Multi-Sectoral Action Plan on Antimicrobial Resistance 2019-2023

2015. Rome: Food and Agriculture Organization, Paris: World Organisation for Animal Health and Geneva: World Health Organization. Accessed at http://www.wpro.who.int/entity/drug_resistance/resources/global_action_plan_en g.pdf WHO. 2014. Cambodia Health Systems in Transition. Geneva: World Health Organization and Asia Pacific Observatory. 28 WHO. 2015. Country Cooperation Strategy Cambodia. Phnom Penh: World Health Organization Cambodia. WHO. 2015. Global Action Plan on Antimicrobial Resistance. Geneva: World Health Organization. WHO. 2017. Global Antimicrobial Resistance Surveillance System GLASS) Guidelines. Geneva: World Health Organization. 29 ឧបសមព័នធ ក. លទធផល មែផនក និងសកមមភពសំខន់ៗ យុទធ ្រស្តទី ១. ធនឱយមនអភប ិ លកច ិ ច្របកបេ យនរិ ន្តរភព មរយៈករស្រមបស្រមួល នង ិ ករបេងកីនភពជៃដគូ្របកបេ យ្របសទ ិ ធភព លទធផលសំខន់ៗ មែផនក៖  លទធផលសំខន់ែផនក ១.១: ព្រងឹងករស្រមបស្រមួលក្រមិតបេចចកេទស និងនេយបយេនថនក់មូល ្ឋ ន ថនក់ជតិ និងអន្តរជតិ  លទធផលសំខន់ែផនក ១.២: ព្រងឹង្រកបខ័ណ្ឌេគលនេយបយ និងចបប់ េដីមបគ ី ំ្រទគំនិតផ្តួចេផ្តីម AMR  លទធផលសំខន់ែផនក ១.៣: េកៀរគរធនធន េដីមបគ ី ំ្រទដល់ករអនុវត្ត ែផនករសកមមភពពហុវ ិស័យ (MSAP)  លទធផលសំខន់ែផនក ១.៤: ែផនករពន ិ ត ិ យ ម ន នង ិ យតៃម្ល សូចនករ នង ិ ករ យតៃម្លឱយបន ជ្របចំ លទធផលសំខន់ៗ ម សកមមភព អនកពក់ព័នធ ថ ប័នស្រមប ែផនក ស្រមួល លទធផលសំខន់ែផនក ២០១៩–២០២០ សុខភិបល៖ ្រកុមករងរបេចចកេទស AMR ្រកសួ ងនម ី ួយៗ ១.១ ព្រងឹងករស្រមប សុខភិបល កសិកមម និងបរ ិ ថ ន ពហុវ ិស័យ និង WHO នឹងប្តូរេវនគន១ឆន ំ ិ បេចចកេទស ក. បញច ប់ នង ស្រមួលក្រមត ិ អនុម័តែផនករសកមមភពពហុវ ិស័យ (MSAP) ស្តព ី ី កសក ិ មម៖ MAFF AMR‐TWG FAO, OIE ម្តង េដើមបដ ី ឹកនំ នង ិ នេយបយេនថនក់ AMR ២០១៩–២០២៣ បរ ិ ថ ន៖ ្រកសួងបរ ិ ថ ននិងៃដគូ ្រកុមករងរ មូល ្ឋ ន ថនក់ជតិ នង ិ ខ. ផ ព្វផ យ នង ិ ែផនករសកមមភពពហុ វ ិស័យស្តព ី ី AMR អន្តរជតិ ២០១៩–២០២៣ មរយៈករេចញេសចក្តី្របកស គ. េរៀបចំេគលនេយបយ និងបេងកីតយន្តករ ស្រមប់ស្រមប ស្រមួលអន្តរ្រកសួង 30 ឃ. បេងកីត ថ ប័នស្រមបស្រមួល សុខភពមួយ (One Health) េន ក្រមត ិ ខពស់ េ យមន្របធនប្តូរេវនវ ិលជុំ ង. ែកស្រមួល និងេធ្វីបចចុបបននភពតួរនទី និងភរៈកិចច របស់្រកុម ករងរបេចចកេទស AMR (្រកសួងសុខភិបល ្រកសួងកសិកមម រុកខ្របមញ និងេន ទ និង្រកសួងបរ ិ ថ ន) េ យបញចូ ល ចំណុចជ ទិ៍៖ • ង.១ េរៀបចំកិចច្របជុំ្រកុមបេចចកេទសជ្របចំ េដីមបីេធ្វីករ ស្រមបស្រមួល នង ិ ែចករ ំែលកព័ត៌មន • ង.២ ធនឱយមនករត្រមម ឹ ែផនករសកមមភពហុវ ិស័យស្តព ី ី AMR ឱយ្រសប មែផនករសកមមភព នង ិ យុទធ ្រស្តរបស់ នយក ្ឋ ន ករ ិយល័យ និងកមមវ ិធីរបស់្រកសួងសុខភិបល ្រកសួងកសិកមម រុកខ្របមញ់ និងេន ទ និង្រកសួងបរ ិ ថ ន • ង.៣ ករែចករ ំែលកព័ត៌មនពី AMR ជមួយនឹងកមមវ ិធីសុខ ភព (ដូចជ រេបង ្រគុនចញ់ េអដស៍ កមេ គ ករេ្របី្របស់ ឱសថឱយបនសម្រសប ករេធ្វីបញញត្តិកមមេលីឱសថ IPC ករ េលក ី កមពស់សុខភពសុវតថភ ិ ពចំណី រ) • ង.៤ ករែចករ ំែលកព័ត៌មន AMR ជមួយនង ឹ កមមវ ិធក ី ុ នង ិ មម (ឧទហរណ៍ៈ ដំ វ ិស័យកសក ំ ផលិតកមមសត្វ ជលផល ករអនុវត្តល ្អ ករ្រតួតពិនិតយ និងករវ ិភគសុវតថិភពចំណី រ • ង.៥ ករែចករ ំែលកព័ត៌មន AMR ជមួយនឹងកមមវ ិធីកុ នងវ ិស័យ បរ ិ ថ ន (ឧទហរណ៍ ទឹក សុខភពបរ ិ ថ ន ករ្រគប់្រគង សំណល់ ជីវសុវតថិភព) 31 ច. ព្រងឹងភពជៃដគូ េដីមបផ ី ្តល់ករគំ្រទបេចចកេទស នង ិ ករអនុវត្ត ដូចជ ភពជៃដគូ ជមួយនង ឹ សមគមវ ិជជជីវៈ នង ិ វ ិស័យពណិជជកមម (ឧទហរណ៍ ្រកុមហ៊ុនផលិតឱសថ និង ភពជៃដគូរ ងរដ្ឋ និងឯកជនដៃទេទៀត) លទធផលសំខន់ែផនក ២០២១–២០២៣ ស្រមប់សុខភិបល កសិកមម បរ ិ ថ ន៖ សុខភិបល៖ ្រកុមករងរបេចចកេទស AMR ១.២ ព្រងង ឹ ្រកបខ័ណ្ឌ ក. ពិនិតយេឡីងវ ិញ និងព្រងឹង្រកបខ័ណ្ឌបទបញញត្តិ ែដលពក់ព័នធនឹង ពហុវ ិស័យ និង WHO ករេ្របី្របស់ឱសថ្របឆំងេមេ គ ករអេងកត ម ន រួមទំងករ កសក ិ មម៖ MAFF AMR‐TWG FAO OIE េគលនេយបយ និង េឆ្លយ ី តបចំេពះ AMR បញ្ហ ឱសថែក្លងក្លយ នង ិ ខុសបទ ្ឋ ន បរ ិ ថ ន៖ អគគនយក ្ឋ នគំពរបរ ិ ថ ន ៃន ចបប់ េដីមបីគ ំ្រទគំនិត គុណភព ករ្រគប់្រគងកកសំណល់ ករចុះបញជ ីមូល ្ឋ ន ផ្តល់ ្រកសួងបរ ិ ថ ន ផ្តួចេផ្តីម AMR េស ករចុះបញជ ីគ្លន ី ក ិ សត្វ នង ិ កសិ ្ឋ នចញ ិ ច ឹមសត្វ ករផ្តល់ ជញប័ណ្ណ បសុេពទយ ករេ្របី្របស់ឱសថ្របឆំងេមេ គ ករពរ ជំងឺឆ្លងសត្វ ករេ្របី្របស់ឱសថ្របឆំងេមេ គស្រមប់ពេន្ល ន ករលូត ស់ (growth promoator) និងចំណីសត្វជលកខណៈ ពណិជជកមម និងក្រមិតកំណត់អតិបរមៃនសំណល់ ខ. េរៀបចំេគលនេយបយគំ្រទ គ. ករអនុវត្តបទ ្ឋ នគតិយុទធស្រមប់ ចុះបញជ ីកសិ ្ឋ ន នង ិ សត្វ ឃត ្ឋ ន ករចុះបញជ ីកែន្លងែកៃចន រ នង ិ ករផ្តល់លិខត ិ ទទួល គ ល់គុណភព េដីមបជ ី ួយស្រមួលដល់ករ្រគប់្រគង ែចក រ ំែលកព័ត៌មន ករអនុវត្តចបប់ ករបណុ ្ត ះប ្ត ល និងករែស្វង រកមតិគ ំ្រទ លទធផលសំខន់ែផនក១.៣ ២០១៩–២០២៣ សុខភិបល៖ ្រកុមករងរបេចចកេទស AMR េកៀរគរធនធន េដីមបី ស្រមប់សុខភិបល កសិកមម បរ ិ ថ ន៖ ពហុវ ិស័យ និង WHO 32 គំ្រទដល់ករអនុវត្ត ក. ត្រមម ឹ ែផនករសកមមភពពហុវ ិស័យឱយ្រសប មែផនករ្របតប ិ ត្តិ កសក ិ មម៖ ្រកុមករងរបេចចកេទស AMR ែផនករសកមមភព ្របចំឆន ំ ែផនករយុទធ ្រស្ត នង ិ សកមមភពរបស់្រកសួងនម ី ួយៗ របស់្រកសួងកសក ិ មម រុកខ្របមញ់ នង ិ និងៃដគូនន េន ទ FAO, OIE ពហុវ ិស័យ ខ. េធ្វីករ យតៃម្ល និងប៉ន់្របមណករចំ យ េដីមប ីផ្តល់ករ បរ ិ ថ ន៖ អគគនយក ្ឋ នគំពរបរ ិ ថ ន ៃន គំ្រទដល់ករេរៀបចំែផនករ និងេរៀបចំកញច ប់ថវ ិក ្រកសួងបរ ិ ថ ន គ. កំណត់ពីយន្តករផ្តល់ថវ ិក ្របកបេ យនិរន្តភពស្រមប់អនុវត្ត ែផនករសកមមភពពហុវ ិស័យ ដូចជ ករផ្តល់ថវ ិក ស្រមប់ករ ្រគប់្រគងមនទរី ពេិ ធន៍ េស កមមនន នង ិ ករក ងសមតថភព ិ ច្របជុំ្រកុម ឃ. អនុវត្តសកមមភព និង ផ្តួចេផ្តីមគំនិត (ឧទហរណ៍ កច ករងរបចចកេទស) េដីមបស ី ំេយគ នង ិ បក្រ យភស្តុ ង វ ិទយ ្រស្តស្រមប់ ជ រ ទក់ទញករគំ្រទក្រមិត េគលនេយបយ ង. ព្រងឹងសមតថភពរបស់សមជិក្រកុមករងរបេចចកេទស AMR និងអនកពក់ព័នធ េលីែផនក អប់រ ំផ ព្វផ យេនក្រមិតេផ ងៗ េ យ េធ្វីេឡីង មរយៈករបណុ ្ត ះប ្ត លអំពីវ ិធី ្រស្តអប់រ ំផ ព្វផ យ ែផនករចង្អុរទស ិ ស្រមប់អនកពក់ព័នធ និងករភជប់ទំនក់ទំនងជ ្របចំ ច. េរៀបចំកច ិ ចពេិ ្រគះេយបល់ជមួយនង ឹ អនកពក់ព័នធននកនុងវ ិស័យ សុខភិបល កសិកមម និងបរ ិ ថ នេន្រគប់ក្រមិតទំងអស់ ឆ. ពិនិតយេឡីងវ ិញជ្របចំេលីធនធនថវ ិក ជ. េរៀបចំកិចចពិេ្រគះេយបល់ជមួយនឹងៃដគូអន្តរជតិ និងអងគករ មិនែមនរ ្ឋ ភិបល អំពីសកមមភព និងគំនិតផ្តួចេផ្តីមនន េដីមបី គំ្រទដល់ AMR 33 ឈ. បេងកីនវត្តមនបុគគលិក មរយៈយន្តកររ ្ឋ ភប ិ ល នង ិ ភពជ ៃដគូដៃទេទៀត លទធផលសំខន់ែផនក ស្រមប់សុខភិបល កសិកមម បរ ិ ថ ន៖ សុខភិបល៖ ្រកុមករងរបេចចកេទស AMR ១.៤ ែផនករពិនិតយ ម ក. ករពិនិតយេលី ថ នភព និងសូចនករេដីម្រគ ពហុវ ិស័យ និង WHO ខ. េរៀបចំបញច ប់ និងអនុវត្ត្រកបខ័ណ្ឌពិនិតយ ម ន និងែផនករ កសិកមម៖ ្រកុមករងរបេចចកេទស AMR ន & យតៃម្ល សូច ពិនិតយ ម ន និង យតៃម្ល ជមួយនឹងែផនករសកមមភព របស់្រកសួងកសិកមម រុកខ្របមញ់ និង នករ និងករ យតៃម្ល ពហុវ ិស័យេនះ។ េរៀបចំករ យតៃម្លពក់ក ្ត ល ណត្តិ កនុងឆន ំ េន ទ FAO, OIE ឱយបនជប់ជ្របចំ ២០២០ បរ ិ ថ ន៖ ្រកសួងបរ ិ ថ ន នង ិ ៃដគូ គ. េធ្វក ី រ យតៃម្ល ម្អត ិ ចុង្រគឆន ំ ២០២៣ យុទធ ្រស្តទី ២. ្របមូលភស្តុ ង មរយៈករឃ្ល ំេមីល (Surveillance) និងមនទីរពិេ ធន៍ េគលេ យុទធ ្រស្តទី ២. េដីមបីព្រងឹងករ្របមូលភស្តុ ង មរយៈមនទីរពិេ ធន៍វ ិស័យសុខភិបល កសិកមម បរ ិ ថ ន ែដលដំេណីរករេទបនល្អ និងយន្តករអេងកត ម នែដលមន្របសិទធភព លទធផលសំខន់ៗ សកមមភព អនកពក់ព័នធ ថ ប័នស្រមប ស្រមួល លទធផលសំខន់ ែផនក ២០១៩–២០២០ សុខភិបល៖ CCDC, DHS, US CDC, NIPH, ២.១ បេងកន ី ក្រមត ិ សុខភប ិ ល Hospitals, DMDP, HOPE Center/ITM, WHO, AHC/COMRU អេងកត ម នន ក. េរៀបចំ និងអនុវត្តេសចក្តីែណនំ និងវ ិធី ្រស្ត ស្រមប់អេងកត កសិកមម៖ GDAHP, FiA, GDA, RUA, PNCA, េពលបចចុបបនន និង ម ន និងេឆ្លីយតប ចំេពះករណីឆ្លងេ គេន ម KNCA, DAI, FAO, OIE សកមមភព និង្របព័នធ មនទរី េពទយ នង ិ ករេ្រប្រី បស់ឱសថ បរ ិ ថ ន៖ ្រកសួងបរ ិ ថ ន នង ិ ៃដគូ 34 មនទរី ពេិ ធន៍ េដីមប ី ខ. េរៀបចំករអនុវត្តន៍ជ្របចំ ករឃ្ល ំេមល ី (point prevalence គំ្រទដល់ AMR survey) ឱយបនជ្របចំ េផ្តតេលីករឆ្លងេ គេន មមនទីរេពទយ ករអេងកត ម នែបបករណី (case) នង ិ សក ិ សំខន់ៗដៃទ េទៀត គ. េរៀបចំ និងអនុវត្តេសចក្តីែណនំ និងពិធី រ ស្រមប់ករេឆ្លីយ តបចំេពះករផទុះជំងឺបក់េតរែដលមនភព ី ុ ំ នង ឹ ឱសថ ឃ. បេងកីនករេ្របី្របស់មនទីរពិេ ធន៍មី្រកូជីវ ្រស្តស្រមប់េ គ វ ិនិចឆ័យ មរយៈករបណុ ្ត ះប ្ត ល និងករអប់រ ំ ស្រមប់កសិកមម និង បរ ិ ថ ន៖ ក. ព្រងង ឹ សមតថភពមនទរី ពេិ ធន៍ មរយៈករចូលរួមកនុង្របព័នធ ឧបករណ៍ យតៃម្ល មនទីរពិេ ធន៍ និងភព ុ ំឱសថ្របឆំង េមេ គ (ATLASS) និងករបណុ ្ត ះប ្ត លអំពីពិធី រជ ទិភព (ឧទហរណ៍ េសចក្តែី ណនំស្តព ី ីករអេងកត ម ន AMR របស់ FAO និង OIE និងវ ិធី ្រស្តែដលេ្របី្របស់កុ នងមនទីរពិេ ធន៍ និង ពិធី រ ESBL របស់ WHO) ខ. ចូលរួមកនុងករេធ្វេី តស្តេ្របៀបេធៀប ែដលេធ្វេី ឡង ី េ យ ថ ប័ន ខងេ្រក េដីមបីផ្តល់ករធនគុណភពដល់មនទីរពិេ ធន៍ ែដលចូលរួមកនុងករអេងកត ម ន AMR គ. ក ងសមតថភពពិនត ិ យ ម ន សំណល់ ឱសថេន មមនទរី 35 ពេិ ធន៍ចំណី រ កសក ិ មម នង ិ បរ ិ ថ ន ឃ. បន្ត និងបេងកីនករកំណត់រកករណីេមេ គ ុ ំនឹងឱសថ្របឆំង េមេ គកនុងផលត ិ ផលចំណី រ ផលត ិ ផលកសក ិ មម នង ិ បរ ិ ថ ន ង .អនុវត្តករពិនិតយ ម នសំណល់ឱសថ្របឆំងេមេ គកនុង ផលត ិ ផលចំណី រ ផលត ិ ផលកសិកមម នង ិ បរ ិ ថ ន ច .បេងកីត្របព័នធឃ្ល ំេមីល និងេឆ្លីយតបចំេពះបញ្ហ AMR េន ម មនទីរពិេ ធន៍វ ិស័យកសិកមម និងបរ ិ ថ ន ស្រមប់កិចចខិតខំ្របឹងែ្របងរួមគន៖ ក. ក់ដំេណីករ្រសបគន េល្រី បព័នធៃនករឃ្ល ំេមល ី អេងកត ម ន ករ យករណ៍ និងករែចករ ំែលកព័ត៌មនរ ងមនទីរពិេ ធន៍ សុខភិបល កសិកមម និងបរ ិ ថ ន េនថនក់ជតិ។ បេងកីត្របព័នធ ទន ិ ន ័យមនទរី ពេិ ធន៍េនថនក់ក ្ត ល ស្រមប់ផុ ទកទន ិ ន ័យ ៃនអេងកត ម ន AMR ខ. គំ្រទដល់ករកច ិ ចសហ្របតប ិ ត្តករណ៍ េលែី ផនកបេចចកេទសមនទរី ពិេ ធន៍ សកមមភពៃនករឃ្ល ំេមីល និងរេបៀបដំេណីករ ្រសប មប ្ត ញេនថនក់ជតិ និងថនក់តំបន់ គ. េធ្វក ី រអេងកត ម នរួមគនេលី AMR រ ង្រកសួងសុខភប ិ ល ្រកសួងកសិកមម រុកខ្របមញ់ និងេន ទ ្រកសួងបរ ិ ថ ន និងៃដគូ 36 ដៃទេទៀត េដីមបព ី ្រងឹងករយល់ដឹងអំពក ី រចម្លងេទ ឬមក។ ២០២១–២០២៣ ស្រមប់សុខភប ិ ល កសក ិ មម នង ិ បរ ិ ថ ន៖ ក. យតៃម្ល ពិនត ិ យេឡង ី វ ិញ នង ិ េធ្វប ី ចចុបបននភពពធ ិ ី រ នង ិ េសចក្តី ែណនំពក់ព័នធនន ករឃ្ល ំេមីល AMR ខ. ព្រងឹងយន្តករែចករ ំែលកព័ត៌មនស្រមប់មនទីរពិេ ធន៍ និងករ អេងកត ម ន AMR លទធផលសំខន់ែផនក ២០១៩–២០២០ សុខភិបល៖ CCDC, DHS, US CDC, NIPH, ២.២ ព្រងឹងសមតថភព ស្រមប់សុខភិបល៖ Hospitals, DMDP, HOPE Center/ITM, WHO, AHC/COMRU ធនធនមនុស ែដល ក. ក ងជំនញម្រី កូជីវ ិ េ គសញញជំងឺ ករឃ្ល ំេមល ្រស្ត នង ី កសិកមម៖ GDAHP, FiA, GDA, RUA, េធ្វីករងរេនកនុងមនទីរ េអពីឌីមី ្រស្ត និងជំនញសំខន់ៗដៃទេទៀត េន មមនទីរេពទយ PNCA, KNCA, DAI, FAO, OIE ពេិ ធន៍ ករែចក មូល ្ឋ នសុ ខភប ិ ល នង ិ មនទរី ពេិ ធន៍ បរ ិ ថ ន៖ ្រកសួងបរ ិ ថ ន CamLAPF រ ំែលកព័ត៌មន ករ ខ. េរៀបចំែផនករ និងេធ្វីករប៉ន់្របមណចំ យស្រមប់ផ្តល់ករ MOE‐EP Lab នង ិ ៃដគូ អេងកត ម ននិងករ បណុ ្ត ះ ្ត លជំនញច្រមុះដល់បុគគលិក េដីមបីកំណត់ពីត្រមូវករ េឆ្លយ ី តបចំេពះករផទុះ សមតថភព ជំងឺ ស្រមប់កសិកមម និង បរ ិ ថ ន ក. ក ងជំនញេអពីឌីមី ្រស្ត ករឃ្ល ំេមីល មី្រកូជីវ ្រស្ត និង ជំនញសំខន់ៗ ដៃទេទៀត ដល់អនកជំនញខងសុខភពសត្វ 37 ិ បែនថម ជំនញេនះេទកនុងវគគ ករបណុ ្ត ះប េនកមពុជ នង ្ត ល េអពីឌីមី ្រស្តបសុពយបលអនុវត្តន៍ (CAVET) និងកមមវ ិធី បណុ ្ត ះប ្ត លដៃទេទៀត ខ. េរៀបចំែផនករ នង ិ េធ្វក ី រប៉ន់្របមណចំ យស្រមប់ផ្តល់ករ បណុ ្ត ះប ្ត លជំនញច្រមុះដល់បុគគលិក េដីមបីកំណត់ពី ត្រមូវករសមតថភព ស្រមប់សកមមភពែដល្រតូវេធ្វីរ ួមគន៖ ក. ផ្តល់ករបណុ ្ត ះប ្ត លរួមគន ដល់វ ិស័យសុខភពមនុស កសិកមម និងបរ ិ ថ ន ខ.. េរៀបចំករ យតៃម្លរួមគនេលីសមតថភពធនធនមនុស ២០២១–២០២៣ ស្រមប់សុខភប ិ ល កសក ិ មម នង ិ បរ ិ ថ ន៖ ក. យតៃម្ល និងព្រងឹងយន្តករេ្រជីសេរ ីស និងបណុ ្ត ះប ្ត ល ស្រមប់មនទីរពិេ ធន៍ និងករងរអេងកត មន ខ. បន្តផ្តល់ករបណុ ្ត ះប ្ត លជំនញអំពីេអឌីពីមី ្រស្ត មី្រកូ ជីវ ំ ញេផ ងេទៀត េនកនុងកមមវ ិធីបណុ ្ត ះប ្រស្ត និងជន ្ត ល CAVET‐MAFF/FETP‐MOH និងកមមវ ិធីបណុ ្ត ះប ្ត លេផ ងេទៀត 38 ព្រងឹងបរក ិ ខ រ នង ិ ្របព័នធ ២០១៩–២០២០ សុខភប ិ ល៖ CCDC, DHS, US CDC, NIPH, ផគត់ផគង់ េន មមនទីរ ស្រមប់សុខភិបល កសិកមម និងបរ ិ ថ ន៖ Hospitals, DMDP, HOPE Center/ITM, WHO, AHC/COMRU េពទយស្រមប់េធ្វីេតស្តមី ក. យតៃម្ល ករេរៀបចំែផនករ នង ិ ករប៉ន់្របមណចំ យ េដីមបី កសក ិ មម៖ GDAHP, FiA, GDA, RUA, PNCA, ្រកូជី ្រស្ត នង ិ បំេពញត្រមូវករធនធន និងមនទីរពិេ ធន៍ KNCA, DAI, FAO, OIE ពិនិតយ ម ន ខ .ព្រងឹងសមតថភពមនទីរពិេ ធន៍ ែដលមន្រ ប់ មរយៈករ បរ ិ ថ ន៖ MoE CamLAPF MOE‐EP Lab ផ្តល់បរក ិ េ្រគឿងផគត់ផគង់នន ិ ខ រ នង and partner ខ.១ បេងកីតមនទីរពិេ ធន៍សុវតថិភពចំណី រ (ឧទហរណ៍ មជឈមណ្ឌលឧត្តមភពសុវតថិភពចំណី រជេដីម) គ .បេងកីនគុណភពមនទរី ពេិ ធន៍េន មមនទរី េពទយេគលេ គ.១ ែកលម្អករ្រតួតពិនិតយគុណភពមនទីរពិេ ធន៍ និងករ ធ ធនគុណភពេន មមនទរី ពេិ ធន៍ម្រី កូជវី ្រស្ត េគល េគលេ យុទធ ្រស្តទី ៣. ករេ្រប្រី បស់ឱសថ្របឆំងេមេ គឱយបនសម្រសប េគលេ យុទធ ្រស្តទី ៣. េរៀបចំ នង ិ ព្រងឹងករអនុវត្តលខ ិ ត ិ បទ ្ឋ នគតយ ិ ុត្ត នង ិ យុទធ ី នលទធភពទទួលបនឱសថអង់ទប ្រស្ត េដីមបធ ី ៊ីយូ ៉ទក ិ នង ិ ករេ្រប្រី បស់ឱសថឱយបន្រតម ឹ ្រតូវ ស្រមប់សុខភប ិ ល សុខភពសត្វ នង ិ កសក ិ មម លទធផលសំខន់ៗ ម សកមមភព អនកពក់ព័នធ ថ ប័នស្រមប ែផនក ស្រមួល លទធផលសំខន់ែផនក ២០១៩–២០២៣ សុខភិបល៖ DDF, DHS, UHS, Hospitals, 39 ៣.១ ករែណនំ នង ិ ករ វ ិស័យសុ ខភិបល គណៈវ ិជជជីវៈសុខភប ិ ល នង ិ ៃដគូអភវិ ឌ អនុវត្តករេ្របី្របស់ ក .េរៀបចំ និងអនុវត្តេគលករណ៍ែណនំពីករេ្របី្របស់ឱសថ ឱសថ្របឆំងេមេ គ ្របឆំងេមេ គឱយបនសម្រសប េន ម្រគះឹ ថ នសុខភប ិ ល កសក ិ មម៖ GDAHP, FiA, GDA, FAO, OIE ឱយបនសម្រសប េគលេ មរយៈករផ្តល់ករគំ្រទដូចជ ករ ក់េចញនូវ បរ ិ ថ ន៖ េគលករណ៍ែណនំ ករផ្តល់បុគគលិក ្រកុមេឆ្លីយតបបនទន់ និង ករផ្តល់ថវ ិក ១.១ ព្រងឹងករពិនិតយ ម នករេ្របី្របស់ឱសថ្របឆំងេមេ គ (ឧទហរណ៍ ករពិនិតយ ម ន និងករេ្របី្របស់ឱសថ ិ ករអេងកតេ្រប ៉ ឡង់េន ្របឆំងេមេ គ នង មេពលេវ មួយជក់ ក់‐PPS ) ១.២ េលក ី កមពស់ករេ្រប្រី បស់ឱសថ្របឆំងេមេ គឱយបន សម្រសប (ឧទហរណ៍ ្រតួតពិនិតយ ម ន និងករផ្តល់ព័ត៌មន ្រតឡប់) ខ. បញចូ ល AMR េទកនុងករែកស្រមួលឯក រមួយចំនួនែដលនឹង េធ្វីេនេពលខងមុខ ដូចជ េសចក្តីែណនំស្តីពីករអនុវត្តគ្លីនិក បញជ ីឱសថជ រវន្ត និងេសចក្តីែណនំដៃទេទៀត អំពីករ េ្រប្រី បស់ឱសថ្របឆំងេមេ គ គ ព្រងឹងករអនុវត្តន៍េគលនេយបយ េដីមប ីរ ឹតបន្តឹង ករលក់ . ឱសថអង់ទប ី ៊ីយូ ៉ទក ិ ែដលពុំមនេវជជបញជ 40 ឃ. ព្រងង ឹ តួនទី នង ិ ករទទួលខុស្រតូវ េលក ី រករពរ នង ិ ្រតួត ពិនិតយករឆ្លងេ គ និងគណៈកមមធិករពយបលេន មនទីរេពទយ ស្រមប់កសិកមម និងបរ ិ ថ ន ក. បញចូ ល AMU/AMR េទកនុងេសចក្តែី ណនំស្តព ី ី GAP, GAHP នង ិ GAqP ខ ករបណុ ្ត ះប . ្ត ល និងករអនុវត្តេសចក្តីែណនំ គ. ករចុះបញជ ីកសិ ្ឋ ន ឃ. ជំរុញឱយមនករេ្រប្រី បស់គំរូ ែផ្អក មភស្តុ ងេផ ងេទៀត ស្រមប់ករអនុវត្តល ្អ (អភិ្រកមែបប្របៃពណី probiotics ។ល។) ង. ជំរុញឱយមនកររក កំណត់្រ អំពីករេ្របី្របស់ឱសថ អង់ទប ី ៊ីយូ ៉ទក ិ នង ិ រយៈេពលែលងមនករេ្រប្រី បស់ឱសថ អង់ទីប៊ីយូ ៉ទិក េនកនុងកសិ ្ឋ ន និងករេ្របី្របស់របស់អនកផ្តល់ េស សុខភពសត្វ និងករលក់ឱសថអង់ទប ី ៊ីយូ ៉ទក ិ ។ ២០២១–២០២៣ ស្រមប់សុខភិបល ក. ផ្តល់ករបណុ ្ត ះប ្ត ល នង ិ េធ្វក ី រផ ព្វផ យជ្របចំ អំពេី សចក្តី ែណនំនន េន មសុខភប ិ ល នង ិ ដល់អនកផ្តល់េស សុខភព។ ខ. អភវិ ឌ មនទរី េពទយ នង ិ ទក ី ែន្លងសុខភប ិ លគំរូ AMS, IPC នង ិ គំនិតផ្តួចេផ្តីមដៃទេទៀតអំពីករេ្របី្របស់ឱសថ្រតឹម្រតូវ 41 គ. ពន ិ ត ិ យ ម ន នង ិ យតៃម្លករទទួលយក ករេ្រប្រី បស់ នង ិ ករអនុវត្តេសចក្តែី ណនំ លទធផលសំខន់ែផនក ២០១៩–២០២៣ សុខភិបល៖ DDF, DHS, Department of ៣.២ ករេធ្វន ី យ ិ ័តកមម ស្រមប់កសិកមម និងបរ ិ ថ ន Legislation, UHS, Hospitals, គណៈវ ិជជ ក. យតៃម្ល ែកស្រមួល នង ិ េរៀបចំ្រកបខ័ណ្ឌគតយ ិ ុ ត្ត ស្រមប់វ ិស័យ េន ក្រមិតេផ ងៗ េដីមបី ជីវៈសុខភិបល និងៃដគូអភិវឌឃ សុខភប ិ ល កសក ិ មម និងបរ ិ ថ ន គំ្រទ ឱយមនករេ្របី ខ. ្រគប់្រគងករេ្រប្រី បស់ឱសថ្របឆំងេមេ គស្រមប់ករពរជំងឺ ្របស់ឱយបន្រតម ឹ ្រតូវ កសក ិ មម៖ GDAHP, FiA, GDA, FAO, OIE សត្វ ពេន្ល នករលូត ស់ នង ិ កនុងចំណីសត្វ គ. ផ ព្វផ យជ ធរណៈ និងអនុវត្តេគលនេយបយ បរ ិ ថ ន៖ ឃ. េរៀបចំ និងផ ព្វផ យេសចក្តីែណនំស្តីពីក្រមិតអបបបរមៃន សំណល់ ្រសប មបទ ្ឋ នអនុសញញអន្តរជតិ ង. ព្រងឹង្របព័នធនិយ័តកមម មរយៈករបេងកីនបុគគលិក និងថវ ិកកនុង វ ិស័យសុ ខភិបល និងកសិកមម ២០២០–២០២៣ ក. ព្រងឹងករងរនយ ិ ័តកមមឱសថ ករធនគុណភព ពន ិ ត ិ យ ម ន និង យតៃម្ល ខ. េលីកកមពស់ករពិនិតយ ម ន ករ្រគប់្រគងករេ្របី្របស់ អង់ទីប៊ីយូ ៉ទិកកនុងផលិតកមមសត្វ និងកសិកមម គ. ព្រងឹងេស បសុឱសថ ថ ន និងមនទីរេពទយសត្វ មនទីរពហុ ពយបលសត្វ គ្លីនិកពយបលសត្វ មរយៈករចុះបណជី និងករ ផ្តល់ ជញប័ណ្ណជំនញបសុ េពទយ 42 លទធផលសំខន់ែផនក ២០១៩–២០២៣ សុខភប ិ ល៖ DDF, DHS, UHS, Hospitals, ែផនក ៣.