antimicrobial resistance prevention and containment. Membership The National Interministerial Committee will have the following members: 1. Ministry of Health – Chair 2. Ministry of Agriculture – Co-chair 3. Ministry of Water, Irrigation and Energy –member 4. Ministry of Education – member 5. Ministry of Science and Higher Education –member 6. Ministry of Innovation and Technology –member 7. Ministry of Finance –member 8. Ministry of Women, Children and Youth –member The secretary of the National Interministerial Committee will be an adviser to the Minister of Health. Meetings • The National Interministerial Committee will meet biannually, using the existing platforms that accommo dated all its members. Extraordinary meetings can be arranged when necessary. Accountability • The National Interministerial Committee will be accountable to the Council of Ministers. Working procedure • The National Interministerial Committee will have a chair and co-chair, members and secretary. • The meeting agenda would be prepared by chair of the National Antimicrobial Resistance Advisory Com mittee and be communicated to the organizers via email and phone at least two weeks before the meeting date. • The National Interministerial Committee will communicate action points (reports and recommenda tions) and correspondence, reports and decisions regularly to the Council of Ministers and member organizations. • Members of National Antimicrobial Resistance Advisory Committee will attend the Inter-Ministerial Committee meetings. Terms of service • Membership is for unlimited period, except for ministers who are leaving or shifted from the former or ganization where they are represented. 84 AMR Prevention and Containment Strategic Plan: 2021–2025 2. TERMS OF REFERENCE NATIONAL ADVISORY COMMITTE FOR ANTIMICROBIAL RESISTANCE PREVENTION AND CONTAINMENT Introduction Resistance to the effects of antimicrobial drugs is a serious problem in the world. Antimicrobial resistance occurs naturally over time, usually through genetic changes. However, the misuse and overuse of antimicrobials is accelerating this process. Antimicrobial resistance costs lives and money and threatens our ability to treat infections in humans and animals. Drug resistance has become a global public health crisis. Because of its effect on food production, economy and security, antimi crobial resistance is also considered a threat to health, national security and the economy. If nothing is done to stem this crisis, it could force up to 24 million people into extreme poverty by 2030. Coordinated action is required to minimize the emergence and spread of antimicrobial resistance. Members of the public, of the scientific and medical communities, local and national authorities as well as the international community can and should contribute to the solutions. Several efforts have been made to curb the multidimensional challenges of antimicrobial resistance. Tackling the global spread of antimicrobial resistance is a high priority for the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE) and their member countries. The three organizations launched the Global Strategy and Plan of Action for Containment of Antimicrobial Resistance. Countries are developing a national action plan to prevent and manage antimicrobial resistance across multiple sectors following the One Health approach. The effective control of infectious diseases in Ethiopia is compromised by the increasing trends of microorganisms’ resistance to the antimicrobials use in human and animal health care system. The emergence and spread of resistant strains have called for swift and concerted efforts of various agencies. The task needs to be overseen by high-level officials of the Ministry of Health, the Min istry of Agriculture and the Forestry, Environment and Climate Change Commission because the outcomes of the overall activities will affect the quality of health services of human, animal and plant as well as food production and economy in the country. In line with the WHO Global Strategy and Plan of Action, Ethiopia has developed a national plan on antimicrobial resistance and mobilized the necessary resources. Under the coordination and leadership of the Ethiopian Food and Drug Authority, a national advisory committee composed of multiple stakeholders has been established to oversee the country’s antimicrobial resistance pre vention and containment activities. Recognizing that bringing antimicrobial resistance under control requires consolidated, concerted action by multiple stakeholders, the Ministry of Health, the Ministry of Agriculture and the Ethiopian Forestry, Environment and Climate Change Commission are leveraging the gains already made by strengthening and restructuring the country’s efforts to contain and prevent antimicrobial resist ance. Having a national multisector governance mechanism will serve as the central intervention around which all the antimicrobial resistance-related activities can be effectively coordinated in each of the relevant sectors. This will ensure a systematic and comprehensive approach. The scope should be broad enough to address all five objectives of the Global Strategy, prioritizing activities in a step-wise approach. The governance mechanism will encompass a high-level National Interministerial Committee, an antimicrobial resistance focal point (the AMR secretariat), the National Antimicrobial Resistance Advisory Committee and multisector technical working groups that will address the respective stra tegic objectives of the national action plan. AMR Prevention and Containment Strategic Plan: 2021–2025 85 In accordance with the governance framework, the National Antimicrobial Resistance Advisory Committee involving a wide range of partners will be reorganized to enhance multisector collab orations in addressing the risk of antimicrobial resistance and minimize its impact on human and animal health in the country. Objective The main objective of the National Antimicrobial Resistance Advisory Committee is to oversee and coordinate all antimicrobial resistance-related activities in all sectors to ensure systematic and comprehensive approaches accorded with defined antimicrobial resistance-related goals and with the global action plan for antimicrobial resistance. The scope should be broad enough to address all five strategic objectives of the national action plan, prioritizing activities in a step-wise approach. Roles and responsibilities • Plan and set an overall direction for antimicrobial resistance control and prevention in Ethiopia and ensure that major goals and timelines are achieved. • Provide platform for programme planning and implementation through a supporting structure comprising of technical working groups for individual strategic objectives. • Facilitate and coordinate efforts to contain and reduce the threat of antimicrobial resistance at all levels. • Collaborate with internal and external agencies and organizations. • Provide a structure for information-sharing to mutually reinforce activities among sectors. • Ensure adequate integration of antimicrobial resistance containment efforts into the existing health sys tem, public health and disease-specific programmes, animal health and food production sector and other environmental initiatives. • Advocate for prevention and containment of antimicrobial resistance. • Monitor and evaluate the existing technical working groups and their respective activities in relation to the national action plan. • Collaboratively work with and support regional and city administration Antimicrobial Resistance Advisory Committees. • Coordinate joint monitoring and evaluation of implementation and results and achievements of the Na tional Antimicrobial Resistance Prevention and Containment Strategy and Plan of Action. Membership The National Antimicrobial Resistance Advisory Committee is to be composed of officially delegat ed members representing the relevant sectors, notably human health, animal health, agriculture and the environment. Representatives should be given sufficient authority by their institutions to make decisions. Hence, the following institutions are members of the National Antimicrobial Resist ance Advisory Committee. 86 AMR Prevention and Containment Strategic Plan: 2021–2025 Organization Remark Government organizations 1 Ministry of Health, Medical Service Director General Chair 2 Veterinary Drug and Feed Administration and Control Authority Co-chair 3 Ministry of Agriculture, Veterinary Public Health Directorate 4 Ministry of Agriculture, Plant Health Directorate 5 Ministry of Health, Clinical Service Directorate 6 Ministry of Health, Deliverology Unit 7 Water, Environment, Forestry and Climate Change Commission 8 Ministry of Science and Higher Education 9 Ethiopian Food and Drug Authority 10 Ethiopian Public Health Institute 11 Armaour Hansen Research Institute 12 Ethiopian Pharmaceutical Supply Agency 13 National Animal Health Diagnostic and Investigation Centre 14 National Veterinary Institute 15 Communication and Broadcast Authority, Ministry of Health, Public Relations Directorate 16 Ministry of Health, Pharmaceuticals and Medical Equipment Directorate Secretary Representatives from professional associations – executive directors 1 Ethiopian