៣ ព្រងឹង នង ិ ស្រមប់សុខភប ិ ល គណៈវ ិជជជីវៈសុខភិបលនិងៃដគូអភិវឌឃ េរៀបចំ្របព័នធ ផគត់ផគង់ ក. ធនឱយមនករផគត់ផគង់ឱសថ រវន្ត និងផលិតផលសុខភិបល ឱសថអង់ទីប៊ីយូ ៉ទិក ្រគប់្រគន់្របកបេ យគុណភព កសិកមម៖ GDAHP, FiA, GDA, DIA, FAO, េដីមបីធនឱយ្របជពល ខ. ព្រងឹង្របព័នធលទធកមម និងសង្វក់ផគត់ផគង់របស់ ថ ប័ន េដីមបីធន OIE រដ្ឋទ ំងអស់ ចទទួល ឱយមនករផ្តល់ឱសថអង់ទីប៊ីយូ ៉ទិក្របកបេ យគុណភព បរ ិ ថ ន៖ MoE និង ៃដគូអភិវឌ ន៍ បនឱសថេនះ។ គ. ព្រងឹងករ្រគប់្រគង េដីមបីឱយមនករេបីកផ្តល់ឱសថអង់ទីបី៊យូ ៉ទិក ែតេនេពលែដលមនេវជជបញជែតប៉ុេ ្ណ ះ ឃ. េរៀបចំ រ នង ិ អប់រ ំផ ព្វផ យអំពគ ី ុណភពឱសថដល់អនក ជំនញសុ ខភព នង ិ ធរណជន ង. ព្រងឹងេស ឱសថ ថ ន និងមូល ្ឋ នសុខភិបល មរយៈករ ចុះបញជ ី និងករផ្តល់ ជញប័ណ្ណ ស្រមប់កសិកមម និងបរ ិ ថ ន ក. ផ ព្វផ យ រអំពីគុណភព និងឱសថែក្លងក្លយ ឱសថែដល ិ កររក ទុកឱសថ ដល់អនកជំនញខង ហួសកលកំណត់ នង សុខភពសត្វ និងបុគគលិកកសិ ្ឋ នចិញចឹមសត្វ 43 យុទធ ្រស្តទី ៤. ទប់ ក ត់ភព ុ ំនង ឹ ឱសថ្របឆំងេមេ គ មរយៈករអនុវត្តល ្អ េគលេ យុទធ ្រស្តទី ៤. េដីមប ីកត់បនថយករណីឆ្លងេ គ មរយៈករអនុវត្តវ ិធនករអនម័យបរ ិ ថ ន អនម័យផទល់ខួ ្លន សុវតថិភពចំណី រ ករ ្រគប់្រគងសំណល់ និងករបងករករឆ្លងេ គ ្របកបេ យ្របសិទធភព លទធផលសំខន់ ម សកមមភព អនកពក់ព័នធ ថ ប័នស្រមប ែផនកៗ ស្រមួល លទធផលសំខន់ ៤.១ ២០១៩–២០២០ សុខភប ិ ល៖ DHS, DPM, CCDC, មនទរី ករែណនំអំពក ី រអនុវត្ត ស្រមប់សុខភប ិ ល េពទយ និងផលិតកមមសត្វ ករ ិយល័យ ល្អ នង ិ ករេគរពេទ ក. ករ យតៃម្លេលក ី រអនុវត្តករងរបងករ នង ិ ្រតួតពន ិ ិតយករឆ្លង សុខភិបល ជធនី េខត្ត និងៃដគូអភិវឌ មករអនុវត្តល ្អ េ គេន មមនទីរេពទយ ធរណៈ េគលេ និងមនទីរេពទយ ធរណៈ ែដលអនុវត្ត កលបង ខ. បងករករអនុវត្ត IPC េន មមនទីរេពទយ មរយៈករផ្តល់ករ បណុ ្ត ះប ្ត ល អំពីឧបករណ៍បងករ និង្រតួតពិនិតយករឆ្លងេ គ កសិកមម៖ GDAHP, GDA, FiA, DIA, FAO, េសចក្តីែណនំនន ែផនករបេងកីនគុណភព និងករេរៀបចំេសច OIE ្រកសួងអភិវឌ ន៍ជនបទ ករ ិយល័យ ក្តីែណនំ និងពិធី រដៃទេទៀត កសក ិ មមេខត្ត ជធនី គ. ករ យតៃម្ល នង បរ ិ ថ ន៖ អគគនយក ្ឋ នគំពរ បរ ិ ថ ន ិ ករព្រងង ឹ កច ិ ចខត ិ ខំ្របង ឹ ែ្របងរបស់គណៈ កមមធក ៃន្រកសួងបរ ិ ថ ន នង ិ ៃដគូអភវិ ឌ ន៍ ិ រពយបលេវជជ ្រស្តេន មមនទីរេពទយ ធរណៈ ឃ. ព្រងឹងតួនទី នង ិ ករទទួលខុស្រតូវរបស់គណៈកមមធក ិ របងករ និង្រតួតពិនិតយករឆ្លងេ គ ង. បញចូ លចំេណះដឹង និងជំនញ AMR កនុងកមមវ ិធីែដលមន្រ ប់ ដូចជ កមមវ ិធី WASH, IMCI, សំណុំសកមមភពអបបបរម និងកមម វ ិធីេន មសហគមន៍ដៃទេទៀត ច. ផ ព្វផ យ បណុ ្ត ះប ្ត ល និងពិនិតយ ម នករអនុវត្ត ករ បងករ នង ិ ករ្រតួតពន ិ ត ិ យករឆ្លងេ គ នង ិ ទក ឹ ្អ ត នង ិ អនម័យ 44 នង ិ អនម័យផទល់ខួ ្លន េន មកសិ ្ឋ នជលកខណៈពណិជជកមម នង ិ កសិ ្ឋ នជលកខណៈ្រគួ រ កែន្លងផលត ិ ៃកៃចន រ គ្លន ី ក ិ សត្វ កែន្លងផ្តល់េស សុខភពសត្វ សត្តឃត ្ឋ ន និងទីផ រលក់ សត្វរស់ ឆ. ក់ឱយអនុវត្តនូវកររក ទុកឯក រកនុងកសិ ្ឋ នែដលេ្របី្របស់ ់ ីប៊ីយូ ៉ទិក និងជំរុញឱយមនករកត់្រ ឱសថអងទ អំពីរយៈេពល ់ ីបី៊យូ ៉ទិក (Widrawal period) ែដល បំែលងអស់ៃនឱសថអងទ ជ. េលក ី កមពស់សុខភព និងសុខុមលភពសត្វ ឈ. េរៀបចំករបណុ ្ត ះប ្ត ល្រគូបេងគល អំពក ី រអនុវត្តល ្អៗ ដូចជ GAP, GAqP, GAHP, GMP, GHP នង ិ ជីវសុវតថភ ិ ពកនុងកសិ ្ឋ ន ញ. ជំរុញឱយមននុ នុវត្តន៍ និងផ ព្វផ យពីករអនុវត្តល ្អ និង ជេ្រមីសៗកនុងករេធ្វីកសិកមម ស្រមប់សកមមភពែដល្រតូវអនុវត្តរួមគន ក. េធ្វីករ យតៃម្លេលីកដំបូង េន មទីកែន្លងសុខភិបល និង កសិ ្ឋ ន នង ិ អំពក ី រសម្អត ករ្រគប់្រគងកកសំណល់ ខ. បេងកីតភូមិ នង ិ សហគមន៍គំរូ ែដលេ្រប្រី បស់វ ីធី ្រស្តសុខភព ែតមួយ (One Health) េដីមប្រី បយុទធ្របឆំងនឹង AMR ២០២១–២០២៣ ស្រមប់សុខភពសត្វ កសិកមម និងបរ ិ ថ ន ក. ពិនិតយ ម នករបងករ និងករ្រតួតពិនិតយចម្លងេ គ គណៈ កមមធិករពយបលេវជជ ្រស្ត និងករអនុវត្តករែកលម្អគុណភព 46 េន មមនទីរេពទយ នង ិ មូល ្ឋ នសុខភប ិ ល ខ. ពន ិ ត ិ យ ម ន ករបងករ នង ិ ករ្រតួតពន ិ ត ិ យករឆ្លងេ គ កមមវ ិធី ផ្តល់ថន ំបងករ ទឹក ្អ តអនម័យ និងករ្រគប់្រគងសំណល់េន មកសិ ្ឋ ន ទី ំងផលិត ែកៃចនចំណី រ គ្លីនិកសត្វ កែន្លង ផ្តល់េស បសុ ពយបល សត្តឃត ្ឋ ន និងទីផ រលក់សត្វរស់។ គ. ព្រងឹងករអនុវត្តបទបញជអនម័យ និងបរ ិ ថ ន ស្រមប់ករ ចិញចឹមសត្វ្រសុក និង រ ីសត្វ ឃ. រេបៀបចំករែណនំបែនថមអំពក ី រអនុវត្តល ្អ ដូចជ ស្រមប់ករ ផ្តល់ថន ំបងករ ករេចលឱសថ្របឆំងេមេ គែដលមន ិ េ្រប្រី បស់ នង ិ ែដលបរេចឆ ិ ទេ្រប្រី បស់ ្របកបេ យសុវតថភ ិ ព និងចំណីសត្វ និងករេ្របី្របស់ជេ្រមីសេផ ងេទៀត ជំនួសឱយករេ្របី្របស់ ឱសថ្របឆំង េមេ គកនុងេគលេ ពេន្ល នករលូត ស់ និងករ ្រគប់្រគងសំណល់ជីវៈ ្រស្តឱយបន្រតឹម្រតូវ លទធផលសំខន់ែផនក ២០១៩–២០២០ សុខភិបល៖ ៤.២ ធនឱយមន សុខភិបល កសិកមម និងបរ ិ ថ ន DHS, DPM, DDF, មនទរី េពទយ ក. ធនឱយមនេហ ្ឋ រចនសមព័នធស្រមប់បងករ និង្រតួតពិនិតយ បេចចកវ ិទយ និងសមភរ មនទីរសុខភិបល ជធនីេខត្ត ចម្លងេ គ ្រពមទំងផលត ិ ផលេធ្វអ ី នម័យ (ដូចជ េ្រ មេ ផគត់ផគង់ ស្រមប់អនុវត្ត កសិកមម៖ GDAHP សុឺ ំង កុ ល ទក ឹ ្អ តេន មមនទរី េពទយ និងមូល ្ឋ ន ពធ ិ ី រ នង ិ េសចក្តី បរ ិ ថ ន៖ ្រកសួងបរ ិ ថ ន សុខភប ិ ល) ែណនំនន ខ. ពិនិតយ ម ន និង យករណ៍អំពីសកមមភពបងករ និង្រតួត ពិនិតយចម្លងេ គ និងសកមមភពដៃទេទៀត គ. ែកលម្អេហ ្ឋ រចនសមព័នធ ស្រមប់បងករ និង្រតួតពិនិតយករចម្លង េ គ និងសមភរៈផគត់ផគង់ និងេ្រគឿងបរ ិកខរស្រមប់រក អនម័យ 47 េន មគ្លន ី ិកសត្វ កែន្លងផ្តល់េស បសុពយបល សត្តឃត ្ឋ ន នង ិ ទផ ី រលក់សត្វរស់ ឃ. ែកលម្អឱយមនករផគត់ផគង់ សមភរៈ និងបរ ិកខរអនម័យេនទី ំង ផលិតកមម ៃកៃចន និងកែន្លងផគត់ផគង់ផលិតផលកសិកមម ២០២១–២០២៣ ស្រមប់សុខភិបល កសិកមម និងបរ ិ ថ ន ក. ព្រងក ី ករអនុវត្តកមមវ ិធប ី ងករ នង ិ ្រតួតពន ិ ត ិ យករចម្លងេ គេទ កន់មនទរី េពទយរដ្ឋដៃទេទៀត ខ. ធនឱយមនេហ ្ឋ រចនសមព័នធ និងផលត ិ ផលែដលចំបច់ ស្រមប់គ ំ្រទដល់ករពិនិតយ ម នសុវតថិភពទឹក ករ្រតួត ពិនិតយ និងករវ ិភគសុវតថិភពចំណី រ និងករ្រគប់្រគង កកសំណល់ លទធផលសំខន់ែផនក ២០១៩–២០២០ សុខភពមនុស ៖ DDF, CCDC, មនទីរ ៤.៣ ពិនិតយ ម ន ស្រមប់សុខភិបល កសិកមម និងបរ ិ ថ ន សុខភប ិ ល ជធនី េខត្ត និងៃដគូអភវិ ឌ ទឹក សុវតថិភពចំណី ក. គំ្រទដល់ករពិនិតយ ម ន និងករ យតៃម្ល្របមូលទិនន ័យ រ នង ិ ករ្រគប់្រគង េដម ី ្រគ អំពី ថ នភពទក ឹ ករ្រតួតពន ិ ត ិ យ នង ិ ករវ ិភគសុវតថភ ិ ព កសិកមម៖ GDAHP GDA FiA DIA FAO OIE សំណល់ ចំណី រ នង ិ ករ្រគប់្រគងសំណល់ េ យបញចូ លករ ្រកសួងអភវិ ឌ ន៍ជនបទ ករយល័ ិ យ ្រពួយបរមភអំពី AMR ខ. េ្រជីសេរ ីសបុគគលិកបែនថម េដីមបីគ ំ្រទដល់ករពិនិតយ ម នទឹក កសិកមមេខត្ត ជធនី FAO OIE ករ្រតួតពិនិតយ និងករវ ិភគសុវតថិភពចំណី រ និងករ ្រគប់្រគងសំណល់ បរ ិ ថ ន៖ ្រកសួងបរ ិ ថ ន និងៃដគូ គ. េរៀបចំ និងអនុវត្តសកមមភពក ងសមតថភពស្រមប់ពិនិតយ 48 ម នទឹក ករ្រតួតពន ិ ត ិ យ នង ិ វ ិភគសុវតថភ ិ ពចំណី រ នង ិ ករ្រគប់្រគង់សំណល់ ឃ. ពិនិតយ ម ន MRL ៃនសំណល់ រធតុគីមី (VPH) កនុងបរ ិ ថ ន ង. េរៀបចំ និងអនុវត្តភពជៃដគូកុ នងករ្រគប់្រគងសំណល់កុ នងវ ិស័យ សុខភិបលកសិកមម និងបរ ិ ថ ន យុទធ ្រស្តទី ៥. បេងកីនករយល់ដឹងជ ធរណៈ េគលេ យុទធ ្រស្តទី ៥. ព្រងឹងករអប់រ ំផ ព្វផ យដល់ ធរណជន លទធផលសំខន់ៗ ម សកមមភព អនកពក់ព័នធ ថ ប័នស្រមប ែផនក ស្រមួល លទធផលសំខន់ែផនក ២០១៩–២០២០ សុខភិបល៖ ្រកុមករងរបេចចកេទស ៥.១ បេងកីនករយល់ដឹង ស្រមប់សុខភិបល AMR ពហុវ ិស័យ ្រកសួងអភវិ ឌ ន៍ជនបទ ជ ធរណៈ មរយៈ ក. េរៀបចំឯក រអប់រ ំផ ព្វផ យែដលមន្រ ប់ ស្រមប់ មនទីរសុខភិបល ជធនីេខត្ត ្របព័នធផ ព្វផ យទូេទ ប ្ត ញផ ព្វផ យ (ឧទហរណ៍ ករផ ព្វផ យ មរយៈ សមគមវ ិជជជីវៈ, WHO នង ិ ្របព័នធផ ព្វផ យ ទូរទស ន៍ វ ិទយុ នង ិ រព័ត៌មន) សងគម ខ. េរៀបចំ និងផ ព្វផ យ រអប់រ ំេន មប ្ត ញទំនក់ទំនង សងគម (ឧទហរណ៍ Facebook Instagram) កសក ិ មម ៖ ្រកុមករងរ AMR របស់ ស្រមប់កសិកមម និងបរ ិ ថ ន ្រកសួងកសិកមម រុកខ្របមញ់ និងេន ទ ក. េរៀបចំឯក រអប់រ ំផ ព្វផ យ ែដលមន្រ ប់ ស្រមប់ ្រកសួងអភិវឌ ន៍ជនបទ ប ្ត ញផ ព្វផ យ (ឧទហរណ៍ ករផ ព្វផ យ មរយៈ PDAFF, ករយល័ ិ យកសិកមម្រសុក FAO, ទូរទស ន៍ វ ិទយុ នង ិ រព័ត៌មន) OIE 49 ខ. េរៀបចំឯក របេងកីនករយល់ដឹងេផ ងេទៀត ែផ្អក ម បរ ិ ថ ន៖ ្រកសួងបរ ិ ថ ននង ិ ៃដគូអភវិ ឌ ន៍ ចំេណះដឹងបចចុបបននអំពី AMR នង ិ AMU េលម ី នុស ផលត ិ កមម ដំ ំ េន ទ ករចិញចឹមសត្វ និងេសប ង រ។ គ. េ្របី្របស់ប ្ត ញទំនក់ទំនងសងគម (ឧទហរណ៍. Facebook, Instagram) ស្រមប់សកមមភពអនុវត្តរ ួមគន ក. េរៀបចំឯក រអប់រ ំផ ព្វផ យ និងឯក របណុ ្ត ះប ្ត លរួមគន ែផនកសុខភិបល កសិកមម និងបរ ិ ថ ន ខ. េរៀបចំ និងផ ព្វផ យសមភរអប់រ ំផ ព្វផ យ និងកញច ប់ឧបករណ៍ បណុ ្ត ះប ្ត លអំពី AMR នង ិ AMU ែដលេ្រប្រី បស់ភ ជតិ ២០២១–២០២៣ ស្រមប់សុខភិបល កសិកមម និងបរ ិ ថ ន ក. ពិនិតយ ម ន និង យតៃម្ល្របសិទធភពៃនសកមមភពអប់រ ំ ផ ព្វផ យេន មប ្ត ញ រព័ត៌មនេផ ងៗគន លទធផលសំខន់ែផនក ២០១៩–២០២០ សុខភិបល៖ ៥.២ បញចូ លករអប់រ ំ ស្រមប់សុខភិបល ្រកុមករងរបេចចកេទស AMR ពហុវ ិស័យ ផ ព្វផ យអំពី AMR េទ ក. បញចូ ល AMR និងករេ្របី្របស់ឱសថ្របឆំងេមេ គេទកនុង ្រកសួងអភិវឌ ន៍ជនបទ មនទីរសុ ខភិបល កនុងកមមវ ិធី នង ិ សកមមភព សកមមភពែស្វងរកករគំ្រទ និងសកមមភពកមមវ ិធស ី ុ ខភពែដល ជធនីេខត្ត សមគមវ ិជជជីវៈ WHO នន កំពុងមន (ឧទហរណ៍ កមមវ ិធស ី ុខភពម នង ិ កុមរ កមមវ ិធី IMCI កមមវ ិធអ ី នម័យរេបង ្រគុនចញ់ េអដស៍) ខ. ផ្តល់ករបណុ ្ត ះប ្ត លអំពី AMR និងករេ្របី្របស់ឱសថ កសិកមម៖ ្រកុមករងរ AMR របស់្រកសួង ្របឆំងេមេ គដល់អនកផ្តល់េស សុខភព កសក ិ មម រុកខ្របមញ់ និងេន ទ ្រកសួង 50 អភវិ ឌ ន៍ជនបទ មនទរី កសក ិ មម រុកខ្របមញ់ ស្រមប់កសក ិ មម និងបរ ិ ថ ន និងេន ទ FAO ក. បញចូ ល AMR និងករេ្របី្របស់ឱសថអង់ទីប៊ីយូ ៉ទិកេទកនុង បរ ិ ថ ន៖ ្រកសួងបរ ិ ថ ន នង ិ សកមមភពែស្វងរកមតិគ ំ្រទ និងផ ព្វផ យពីកសិកមម សុខភព ៃដគូអភិវឌ ន៍ សត្វៃនកមមវ ីធី ែដលមនស្រមប់កមមវ ិធីផ្ល ់ថន ំបងករ កររក ធនធនែហ េនទិច ករបងកត់ពូជ ចំណីសត្វជេដីម ខ. េធ្វីសកមមភពបេងកីនករយល់ដឹងេនមូល ្ឋ ន គ. េរៀបចំករបណុ ្ត ះប ្ត លអំពី AMR នង ិ ករេ្រប្រី បស់ឱសថ ្របឆំងេមេ គស្រមប់អនកេ្របេី ស ទូេទ ដូចជ បសុេពទយ កសក ិ រ អនកែថទំសុខភពសត្វភូម។ ិ ស្រមប់សកមមភពអនុវត្តន៍រួមគន ក. ្របរពធទិ សប្តហ៍បេងកីនករយល់ដឹងអំពីឱសថអង់ទីប៊ីយូ ៉ទិក ជេរៀង ល់ឆន ំ ែដលមនករចូលរួមពីអនកពក់ព័នធកុ នងវ ិស័យ សុខភិបល កសិកមម និងបរ ិ ថ ន ទំងមកពីវ ិស័យ រធរណៈ នង ិ ឯកជន ខ. បញចូ លយុ ទធ ្រស្តអប់រ ំផ ព្វផ យ េទកនុងកមមវ ិធប ី េងកីនករយល់ ដឹង មសហគមន៍ កមមវ ិធេី លក ី កមពស់សុខភព នង ី ំរុញ ិ កមមវ ិធជ ឱយមនករអនុវត្តល ្អែផនកកសិកមម គ. េរៀបចំកិចចពិេ្រគះេយបល់េន មសហគមន៍ េដីមបីបេងកីនករ យល់ដឹង និងបញចូ ល AMR េទកនុងេវទិកសហគមន៍ 51 ២០២១–២០២៣ ស្រមប់សុខភប ិ ល កសក ិ មម នង ិ បរ ិ ថ ន ក. ពិនិតយ ម ន និង យតៃម្លឧបករណ៍ និងសកមមភពអប់រ ំ ផ ព្វផ យ អំពី AMR និងករេ្របី្របស់ឱសថ្របឆំងេមេ គកនុង សកមមភពែស្វងរកករគំ្រទ និងេលីកកមពស់សុខភព ែដល អនុវត្តេ យកមមវ ិធីសុខភព និងកសិកមម ែដលមន្រ ប់ ខ. ពិនិតយ ម នលទធផលៃនកមមវ ិធីអប់រ ំផ ព្វផ យ និងផ្លស់បូ ្តរ ឥរយបថ ិ េន មទី ំង កលបង នង ិ ទី ំងេគលេ 52 យុទធ ្រស្តទី ៦. ករក ងសមតថភពធនធនមនុស េលភ ី ព ុ ំនង ឹ ឱសថ្របឆំងេមេ គ េគលេ យុទធ ំ ញ និងបុគគលិក េដីមបីែស្វងរកករគំ្រទដល់ AMR និងផ្តល់ករគំ្រទដល់្រគប់ករងរទំងអស់ ្រស្តទី ៦. ព្រងឹងសមតថភពអនកជន លទធផលសំខន់ៗ ម សកមមភព អនកពក់ព័នធ ថ ប័នស្រមប ែផនក ស្រមួល លទធផលសំខន់ែផនក ២០១៩–២០២០ សុខភិបល៖ HRD, UHS, NIPH, ៦.១ បញចូ ល AMR មី្រកូ ស្រមប់សុខភិបល កសិកមម និងបរ ិ ថ ន សមគមវ ិជជជវី ៈ នង ិ ៃដគូអភិវឌ ជីវ ្រស្ត ករេ្របី្របស់ ក. ពិនិតយេឡីងវ ិញ និងបញចូ ល AMR និងចំេណះដឹងែដលពក់ព័នធ ឱសថ្រតម ឹ ្រតូវ នង ិ មុខ េទកនុងករបណុ ្ត ះប ្ត ល ដល់្រគូេពទយ គិ នុប ្ឋ យក ិ វ ិជជែដលពក់ព័នធេទកនុង ឱសថករអន ី កបេចចកេទស មនទរី ពេិ ធន៍ នង ិ កមមវ ិធក ី ្រមត ិ ិ មម៖ ្រកសួងកសក កសក ិ មម រុកខ្របមញ់ និង កមមវ ិធប ី ណុ ្ត ះប ្ត ល សញញប្រតដៃទេទៀត និងធនធនែដលេ្របី  កមមវ ិធីែណនំពីករេ្របី្របស់ឱសថអង់ទីប៊ីយូ ៉ទិក ករេធ្វី េន ទ អគគនយក ្ឋ នសុខភព និង ្របស់ស្រមប់ េតស្តមី្រកូជីវ ្រស្តេន មេន មមនទីរពិេ ធន៍ ករចង ផលិតកមមសត្វ, រដ្ឋបលជលផល បណុ ្ត ះប ្ត មុនេពល ្រកងប ្ត ញ និងករែចករ ំែលកព័ត៌មនជីវសុវតថិភព និង អគគនយក ្ឋ នកសក ិ មម េចញបំេរ ីករងរ ករេ្របី្របស់ឱសថ្របឆំងនឹងេមេ គ IPC មី្រកូជី ្រស្ត និង កលវ ិទយល័យភូមិនទកសិកមម ករេ្របី្របស់ឱសថ្របឆំងេមេ គឱយបនសម្រសប និងករ កសក ិ មមជតិែ្រពកេលៀប ឃ្ល ំេមល ី ករេ្រប្រី បស់ឱសថ ជតិកសិកមមកំពង់ចម FAO, OIE  វគគបណុ ្ត ះប ្ត លែដលពក់ព័នធ បរ ិ ថ ន៖ ្រកសួងបរ ិ ថ ន និងៃដគូ ខ. ពន ិ ត ិ យេឡង ី វ ិញេលក ី មមវ ិធស ី ក ិ នង ិ បញចូ ល AMR ្រពមទំង ចំេណះដឹងពក់ព័នធ េទកនុងករបណុ ្ត ះប ្ត ល ជំនញ វ ិទយ ្រស្តសត្វ េវជជ ្រស្តសត្វ ជលផល ចំណី រកសិកមម បរ ិ ថ ន និងកមមវ ិធីសញញប្រតដៃទេទៀត  ដំេណីករៃនេស សុខភពសត្វ (PVS) OIE 53  កមមវ ិធច ី ញ ិ ច ឹមសត្វ ជលផល នង ិ កសឧ ិ ស ហកមម  វគគបណុ ្ត ះប ្ត លែដលពក់ព័នធ គ. េលីកកមពស់ទំនក់ទំនង និងភពជៃដគូជមួយនឹង ថ ប័នសិក ្រ វ្រជវ និង អន្តរជតិ េ យេផ្តតេលីករក ង សមតថភព ករ្រ វ្រជវ និងគំនិតផ្តួចេផ្តីមដៃទេទៀត ២០២១–២០២៣ ស្រមប់សុខភប ិ ល កសក ិ មម នង ិ បរ ិ ថ ន ក. េរៀបចំ នង ិ ពន ិ ត ិ យេឡង ី វ ិញេលធ ី នធនអប់រ ំ (ឧទហរណ៍ េធ្វី បចចុបបននភពេសៀវេភ និងឯក រេយង) េផ្តតេលក ី រសក ិ ជំនញឱសថ ឱសថ ្រស្ត គ្លីនិក ករឃ្ល ំេមីលករេ្របី្របស់ ឱសថបសុ ពយបល និងវគគសិក ដៃទេទៀត ខ. យតៃម្ល ពិនិតយេឡីងវ ិញ និងែ្របក្លយករអនុវត្តល ្អ ែដលមន ្រ ប់ េទជកមមវ ិធីថមីៗ អំពី AMR េ យេផ្តតេលីអនកជំនញ ខងផលិតកមមសត្វ បសុ ពយបល និងកសិកមម លទធផលសំខន់ែផនក ២០១៩–២០២០ សុខភិបល៖ ្រកសួងសុខភិបល, UHS, ៦.២ េរៀបចំធនធន ស្រមប់សុខភប ិ ល កសក ិ មម នង ិ បរ ិ ថ ន NIPH, សហគមន៍វ ិជជជីវៈ នង ិ ៃដគូអភវិ ឌ បណុ ្ត ះប ្ត នង ិ ក. េរៀបចំមូ៉ឌុល នង ិ េធ្វក ី របណុ ្ត ះប ្ត លអនកជំនញខងសុខភព កសិកមម និងបរ ិ ថ ន៖ ្រកសួងកសិកមម រុកខ ក ងសមតថភព AMR ជែផនកមួយៃនករអប់រ ំេវជជ ្រស្តជបន្ត េ យេផ្តតេទេលី ្របមញ់ និងេន ទ អគគនយក ្ឋ នសុខ មី្រកូជីវ ្រស្ត ករេ្របី ្របធនបទ ដូចខងេ្រកម៖ ភព និងផលិតកមមសត្វ រដ្ឋបលជលផល ្របស់ឱសថឱយបន  ករបណុ ្ត ះប ្ត លេអពីេឌមី ្រស្ត អគគនយក ្ឋ នកសក ិ មម, កលវ ិទយល័យ ្រតឹម្រតូវ និងែផនកែដល  មនទីរពិេ ធន៍៖ ករេ្របី្របស់មនទីរពិេ ធន៍មី្រកូជីវ ្រស្ត ភូមន ិ ទកសិកមម ជតិកសក ិ មមែ្រពក ពក់ព័នធកុ នងករ ជីវៈសមតថភព ជីវសន្តិសុខ (មនទីរពិេ ធន៍េអពីឌីមី េលៀប កសក ិ ំពង់ចម ិ មមជតក 54 បណុ ្ត ះប ្ត លមុន ្រស្ត) កររក ទុក ករេវចខចប់ នង ិ ករដឹកជញជូ ន ករ ្រកសួងបរ ិ ថ ន សមគមវ ិជជជីវៈ េចញបេ្រមក ី រងរ នង ិ ្រគប់្រគងេមេ គ ករ ងសមតថភព  ករ្រគប់្រគងឱសថ្របឆំងេមេ គ  ករេ្របី្របស់ឱសថឱយបន្រតឹម្រតូវ  ្របធនបទែដលពក់ព័នធ ខ. េរៀបចំ និងពិនិតយេឡីងវ ិញនូវម៉ូឌុល និងេរៀបចំវគគបណុ ្ត ះប ្ត ល ស្រមប់អនកជំនញកសិកមម បសុពយបល និងសុ វតថិភពចំណី រ ែដលេផ្តតេលែី ផនកខងេ្រកម៖  ករបណុ ្ត ះប ្ត លេអពឌ ី ីមី ្រស្តបសុពយបលែដលបន អនុវត្តន៍េនកមពុជ  ករបណុ ្ត ះប ្ត លអំពី AMU និង AMR  មនទីរពិេ ធន៍មី្រកូជីវ ្រស្ត  ករអនុវត្តល ្អ  ់ ីប៊ីយូ ៉ទិក េសចក្តីែណនំស្តីពីករេ្របី្របស់ឱសថអងទ  GAP, GAHP, GAqP, ជីវសុវតថិភព  ្របធនបទែដលពក់ព័នធ គ. េរៀបចំឯក របណុ ្ត ះប ្ត លអំពី AMR ដល់ម្រន្តី នង ិ បុគគលិក េនថនក់េខត្ត ្រសុក នង ិ ភូមិ ឃ. បន្ត និងព្រងឹងភពជៃដគូ រ ង ថ ប័នកនុង្រសុក ជមួយនឹង ថ ប័នអន្តរជតិ េផ្តតេលី AMR េដីមបីឱយមនករែចករ ំែលក ជំនញ និងេមេរៀនរ ងប ្ត ្របេទសនន ង. ព្រងឹងករចូលរួមកនុងសននិសីទអន្តរជតិ និងករែចករ ំែលក ព័ត៌មនអំពី AMR 55 ច. ចូលរួមកនុងប ្ត ញ នង ិ គំនត ិ ផ្តួចេផ្តីមអន្តរជតិ (ឧទហរណ៍ ប ្ត ញគណៈកមមធក ិ រជតជ ិ ីវសុ វតថភ ិ ពប ្ត ញមនទរី ពិេ ធន៍មី្រកូជី ្រស្តេវជជ ្រស្តេនថនក់ជតិ បញជ ី CALM, CamLQMS, បញជ ី្រតួតពិនិតយស្រមប់ករបញជក់គុណភព ស្តង់ រគុណភពជតិ ២០២១–២០២៣ ស្រមប់សុខភប ិ ល កសក ិ មម នង ិ បរ ិ ថ ន ក. េរៀបចំករបណុ ្ត ះប ្ត លរួមគនដល់អនកជំនញ នង ិ អនក បេចចកេទស កនុងវ ិស័យសុ ខភពមនុស កសក ិ មម នង ិ បរ ិ ថ ន លទធផលសំខន់ែផនក ២០១៩–២០២៣ សុខភប ិ ល៖ ្រកសួងសុខភិបល, UHS, ៦.៣ សហករជមួយ ស្រមប់សុខភិបល កសិកមម និងបរ ិ ថ ន NIPH សងគមវ ិជជជីវៈ និងៃដគូអភិវឌ សមគមវ ិជជជីវៈ េដីមបី ក. បញចូ លសកមមភពៃនយុទធ ្រស្តេនះ (ឧទហរណ៍ ជីវសុវតថិភព បញចូ ល AMR និងបញ្ហ ជីវសន្តិសុខ និងករ្រគប់្រគងសំណល់)េទកនុងកមមវ ិធីែដលមន កសិកមម និង បរ ិ ថ ន៖ ែដលពក់ព័នធេទកនុងករ ្រ ប់របស់សមគមវ ិជជជីវៈ ខងសុខភពមនុស កសិកមម និង ្រកសួងកសិកមម រុកខ្របមញ់ និងេន ទ ក ងសមតថភព បរ ិ ថ ន ករែស្វងរកមតគ ខ. េរៀបចំសកមមភពអនុវត្តរួមគន (ឧទហរណ៍ កិចច្របជុំេវទក អគគនយក ្ឋ នសុខភព នង ិ ផលត ិ កមម ិ ំ្រទ ិ ករ្រ វ្រជវ នង ិ សននស ិ ទ ី ករ្រ វ្រជវ គេ្រមង) សត្វ រដ្ឋបលជលផល អគគនយក ្ឋ ន ករអប់រ ំ គ. ព្រងឹងភពជៃដគូរ ងរដ្ឋ នង ិ ឯកជន េដីមបប ី េងកីនករអនុវត្ត កសក ិ មម កលវ ិទយល័យភូមន ិ ទកសក ិ មម សកមមភព AMR ជតិកសិកមមែ្រពកេលៀប ឃ. ែចករ ំែលកចំេណះដឹង និងជំនញ AMR េនមូល ្ឋ ន និងេន កសិកមមជតិកំពង់ចម ្រកសួងបរ ិ ថ ន ថនក់ជតិ ជមួយនឹងសហករ ីអន្តរជតិ សមគមវ ិជជជីវៈ 56 យុទធ ្រស្តទី ៧. ្រ វ្រជវ និងន នុវត្តន៍ (Innovation) េដីមប ី្របឆំងនឹងភព ុ ំនឹងឱសថ្របឆំងេមេ គ (AMR) េគលេ យុទធ ្រស្តទី ៧. ក ងសមតថភព្រ វ្រជវ នង ិ ន នុវត្តន៍ េដីមបគ ី ំ្រទដល់ករេរៀបចំេគលនេយបយ ករអនុវត្តល ្អ ករអនុវត្ត ករពន ិ ត ិ យ ម ន នង ិ យតៃម្លសកមមភពភព ុ ំនង ឹ ឱសថ្របឆំងេមេ គ លទធផលសំខន់ៗ ម សកមមភព អនកពក់ព័នធ ថ ប័នស្រមប ែផនក ស្រមួល លទធផលសំខន់ែផនក ២០១៩–២០២០ សុខភប ិ ល៖ ្រកសួងសុខភិបល UHS, ៧.