Medical Association 2 Ethiopian Veterinary Association 3 Ethiopian Pharmacy Association 4 Ethiopian Public Health Association 5 Ethiopian Nurse Association 6 Ethiopian Medical Laboratory Association 7 Ethiopian Private Health Facilities Employers Association Representatives from international organizations – focal persons 1 World Health Organization 2 Food and Agriculture Organization of the United Nations 3 United States Agency for International Development 4 Africa Centres for Disease Control and Prevention Representatives from development partners – executive directors and focal persons 1 USAID Global Health Supply Chain Program’s Procurement and Supply Management 2 USAID Medicine, Technology and Pharmaceutical Service 3 United States Pharmacopeia AMR Prevention and Containment Strategic Plan: 2021–2025 87 Meetings The National Antimicrobial Resistance Advisory Committee will have a regular meeting schedule every two months. Extraordinary meetings can be arranged when necessary. Accountability The National Antimicrobial Resistance Advisory Committee is accountable to the National Intermin isterial Committee. Working procedure • The National Antimicrobial Resistance Advisory Committee will have a permanent chair and co-chair, member and secretary. • The venue will be at the Ministry of Health’s meeting hall, unless members are informed to the contrary. The secretariat shall notify members of the venue of the meetings when communicating the agenda. • Meeting agenda would be prepared jointly by the chairperson and secretary and be communicated to members via email and phone at least seven days before the meeting date. • The quorum shall be the chairman, co-chairman, secretary and representatives from 50% plus one of the members. • Minutes will be recorded by secretary and officially distributed to members through email within a week time after meetings occur. The minutes should be kept by the secretary and copy should be maintained in records at the Ministry of Health and offices for further references. • All members should attend all meetings regularly in person or send a delegate, when necessary. • Absenteeism without notifying the chair (co-chair) or secretary is unacceptable. • If a member is absent for more than three consecutive meetings, an official reminder will be sent to them with a copy to their office. • If a member is leaving their organization, the organization is required to designate a successor. • The National Antimicrobial Resistance Advisory Committee will communicate action points (correspond ence, reports and decisions) regularly to member organizations. Terms of service • Membership is for unlimited period, except for persons who are leaving their organization. 88 AMR Prevention and Containment Strategic Plan: 2021–2025 3. TERMS OF REFERENCE NATIONAL ANTIMICROBIAL RESISTANCE PREVENTION AND CONTAINMENT TECHNICAL WORKING GROUPS Introduction During the past century, discoveries of microorganisms as causes of infections and antibiotics as effective therapeutic agents have contributed to significant gains in public health in many parts of the world. Antimicrobials, which includes antibiotics, antifungals, antivirals and anti-protozoal, are critical to human, animal and plant health, the environment, national development and security. Despite the innovation of many antimicrobials in the world, the emergence of drug-resistant bacterial strains has become high on the global public health agenda. Antimicrobials used and misused by humans and animals can be found in food as residues and also are excreted unchanged to the environment (water and soil) as contaminants, creating selection pressure on microorganisms. Antimicrobial re sistance occurs when microorganisms change, which reduces or eliminates the effectiveness of the antimicrobials that were used to cure or prevent infections. By so doing, the microorganisms continue to survive and multiply, even in their presence, causing more harm. In human and animal health, it implies that life-threatening infections that were previously manageable are poised to be untreatable. Antimicrobial resistance leads to high morbidity and mortality in human diseases, reduction in agricultural output and related livelihood and economy-wide impacts. It contributes to poverty and to making achievement of the Sustainable Development Goals difficult if not impossi ble. Without action now, the global economy may lose more than $100 trillion dollars annually by 2050 due to antimicrobial resistance and associated GDP reductions by a global average of 3.8%, which is high for low-income countries. Many people may fall back into poverty due to antimicrobial resistance. Resistant microorganisms have no borders, making it truly a global problem that requires One Health solutions. Tackling the global spread of antimicrobial resistance is a high priority for the World Health Or ganization (WHO), the Food and Agriculture Organization of the United Nations and the World Organization for Animal Health and their member countries. In collaboration, the three organiza tions launched the Global Strategy and Plan of Action for Containment of Antimicrobial Resistance. Countries have developed national strategies and action plans so that they can better prevent and manage antimicrobial resistance across multiple sectors. In line with the WHO Global Strategy and Plan of Action, Ethiopia has developed a national plan of action on antimicrobial resistance and mobilized the necessary resources. The second five-year (2015–2020) strategy to prevent and con tain antimicrobial resistance and respective action plan was developed in 2015 with five objectives: • Raise awareness and understanding and improve education on antimicrobial use, resistance prevention and containment through effective communication and training. • Strengthen the knowledge and evidence on antimicrobial use and resistance through One Health surveil lance and research. • Improve infection prevention and contain the spread of resistant microorganisms across human and an imal communities and health care settings through individual and environmental sanitation, hygiene and infection prevention measures. • Optimize the use of antimicrobials in human and animal health through effective stewardship practices. • Strengthen and establish federal alliances and partnerships, management and governance arrangements and resource mobilization for the prevention and containment of antimicrobial resistance at all levels. AMR Prevention and Containment Strategic Plan: 2021–2025 89 Recognizing that bringing antimicrobial resistance under control requires consolidated, concerted action by multiple stakeholders, the Ministry of Health, in collaboration with the Ministry of Agri culture and the Forestry, Environment and Climate Change Commission, has taken the initiative to leverage the gains already made and to thus strengthen and restructure the country’s efforts to contain and prevent antimicrobial resistance. In accordance with the country’s governance mechanism for the multisector national antimicrobial resistance prevention and containment activities, technical working groups are tasked to provide technical oversight and guidance to implement and monitor the five objectives of the national ac tion plan. The technical working groups are mandated to provide technical input and conduct sit uation analyses under the guidance of the National Antimicrobial Resistance Advisory Committee. The terms of reference of the technical working group were established by the National Antimi crobial Resistance Advisory Committee, providing specific scope, roles and responsibilities. The groups will be task-specific and focused on areas that the coordinating group has determined to be of particular focus for the country. Depending on the purpose, scope and tasks of the technical working group, membership may come from any of the relevant technical specialties. These may include experts from such areas as infectious diseases, microbiology, infection prevention and con trol, social health, food and drug regulation, surveillance system expertise, environment and others. The terms of reference should guide the function of the national antimicrobial resistance prevention and containment technical working groups. Objective The objective of establishing a technical working group is to have an active technical role in the implementation of the National Antimicrobial Resistance Prevention and Containment Action Plan. Each technical working group, as a team of experts, will be proactive in providing technical input, conducting situation analyses, monitoring and evaluating and recommending revision of the nation al action plan. Roles and responsibilities The roles and responsibilities of each technical working group may depend on the scope of imple mentation of the strategic objectives and action plans. However, each technical working group will have the following roles and responsibilities in common. • Operationalize the national action plan under their respective strategic objectives. • Prepare annual work plan as per the national action plan. • Collaborate with the National Antimicrobial Resistance Advisory Committee in formulation and revision of the national action plan. • Report to the National Antimicrobial Resistance Advisory Committee on the progress to the implemen tation of the respective strategic objective. • Provide updates of ongoing activities and provide technical advice to the National Antimicrobial Resist ance Advisory Committee or to the national antimicrobial resistance focal point (the AMR secretariat). • Work closely with relevant sectors in the implementation of the respective strategic objective to identify challenges, gaps and opportunities. • Ensure regular data collection and documentation. • Develop monitoring tools for the performance of implementation of the respective strategic objective. • Undertake supportive supervision to assess the implementation process. 