១ កំណត់ពច ស្រមប់សុខភប ិ ល កសក ិ មម នង ិ បរ ិ ថ ន NIPH, និងៃដគូអភិវឌ ី ំណុច ក. បញចូ លបញ្ហ AMR និងបញ្ហែដលពក់ព័នធេទកនុងយុទធ ្រស្តេនះ ខ្វះខត និង ទិភព (ឧទហរណ៍ ករអេងកត ម ន មនទីរពិេ ធន៍ IPC ករ ស្រមប់្រ វ្រជវអំពី កសិកមម និង បរ ិ ថ ន៖ េ្របី្របស់ឱសថឱយបន្រតឹម្រតូវ ករ្រគប់្រគងអនម័យបរ ិ ថ ន AMR កនុងវ ិស័យេផ ងៗ ្រកសួងកសិកមម រុកខ្របមញ់ និងេន ទ និងអនម័យផទល់ខួ ្លន) េធ្វីជធតុផ ំមួយដ៏សំខន់ៃនរេបៀប រៈ ដូចជ វ ិទយ ្រស្ត ្រ វ្រជវ កនុងវ ិស័យសុខភិបល កសិកមម និងបរ ិ ថ នរបស់ ្រកសួងបរ ិ ថ ន កលវ ិទយល័យ ធមមជតិ វ ិទយ ្រស្ត ្របេទស ភូមិនទកសិកមម ខ. ខត ិ ខំេរៀបចំកច ិ ច្រពមេ្រពៀងរួមស្តព ី ក ី រ្រ វ្រជវ្រគបដណ្តប់្រគប់ FAO, OIE អនុវត្តន៍ វ ិទយ ្រស្ត វ ិស័យទំងអស់ នង ិ ្រកសួងពក់ព័នធ េដីមបធ ី ន្របសទ ិ ធភព សងគម េសដ្ឋកច ិ ច និ ង តម្លភព និងករែចករ ំែលកទិនន ័យឱយបនល្អបំផុត ករ្រគប់្រគង ២០២០–២០២៣ ស្រមប់សុខភិបល កសិកមម និង បរ ិ ថ ន ក. េរៀបចំករសិក ថនក់ជតិ អំពីេ្រប ៉ ឡង់ AMR ខ. េលក ី កមពស់ភពជៃដគូជមួយនង ឹ ថ ប័ននន េដម ី បព ី ្រងង ឹ ករ ្រ វ្រជវអំព្រី បតប ិ ត្តក ិ រ នង ិ ករអនុវត្ត នង ិ ចូលរួមឱយបនសកមម ិ ជំរុញឱយមនករចូលរួមឱយបនសកមមពវី ិស័យឯកជន នង 57 លទធផលសំខន់ែផនក ២០១៩–២០២០ សុខភប ិ ល៖ MOH, UHS, NIPH នង ិ ៧.២ ករបណុ ្ត ះ ស្រមប់សុខភប ិ ល កសក ិ មម នង ិ បរ ិ ថ ន ៃដគូអភិវឌ ក. េលីកកមពស់ និងគំ្រទដល់ករ្រ វ្រជវអំពិ AMR េ យបញចូ ល ប ្ត ល នង ិ ករក ង េទកនុងសកមមភព ែដលមន្រ ប់ និងសកមមភពថមីៗរបស់ សមតថភពបុគគលិកជតិ កសិកមម និង បរ ិ ថ ន៖ េរៀន និងេរៀបចំកមមវ ិធី្រ វ្រជវពិេសស ស្រមប់និស ិត អំពី AMR និងករ ្រកសួងកសិកមម រុកខ្របមញ់ និងេន ទ ែដលបន្តករសិក ក្រមិតបរ ិញញប្រតេ្រកយឧត្តមសិក ្រ វ្រជវ ែដលពក់ព័នធ ខ. បេងកីនករយល់ដឹងអំពីឱកសបណុ ្ត ះប ្ត លេនមូល ្ឋ ន ្រកសួងបរ ិ ថ ន កលវ ិទយល័យ ថនក់ជតិ នង ិ អន្តរជតិ ភូមិនទកសិកមម FAO, OIE គ. េលក ី កមពស់ករ្រ វ្រជវេនកនុងចំេ មវ ិស័យនន ២០២១–២០២៣ ក. ករក ងសមតថភពេផ្តតេលីករ្រ វ្រជវែបបគុណវ ិស័យ និង ករ្រ វ្រជវក្រមិត្របតិបត្តិករ ខ. ស្រមបស្រមួលករេផ្តះប្តូរជំនញ និងេមេរៀនែដលទទួលបនពី ្របេទសដៃទេទៀត និងៃដគូនន មរយៈកិចច្របជុំ ស្រមបស្រមួល ជេទៀងទត់ លទធផលសំខន់ែផនក ២០១៩–២០២០ សុខភប ិ ល៖ ៧.៣ ករអនុវត្ត និងករ ស្រមប់សុខភប ិ ល កសក ិ មម នង ិ បរ ិ ថ ន ្រកសួងសុខភិបល, UHS, NIPH, និង ក. េធ្វក ី រ្រ វ្រជវ េដីមបប ី ំេពញកង្វះចំេណះដឹង អំពីបញ្ហ AMR ផ ព្វផ យករ្រ វ្រជវ ៃដគូអភិវឌ កនុង្រគប់ែផនកទំងអស់ និងគំ្រទដល់ករេរៀបចំ្រកបខ័ណ្ឌ AMR េគលនេយបយ និងែផនករអភិវឌ ន៍ ដូចជ ករ្រ វ្រជវអំពី កសិកមម៖ ចំេណះដឹង កបបកិរ ិយ និងករអនុវត្តជុំវ ិញឱសថសផ ះ AMR ្រកសួងកសិកមម រុកខ្របមញ់ និងេន ទ និង AMU កនុងចំេ មបុ គគលិកសុខភិបល ភនក់ងរសុខភពភូមិ ្រកសួងបរ ិ ថ ន កលវ ិទយល័យ 58 ភនក់ងរកសិកមម ភនក់ងរសុខភពសត្វភូមិ កសក ិ រ នង ិ សមជិក ភូមន ិ ទ កសក ិ មម FAO, OIE សហគមន៍ (រដ្ឋ នង ិ ឯកជន) បរ ិ ថ ន៖ ខ. ចូលរួមកនុងករសិក េ្រប ៉ ឡង់អំពីករេ្របី្របស់ឱសថផ ះ សម្រសបេលីមនុស កនុងសកលេ កទំងមូល គ. ចូលរួមកនុងករពិនិតយ ម នរបស់ OIE េលីបរ ិមណ និង និននករៃនករេ្របី្របស់ រធតុ្របឆំងេមេ គេលីសត្វែដលរស់ េនកនុងទឹក និងសត្វែដលេ្របី្របស់ស្រមប់ផលិតជ រ ឃ. េធ្វក ី រសនយ េដម ី បក ី ំណត់ពទ ី ំនក់ទំនងេទវ ិញេទមករ ង AMR កនុងសត្វ បរ ិ ថ ន នង ិ មនុស ង. ែស្វងយល់ពអ ី ភ្រិ កមែដលមនលកខណៈន នុវត្តន៍ (ឧទហរណ៍ ករេ្របី្របស់ IT កមមវ ិធី មទូរសពទ bioinformatics, probiotics និងអភិ្រកមដៃទេទៀត េដីមបីកត់បនថយភពចំបច់កុ នងករ េ្របី្របស់ឱសថ្របឆំងនឹងេមេ គ) ច. ែចករ ំែលកលទធផលរកេឃីញពីករ្រ វ្រជវឱយបនជប់ជ្របចំ មរយៈកិចច្របជុំរបស់្រកុមករងរ និងសននិសិទ ឆ. េរៀបចំេវទក ិ រ្រ វ្រជវអំពី AMR 59 ឧបសមព័ន ធ ខ ស ូចនករព្រងងសំ ប់ករ ម ន និង យតំៃល សូចនករទូេទ AMR ្រតូវបនបង្ហញ េនកនុងែផនកស្តីពីករ ម ន និងករ យតំៃល។ រួមមន ធតុចូល ដំេណីករ និងធតុេចញ (input, process and output indicators) ែដលជួយកំណត់បននូវកររ ីកចំេរ ីនៃនសកមមភពទក់ទងនឹង AMR េនកនុង្រគប់វ ិស័យទំងអស់។ មនសកមមភព ម ននិង យ តៃម្លចំនួពីរ្របេភទ ្រតូវបនេសនីេឡីង i) ករ ម នជ្របចំ ជឧទហរណ៍ េនកនុងរបយករ្របចំឆន ំ និង ii) ករ យតំៃល និងករអេងកតេ យែឡក ជ ឧទហរណ៍ ករពន ិ ត ី វ ិញ ករអេងកតេ្រប ៉ ឡង់ថនក់ជតិ នង ិ យេឡង ិ ករសក ិ េ យែឡកេផ ងៗេទៀត េនពក់ក ្ត ល នង ិ ចុងអណត្ត។ ិ ករ យតំៃលសូចនករ េដម ី េនកនុងឆន ំ ២០១៩ េដម ី ្រគ ្រតូវបនេសនេី ឡង ី បក ី ំណត់រក ថ នភពនេពលបចចុបបនន។ យុទ ធ ្រស្ត និង លទធផលសំខន់ែផនក ស ូចនករ ធតុច ូល និងដំេណីករ ស ូចនករធតុេចញ output indicators (KRA) input and process indicators យុទធ ្រស្តទី ១. អភិបលកិចច និងករស្រមបស្រមួល េដើមប ី ត់បនថយAMR េគលេ យុទធ ្រស្តទី ១. ធនឱយមនអភិបលកិចច្របកបេ យនិរន្តរភព មរយៈករស្រមបស្រមួល និងករបេងកីនភពជៃដគូ្របកបេ យ្របសិទធភព លទធផលសំខន់ែផនក លទធផលសំខន់ ១.១: ព្រងឹងករស្រមបស្រមួលក្រមិត  ែផនករ បនបញច ប់ ទទួលករយល់្រពម អនុមតិ បេចចកេទស និងនេយបយេនថនក់មូល ្ឋ ន ថនក់ជតិ នង ិ ផ ព្វផ យ  មនតំ ងភគីពក់ព័នធជសមជិកភពេន្រកុម នង ិ អន្តរជតិ ករងរបេចចកេទស  េគលនេយបយ និងនិយ័តកមម ្រតូវបនបេងកីត លទធផលសំខន់ ១.២: ព្រងង ឹ ្រកបខ័ណ្ឌេគល េឡីង និងអនុមតិេ យភគី និងៃដគូអភិវឌ ន៍ នេយបយ និងចបប់ េដីមបីគ ំ្រទគំនិតផ្តួចេផ្តីម AMR ពក់ព័នធ លទធផលសំខន់ ១.៣: េកៀរគរធនធន េដីមបីគ ំ្រទដល់  ចំនួនសមគមវ ិជជជីវៈ និងមនទីរេពទយ ែដលបេងកីត ករអនុវត្តែផនករសកមមភពពហុវ ិស័យ កមមវ ិធស ី ី AMR េ យេ្រប្រី បស់ថវ ិកផទល់ខួ ្លន ី ្តព 60  ករពន ិ ត ិ យេឡង ី វ ិញេនពក់ក ្ត លអណត្តិ ្រតូវ លទធផលសំខន់ ១.៤: ែផនករពន ិ ត ិ យ ម ន នង ិ បនេរៀបចំេឡីង  ករ្របជុំរបស់្រកុមករងរបេចចកេទស AMR យតៃម្ល សូចនករ នង ិ ករ យតៃម្លឱយបនជប់ជ េ យេទៀងទត់ ្របចំ  ករពិនិតយេឡីងវ ិញនូវ MSAP េនចុងអណត្តិ ្រតូវ បនេរៀបចំេឡង ី យុទធ ្រស្តទី ២. ្របមូលភស្តុ ង មរយៈករ ម ន និងមនទីរពិេ ធន៍ េគលេ យុទធ ្រស្តទី ២. េដីមបព ី ្រងឹងករ្របមូលភស្តុ ង មរយៈមនទរី ពេិ ធន៍វ ិស័យសុខភប ិ មម បរ ិ ថ ន ែដលដំេណីរករេទបនល្អ នង ិ ល កសក ិ យន្តករ ម នែដលមន្របសិទធភព លទធផលសំខន់ែផនក លទធផលសំខន់ ២.១: បេងកីនក្រមត ិ អេងកត ម នន  ចំនួនបុគគលក ិ ថមីៗ បនទទួលករបណុ ្ត ះ  ចំនួនមនទរី ពេិ ធន៍សុខភប ិ ល ែដល យ េពលបចចុបបនន នង ិ សកមមភព និង្របព័នធមនទរី ពេិ ធន៍ ប ្ត លេនកនុងវគគ CAVET‐MAFF និង ករណ៍េទ្របព័នធ ម ន AMR FETP‐MOH  ចំនួនមនទរី ពេិ ធន៍សុខភប ិ ល ែដលវ ិវឌ ន៍ េដីមបគ ី ំ្រទដល់ AMR  ចំនួបុគគលក ិ ថមីបនទទួលករបណុ ្ត ះប ្ត ល ដល់ជំ នទី ____ េនកនុងករ្រគប់្រគង អំពីអតិសុខុម្របណ ្រស្ត microbiology គុណភពមនទីរពិេ ធន៍ លទធផលសំខន់ ២.២: ព្រងឹងសមតថភពធនធន  ចំនួនមនទីរពិេ ធន៍ែផនកកសិកមម និងបរ ិ ថ ន មនុស ែដលេធ្វីករងរេនកនុងមនទីរពិេ ធន៍ ករែចក មនសមតថភពនឹងេធ្វីេតស្ត AST រ ំែលកព័ត៌មន, ករអេងកត ម ននិងករេឆ្លីយតប  ទន ិ ន ័យ AMR េដីម្រគ ចំេពះករផទុះជំងឺ  ចំនួនអនកជំងឺ ែដល្រតូវបនយកសំ ក េទ ម្របេភទសំ ក កនុងចំេ មចំនួន 61 លទធផលសំខន់ ២.៣: ព្រងឹងបរ ិកខរ និង្របព័នធផគត់ផគង់ ្របជជនមួយ េន មមនទរី េពទយ ស្រមប់េធ្វីេតស្តម្រី កូជីវ ្រស្ត នង ិ  ចំនួនអនកជំងឺ ែដលដុះបក់េតរ ី ុ ំនឹងឱសថ ម្របេភទសំ ក ្របេភទេមេ គ ពន ិ ត ិ យ ម ន។ ិ អង់ទប ‘species’ នង ី ៊ីេយទក ិ  ភគរយអនកជំងឺ ែដល្រតូវបនយកសំ ក បនបណុ ្ត ះេមេ គវ ិជជមន ជបក់េតរ ី ែដល កប កំរ ិតក ្ត ល “intermediate’ ឬ ុ ំនឹង ឱសថ ម្របេភទសំ ក  ភគរយៃនសំ ក ែដលដុះបក់េតរ ី ុ ំ នឹងអង់ទីប៊ីេយទិក នូ វ្របេភទ និង អង់ទីបី៊េយទិកេនេ្រកមករ ម ន ម្របេភទសំ ក យុទធ ្រស្តទី ៣. ករេ្របើ្របស់ឱសថ្របឆ ំងេមេ គឱយបនសម្រសប េគលេ យុទធ ្រស្តទី ៣. េរៀបចំ និងព្រងឹងករអនុវត្តលិខិតបទ ្ឋ នគតិយុត្ត និងយុទធ ់ ីប៊ីយូ ៉ទិក ្រស្ត េដីមបីធនលទធភពទទួលបនឱសថអងទ និងករេ្របី្របស់ឱសថឱយបន្រតឹម្រតូវ ស្រមប់សុខភិបល សុខភពសត្វ និងកសិកមម លទធផលសំខន់ែផនក លទធផលសំខន់ ៣.១: ករែណនំ និងករអនុ វត្តករ  ចំេណះដឹងរបស់បុគគលិកអំពីមគគុេទសន៌នន េ្របី្របស់ឱសថ្របឆំងេមេ គឱយបនសម្រសប ទក់ទងនឹង AMR, AMS, IPC, GAP, GAHP, GAqP  ចំនួនកសិ ្ឋ នគំរូ ែដលអនុ វត្តន៍ មមគគុេទស 62 លទធផលសំខន់ ៣.២: ករេធ្វីនិយ័តកមមេនក្រមិត ក៏ករអនុវត្តល ្អ good practice guidelines េផ ងៗ េដីមបគ ី ំ្រទឱយមនករេ្រប្រី បស់ឱសថ្របឆំង  សូចនករ ម ន AMS  អ្រ ច់សុ ្តក ៃនអង់ទីប៊ីេយទិក េមេ គឱយបនសម្រសប  អ្រ េចញេវជជបញជអង់ទប ី ៊ីេយទក ិ  ករេ្របី្របស់អង់ទីប៊ីេយទិក លទធផលសំខន់ ៣.៣: ព្រងឹងករ្រគប់្រគងសង្វក់ ផគត់ផគង់ឱសថ្របឆំងេមេ គ េដីមបីធនឱយ្របជពលរដ្ឋ ទំងអស់ ចទទួលបននូវឱសថជសកល ្របកបេ យសមធម៌។ យុទធ ្រស្តទី ៤. ទប់ ក ត់ AMR មរយៈករអនុវត្តល ្អ េគលេ យុទធ ្រស្តទី ៤. េដីមប ីកត់បនថយករណីឆ្លងេ គ មរយៈករអនុវត្តវ ិធនករអនម័យបរ ិ ថ ន អនម័យផទល់ខួ ្លន សុវតថិភពចំណី រ ករ ្រគប់្រគងកកសំណល់ នង ិ ករបងករករចម្លងេ គ្របកបេ យ្របសទ ិ ធភព។ លទធផលសំខន់ែផនក លទធផលសំខន់ ៤.១: ករែណនំអំពីករអនុវត្តល ្អ និង  ចំនួនមនទីរេពទយ និងបុគគលិក្រគឹះ ថន  ចំនួនបុគគលិក ែដលអនុវត្តន៍មគគុេទសន៍ IPC ករេគរពេទ មករអនុវត្តល ្អ សុខភប ិ ល ែដលទទួលបននូវករបណុ ្ត ះ  ចំនួនកសិ ្ឋ នគំរួ ែដល្រប្រពត ឹ ្ត មមគគុេទស ប ្ត ល និងបណុ ្ត ះប ្ត លរ ំលឹក អំពី IPC ក៏ៃនករអនុ វត្តបនល្អ ‘good practice  ចំនួនបុគគលក ិ កសក ិ មម ជធនី េខត្ត ែដល guidelines’ លទធផលសំខន់ ៤.២: ធនឱយមនបេចចកវ ិទយ នង ិ ទទួលបននូវករបណុ ្ត ះប ្ត លអំពីករ សមភរផគត់ផគង់ស្រមប់អនុវត្តពធ ិ ី រ នង ិ េសចក្តីែណនំ អនុវត្តកសិកមមបនល្អ good practices នន 63  ចំនួនសហគមណ៍ ែដលបនចុ ះបញជ ីករ ជ លទធផលសំខន់ ៤.៣: ពន ិ ត ិ យ ម នទក ឹ សុវតថភ ិ ព ភូមិគំរូ ចំណី រ នង ិ ករ្រគប់្រគងសំណល់។ យុទធ ្រស្តទី ៥. បេងកើនករយល់ដឹងដល់ ធរណជន េគលេ យុទធ ្រស្តទី ៥. ព្រងឹងករព្វផ យេដីមបីអប់រ ំ និងករយល់ដឹងដល់ ធរណជន លទធផលសំខន់ែផនក លទធផលសំខន់ ៥.១: បេងកីនករយល់ដឹងជ  ករេរៀបចំសប្តហ៍ យល់ដឹង  ករផ្លស់បូ ្តរជវ ិជជមន ទក់ទងនឹចំេណះដឹង ធរណៈ មរយៈ្របព័នធផ ព្វផ យទូេទ និង្របព័នធ  សមភរៈអប់រ ំសុខភព ្រតូវបនែបងែចក កបបករិ យ ិ និងករអនុវត្ត បនទប់ពី  ចំនួនករសនទនជមួយសហគមន៏ រយៈេពល ៣ឆន ំ ផ ព្វផ យសងគម ‘community dialogues’  ចំនួនករសនទននន ជមួយៃដគូ និង លទធផលសំខន់ ៥.២: បញចូ លករអប់រ ំផ ព្វផ យអំពី ភគន ី ន AMR េទកនុងកមមវ ិធី នង ិ សកមមភពនន។ យុទធ ្រស្តទី ៦. បេងកើនសមតថភពធនធនមនុស ស្រមប់ AMR េគលេ យុទធ ្រស្តទី ៦. ព្រងឹងសមតថភពអនកជំនញ និងបុគគលិក េដីមបីែស្វងរកករគំ្រទដល់ AMR និងផ្តល់ករគំ្រទដល់្រគប់ករងរទំងអស់ 64 លទធផលសំខន់ែផនក លទធផលសំខន់ ៦.១ បញចូ ល AMR មី្រកូជីវ ្រស្ត  ចំនួនកមមវ ិធីសិក ទក់ទងនឹង AMR  ចំនួនបុគគលិកេនថនក់ជតិ និងថនក់េ្រកម ករេ្របី្របស់ឱសថសម្រសប និងមុខវ ិជជែដលពក់ អតស ិ ុខុម្របណ ្រស្ត នង ិ ករេ្រប្រី បស់ ជតិ ែដលបនទទួលករបណុ ្ត ះប ្ត លថនក់ អង់ទីប៊ិេយទិក ែដល្រតូវបនេធ្វី ជន់ខពស់ ‘advanced training’ េទ មឯក ព័នធេទកនុងកមមវ ិធប ី ណុ ្ត ះប ្ត ល នង ិ ធនធនែដល សមហរណកមម េទសេផ ងៗទក់ទងនង ឹ AMR (ឧ. េ្របី្របស់ មុនេពលេចញបេ្រមក ី រងរ  ចំនួនសមភរៈបេចចកេទស ‘technical អតិសុខម្របណ ្រស្ត clinical pharmacy, materials’ ែដល្រតូវបនេបះពុមភផ យ AMR, ករ ម ន នង ិ ករេឆ្លីយតបេទ លទធផលសំខន់ ៦.២ េរៀបចំធនធនបណុ ្ត ះប ្ត ល  ចំនួនសកមមភពនន ែដល្រតូវេធ្វី និង នឹង AMR) និងក ងសមតថភព AMR មី្រកូជីវ ្រស្ត ករេ្របី ជមួយសមគមវ ិជជជីវៈ ្របស់ឱសថឱយបនសម្រសប និងែផនកែដលពក់ព័នធ  ចំនួនកមមវ ិធីបណុ ្ត ះប ្ត លអំពី AMR ែដល ្រតូវបនេធ្វី កនុងករបណុ ្ត ះប ្ត លមុនេចញបេ្រមីករងរ និងករ  ចំនួនសមគមវ ិជជជីវៈ នង ិ មនទរី េពទយ ែដល ងសមតថភព បនបេងកីតកមមវ ិធី AMR េ យេ្របីថវ ិក របស់ខួ ្លន លទធផលសំខន់ ៦.៣ សហករជមួយសមគម វ ិជជជីវៈ េដីមបីបញចូ ល AMR និងបញ្ហែដលពក់ព័នធេទ កនុងករក ងសមតថភព ករតស៊ូមតិ ករ្រ វ្រជវ និងករអប់រ ំ។ 65 យុទធ ្រស្តទី ៧. ្រ វ្រជវ និងន នុវត្តន៍ (Innovation) េដើមប ី្របឆ ំងនឹងភព ុ ំនឹងឱសថ្របឆ ំងេមេ គ (AMR) េគលេ យុទធ ្រស្តទី ៧. ក ងសមតថភព្រ វ្រជវ និងន នុវត្តន៍ េដីមបីគ ំ្រទដល់ករេរៀបចំេគលនេយបយ ករ្របតិបត្តិបនសម្រសប ករអនុវត្ត ករ ពន ិ ត ិ យ ម ន នង ិ យតៃម្លសកមមភព AMR។ លទធផលសំខន់ែផនក លទធផលសំខន់ែផនក ៧.១ កំណត់ពីចំណុចខ្វះខត  ចំនួនករសិក ្រ វ្រជវ ែដលបនេធ្វី ស្តីពី  អ្រ េ្រប ៉ ឡង់ថនក់ជតិ ែដលបនរកេឃីញ នង ទភ ្របធនបទនន ទក់ទងនឹង AMR មរយៈករអេងកត និង្របព័នធ ម ន ិ ិ ព្រ វ្រជវអំពី AMR កនុងវ ិស័យេផ ងៗ  ចំនួនៃដគូ្រ វ្រជវកនុង្រសុក និងអន្តរជតិ េផ ងៗ ដូចជ វ ិទយ ្រស្តធមមជតិ វ ិទយ ្រស្តអនុ វត្តន៍  ចំនួនបទបង្ហញកនុង្រសុក និងអន្តរជតិ ស្តីពី វ ិទយ ្រស្តសងគម េសដ្ឋកច ិ ច នង ិ ករ្រគប់្រគង ្របធនបទទក់ទងនង ឹ AMR  ចំនួនករសិក ្រ វ្រជវ ស្តីពី្របធនបទ លទធផលសំខន់ែផនក ៧.២ ករបណុ ្ត ះប ្ត ល និង ននទក់ទងនង ឹ AMR ្រតូវបនពន ិ ត ិ យេ យ ករក ងសមតថភពបុគគលិកជតិ អំពី AMR និង អនកវ ិទយ ្រស្តឬអនកជំនញករ ែដលមន ករ្រ វ្រជវែដលពក់ព័នធ ជំនញ AMR ‘peer‐reviewed’ និង្រតូវបន េបះពុមភផ យ លទធផលសំខន់ែផនក ៧.៣ ករអនុវត្ត និង ករផ ព្វផ យករ្រ វ្រជវ AMR។ 66 ឧបសមព័នធ គ. ៃដគូ េនកនងដ ុ ំេណើករ និងករផ្តួចេផ្តើម ែដលពក់ព័នធនឹង AMR េនកនង្របេទសកមព ុ ុជ ្រកស ួងកសិកមម រុកខ្របមញ់ និងេន ទ (MAFF) ថ នប័ន េឈមះ ត ួនទី អុីែម៉ល អគគនយក ្ឋ នសុខភពសត្វ នង ិ ផលត ិ កមមសត្វ ឯកឧត្តម ន់ ផន់ ៉ អគគនយក នង ិ ្របតភ ិ ូ ជរ ្ឋ ភប ិ ល tan.phannara@gmail.com ្រកសួងកសិកមម រុកខ្របមញ់ និងេន ទ បណិ្ឌ ត សរ ចិ្រ អគគេលខធិកររង chetrass@gmail.com នយក ្ឋ នកសឧ ិ ស ហកមម េ ក គង់ ភជ នយក peachkong@gmail.com វ ិទយ ថ នជតិ្រ វ្រជវសុខភពសត្វ និងផលិតកមមសត្វ បណិ្ឌ ត ទុំ សុធធី ៉ នយក sothyratum@gmail.com ៃនអគគនយក ្ឋ នសុខភពសត្វ នង ិ ផលត ិ កមមសត្វ វ ិទយ ថ នជតិ្រ វ្រជវសុខភពសត្វ និងផលិតកមមសត្វ េ ក ជ រតន ម្រន្តីបេចចកេទស rortanachea@gmail.com ៃនអគគនយក ្ឋ នសុខភពសត្វ នង ិ ផលត ិ កមមសត្វ នយក ្ឋ នសុខភព រធរណៈ និងសុខភព រធរណៈ េ ក េទព េបងៃថ អនុ្របធន bengthay@gmail.com បសុពយបល ៃនអគគនយក ្ឋ នសុខភពសត្វ នង ិ ផលិតកមមសត្វ នយក ្ឋ នករពរដំ ំ អនម័យ នង ិ ភូតគមអនម័យៃន បណ្ឌិត នី វុទធី អនុ្របធន n.vuthy@yahoo.com អគគនយ ្ឋ នកសិកមម នយក ្ឋ ននត ិ ក ិ មមកសក ិ មម ៃន្រកសួងកសក ិ មម រុកខ្របមញ់ បណ្ឌិត ម៉ុច ចនថ អនុ្របធន chanthamoch@gmail.com និងេន ទ នយក ្ឋ នកសឧ ិ ស ហកមម េ ក្រសី ជួន មុននី ្របធន chuonmony@yahoo.com នយក ្ឋ នកសិឧស ហកមម េ ក ផុន រ ិណុ ្របធន ai_reno@yahoo.com នយក ្ឋ នកសឧ ិ ស ហកមម េ ក្រសី គង់ វួ ៉ចសុម ី ម្រន្តប ី េចចកេទស kongvouchsim@gmail.com នយក ្ឋ នបេចចកេទសែកៃចន និងគុណភព ៃនរដ្ឋបល េ ក ចប ពិសិដ្ឋ អនុ្របធន pisethchap@gmail.com ជលផល ករ ិយល័យ រ ីវបបកមមទឹក ប ៃននយក ្ឋ នអភិវឌ ន៍ នង វុឌ ី អនុ្របធន vuthdynady@yahoo.com រវបបកមម ី រដ្ឋបលជលផល 67 នក ្ឋ នអភិវឌ ន៍ រ ីវបបកមម ៃនរដ្ឋបលជលផល េ ក្រសី េពឿង េសង ៊ ង ម្រន្តីបេចចកេទស heangfia@gmail.com នយក ្ឋ នែផនករ និងសថិតិ េ ក្រសី សូ ្រសីមុំ អនុ្របធននយក ្ឋ ន sreymomso88@gmail.com ្រកស ួងសុខ បល (MOH) ថ ប័ណ េឈមះ ត ួនទី ទំនក់ទំនង ្រកសួ ងសុ ខភិបល ្រ ្ត ចរយ េអង ហួត រដ្ឋេលខធិករ នយក ្ឋ ន្របយុទធនឹងជំងឺឆ្លង ្រកសួងសុខភិបល េវជជ. លី សូ ៉ ន់ ្របធននយក ្ឋ ន sovann_ly@yahoo.com ឹ ជំងឺឆ្លង ្រកសួងសុខភិបល នយក ្ឋ ន្របយុទធនង េវជជ. ្រកង សុដ ី ន អនុ្របធននយក ្ឋ ន sidonnkrang@yahoo.com េវជជ. សុខ ្រស៊ុន ្របធននយក ្ឋ ន soksrun@online.com.kh នយក ្ឋ នមនទរី េពទយ ៃន្រកសួងសុខភប ិ ល soksrun@gmail.com នយក ្ឋ នមនទីរេពទយ ៃន្រកសួងសុខភិបល ្រ ្ត ចរយ គឹម វួន អនុ្របធននយក ្ឋ ន នយក ្ឋ នមនទរី េពទយ ៃន្រកសួងសុខភប ិ ល េវជជ. េ សុគនធ អនុ្របធននយក ្ឋ ន sintouch358@gmail.com នយក ្ឋ នមនទីរេពទយ ៃន្រកសួងសុខភិបល េវជជ. ជឺ សុីវុទធី ្របធនករ ិយល័យ វ ិទយ ថ នជតស ិ ុខភព ធរណៈ ៃន្រកសួងសុខភប ិ ល ្រ ្ត ចរយ ឈ ឆវណ្ណ ្របធនវ ិទយ ថន cchhorvann@niph.org.kh វ ិទយ ថ នជតិសុខភព ធរណៈ ៃន្រកសួងសុខភិបល េ ក េន វណ្ណ រ ិទធ ម្រន្តី nvandasrith@niph.org.kh មជឈមណ្ឌលជតិេលីកកមពស់សុខភព ៃន្រកសួងសុខភិបល េ ក្រសីបណ្ឌិត ឈ ឆ ភ ្របធនមជឈមណ្ឌល នយក ខ នអភិវឌ ន៍ធនធនមនុស ៃន្រកសួងសុខភិបល េ ក្រសី ទូច សុខនង ្របធនមជឈមណ្ឌល touchsokneang@yahoo.com នយក ្ឋ នទំនក់ទំនងអន្តរជតិ ៃន្រកសួងសុខភិបល េវជជ. ស៊ុង វ ិនតៈ ្របធននយក ្ឋ ន sungvinntak@yahoo.com ឹ ជំងឺេអដស៏ េសីែសបក នង មជឈមណ្ឌលជត្រិ បយុទធនង ិ េវជជ. លុន យេហង ្របធនែផនកជំងឺកមេ គ កមេ គ (NCHADS) ៃន្រកសួងសុខភិបល នយក ្ឋ នឱសថ ចំណី រ បរក ិ ខ រេពទយ នង ិ េ្រគឿង ្រ ្ត ចរយ េហង ប៊ុនគត ្របធននយក ្ឋ ន hengbunkiet@yahoo.com សម្អង (DDF) ៃន្រកសួងសុខភិបល នយក ្ឋ នឱសថ ចំណី រ បរក ិ ខ រេពទយ នង ិ េ្រគឿង ឱសថបណ្ឌិត យ៉ង់ វុធ អនុ្របធននយក ្ឋ ន yangdaravuth@gmail.com សម្អង (DDF) ៃន្រកសួងសុខភិបល 68 នយក ្ឋ នករពរសុខភព ៃន្រកសួងសុខភិបល ទន្តបណ្ឌិត ក់ សុីថន អនុ្របធននយក ្ឋ ន sithan_hak@yahoo.com មជឈមណ្ឌលជតក ិ ហង់សន ិ ំចត់េ គរេបង នង ិ (CENAT), ៃន េ កេវជជ. ហួត ចន់យូ អនុ្របធនមជឈមណ្ឌល ្រកសួងសុខភិបល ឹ ជំង្រឺ គុនចញ់ ប៉ ៉ សុត មជឈមណ្ឌលជត្រិ បយុទធនង ី ្រស្ត ្រ ្ត ចរយ ឡក ឹ ឌស ី ូឡី អនុ្របធនមជឈមណ្ឌល soleycnm@gmail.com និងបណក ្រស្ត (CNM) ៃន្រកសួងសុខភិបល ្រកស ួងបរិ ថ ន (MOE) ថ ប័ណ េឈមះ ត ួនទី ទំនក់ទំនង ្រកុម្របក ឹ ជតអ ិ ភវិ ឌ េ យចរី ភព ៃន្រកសួងបរ ិ ថ ន ឯកឧត្តម ឯ វុឌ ី អនុរដ្ឋេលខធិករ evuthy@gmail.com អគគនយក ្ឋ នគំពរបរ ិ ថ ន ៃន្រកសួងបរ ិ ថ ន ឯកឧត្តម េហង េរ ៉ត អគគនយក heng.nareth@online.com.kh អគគនយក ្ឋ នចំេណះដឹង និងព័ត៌មនបរ ិ ថ ន ៃន្រកសួង េវជជ. មស ច័នទធី អគគនយករង Measchanthyda39@gmail.com បរ ិ ថ ន នយក ្ឋ ន យតៃម្លេហតុប៉ះពល់បរ ិ ថ ន េ ក ជួប សុីវុ ថ អនុ្របធននយក ្ឋ ន Sivuthachuop097@gmail.com មនទរី ពិេ ធន៍ ៃនអគគនយក ្ឋ នគំពរបរ ិ ថ ន េ ក ំង ៃហេផង ម្រន្តម ី នទីរពេិ ធន៍ hayphengaing@gmail.com អគគនយក ្ឋ នគំពរបរ ិ ថ ន េ ក ជ េឡង អនុ្របធននយក ្ឋ ន lengmoe@gmail.com អគគនយក ្ឋ នគំពរបរ ិ ថ ន េ ក ែង៉ត បុ ល អនុ្របធននយក ្ឋ ន ngetbol@gmail.com អគគនយក ្ឋ នគំពរបរ ិ ថ ន កញញ ហួត សុី ៉ ែដត អនុ្របធនករ ិយល័យ syradoth_huot4@yahoo.com អគគនយក ្ឋ នគំពរបរ ិ ថ ន េ ក វង យ អនុ្របធនករយល័ ិ យ sayvorng@ymail.com ្រកសួងបរ ិ ថ ន េ ក ែប៉ន វ ិសិទធ អនុ្របធនករ ិយល័យ + 885 85 777 275 ្រកសួងបរ ិ ថ ន េ ក្រសី សួន សុគុណ អនុ្របធនករ ិយល័យ + 885 93 852 003 69 ្រកស ួងេផ ងៗេទៀត ថ ប័ណ េឈមះ ត ួនទី ទំនក់ទំនង ្រកសួងអភិវឌ ន៍ជនបទ Mr Thay Chanto thaychanto@gmail.com មនទីរេពទយ ថ ប័ណ េឈមះ ត ួនទី ទំនក់ទំនង មនទីរេពទយកល់ែម៉្រត Dr Huot Sotheara Medical Director hsotheara@yahoo.com មនទរី េពទយកល់ែម៉្រត េវជជ. បូ រ ី សុថថរទធ ិ ្របធន គរជំងទ ឺ ូេទ <ក> sotharith_bory@yahoo.com; 012632868 មនទីរេពទយកល់ែម៉្រត េ ក្រសី ហូ ៊ ងហួយ អនកឯកេទសមី្រកុបវ ិទយ ្របធនែផនក seanghuoy.ho.gmail.com Microbiology មជឈមណ្ឌលជតគ ិ ំពរម និងទរក ្រ ្ត ចរយ ទុ ង រ ្ឋ វ ី ្របធនមជឈមណ្ឌល rathavy.tung@gmail.com No 31A, Rue de France (St. 47), 12202, Phnom Penh មនទីរេពទយកុមរជតិ េវជជ. ញឹក អងគបុស ្របធនមនទីរេពទយ 100 Russion Federation Boulevard, Phnom Penh; +855 23 884 137 មនទីរេពទយ្រពះសីហនុ មណ្ឌលៃនក្តីសងឃឹម េវជជ. ែផ ថុង អនកសំរបសំរួល AMR និង AMS thongphe@sihosp.org មនទីរេពទយកុមរអងគរ េ កេវជជ. ងួន ច័នទភ្រក្ត ្របធនមនទីរេពទយ pheaktra@angkorhospital.org; Tep Vong (Achamean) Road & Oum Chhay Street, Svay Dangkum, Siem Reap មនទីរេពទយកុមរអងគរ េវជជ. មីលីយ៉ ធីល អនកជំនញអតិសុខុម្របណ ្រស្ត miliya_thyl@angkorhospital.org 089 287 059 គ្លីនិក ‘Clinical Microbiologist’ ថ ប័ណ េឈមះ ត ួនទី ទំនក់ទំនង កលវ ិទយល័យវ ិទយ ្រស្តសុខភប ិ ល ្រ ្ត ចរយ ផុន វឌ នៈ កលវ ិទយធិករ #73, Preah Monivong Blvd, Sangkat Sras Chak, Khan Daun 70 Penh, Phnom Penh; Tel +855 (0) 23 430 559 ម វ ិទយល័យឱសថ ្រស្ត ៃន កលវ ិទយល័យ ្រ ្ត ចរយ ជូ មុនី រ ិន ្រពឹទធបុរសរងម វ ិទយល័យ cmonnidarin@uhs.edu.kh, 016 306 668 វ ិទយ ្រស្តសុខភប ិ ល ឱសថ ្រស្ត និងជ្របធនមនទរី ពិេ ធន៍ រូ ៉ដុលហ្វេមរ ីេយី កលវ ិទយល័យភូមន ិ ទកសក ិ មម ម វ ិទយល័យេវជជ ្រស្ត ្រ ្ត ចរយ កង ្រកឹ ន ្រពទ ឹ ធបុរស kkroesna@rua.edu.kh សត្វ កលវ ិទយល័យភូមន ិ ទកសក ិ មម ម វ ិទយល័យេវជជ ្រស្ត បណ្ឌិត វុ ិន វុត្តី ្រពទ ឹ ធបុរសរង vennvutey@rua.edu.kh សត្វ កលវ ិទយល័យភូមន ិ ទកសក ិ មម ម វ ិទយល័យវ ិទយ ្រស្ត េ ក ែត គុយេ ្រពទ ឹ ធបុរស tkuyhor@yahoo.com សត្វ មនទីរពិេ ធន៍ ថ ប័ណ េឈមះ ត ួនទី ទំនក់ទំនង វ ិទយ ថ នប៉សទ័រកមពុជ Dr Didier Fontenille Director 5 Monivong Boulevard, PO Box 983, Phnom Penh; accueil@pasteur‐kh.org វ ិទយ ថ នប៉សទ័រកមពុជ Agathe de Lauzanne adelauzanne@pasteur‐kh.org Diagnostic Microbiology Development Program Joanne Letchford Country Director joanne.letchford@dmdp.org (DMDP) Diagnostic Microbiology Development Program Joe Hessell Clinical Pharmacist (DMDP) Diagnostic Microbiology Development Program Oeng Sopheap oeng.sopheap@dmdp.org (DMDP) មជឈមណ្ឌល្រគប់្រគង នង ិ បងករជំងស ឺ ហរដ្ឋ េមរកិ ្របចំ Dr. Robert Newman Country Director National Institute of Public Health, #80, 289 Samdach Penn េនកមពុជ Nouth St. (289), Phnom Penh, Cambodia ិ បងករជំងស មជឈមណ្ឌល្រគប់្រគង នង ឺ ហរដ្ឋ េមរក ិ ្របចំ Dr. Michael Kinzer DGHP Program Director mnk6@cdc.gov េនកមពុជ 71 មជឈមណ្ឌល្រគប់្រគង និងបងករជំងឺសហរដ្ឋ េមរ ិក ្របចំ េវជជ. ប៊ុន េ្រសង iiy0@cdc.gov េនកមពុជ មជឈមណ្ឌល្រគប់្រគង និងបងករជំងឺសហរដ្ឋ េមរ ិក ្របចំ េវជជ. សរ បូ ៉ ន់ iez8@cdc.gov េនកមពុជ Oxford Medical Research Unit Prof. Paul Turner pault@tropmedres.ac Armed Force Research Institutes of Medical Sciences Mr Lon Chanthap Chief Field Operations chanthapl.ca@afrims.org (AFRIMS) 012 976 799 ៃដគ ូអ វឌ ន៍ ថ ប័ណ េឈមះ ត ួនទី ទំនក់ទំនង FAO Regional Office for Asia and the Pacific Dr Katinka De Balogh Senior Animal Health and Katinka.DeBalogh@fao.org Production Officer FAO Cambodia Dr Kristina Osbjer ECTAD Team Leader kristina.osbjer@fao.org FAO Cambodia Dr Sokerya Seng National coordinator on AMR sokerya.seng@fao.org WHO Cambodia Dr Kumanan Rasanathan Health Systems Team Lead rasanathank@who.int WHO Cambodia Lkhagvadorj Vanchinsuren Technical Officer for Medicines lkhagvadorjv@who.int WHO Cambodia Dr Lester S A Geroy AMR Consultant lester.geroy@upou.edu.ph, lelim22@yahoo.com WHO Western Pacific Region Dr Ketevan Kandelaki Technical Officer kandelakik@who.int WHO Western Pacific Region Dr Escalante Socorro Team Coordinator escalantes@who.int WHO Secretariat (Bangkok) Dr David Sutherland sutherlandda@who.int World Organisation for Animal Health Dr Hirofumi Kugita h.kugita@oie.int European Union H.E. George Edgar Ambassador 220 611; No. 100 A, Preah Norodom Boulevard, Khan Daun Penh, 12207 Phnom Penh + 855 23 216 996 USAID Ms Polly Dunford Mission Director USAID Sotheara Nop Development Assistance snop@usaid.gov Specialist for Infectious Diseases World Bank Ellen Goldstein Country Director for Myanmar, Exchange Square Building, No. 19‐ Cambodia and Lao PDR 20, Street 106, Sangkat Wat 72 ថ ប័ណ េឈមះ ត ួនទី ទំនក់ទំនង Phnom, Khan Daun Penh, Phnom Penh ADB Cambodia Mr Samiuela T. Tukuafu Country Director No. 29 Suramarit Blvd. (268/19) Sangkat Chaktomuk, Khan Daun Penh, Phnom Penh, Cambodia; + 855 23 215805, 215806, 216417 Australia Department of Foreign Affairs and Trade Ms Angela Corcoran Ambassador to Cambodia 16B National Assembly St, Sangkat Tonle Bassac, Khan Chamkamon, Phnom Penh; +855 23 213 470 Korean International Cooperation Agency Yun Gil Jeong Representative cambodia@koica.go.kr; Phnom Penh Tower, 12th Floor, #445, Monivong Blvd, Corner Street 232, Sangkat Boeung Prolet, Khan 7 Makara, Phnom Penh, Cambodia Japan International Cooperation Agency (JICA) Yuichi Sogano Chief Representative 6th,7th,8th Floors, Building #61‐ 64, Preah Norodom Blvd, Phnom Penh, Cambodia GIZ Thomas Waldraff Country Director GIZ‐kambodscha@giz.de; #17, Street 306; Phnom Penh; +855(23)86011 Global Fund Malaria Consortium Yves Bourny Director y.bourny@malariaconsortium.org Malaria Consortium Dyna Doum d.doum@malariaconsortium.org Malaria Consortium Prudence Hamade p.hamade@malariaconsortium.org Malaria Consortium Sergio Lopes s.lopes@malariaconsortium.org University Research Council (URC) Dr Som Hun shun@URC‐CHS.COM Phnom Penh Post Yesenia Amaro Journalist m.yesenia.amaro@gmail.com 73 Mul -Sectoral Ac on Plan on An microbial Resistance in Cambodia 2019-2023 December 2019 Ministry of Health Ministry of Agriculture, Forestry and Fisheries Ministry of Environment TABLE OF CONTENTS Contents Ministerial Message ......................................................................................................................... i Executive Summary ..........................................................................................................................ii Chapter 1. Background ................................................................................................................... 1 Global challenge and response ................................................................................................... 1 Regional challenges..................................................................................................................... 3 Cambodia’s general health and development status and importance of AMR ......................... 4 Cambodia’s AMR initiatives ........................................................................................................ 5 Chapter 2. Goal, purpose and objectives of the multi‐sectoral action plan................................... 6 Chapter 3. How the plan was developed ........................................................................................ 6 Chapter 4. strategic areas, objectives and key results areas.......................................................... 8 Strategic Area 1. Governance and coordination to reduce AMR ............................................... 8 Strategic Area 2. Evidence generation through surveillance and laboratories .......................... 9 Strategic Area 3. Rational use of antimicrobial medicines ......................................................... 9 Strategic Area 4. Containing AMR through good practices ...................................................... 10 Strategic Area 5. Increase public awareness ............................................................................ 11 Strategic Area 6. Building human capacity for AMR ................................................................. 11 Strategic Area 7. Research and innovation for AMR ................................................................ 12 CHAPTER 5. Implementation ........................................................................................................ 13 Chapter 6. Monitoring and evaluation ......................................................................................... 13 References .................................................................................................................................... 14 Annex A. Key results areas and activities ..................................................................................... 16 Annex B. Draft indicators for monitoring and evaluation ............................................................ 36 Annex C. Stakeholders in functions and initiatives related to antimicrobial resistance in Cambodia ...................................................................................................................................... 41 LIST OF ABBREVIATIONS AFRIMS Armed Forces Research Institute for IPC Infection Prevention and Control Medical Sciences IPC Institute Pasteur du Cambodge AHC Angkor Hospital for Children ITM Institute of Tropical Medicine AMR Antimicrobial Resistance JEE Joint External Evaluation AMU Antimicrobial use KRA Key Result Area ATLASS Assessment Tool for Laboratory and MAFF Ministry of Agriculture, Forestry and Antimicrobial Resistance Surveillance Systems Fisheries CAET Cambodia Applied Epidemiology Training MDR Multidrug Resistant CamLAPF Cambodia Laboratory of Agricultural MIH Ministry of Industry and Handicraft Products and Food MIME Ministry of Mines and Energy CamLIS Cambodia Laboratory Information System MOE Ministry of Environment CAVET Cambodia Applied Veterinary MOEYS Ministry of Education, Youth and Sports Epidemiology Training MOH Ministry of Health C‐CDC Cambodia Centers for Disease Control and MPA Minimum Package of Activities Prevention MRD Ministry of Rural Development CDC Department of Communicable Disease MRL Maximum Residue Limit Control (MOH) MRSA Methicillin‐Resistant Staphylococcus aureus COMRU Cambodia‐Oxford Medical Research Unit NAHPRI National Animal Health and Production CPA Complementary Package of Activities Research Institute CPG Clinical Practice Guidelines NIPH National Institute of Public Health DAI Department of Agro‐Industry NMCHC National Maternal and Child Health Center DAL Department of Agricultural Registration NPH National Pediatric Hospital DDF Department of Drugs and Food OIE World Organization for Animal Health DHS Department of Health Services PDAFF Provincial Department of Agriculture DIC Department of International Cooperation Forestry and Fisheries DMDP Diagnostic Microbiology Development PDAFF Provincial Department of Agriculture Program Forestry and Fisheries EQA External Quality Assessment RUA Royal University of Agriculture FAO Food and Agriculture Organization SHCH Sihanouk Hospital Centre of Hope FiA Fisheries Administration UHS University of Health Sciences GAHP Good Animal Husbandry Practice URC University Research Council GAP Good Agricultural Practice USAID United States Agency for International GAqP Good Aquaculture Practice Development GDA General Directorate of Agriculture USCDC US Centers for Disease Control and GDAHP General Directorate of Animal Health and Prevention Production VAHWs Village Animal Health Workers GDP Gross Domestic Product VHWs Village Health Workers GLASS Global AMR Surveillance System WHO World Health Organization HRD Human Resource Development XDR‐TB Extensively‐drug resistant tuberculosis IHR International Health Regulations IMCI Integrated Management for Childhood Illnesses Executive Summary The Multi‐Sectoral Action Plan on Antimicrobial Resistance in Cambodia 2019–2023 envisions a country with a healthy population and strong governance systems without the threat of AMR that will impede economic growth and cause unnecessary risks to health, security and social protection. Before drafting the Multi‐Sectorial Action Plan (MSAP), the Technical Working Group on Antimicrobial Resistance of the Ministry of Health and the Ministry of Agriculture, Forestry and Fisheries, and Ministry of Environment with support from FAO, OIE and WHO, conducted a situation analysis in October to December 2017 to assess AMR efforts by the agriculture, human health and environment sectors. Published articles, documents, presentations and other reports were reviewed. Key informant interviews and site visits were conducted among government agencies, hospitals, partners and experts. Results of the situation analysis were presented during a consultation of stakeholders on 29–30 November 2017 in Phnom Penh. The participants (government officials, experts and technical officials, and representatives from partner organizations) validated the results, confirmed the gaps and endorsed seven strategic areas where actions should be focused over the next five years. 1. Building human capacity for antimicrobial resistance 2. Containing AMR through good practices 3. Evidence generation through surveillance and laboratories 4. Governance and coordination to reduce antimicrobial resistance 5. Increasing public awareness 6. Rational use of antimicrobial medicines