90 AMR Prevention and Containment Strategic Plan: 2021–2025 • Coordinate and participate in selected activities, and build a sustained partnership between implementing sectors. Membership Under the leadership of the chairperson of each technical working group who would be an assigned member of the National Antimicrobial Resistance Advisory Committee representing the relevant sectors to the specific activities, membership of technical working groups will comprise relevant technical specialties from relevant sector organizations, partners and associations. Each technical working group shall comprise representatives of the following member organizations. Technical working group members Technical working groups Member organizations Technical working group for education and aware ness • · Ministry of Health, Public Relations Directorate – Chair • · Ministry of Agriculture, Public Relations Directorate • · Ministry of Education, Public Relations Directorate • · Ethiopian Food and Drug Authority, Public Relations Directorate • · Veterinary Drug and Feed Administration and Control Authority, Public Relations Directorate • · Environment, Forestry and Climate Change Commission, Public Relations Directorate • · Ministry of Health, Planning, Monitoring and Evaluation Directrate • · Ministry of Health, Clinical Service Directorate • · Ethiopian Medical Association • · Ethiopian Veterinary Association • · Ethiopian Pharmacy Association • · Ethiopian Public Health Association • · Ethiopian Nurse Association • · Ethiopian Medical Laboratory Association • · Private Health Facility Association • · World Health Organization • · Food and Agriculture Organization of the United Nations • · USAID Global Health Supply Chain Program’s Procurement and Supply Management • · USAID Medicine, Technology and Pharmaceutical Service AMR Prevention and Containment Strategic Plan: 2021–2025 91 Technical working group for infection prevention and hygiene • · Ministry of Health, Clinical Service Directorate – Chair • · Ministry of Health, Quality Directorate • · Ministry of Health, Hygiene and Environmental Health Directorate • · Ministry of Health, Disease Prevention and Control Directorate • · Ministry of Agriculture, Veterinary Public Health Directorate • · Ministry of Agriculture, Plant Health Directorate • · Ministry of Water, Irrigation and Energy • · Environment, Forest and Climate Change Commission • · Ethiopian Food and Drug Authority • · Veterinary Drug and Feed Administration and Control Authority • · Ethiopian Pharmaceutical Supply Agency • · Ethiopian Nurse Association • · Africa Centres for Disease Control and Prevention • · Food and Agriculture Organization of the United Nations • · Infectious Disease Detection and Surveillance Project • · United Nations Children’s Fund • · USAID Medicine, Technology and Pharmaceutical Service • · World Health Organization Technical working group for surveillance and re search • · Ethiopian Public Health Institute – Chair • · Armaour Hansen Research Institute • · Ethiopian Food and Drug Authority • · Veterinary Drug and Feed Administration and Control Authority • · Ethiopian Pharmaceutical Supply Agency • · National Animal Health Diagnostic and Investigation Centre • · National Veterinary Institute • · Addis Ababa University • · St Paul Hospital Millennium Medical College • · Infectious Disease Detection and Surveillance Project • · Ethiopian Medical Laboratory Association • · Africa Centres for Disease Control and Prevention • · World Health Organization • · Food and Agriculture Organization of the United Nations 92 AMR Prevention and Containment Strategic Plan: 2021–2025 Technical working group for antimicrobial steward ship • · Ministry of Health, Planning, Monitoring and Evaluation Directorate Chair • · Ethiopian Food and Drug Authority • · Ministry of Health, Clinical Service Directorate • · Pharmaceuticals Supply Agency • · Ethiopian Public Health Institute • · Armaour Hanssen Research