7. Research and innovation for antimicrobial resistance Important findings of the situation analysis are reflected in this Action Plan, including policies, achievements, initiatives, recent studies, country activities and stakeholders. Broadly, these include observations in these areas:  Need for strengthening laboratory capacity, especially in the environment, food and agriculture sectors.  Need for exchange of experiences and transfer of knowledge on AMR surveillance in human health, agriculture, food and environment.  Need to enforce regulations and rational use of antibiotics in agriculture and human healthcare.  Need for research on different aspects of AMR, especially on operations and implementation.  Need to improve practices contributing to the mitigation of AMR, including infection prevention and control in health facilities, good agricultural practices, good animal husbandry practice, good aquaculture practice, water, sanitation, hygiene, food safety inspection and analysis, and waste management. ii  Need for public awareness and advocacy on antibiotic use, AMR and basic practices on agriculture, disease prevention in animals and humans and basic health care.  Need for capacity building of staff and professionals in several areas of work that influence AMR such as laboratories, surveillance, clinical practice guidelines, infection prevention and control and other areas that require professional skills.  Need for stronger programme support through governance and coordination between and within Ministries, partnerships and financing. The Multi‐Sectoral Action Plan aims to guide the Royal Government of Cambodia, partners and donors as they identify priority areas for work and collaboration. Target users of the Multi‐ Sectoral Action Plan include policy and decision‐makers and officials of ministries not limited to the Ministry of Health (MOH), the Ministry of Agriculture, Forestry and Fisheries (MAFF) and the Ministry of Environment (MOE), researchers, students, advocates and the media, professional societies and technical experts, community leaders and mobilizers and international partners in designing programmes and activities aimed to combat AMR. iii Chapter 1. Background Global challenge and response Failure to address AMR will have implications for public health, the global economy and agriculture that will threaten current initiatives towards sustainable development. A potential 10 million deaths by 2050 could be due to AMR.1 Public Health initiatives are threatened by the spread of AMR, especially in countries with few resources to combat resistance.2 In developing and low‐income countries, there are still gaps in surveillance and laboratory capacity and a lack of standards for methodology, data sharing and coordination. AMR is linked to concerns about multidrug resistant tuberculosis (MDR‐TB), artemisinin resistance, anti‐HIV drug resistance and resistance to antivirals recommended for influenza prevention and treatment. The danger is that antimicrobials responsible for advances in healthcare will no longer be useful for treatment because of AMR. The 2014 World Bank report on AMR surveillance showed that infections caused by antimicrobial‐resistant organisms can cause global economic damage on par with the 2008 financial crisis.3 If no action is taken, low‐income countries could lose over 5 percent of their Gross Domestic Product (GDP) due to healthcare and agriculture costs and losses. Unmitigated AMR could push up to 28 million people into poverty, mostly in developing countries, because of the difficulty in treating infections and losses in agricultural productivity. Healthcare costs could increase by USD 300 billion to more than USD 1 trillion per year. Absence of actions to combat AMR will have huge repercussions in agriculture in terms of production losses, reduced livelihoods and risks to food security (FAO 2016). A decline in global livestock production is estimated to range from 2.6 percent to 7.5 percent per year. The estimated decrease in global GDP is USD 100 trillion by 2050. The Tripartite Collaboration between FAO, OIE and WHO advocates the need for a One Health or Health in All Policies Approach and joint efforts in combatting AMR. The 2016 FAO Action Plan identified factors contributing to AMR, among them a lack of regulation, legislation and oversight on the use of antimicrobials in agriculture. Most antibiotics are used in agriculture as growth promoters and for disease prevention in animals. There is irrational use of antibiotics in healthcare practices as well, for example, poor therapy adherence and non‐prescribed use. Because of poor regulation and marketing policies in many countries, antibiotics can be purchased over‐the‐counter or over the Internet. Substandard and falsified antimicrobials further contribute to AMR. Poor practices in husbandry, hygiene and agricultural waste 1 Review on Antimicrobial Resistance (2016). Tackling Drug‐Resistant Infections Globally: Final Report and Recommendations. The Review on Antimicrobial Resistance, Chaired by Jim O’Neill. Accessed at https://amr‐ review.org/ 2 World Bank Group (2017). Drug‐Resistant Infections: A Threat to our Economic Future. Discussion Draft. 3 World Bank Group (2016). Drug‐Resistant Infections: A Threat to our Economic Future. Discussion Draft. 1 management further contribute to the spread of resistant bacteria in the food chain and into the environment. Having understood the urgency to act and the importance of multi‐sectoral cooperation, FAO, OIE and WHO formed a Tripartite Collaboration and endorsed a One Health Approach to combat AMR. Strategic areas are outlined in the Global Action Plan on Antimicrobial Resistance 2015 (WHO 2015). They are:

1. Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investments in new medicines, diagnostic tools, vaccines and other interventions.

2. Improve awareness and understanding of antimicrobial resistance through effective communication, education and training.

3. Optimize the use of antimicrobial medicines in human and animal health.

4. Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures.

5. Strengthen the knowledge and evidence base through surveillance and research. The Sixty‐Eighth World Health Assembly in May 2015 declared Resolution WHA 68.7 on the Global Action Plan on Antimicrobial Resistance. The AMR resolution recalled previous resolutions on rational use of drugs, emerging and other communicable diseases, global health security, and containment of AMR. Because actions go beyond health at the global, regional and national levels, a One Health Approach has been endorsed to involve actors in human and veterinary medicine, agriculture, food, financing, environment and consumers. Member States are urged to develop national plans and mobilize human and financial resources to combat AMR. Following the Tripartite Action Plan, FAO developed an action plan for Antimicrobial Resistance 2016–2020 to support the food and agriculture sectors in implementing the Global Action Plan on Antimicrobial Resistance. There are four focus areas: i) improve awareness on antimicrobial resistance and related threats; ii) develop capacity for surveillance and monitoring antimicrobial resistance and antimicrobial use in food and agriculture; iii) strengthen governance related to antimicrobial use and antimicrobial resistance in food and agriculture; and iv) promote good practices in food and agriculture systems and the prudent use of antimicrobials. In 2016, the OIE Strategy on Antimicrobial Resistance and Prudent Use was published to outline strategies in the animal health sector (OIE 2016). Surveillance is a key area to be enhanced as part of the global action on AMR. WHO developed the Global Antimicrobial Resistance Surveillance System (GLASS) to enhance the capacities of countries to contribute to global monitoring.4 GLASS aims to enable standardized, comparable and validated data on AMR to be collected, analyzed and shared with countries to better inform decision‐making, drive local, national and regional action and provide an evidence base for action and advocacy. The system combines patient, laboratory and epidemiological surveillance 4 http://www.who.int/glass/en/ 2 data. GLASS harmonizes surveillance methods in terms of routine surveillance and case‐finding, routine clinical sample collection, pathogen‐antibacterial combinations and priority specimen types. The GLASS manual contains a list of index pathogens and antibacterial agents used for standards monitoring and comparability. The index bacteria include: Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus, Streptococcus pneumoniae, Salmonella spp, Shigella spp and Neisseria gonorrhoeae. FAO published an Assessment Tool for Laboratory and Antimicrobial Resistance (ATLASS) to support countries in their efforts to identify needs and develop plans to strengthen agricultural surveillance. The tool helps guide the assessment, quantities and types of antimicrobials being used, determine the burden of AMR, identify emergence of new strains, guide treatment strategies and evaluate the efficacy of intervention strategies. OIE has developed a global database on antimicrobial agents intended for use in animals and has collected information related to antimicrobial use in the animal health sector from its member countries annually since 2015.5 Regional challenges Challenges include lack of national AMR surveillance, limited general public awareness, lack of national policies on antibiotic use in human health, agriculture and the food industry, the unregulated distribution and sale of antimicrobials and the lack of comprehensive infection prevention control (IPC) programmes. In 2014, Member States in the Western Pacific Region endorsed the Action Agenda for Antimicrobial Resistance during the Sixty‐fifth Session of the WHO Regional Committee. Three priority actions were agreed:

1. Improve surveillance of AMR and monitoring of antimicrobial use.

2. Strengthen development and implementation of comprehensive national plans to contain AMR and raise awareness in multiple sectors.

3. Strengthen health system capacity to contain AMR (WHO, 2015). Similarly, the ASEAN community recognizes the AMR problem and the need for integrated and multi‐sectoral efforts on AMR in its Member Nations6 and endorsed the ASEAN Leaders’ Declaration on Antimicrobial Resistance (AMR): Combating AMR through One Health Approach. AMR is the tenth of the 20 priorities in the ASEAN Post 2015 Health Development Agenda. ASEAN Member Nations are urged to strengthen several areas as part of national strategies to combat AMR: agricultural value chains, antimicrobial stewardship, awareness and advocacy, environmental management, infection prevention and control, laboratory capacity and AMR surveillance and research in health, environment and agriculture, multi‐sectoral participation, pharmaceutical and food supply chain management, quality antimicrobials, regulatory systems 5 See http://www.oie.int/en/our‐scientific‐expertise/veterinary‐products/antimicrobials/ 6 http://asean.org/asean‐leaders‐declaration‐on‐antimicrobial‐resistance‐amr‐combating‐amr‐through‐one‐health‐ approach/ . 3 and training of professionals and students. The ASEAN study on the Rational Use of Medicines in the ASEAN Region recognizes the AMR challenge in Southeast Asia and recommends the development of national multi‐sectoral strategies on AMR.7 These efforts are within the scope of national structures for prescribing and dispensing medicines. The ASEAN Post‐2015 socioeconomic goals include efforts on AMR, food safety, laboratory strengthening and pharmaceutical development. Cambodia’s general health and development status and importance of AMR Cambodia has generally improved its health status. The government increased its General Government Health Expenditure per capita from USD 4.00 in 2000, to USD 7.00 in 2005, USD 11.00 in 2009 and to USD 14.52 in 20158. Due to its epidemiological status, Cambodia is facing the double burden of communicable diseases and NCDs. However, Cambodia still has low aggregate health indicators compared to neighboring countries despite its increased per capita spending. The quality of healthcare system in Cambodia still have some rooms for improvement to meet the demand side. The universal access to the healthcare for the poor people has not been met. A recent analysis recognized the problems of AMR in Cambodia.9 Among the early causes of concern was the discovery of multidrug resistant malaria along the Cambodia‐Thailand border, especially for artemisinin derivatives, Plasmodium falciparum, and artemisinin resistance containment and elimination (ARCE) as previously mentioned. Artemisinin resistance is a global threat because there is no alternative at the moment. An increase in multidrug‐ resistant TB was also observed from 3.1 percent in 2001 to 10.3 percent in 2007 and to 11 percent to 2011. During the first National AMR Workshop in 2011 (Vlieghe et al. 2012), multidrug‐ resistant bacteria (e.g. MRSA, ESBL‐producing E coli, MDR Salmonella enterica serovar Typhi) had already been identified. However, there are still data gaps because of the scarcity of microbiology laboratories in Cambodia. Cambodia and the WHO Country Cooperation Strategy 2016–2020 acknowledge major factors that contribute to AMR in Cambodia including: i) weak surveillance and laboratory capacity; ii) irrational use of antimicrobial agents during treatment of human infections; iii) overuse and misuse of antibiotics in animals raised for food; and iv) limited infection prevention and control measures in health facilities. Consumers can access antibiotics even without valid prescriptions despite existing laws and professional codes. The same strategy also identifies the main barriers to combat AMR. For example, there is limited awareness of AMR among most stakeholders. Surveillance data to support evidence‐ based decisions is limited, especially in hospitals. The Clinical Practices Guidelines were not 7 http://asean.org/storage/2017/04/4.‐March‐2017‐Rational‐Use‐of‐Medicines‐in‐the‐ASEAN‐Region.pdf . 8 World Bank (2018). https://data.worldbank.org/indicator/SH.XPD.GHED.PC.CD?locations=NG‐GH‐KE‐ZA‐1W‐KH 9 WHO (2014). Cambodia Health Systems in Transition. World Health Organization and Asia Pacific Observatory. 4 developed based on evidence, but based on expert opinion, especially the use of the antibiotics. Coordination among different sectors is challenging, especially human health, agriculture and environment, and information remains limited because of the lack of national multi‐sectoral policies and strategies. Cambodia’s AMR initiatives Cambodia’s recent achievements on antimicrobial resistance were anchored in the AMR Country Situation Analysis Report 2013, the National Policy to Combat Antimicrobial Resistance in Cambodia (2014) and the National Strategy to Combat Antimicrobial Resistance 2015–2017. The National Policy and Strategy uses a seven‐point strategic framework with strategic objectives that reflected the country’s needs in 2015 to 2017. The policies were developed by departments of the Ministry of Health, public and private hospitals, laboratories and professional societies with important functions related to AMR. The seven strategic areas are as following:

1. Develop a comprehensive national plan

2. Strengthen laboratory capacity for AMR

3. Strengthen AMR surveillance

4. Ensure uninterrupted access to antimicrobial medicines of assured quality

5. Regulate and promote rational use of medicines

6. Enhance infection prevention and control

7. Foster innovations and research and development for new tools In 2016–2017, MAFF with support from FAO organized four consultations to strengthen food and agriculture sector engagement with AMR efforts. MAFF and FAO developed a draft One Health Roadmap and Action Plan with greater focus on the food and agriculture sector. The One Health Roadmap synthesized recommendations from the consultations into seven action areas: i) coordination mechanism, ii) information sharing, iii) legislation, iv) surveillance, v) research and laboratory practice, vi) rational use and vii) advocacy and awareness. In 2017, the activities proposed under the One Health Roadmap mandated that several agencies be incorporated into this Multi‐Sectoral Action Plan, specifically the General Directorate for Animal Health and Production, Fisheries Administration, Department of Agro‐Industry, Royal University of Agriculture and the General Directorate of Agriculture of MAFF. The work was coordinated by the MAFF AMR Technical Working Group that was officially formed in October 2017 with technical support provided by FAO and OIE. The core mandates of MOH and MAFF allowed them to lead efforts in several areas that contribute to combatting AMR. In the health sector, notable achievements include development of policies, guidelines and tools such as the AMR surveillance protocol and pilot sites with links to the Global AMR Surveillance System, Clinical Practice Guidelines, Essential Medicines List, Minimum Package of Activities, Complementary Package of Activities and national policy and guidelines on infection prevention and control and hospital IPC committees, 5 capacity building of diagnostic microbiology, implementation of a laboratory external quality assessment system, various research studies, and Antimicrobial Awareness Week celebrations, among other health programmes and initiatives. In the agriculture sector, ongoing actions include new agriculture laboratories in different parts of the country, although with limited capacity to detect AMR, Identification of antibiotics used in agriculture, farm registration and certification, dissemination of good agriculture, aquaculture and good husbandry practices, non‐antibiotic residue products certification and Antimicrobial Awareness Week celebrations among other existing agriculture programmes and initiatives. Policies, protocols and detailed descriptions of Cambodia’s current status, recent initiatives and key action areas are described in the Situation Analysis on Antimicrobial Resistance in Cambodia 2018 that accompanies this Multi‐Sectoral Action Plan. Chapter 2. Goal, purpose and objectives of the Multi‐Sectoral Action Plan The Multi‐Sectoral Action Plan visualizes a country with a healthy population and strong governance systems to control the threat of AMR that would impede economic growth and cause unnecessary risks to health, security and social protection. The plan sets these objectives:

1. Establish a unifying framework and governance mechanisms that enable ministries and other stakeholders to collaborate.