Institute • · Tikur Anbessa Specialized Hospital • · St Paul Millennium Medical College Hospital • · St Peter Hospital • · Zewditu Memorial Hospital • · Ethiopian Medical Association • · Ethiopian Pharmacy Association • · World Health Organization • · Food and Agriculture Organization of the United Nations • · USAID Global Health Supply Chain Program’s Procurement and Supply Management • · USAID Medicine, Technology and Pharmaceutical Service Technical working group for resource mobilization for antimicrobial resistance • · Ministry of Health, Resource Mobilization Directorate – Chair • · Ministry of Agriculture, Resource Mobilization Directorate • · Ministry of Education, Resource Mobilization Directorate • · Environment, Forest and Climate Commission, Resource Mobiliza tion Directorate AMR Prevention and Containment Strategic Plan: 2021–2025 93 Technical working group for regulations and phar macovigilance • · Ethiopian Food and Drug Authority – Chair • · Ethiopian Food and Drug Authority, Product Safety Directorate • · Ethiopian Food and Drug Authority, Medicines Registration and Licensing Directorate • · Ethiopian Food and Drug Authority, Medicines Facility Inspection Directorate • · Veterinary Drug and Feed Administration and Control Authority • · National Animal Health, Diagnostic and Investigation Centre • · Ministry of Health, Planning, Monitoring and Evaluation Directorate • · Ministry of Health Regulatory • · Addis Ababa Regulatory (Food, Medicine and Healthcare Adminis tration and Control Authority) • · Customs Authority and Commission • · Ethiopian Public Health Association • · World Health Organization • · United States Agency for International Development • · United States Pharmacopeia, Pharmaceutical Quality Management • · USAID Medicine, Technology and Pharmaceutical Service • · USAID Global Health Supply Chain Program- Procurement and Supply Management • · Ethiopian Pharmacy Association 94 AMR Prevention and Containment Strategic Plan: 2021–2025 Accountability All antimicrobial resistance technical working groups are accountable to the National Antimicrobial Resistance Advisory Committee. Working procedure • Each technical working group shall have a chair and co-chair, member and secretary. • Each technical working group shall have a regular meeting schedule every month on Friday of the third week of the month starting at 9 a.m. Extraordinary meetings can be arranged when necessary. • The meeting agenda will be prepared jointly by the chairperson and secretary and be communicated to members via email and phone at least three days before the meeting date. • The venue for the technical working group meetings would will be the meeting halls of chairs of each technical working group, unless members are informed to the contrary. The secretariat shall notify mem bers of the venue of the meetings when communicating the agenda. • Minutes will be recorded by the secretary and officially distributed to members through email within a week after each meeting. The minutes should be kept by the secretary, and a copy should be maintained in the records for further reference. • At each meeting, minutes of the previous meeting will be endorsed, progress on the decision of previous meetings reported, emerging concerns discussed and recommendations forwarded for high-level decision and action. • For a meeting that entails a decision, the quorum shall be 50% plus one of the technical working group members, including the chairperson and secretary. The decision will be made on a consensus of the members. If consensus is not reached, the decision shall be made by majority vote. In case of a tie, the chairperson has the deciding vote. • All members should attend all meetings regularly in person or send a delegate, when necessary. • If a member is leaving their organization, the organization is required to immediately assign and update their successor. Each technical working group shall regularly communicate action points (correspondence, reports, decisions and recommendations to the multisector National Antimicrobial Resistance Advisory Committee and respective member organizations. Terms of service Membership to the technical working groups is for an unlimited period unless required otherwise by the federal governance mechanism or the federal antimicrobial resistance strategy and action plan. AMR Prevention and Containment Strategic Plan: 2021–2025 95 4. STAKEHOLDER ANALYSIS Stakeholders SO1 SO2 SO3 SO4 SO5 National Antimicrobial Resistance Advisory Committee, One Health Steering Committee X Academia X Animal Products, Veterinary Drug and Feed-Quality Assessment Center X Armauer