2. Outline gaps and challenges in areas that directly influence AMR.

3. Set strategic areas, objectives and activities to guide annual planning, communication and resource mobilization for stakeholders to ensure coordinated effort. The Multi‐Sectoral Action Plan will guide the Royal Government of Cambodia, partners and donors as they identify priority areas for work and collaboration. Target users of the Plan include policy and decision‐makers, officials of MOH, MAFF, MOE and other ministries, researchers, educators and students, advocates and the media, professional societies and technical experts, community leaders and mobilizers, and international partners. The strategies, activities and tasks identified in this Plan cannot be done by one agency alone. Stakeholders are encouraged to identify that part of the work they can do best based on their organization’s mandate. Chapter 3. How the plan was developed? The MOH AMR Technical Working Group, with support from FAO and WHO, conducted a situation analysis in October to December 2017 to assess progress on AMR from the 6 agriculture, human health and environment sectors. Results of the situation analysis were presented during a consultation among stakeholders on 29‐30 November 2017 in Phnom Penh. Key areas discussed included these areas of work:  AMR surveillance in humans and agriculture.  Governance, coordination, partnerships and financing.  Laboratory development and capacity.  Practices contributing to the mitigation of AMR, including infection prevention and control in health facilities, good practices (GAP, GAHP, GAqP), water, sanitation, hygiene, food safety inspection and analysis and waste management.  Public awareness, advocacy and education.  Regulation and rational use of antibiotics in agriculture and human healthcare.  Research on different aspects of AMR.  Staff training and capacity building. The AMR Technical Working Groups from MOH and MAFF led the review of the situation analysis and the drafting of the Multi‐Sectoral Action Plan. Teams from MOH, MAFF and MOE reviewed the initial draft. On 12‐13 February 2018 a national consultation on the Multi‐Sectoral Action Plan was held in Kampong Cham involving 60 participants, mostly officials and technical experts who reviewed the draft Plan. FAO, WHO and OIE supported the drafting, coordination and finalization of the Plan. 7 Chapter 4. strategic areas, objectives and key results areas Strategic areas include:

1. Building human capacity for antimicrobial resistance

2. Containing AMR through good practices

3. Evidence generation through surveillance and laboratories

4. Governance and coordination to reduce antimicrobial resistance

5. Increasing public awareness

6. Rational use of antimicrobial medicines

7. Research and innovation for antimicrobial resistance Strategic Area 1. Governance and coordination to reduce AMR Strategic Objective 1. To ensure sustainable governance through effective coordination and partnerships. The National AMR Policy (2014) and Strategy (2015–2017) have initiated many developments in AMR coordination, communication and information sharing among human health and agriculture sectors. Almost all the activities were accomplished by government agencies as the lead with strong support from development partners and hospitals. Most partnerships are at the national level and in major cities. A major challenge for stakeholders is how to identify potential sources of funding to ensure adequate staffing, equipment and supplies, skills‐ building and capacity development. Activities in the final Plan should be included in ministerial and departmental annual plans to secure funds. Several stakeholders and consultations have discussed the need for a committee above MOH and MAFF with political power to coordinate, while the existing technical working groups focus on technical work. Current stakeholders:  Human health: Multi‐Sectoral AMR Technical Working Group  Agriculture: MAFF AMR Technical Working Group Key Results Areas (KRA):  KRA 1.1 Strengthen technical and political coordination at local, national and international levels  KRA 1.2 Strengthen policy and legislative frameworks to support AMR initiatives  KRA 1.3 Resource mobilization to support MSAP implementation  KRA 1.4 M&E plan, indicators and regular evaluation The details of the key results areas 1‐7 are in Annex A. 8 Strategic Area 2. Evidence generation through surveillance and laboratories Strategic Objective 2. To strengthen evidence generation through functional human, agriculture and environment laboratories and effective surveillance mechanisms. An AMR surveillance system for people was initiated in 2017 with 8 reporting sentinel sites across the country starting in January 2018. An AMR surveillance framework for animals was developed in 2017, initially focusing on foodborne and commensal bacteria isolates from food animals (pigs, poultry and cattle). Sampling started in 2017. There are large data gaps in agriculture and environment. Index organisms need to be added to conform with GLASS guidelines. Expanded surveillance and monitoring systems for aquatic and terrestrial animals, water, food and environment should be started, and the other sectors can learn from human surveillance experiences. Mechanisms for information sharing should be developed. Well‐functioning laboratories can enhance prescribing practices and AMR surveillance. Laboratory development has received huge support from development partners. There have been additional human and agriculture labs with better equipment and staff capacity, antibiotic susceptibility tests (AST) and microbiology facilities. Labs for human health already have a laboratory information system and many are part of an external quality assurance programme. Limited resources contribute to the challenge of strengthening laboratories, lack of sample referral systems, training staff, ensuring quality and providing equipment. Existing labs for human health with microbiology capacity need further strengthening and mechanisms to ensure sustainability. Links between human and agriculture labs are limited. Current stakeholders:  Human health: Cambodia CDC, US CDC, NIPH, DMDP, hospitals, ITM, WHO, AHC/University of Oxford (COMRU)  Agriculture & Environment: GDAHP, FiA, GDA, DAI, CamLAPF, RUA, MOE‐Epidemiology‐ Lab, FAO, OIE Key Results Areas:  KRA 2.1 scaling‐up existing surveillance and laboratory activities and systems to support AMR action plan  KRA 2.2 Strengthening human capacity for laboratory, information sharing, surveillance and outbreak response  KRA 2.3 Strengthen equipment and supply systems in laboratories for microbiology and surveillance Strategic Area 3. Rational use of antimicrobial medicines Strategic Objective 3. To develop and enforce regulations and strategies to ensure access to and rational use of antibiotics in human health, animal health and agriculture. 9 Cambodia’s health sector has been publishing Clinical Practice Guidelines, an Essential Medicines List, and a Minimum Package of Activities (MPA) for Health Centres, and Complementary Packages of Activities (CPA) for Hospitals. Some hospitals have established a Medicine and Therapeutics Committee (MTC). Antibiotics are widely used in fisheries, poultry and pig farms. Farm registration and certification should be strengthened. Regulation of antibiotic use in agriculture should be continued, with dissemination of good agriculture, aquaculture and animal husbandry practices (GAP, GAqP, GAHP) and encouragement of innovative evidence‐based practices with a reduction of antimicrobials used for disease prevention and as growth promotors. Knowledge of doctors, nurses, veterinary practitioners is important for effective implementation of appropriate use of antibiotics in humans and agriculture. Data on the use of antimicrobial agents in human and animal health and agriculture should be continuously collected so trends can be monitored and the impact of action plans can be assessed. Current Stakeholders:  Human health: DDF, DHS, UHS, hospitals, professional societies, WHO and other partners.  Agriculture: GDAHP, GDA, Department of Agricultural Legislation (DAL), FiA, DAI, FAO, OIE, professional societies Key Results Areas:  KRA 3.1 Guidance for and implementation of rational use of antimicrobials  KRA 3.2 Regulation at different levels to support rational use of antimicrobials  KRA 3.3 Strengthen the supply chain management for antimicrobials to ensure equitable and universal access for all citizens Strategic Area 4. Containing AMR through good practices Strategic Objective 4. To reduce the incidence of infection through effective sanitation, hygiene, food safety, waste management and infection prevention measures. Practices contributing to the mitigation of AMR include infection prevention and control in health facilities, good practices (GAP, GAHP, GAqP), clean water, sanitation, hygiene, food safety and waste management. IPC guidelines in hospitals have been disseminated and integrated in other programmes in rural health facilities. Other basic health advice and guidelines should be integrated into existing health programmes in maternal and child health, IMCI and disease programmes. Implementation should be strengthened and monitored. Local guidelines in agriculture should be developed and disseminated based on recent international knowledge. Farmers should follow good practices in agriculture including GAP, GAHP and GAqP. Current Stakeholders: 10  Human health: DHS, DPM, hospitals, GDAHP, provincial and municipal health offices, URC, WHO and other partners.  Agriculture & Environment: FiA, GDA, Provincial Department of Agriculture, Forestry and Fisheries, PDAHP, DAI, MOE‐GDEP, MRD, FAO, OIE Key Results Areas:  KRA 4.1 Guidance for and implementation of good practices  KRA 4.2 Ensure available technologies and supplies to implement protocols and guidelines  KRA 4.3 Monitoring water, food safety and waste management Strategic Area 5. Increase public awareness Strategic Objective 5. Strengthen communication for public education and awareness. Cambodia participated in World Antimicrobial Awareness Week in 2015, 2016 and 2017. Most activities included awareness forums for health and agriculture professionals and students. IEC materials were distributed. In 2017, a MOH‐MAFF‐WHO‐FAO AMR team developed and pilot‐ tested communication messages for advocacy at the community level. These messages are designed for midwives, nurses, agriculture officers, village health support group, village animal health workers, to use in educating their clients and constituents. Advocacy and education in communities should be continued. In addition, communication and dialogue at the level of decision‐makers, managers and political leaders should be strengthened to ensure political and financial support for AMR initiatives. Current Stakeholders:  Human health: Multi‐sectoral AMR Technical Working Group, MRD, provincial and municipal health departments, professional societies, WHO and other partners.  Agriculture & Environment: MAFF AMR Technical Working Group, MOE, MRD, PDAFF, FAO, OIE Key Results Areas:  KRA 5.1 Increase public awareness through mass media and social media  KRA 5.2 Integrate AMR communications in programmes and activities Strategic Area 6. Building human capacity for AMR Strategic Objective 6. Strengthen capacity of professionals and staff for AMR advocacy and support all areas of work. Health professionals must know the importance of and increase the use of diagnostic laboratories. There are plans to review pre‐service curricula in medicine, nursing, pharmacy, veterinary medicine and animal, fisheries and crops sciences and ensure integration of 11 microbiology, AMR and infection control. There is a call for more local experts in healthcare and agriculture. The government and development partners should explore, encourage and enhance mechanisms to train more officials and young staff locally and in advanced studies abroad. Participation in regional and international conferences can facilitate knowledge sharing and provide venues for Cambodia to share its best practices and experiences. There is a need for stronger regulation of medicines, agriculture products and feeds that will cover manufacturing, import, export, licensing, distribution and access. Current Stakeholders:  Human health: MOH, UHS, professional societies, WHO and other partners.  Agriculture & Environment: MAFF, RUA, MOE, professional societies, FAO, OIE Key Results Areas:  KRA 6.1 Integrate AMR, microbiology, rational medicine use and related areas into pre‐ service training curriculum and resources  KRA 6.2 Develop training resources and build capacity on AMR, microbiology, rational medicine use and related areas in in‐service training and capacity building  KRA 6.3 Collaboration with professional societies to integrate AMR and related issues for capacity building, advocacy, research and education Strategic Area 7. Research and innovation for AMR Strategic Objective 7. Build research and innovation to support policy, good practices, implementation, monitoring and evaluation of AMR activities. In recent years, research findings have been published on detection of AMR and genetic characterization of resistant bacteria. Some studies on practices and knowledge of health providers, farmers and the general public on antibiotic use have also been done. The AMR situation analysis includes summaries of research areas, gaps and questions raised in in consultations on AMR research. While much has been done, there is a huge gap in our knowledge on implementation, operations, and best practices. Lessons learnt from other programmes (e.g. TB, HIV/AIDS, malaria, and MDR salmonella in poultry meat) can provide good examples for AMR. Current Stakeholders:  Human health: MOH, UHS, AHC, NPH, SHCH, IPC, University of Oxford Group (COMRU), LSHTM, AFRIMS, NAHPRI, ITM, Malaria Consortium, WHO, US CDC and other partners.  Agriculture & Environment: MAFF, MOE, FAO, OIE Key Results Areas: 12  KRA 7.1 Identifying AMR research gaps and priorities in different areas from natural sciences, applied sciences, social sciences, economics and management  KRA 7.2 Training and capacity building of national staff for AMR and related research  KRA 7.3 Implementation and dissemination of AMR research CHAPTER 5. Implementation Work begins when the priorities and action points are integrated into annual plans and budgets. This is what managers, advocates, officials and partners monitor. Annual budgets mobilize funds at the national and provincial levels. Partnership projects between government and development partners should ensure that action points are adequately resourced. The availability and capacity of the workforce is an area that will need innovative mechanisms in staff recruitment and hiring. Coordination between government and partners on technical and operational matters should be done regularly. Joint annual implementation reviews will be useful. In all these activities, strong project management and operations capacity in government offices and partners is important. Chapter 6. Monitoring and evaluation Monitoring and evaluation will be done under the guidance of the AMR Technical Working Group. Baseline values of the proposed indicators should be collected in 2020. Table 1. General indicators for M&E Indicator Baseline (2020 ) Annual Target

1. Reduction of morbidity To be determined 10‐20 percent reduction caused by AMR

2. Reduction of irrational To be determined 10‐20 percent reduction antimicrobial use in humans

3. Reduction of antimicrobial To be determined 10‐ 20 percent reduction consumption in animals

4. Reduction in hospital‐ To be determined 10‐20 percent reduction acquired infections

5. Increased public To be determined 10‐30 percent increased knowledge on AMR and public knowledge appropriate use of antimicrobials There will be two types of M&E: i) routine data collection done annually and ii) special surveys and evaluation activities, mid‐term (2021) and end‐of‐term (2023). Routine data collection and reporting will use indicators and reporting mechanisms built into relevant programmes and departments (e.g. AMR surveillance, laboratories, IPC, AMS) as guided by their specific protocols. Mid‐term and final evaluation will make use of additional indicators and shall review 13 the initiatives based on the strategic objectives and key results areas. It is important that M&E indicators monitor inputs, processes, outputs and outcomes. Suggested indicators are in Annex B. Many of the indicators proposed will require special surveys and studies (e.g. reduction of antimicrobial consumption in animals). References ASEAN (Association of Southeast Asian Nations). 2015. ASEAN Post2015 Health Development Agenda. Jakarta: Association of Southeast Asian Nations. Accessed at http://asean.org/wp‐content/uploads/2017/02/APHDA‐In‐a‐Nutshell.pdf ASEAN. 2017. ASEAN Leader’s Declaration on Antimicrobial Resistance: Combating AMR through One Health Approach. November 2017. Jakarta: Association of Southeast Asian Nations. ASEAN. 2017. Rational Use of Medicines in the ASEAN Region. Jakarta: Association of Southeast Asian Nations. FAO (Food and Agriculture Organization of the United Nations). 2016. The FAO Action Plan on Antimicrobial Resistance 2016‐2020. Supporting the food and agriculture sectors in implementing the Global Action Plan on Antimicrobial Resistance to minimize the impact of antimicrobial resistance. Rome: Food and Agriculture Organization of the United Nations. Accessed at http://www.fao.org/3/a‐i5996e.pdf FAO. 2017. FAO Initiatives on Prevention and Control of Antimicrobial Resistance (AMR). Rome: Food and Agriculture Organization of the United Nations. MOH (Ministry of Health, Cambodia). 2014. National Policy for Combating Antimicrobial Resistance. Phnom Penh: Ministry of Health. Kingdom of Cambodia. MOH. 2015. National Strategy to Combat Antimicrobial Resistance 2015‐2017. Phnom Penh: Ministry of Health. Kingdom of Cambodia. MOH. 2018. Antimicrobial Resistance AMR) Situation Analysis: Cambodia. Ministry of Agriculture, Forestry and Fisheries; Ministry of Health and Ministry of Environment. Phnom Penh: Ministry of Health. Kingdom of Cambodia. OIE (World Organisation for Animal Health). 2016. The OIE Strategy on Antimicrobial Resistance and the Prudent Use of Antimicrobials. November. Paris: World Organisation for Animal Health. Accessed at http://www.oie.int/fileadmin/Home/eng/Media_Center/docs/pdf/PortailAMR/EN_ OIE‐AMRstrategy.pdf Vlieghe, E., Sary, S., Lim, K., Sivuthy, C., Phe, T., Parry, C., De Smet, B., Monidarin, C., Baron, E., Moore, C.E., Mfuko, W., Asgari, N., Chhorvoin, O., Steenkeste, N., Leyer, C., van Griensven, J., Thai, S., Jacobs, J. (2012). First National Workshop on Antibiotic Resistance in Cambodia: Phnom Penh, Cambodia, 16‐18 November 2011. Journal of Global Antimicrobial Resistance. WHO (World Health Organization). 2015. Global Action Plan on Antimicrobial Resistance