Hansen Research Institute X X Civil society organizations X Community, patients, animal owners, clients X Development partners (local and international) X X X X X Ethiopian Environment and Forest Research Institute X Ethiopian Food and Drug Authority and its regional counterparts X X X X X Environment, Forestry and Climate Change Commission and its regional counterparts X X X X X Ethiopian Public Health Institute and its regional counterparts X X X X X Ethiopian Pharmaceutical Supply Agency X X X Health Facilities (public and private, human and animal) X X X X X Farm owners X Farmer-based associations X Human, veterinary and environmental health professionals X X International organizations (World Health Organization, Food and Agriculture Organization of the United Nations, World Organisation for Animal Health) X X X X X Livestock owners X Media (public and private, print and electronic, owners and professionals) X X Ministry of Agriculture and its regional counterparts X X X X X Ministry of Education X X X Ministry of Finance X X Ministry of Health and its regional counterparts X X X X X Ministry of Science and Higher Education X X X Ministry of Urban Development and Housing X Ministry of Water, Irrigation and Electricity X National Animal Health Diagnostic and Investigation Center and its regional counterparts X X X National Vaccine Institute X Public relation offices of government institutions X Professional associations (health, agriculture, veterinarian, environment) X X X X X Regional bureaus of health, agriculture and environment X X X X X Technical and vocational education training X X University and research institutions X X X X X Veterinary Drugs and Feed Administration and Control Authority and its regional Counterparts X X X X X Water and sewerage authorities X 96 AMR Prevention and Containment Strategic Plan: 2021–2025 5. SUMMARY OF ROLES AND RESPONSIBILITIES OF ANTIMICROBIAL RESISTANCE GOVERNANCE Interministerial Committee The Interministerial Committee oversees and implementation of the national strategy, which in cludes: • policy direction; • approval of the national strategic plan; • approval of budget; • mobilizing and allocating resources; • ensuring sector implementation of the national strategic plan; and • regularly monitoring and evaluating implementation and achievements. National AMR secretariat • Links the national strategic plan at the national and regional state and city administration levels. • Coordinates cascaded implementation of the national strategic plan at all levels. • Ensures continuous national, regional state and city administration and international engagement. • Collects, compiles, prepares and disseminates reports on the implementation and achievements to all stakeholders. • Coordinates regular review meeting and monitoring and evaluation platform. • Engages AMR Advisory Committees and the technical working groups. National Antimicrobial Resistance Advisory Committee • Mobilizes human and financial resource to support implementation of the national strategy. • Submits regular reports and budget proposal on the implementation of the National strategic plan. • Collaborates and coordinates with the regional state and city administration Antimicrobial Resistance Advisory Committees. • Regularly reviews, monitors and evaluates cascade implementation of the national AMR strategic plan. • Oversees and supports the technical working groups. Regional Antimicrobial Resistance Advisory Committees • Mobilize human and financial resources to support implementation of the national strategy. • Submit regular status reports and budgets proposal on the implementation of the regional AMR strategic plan. • Collaborate with the National Antimicrobial Resistance Advisory Committee. AMR Prevention and Containment Strategic Plan: 2021–2025 97 • Oversee and support the regional technical working groups. • Regularly review, monitor and evaluate the cascade implementation of the regional strategic plan. Technical working groups • Ensure cascaded planning and implementation of the national strategic plan by sector. • Prepare regular status reports and budget proposal on the implementation of the national strategic plan to the National Antimicrobial Resistance Advisory Committee. • Regularly review the cascade implementation of the national strategic plan. • Stakeholders • Cascade and implement the national strategic plan. • Submit regular reports and allocate budgets on the implementation of the national strategic plan. • Regularly review, monitor and evaluate cascade implementation of the national strategic plan. 98 AMR Prevention and Containment Strategic Plan: 2021–2025 6. CONTRIBUTORS Task force members to advise on revisions for the third strategic plan FULL NAME ORGANIZATION Yidnekachew Degefaw Ministry of Health Million Tirfe Megerssa Ethiopian Food and Drug Authority Getachew Asfaw Tariku Ministry of Health Dr Hayat Seid Hassen Veterinary Drug and Feed Administration and Control Authority Wendwosen Shewarega Ministry of Health Mengsteab W/Aregay World Health Organization Tenaw Andualem Food and Agriculture Organization of the United Nations Wondie Alemu Ethiopian Food and Drug Authority, Procurement and Supply Management DR Meseret Bekele Ministry of Agriculture Wendimnew Abrie Environment, Forest and Climate Change Commission Dr Yohannes Demissie Medicine, Technology and Pharmaceutical Service Workineh Getahun PMED and USAID-Medicine, Technology and Pharmaceutical Service Yakob Seman Ministry of Health Regassa Bayisa Ministry of Health Contributors, reviewers and workshop participants FULL NAME ORGANIZATION Abebe kebede Southern Nations, Nationalities and Peoples’ Region Abera Alemu Dire Dawa Regional Health Bureau Abraham Yirgu Ethiopian Environment and Forest Research Institute Alemtsehay Adamu Addis Ababa City Administration Health Bureau Asnakech Alemu Ethiopian Food and Drug Authority Assefa Gudina Environment, Forest and Climate Change Commission Atalay Mulu Fentie Addis Ababa University and Ethiopian Pharmacy Association BekureTsion Gidey Ethiopian Public Health Institute Belayneh Getachew National Veterinary Institute Bitseat Shimelis Ethiopian Food and Drug Authority Dagnew Tadesse Ministry of Health Deneke Ayele Ministry of Health Dr Ashenafi G/Mariam Ministry of Agriculture Dr Ermias Alemu Ministry of Agriculture Dr Getachew Tesfaye Armauer Hansen Research Institute Dr Hayat Seid Hassen Veterinary Drug and Feed Administration and Control Authority Dr Kuastros Mekonnen National Animal Health Diagnostic and Investigation Center Dr Meseret Bekele Ministry of Agriculture Dr Nardos Tefera Veterinary Drug and Feed Administration and Control Authority AMR Prevention and Containment Strategic Plan: 2021–2025 99 Dr Wondu Mengesha Ministry of Agriculture Dr Yohannes Demissie USAID Medicines, Technologies and Pharmaceutical Supplies Dr, Nabon Debela Ministry of Agriculture Dr Alemseged Abdissa Armauer Hansen Research Institute Dr Asayegn Bekele Ministry of Agriculture Dr Aynishet Adane University of Gondar Dr Ermias Alemu Ministry of Agriculture Dr Gezahagn Mamo Addis Ababa University Veterinary Faculty Dr Kassu Desta Ethiopian Medical Laboratory Association Dr Lemma Minda Ministry of Agriculture Dr Solomon Kebede Veterinary Drug and Feed Administration and Control Authority Ehitemariam Shambel Ministry of Health Gebrie Alebachew Ethiopian Public Health Institute Gemechu Asmera Jimma University Medical Center Getachew Alemkere Kolech Addis Ababa University School of Pharmacy Getachew Asfaw Tariku Ministry of Health Hailu Zeru Berhie Veterinary Drug and Feed Administration and Control Authority Meaza Debebe Environment, Forest and Climate Change Commission Mengsteab W/Aregay World Health Organization Mesfin Mezimur Orinua Regional Health Bureau Million Tirfe Megerssa Ethiopian Food and Drug Authority Mintamir mesele Environment, Forest and Climate Change Commission Moa Abate Ethiopian Public Health Institute Rogers Kisame Infectious Disease Detection and Surveillance Project Samuel Aytenfsu Desta Veterinary Drug and Feed Administration and Control Authority Tenaw Andualem Food and Agriculture Organization of the United Nations Teshita Shti Ethiopian Food and Drug Authority Teshome Habtamu Veterinary Drug and Feed Administration and Control Authority Tigist Abebe Ministry of Health Tofik Abagaro Infectious Disease Detection and Surveillance Project Wendimnew Abrie Environment, Forest and Climate Change Commission Wendwosen Shewarega Ministry of Health Wondie Alemu Ethiopian Food and Drug Authority, Procurement and Supply Management Workineh Getahun USAID-Medicine, Technology and Pharmaceutical Service Yidnekachew Degefaw Ministry of Health Yimer Mulugeta Aga Ethiopian Public Health Institute 100 AMR Prevention and Containment Strategic Plan: 2021–2025 Contributors from Medical Service General Directorate FULL NAME ORGANIZATION Yakob Semana Ministry of Health Regarsa Bayisa Ministry of Health Mahdi Abdela Ministry of Health Dr Hillina Tadesse Ministry of Health Dr Desalew Mekonnen Ministry of Health Kassu Tolla Ministry of Health Essayas Mesele Ministry of Health Abas Hassen Ministry of Health Dr Hassen Mohammed Ministry of Health Binyam Kemal Ministry of Health Fatuma Ebrahim Ministry of Health Dr Simret Amha Ministry of Health