2015. Rome: Food and Agriculture Organization, Paris: World Organisation for Animal Health and Geneva: World Health Organization. Accessed at 14 http://www.wpro.who.int/entity/drug_resistance/resources/global_action_plan_en g.pdf WHO. 2014. Cambodia Health Systems in Transition. Geneva: World Health Organization and Asia Pacific Observatory. WHO. 2015. Country Cooperation Strategy Cambodia. Phnom Penh: World Health Organization Cambodia. WHO. 2015. Global Action Plan on Antimicrobial Resistance. Geneva: World Health Organization. WHO. 2017. Global Antimicrobial Resistance Surveillance System GLASS) Guidelines. Geneva: World Health Organization. 15 Annex A. Key results areas and activities Strategic Area 1. Governance and coordination to reduce AMR Strategic Objective 1. Ensure sustainable governance through effective coordination and partnerships. Key results areas:  KRA 1.1 Strengthen technical and political coordination at local, national and international levels  KRA 1.2 Strengthen policy and legislative frameworks to support AMR initiatives  KRA 1.3 Resource mobilization to support MSAP implementation  KRA 1.4 M&E plan, indicators and regular evaluation KRAs Activities Stakeholders Lead Institution KRA 1.1 Strengthen 2019–2020 Human health: Multi‐ Each ministry will technical and political Sectoral AMR rotate on annual basis coordination at local, Human health, agriculture and environment Technical Working to chair the Working national and international Group, WHO Group levels a. Finalize and endorse the Multi‐Sectoral Action Plan on AMR 2019–2023 b. Disseminate and launch Multi‐Sectoral Action Plan on AMR 2019–2023 Agriculture: MAFF with Joint Proclamations AMR Technical c. Establish policy and mechanism for high‐level inter‐ministerial Working Group, FAO, coordination OIE d. Establish a high‐level One Health coordination body with rotating chair Environment: MOE & person Partners e. Revise and update the TORs of the technical working groups (MOH, MAFF and MOE) including, but not limited to: • e.1 Conduct regular technical working group meetings for coordination and information sharing • e.2 Ensure alignment of Multi‐Sectoral Action Plan on AMR with plans, activities and strategies of specific departments, offices and programmes of MOH, MAFF and MOE • e.3 Information sharing with AMR programmes in health (e.g. tuberculosis, malaria, HIV/ AIDS, STIs, rational medicines use, medicines regulation, IPC, disease prevention, health promotion, 16 KRAs Activities Stakeholders Lead Institution food safety) • e.4 Information sharing with AMR programmes in agriculture (e.g. crops, animal production, fisheries, good practices, food safety inspection and analysis) • e.5 Information sharing with AMR programmes in environment (e.g. water, environmental health, waste management, biosafety) f. Strengthen partnerships for technical support and implementation including partnerships with professional associations and the commercial sector (e.g. pharmaceutical companies and other public‐private partnerships) KRA 1.2 Strengthen policy 2021–2023 Human health: Multi‐ and legislative frameworks Sectoral AMR to support AMR initiatives Human health, agriculture, environment Technical Working Group, WHO a. Review and strengthen regulatory and legislative frameworks in different aspects of antimicrobial use, surveillance and monitoring, including AMR Agriculture & response, substandard and falsified medicines, waste management, Environment: MAFF registration of facilities, registration of animal clinics and farms, licensing, AMR Technical use of antimicrobials for animal disease prevention, use of antimicrobials in Working Group, FAO, growth promoters and commercial feeds and maximum residue limits OIE b. Develop supporting policies Environment: c. Implementation of farm, slaughter facility and food processing registration and certification to facilitate information sharing, policy implementation, training and advocacy KRA 1.3 Resource 2019–2023 Human health: Multi‐ mobilization to support Sectoral AMR MSAP implementation Human health, agriculture, environment Technical Working Group, WHO a. Align the MSAP with annual operational plans, strategies and activities of ministries and partners Agriculture & b. Conduct assessment and costing to provide support for planning and Environment: MAFF budgeting AMR Technical c. Identify sustainable funding mechanisms for MSAP implementation Working Group, FAO, including financing for laboratory management, services and capacity OIE building 17 KRAs Activities Stakeholders Lead Institution d. Conduct activities and initiatives (e.g. working group meetings) to synthesize and translate evidence into communication messages for policy support e. Strengthen capacity of technical working group members and stakeholders for communications at different levels through communications training, stakeholder mapping and regular coordination f. Conduct dialogues with stakeholders in health, agriculture and environment sectors at all levels g. Regularly review funding resources h. Conduct dialogues with international partners and NGOs on activities and initiatives to support AMR i. Improving availability of staffing through government mechanisms and other partnerships KRA 1.4 M&E plan, Human health, agriculture and environment Human health: Multi‐ indicators and regular Sectoral AMR evaluation a. Baseline review of status and indicators Technical Working b. Finalize and implement M&E framework and plan with this MSAP Group, WHO c. Conduct mid‐term evaluation in 2020 d. Conduct full review in 2023 Agriculture & Environment: MAFF AMR Technical Working Group, FAO, OIE 18 Strategic Area 2. Evidence generation through surveillance and laboratories Strategic Objective 2. Strengthen evidence generation through functional human, agriculture and environment laboratories and effective surveillance mechanisms KRAs Activities Stakeholders Lead Institution KRA 2.1 2019–2020 Human health: C‐CDC, Establish/strengthen US CDC, NIPH, DMDP, surveillance and laboratory Human health Hospitals, ITM, WHO, activities and systems to AHC/University of support AMR a. Develop and implement guidelines and protocols for surveillance and Oxford (COMRU) response for hospital‐acquired infections and antibiotic use b. Implementation of regular point‐prevalence surveys for hospital‐acquired Agriculture: GDAHP, infections, prospective incidence‐based surveillance and other essential FiA, GDA studies DAI, c. Develop and implement guidelines and protocols for AMR outbreak FAO, OIE, PNCA, KNCA response Environment: MoE, d. Increase use of clinical microbiology laboratories through training and CamLAPF education MOE‐Epidemiology‐ Lab Agriculture & Environment and partners a. Strengthen laboratory capacity through involvement in the Assessment Tool for Laboratory and Antimicrobial Resistance (ATLASS) and training on priority protocols (e.g. the FAO and OIE AMR surveillance and laboratory methodology guidelines and WHO ESBL protocol) b. Participate in proficiency tests conducted by external institutions to provide external quality assurance for laboratories involved in AMR surveillance c. Build capacity for drug residue monitoring in food, agriculture and environment laboratories d. Continue and increase identification of antimicrobial resistance in food, agricultural products and the environment e. Implement drug residue monitoring in food, agriculture and environment systems f. Establish AMR surveillance and response systems in agriculture and environment labs 19 KRAs Activities Stakeholders Lead Institution Joint efforts a. Harmonize surveillance and monitoring, reporting and information sharing between human health, agriculture and environment laboratories at national level. Establish a centralized laboratory database for AMR surveillance data b. Support coordination of laboratory and surveillance activities and procedures through national and regional networks c. Conduct joint AMR surveillance between MOH, MAFF, MOE and other partners to strengthen understanding of cross‐transmission 2021–2023 Human health, agriculture and environment a. Evaluate, review and update protocols and guidelines related to AMR surveillance b. Strengthen mechanisms for information sharing for labs and surveillance of AMR KRA 2.2 Strengthening 2019–2020 Human health: C‐CDC, Human capacity for US CDC, NIPH, DMDP, laboratory, information Human health hospitals, ITM, WHO, sharing, surveillance and AHC/University of outbreak response a. Build skills in microbiology and clinical infection, surveillance, Oxford (COMRU) epidemiology and other essential skills in hospitals, health facilities and laboratories b. Conduct planning and costing of workforce skills‐mix to identify capacity needs Agriculture: GDAHP, Agriculture & Environment FiA, GDA DAI, a. Build skills for epidemiology, surveillance, microbiology and other FAO, OIE essential skills for animal health professionals and in Cambodia Applied Veterinary Epidemiology Training (CAVET) and other training programmes Environment: , MoE, b. Conduct planning and costing of workforce skills‐mix to identify capacity CamLAPF 20 KRAs Activities Stakeholders Lead Institution needs BMOE‐EP Lab and partner Joint efforts a. Joint training in human health, agriculture and environment sectors c. Conduct joint human workforce capacity assessment 2021–2023 Human health, agriculture and environment a. Evaluate and strengthen mechanisms for staff recruitment and training for laboratories and surveillance b. Continue skills training for epidemiology, surveillance, microbiology and other skills through CAVET‐MAFF/FETP‐MOH and other training programmes KRA 2.3 Strengthen 2019–2020 Human health: C‐CDC, equipment and supply US CDC, NIPH, DMDP, systems in laboratories for Human health, agriculture and environment hospitals, ITM, WHO, microbiology and AHC/University of surveillance a. Assessment, planning and costing of laboratory resource needs Oxford (COMRU) b. Strengthening capacity of existing labs through provision of equipment and supplies Agriculture: GDAHP, b.1. Establish a laboratory for food safety (e.g. Food Safety Centre of FiA, GDA Excellence) DAI, PNCA, KNCA, c. Laboratory quality enhancement in target hospitals FAO, OIE c.1. Enhance laboratory quality control and assurance in target Environment: MoE, microbiology laboratories CamLAPF MOE‐EP Lab and partner 21 Strategic Area 3. Rational use of antimicrobial medicines Strategic Objective 3. Develop and enforce regulations and strategies to ensure access to and rational use of antibiotics in human health, animal health and agriculture. KRAs Activities Stakeholders Lead Institution KRA 3.1 Guidance for and 2019–2023 Human health: DDF, implementation of rational DHS, UHS, hospitals, use of antimicrobial Human health professional societies medicines and development a. Develop and implement an antimicrobial stewardship programme in partners target health facilities with supporting local policies, staffing, dedicated teams and budgets a.1. Implement monitoring and surveillance of antimicrobial use (e.g. antimicrobial consumption monitoring and point‐prevalence surveys) Agriculture GDAHP, a.2. Implement initiatives to promote rational antibiotic use (e.g. GDA, FiA, DIA, FAO, prospective audit and feedback) OIE b. Incorporate AMR in the upcoming revision of Clinical Practice Guidelines, Environment: Essential Medicines List and other guidelines for antibiotic use c. Develop and implement policy to restrict the sale of antibiotics without prescriptions d. Strengthen roles and responsibilities of infection prevention and control and Medicine and Therapeutics Committees in hospitals Agriculture and environment a. Integrate AMU/AMR in guidelines for GAP, GAHP and GAqP b. Training and implementation of guidelines c. Registration of model farms d. Promote use of alternative evidence‐based modalities in good practices (traditional approaches, probiotics, etc.) e. Promote record keeping of antimicrobial use and withdrawal time on farms and by animal health service providers and of antimicrobial sales 2021–2023 Human health 22 KRAs Activities Stakeholders Lead Institution a. Provide continuous training and dissemination of guidelines in health facilities and to health care providers b. Develop model hospitals and health facilities on AMS, IPC and other initiatives on rational use of antimicrobials c. Monitor and evaluate the uptake, use and implementation of guidelines KRA 3.2 Regulation at 2019–2023 Human health: DDF, different levels to support DHS, UHS, hospitals, rational use Agriculture and environment professional societies and development a. Assess, revise and develop regulatory frameworks for human health, partners agriculture and environment sectors b. Regulate the use of antibiotics for prevention and growth promotion and Agriculture & commercial feeds for animals Environment: GDAHP, c. Public dissemination and implementation of policies GDA, FiA, d. Develop and disseminate guidelines for minimum residue limits aligned professional societies with international standards FAO, OIE e. Strengthen regulatory systems through increased workforce and funding in human health and agriculture 2020–2023 a. Strengthen national regulatory authorities for medicine quality assurance and establish mechanisms for systematic monitoring and evaluation of regulatory processes b. Enhance monitoring of regulation of antibiotics used in animals and agriculture c. Strengthen the services of veterinary drugs and veterinary hospital, veterinary clinic through registration and licensing the veterinary professional. KRA 3.3 Establish supply 2019–2023 Human health: DDF, chain management for DHS, UHS, hospitals, antimicrobials to ensure Human health professional societies equitable and universal and development access for all citizens a. Ensure availability of quality essential medicines and medical products partners 23 KRAs Activities Stakeholders Lead Institution b. Strengthen institutional procurement and supply chain systems for quality antibiotics c. Enforce regulations on prescription‐only dispensing of antimicrobials d. Develop messages on and communicate quality of medicines to health professionals and the general public Agriculture & e. Strengthen the services of pharmacies and health facilities through Environment: GDAHP, registration and licensing GDA, FiA, FAO, professional societies Agriculture and environment a. Communicate messages about quality, including falsified and counterfeit medicines, expired medicine and medicines storage, to veterinary professionals and farm workers Strategic Area 4. Containing AMR through good practices Strategic Objective 4. Reduce the incidence of infection through effective sanitation, hygiene, food safety, waste management and infection prevention measures KRAs Activities Stakeholders Lead Institution KRA 4.1 Guidance for and 2019–2020 DHS, DPM, CCDC, implementation of good Hospitals, Provincial/ practices Human health Municipal Health Offices and a. Assessment of implementation of infection prevention and control efforts development partners in target and pilot public hospitals b. Strengthen IPC implementation in hospitals through training on infection Agriculture: FiA, MRD, prevention and control tools and guidelines, quality improvement plans and Provincial Agriculture development of other guidelines and protocols Offices, DAI, c. Assessment and strengthening of medicine and therapeutics committee FAO, OIE efforts in public hospitals Environment: MOE‐ d. Strengthen roles and responsibilities of infection prevention and control GDEP committees FAO, OIE 24 KRAs Activities Stakeholders Lead Institution e. Integrate AMR knowledge and skills in existing programmes in WASH, IMCI, Minimum Package of Activities and other community programmes f. Dissemination, training and monitoring implementation of infection prevention and control and WASH in hospitals and health facilities Agriculture and environment a. Integrate existing internationally recognized good practices into local contexts b. Adopt ASEAN and international good agriculture practice guidelines to improve terrestrial and aquatic animal health and welfare and ensure quality and safety of agricultural products c. Conduct a baseline review of good practices including gap analysis and stakeholder mapping and provide recommendations for producers of animal and other agricultural and food products d. Conduct baseline assessment of the status of water, food safety inspection and analysis and waste management integrating AMR concerns (e.g. in animal husbandry) e. Assess the implementation of GAP, GAqP, GAHP, GMP, GHP and biosecurity on farms, collect evidence on the AMR impact, and recommend sustainable use of antimicrobials in agriculture and food production f. Disseminate, train and monitor implementation of infection prevention and control, safe water, sanitation and hygiene in commercial and backyard farms, food production, processing and manufacturing in animal clinics, veterinary practices, slaughter facilities and live animal markets g. Introduce record keeping on farms using antimicrobials and withdrawal times h. Promote animal health and welfare i. Conduct training‐of‐trainers on good practices in GAP, GAqP, GAHP, GMP, GHP and biosecurity on farms j. Promote innovation and dissemination of good practices and alternatives in agriculture Joint activities a. Baseline assessments in health facilities and farms and waste treatment and management 25 KRAs Activities Stakeholders Lead Institution b. Establish model villages and communities with a One Health Approach to combating AMR 2021–2023 Human health, agriculture and environment a. Monitor infection prevention and control, MTC and quality improvement implementation in hospitals and health facilities b. Monitor implementation of infection prevention and control, immunization programmes, WASH and waste management on farms, food production, processing, and manufacturing, in animal clinics, veterinary practices, slaughter facilities, and live animal markets c. Strengthen sanitary and environmental regulations on farm practices for terrestrial and aquatic animals d. Develop additional best practice guidance in areas such as vaccinations, safe disposal of unused and expired antibiotics and animal feeds and alternatives to antimicrobial growth promoters and biological waste management. KRA 4.2 Ensure available 2019–2020 Human health: DHS, technologies and supplies to DPM, hospitals, implement protocols and Human health, agriculture and environment Provincial and guidelines Municipal Health a. Ensure availability of infection prevention and control infrastructure and Offices hygiene products and supplies (e.g. gloves, syringes, alcohol, running water) in hospitals and health facilities) Agriculture: GDAHP b. Monitor and report on infection prevention and control and other activities Environment: MOE c. Improve provision of infection prevention and control infrastructure and hygiene supplies and equipment in veterinary clinics, veterinary practices, slaughter facilities and live animal markets d. Improve hygiene supply and equipment in production, processing and marketing agricultural products 2021–2023 26 KRAs Activities Stakeholders Lead Institution Human health, agriculture and environment a. Roll out implementation of infection prevention and control in other government hospitals b. Ensure availability of required infrastructure and products to support monitoring water, food safety inspection and analysis, and waste management KRA 4.3 Monitoring water, 2019–2020 Human health: DDF, food safety and waste CCDC, management Human health, agriculture and environment Provincial/Municipal Health Departments a. Support monitoring and conduct baseline assessment of the status of and development water, food safety inspection and analysis and waste management partners integrating AMR concerns b. Hire additional staff to support monitoring water, food safety inspection Agriculture GDAHP, and analysis and waste management FiA, DAI, MRD, MOE‐ c. Develop and implement capacity building activities for monitoring water, GDEP food safety inspection and analysis and waste management Provincial Agriculture d. Monitor MRLs of chemical residues (VPH) in the environment Offices (PDAFF), FAO, e. Develop and implement partnerships for waste management in the OIE health, agriculture and environment sectors Environment: MoE and partners 27 Strategic Area 5. Increase public awareness Strategic Objective 5. Strengthen communication for public education and awareness. KRAs Activities Stakeholders Lead Institution KRA 5.1 Increase public 2019–2020 Human health: Multi‐ awareness through Sectoral AMR traditional and social media Human health Technical Working Group, MRD, a. Develop existing information, education and communication materials for Provincial and mass media (e.g. ads for TV, radio and newspapers). Municipal Health b. Develop and disseminate communication messages and material for Departments, social media (e.g. Facebook, Instagram) professional societies, WHO Agriculture and environment a. Develop existing information, education and communication materials for Agriculture: MAFF mass media (e.g. ads for TV programmes, radio and newspapers) AMR Technical b. Develop other awareness raising materials based on recent knowledge Working Group, MRD, about AMR and AMU in humans, plant production, fisheries, livestock and Provincial and District food Agriculture Offices c. Use social media (e.g. Facebook, Instagram) (PDAFF), FAO, OIE Joint activities Environment: MoE and partners a. Develop joint human health, agriculture and environment IEC and training materials b. Develop and disseminate IEC and training tool kits on AMR and AMU in Khmer languages 2021–2023 Human health, agriculture and environment a. Monitor and evaluate effectiveness of communication activities in different media 28 KRAs Activities Stakeholders Lead Institution KRA 5.2 Integrate AMR 2019–2020 Human health: Multi‐ communications in Sectoral AMR programmes and activities Human health Technical Working Group, MRD, a. Integrate AMR and antibiotic use in advocacy and health promotion Provincial and activities of existing health programmes (e.g. MCH, IMCI, sanitation and Municipal Health hygiene, TB, malaria, HIV/AIDS) Departments, b. Conduct AMR and antibiotic use training for healthcare providers professional societies, WHO Agriculture and environment a. Integrate AMR and antimicrobial use in advocacy, agriculture and animal Agriculture and health promotion activities of existing programmes (e.g. vaccination Environment: MAFF programs, genetics, conservation, breeding, animal feed) AMR Technical b. Conduct grassroots awareness activities Working Group, MRD, c. Conduct AMR and antimicrobial use training for general service providers Provincial Agriculture including veterinarians, farmers, village animal health workers Offices, FAO Joint activities a. Antimicrobial Awareness Week celebration every year with participation from health, agriculture and environment from both government and private sectors b. Integrate communications strategies into existing community awareness, health promotion programmes and good agriculture advocacy c. Conduct community dialogues to enhance awareness and integrate AMR into community forums 2021–2023 Human health, agriculture and environment a. Monitor and evaluate communications tools and activities for AMR and antimicrobial use in advocacy and health promotion activities of existing health and agriculture programmes b. Monitor impact of communication and behavior change programmes in pilot and target areas 29 KRAs Activities Stakeholders Lead Institution Strategic Area 6. Building capacity for AMR Strategic Objective 6. Strengthen capacity of professionals and staff for AMR advocacy and support all areas of work. KRAs Activities Stakeholders Lead Institution 30 KRAs Activities Stakeholders Lead Institution KRA 6.1 Integrate AMR, 2019–2020 Human health: HSD, microbiology, rational drug UHS, NIPH, use and other areas into Human health, agriculture and environment professional societies, pre‐service training development partners curriculum and resources a. Curriculum review and integration of AMR and related knowledge in pre‐ service training for physicians, nurses, pharmacists, laboratory technicians and other degree programmes: Antimicrobial stewardship program Agriculture Microbiology laboratory practice, networking and information sharing, MAFF, GDAHP, FiA, biosafety and antimicrobial use, microbiology IPC and rational antibiotic use GDA, RUA, Prekleab and pharmacovigilance National Agricultural Related courses School, Kampong b. Curriculum review and integration of AMR and related knowledge into pre‐ Cham National service training of animal science, veterinary medicine, fisheries, food, Agricultural School, agriculture, environment and other degree programmes: FAO, OIE Performance of veterinary service by OIE Environment: MOE Animal husbandry and fisheries and agro‐industry programmes and partners Related courses c. Enhance links and partnerships with international academics and schools for capacity building, research and other initiatives 2021–2023 Human health, agriculture and environment a. Development and review of education resources (e.g. update books and references) in clinical pharmacology, pharmacovigilance, veterinary pharmacy and related courses b. Assess, review and translate existing good practices into new programmes for AMR for animal production, veterinary and agriculture practitioners KRA 6.2 Develop training 2019–2020 resources and build Human health: MOH, 31 KRAs Activities Stakeholders Lead Institution capacity on AMR, Human health, agriculture and environment UHS, NIPH, microbiology, rational professional societies medicines use and related a. Develop modules and conduct training for health professionals as part of and development areas for in‐service training the continuous medical education in these areas: partners and capacity building  Applied epidemiology training  Laboratory: use of microbiology laboratory, biosafety, biosecurity (epi‐lab), storage, packaging and transportation, pathogen Agriculture & management Environment: MAFF,  Antimicrobial stewardship GDAHP, FiA, GDA,  Rational medicines use RUA, Prekleab  Related areas National Agricultural b. Develop and review modules and conduct training for agriculture, School, Kampong veterinary and food safety professionals in these areas: Cham National  Cambodia applied veterinary epidemiology training Agricultural School,  AMU and AMR training MOE, professional  Microbiology labs societies  Good practices  Guidelines for antibiotic use  GAP, GAHP, GAqP, biosafety  Related areas c. Develop AMR training materials for provincial, district and village officials and staff d. Continue and strengthen partnerships among local institutions and with international institutions on AMR for sharing expertise and lessons learnt between countries e. Strengthen participation in international conferences and sharing AMR information f. Participate in international networks and initiatives (e.g. national biosafety committee network, national medical microbiology laboratory network, CALM List, CamLQMS, check list for accreditation, national quality standards) 2021–2023 Human health, agriculture and environment a. Conduct joint training for professionals and technicians in human health 32 KRAs Activities Stakeholders Lead Institution agriculture and environment sectors KRA 6.3 Collaboration with 2019–2020 professional societies and Human health: MOH, academics to integrate Human health, agriculture and environment UHS, NIPH, AMR and related issues for professional societies capacity building, a. Integrate action points of the strategy (e.g. biosafety, biosecurity and and development advocacy, research and waste management) into existing programmes of professional societies in partners education human health, agriculture and environment b. Conduct joint activities (e.g. meetings, forums, conferences, research, projects) Agriculture & c. Strengthen public‐private partnerships to level‐up AMR activities Environment: d. Share local and national AMR knowledge and expertise with international MAFF, GDAHP, FiA, colleagues GDA, RUA, Prekleab National Agricultural School, Kampong Cham National Agricultural School, MOE, professional societies 33 Strategic Area 7. Research and innovation for AMR Strategic Objective 7. Build research and innovation capacity to support policy, good practice, implementation, monitoring and evaluation of AMR activities. KRAs Activities Stakeholders Lead Institution KRA 7.1 Identifying AMR 2019–2020 Human health: MOH, research gaps and priorities UHS, NIPH, and in natural sciences, applied Human health, agriculture and environment development partners sciences, social sciences, economics and a. Integrate AMR and related issues into this strategy (e.g. surveillance, Agriculture & management laboratories, IPC, rational use, sanitation and hygiene, regulation) as an Environment: important component of the national health, agriculture and environmental MAFF, MOE, RUA, research agendas FAO, OIE b. Work towards an overarching research agreement covering all sectors and related ministries to ensure optimal efficiency, transparency and data sharing 2020–2023 Human health, agriculture and environment a. Conduct a national AMR prevalence study b. Enhance partnerships with institutions to strengthen research on operations and implementation and actively engage the private sector KRA 7.2 Training and 2019–2020 Human health: MOH, capacity building of national UHS, NIPH, and staff for AMR and related Human, agriculture and environment development partners research a. Promote and support AMR research as part of existing and new activities Agriculture & in schools and develop specific research tracks for post‐graduate degrees Environment: b. Raise awareness of local, national, and international training MAFF, MOE, RUA, opportunities FAO, OIE c. Promote research among sectors 2021–2023 34 KRAs Activities Stakeholders Lead Institution a. Capacity building for qualitative and operational research b. Facilitate the exchange of expertise and lessons learnt from other countries and partners through regular coordination meetings KRA 7.3 Implementation 2019–2020 and dissemination of AMR Human health: MOH, research Human health, agriculture and environment UHS, NIPH, and development partners a. Conduct research to fill knowledge gaps on AMR issues in all areas and support policy frameworks and development plans, including research on knowledge, attitudes and practices on antibiotics, AMR and AMU among Agriculture & health workers, VHWs, agricultural workers, VAHWs, farmers and Environment: community members (public and private) MAFF, MOE, RUA, b. Participate in the human global antibiotic appropriateness prevalence FAO, OIE study c. Participate in OIE monitoring of the quantities and usage patterns of antimicrobial agents used in aquatic and food producing animals d. Conduct studies to establish correlations between AMR in animals, the environment and humans e. Explore innovative approaches (e.g. IT approaches, mobile apps, bioinformatics, probiotics and other approaches to reduce the need for antimicrobials) f. Regular sharing of research findings through working group meetings and conferences g. Conduct AMR research forums 35 Annex B. Draft indicators for monitoring and evaluation General AMR indicators are presented in the section on monitoring and evaluation. These are input, process and output indicators that can help determine the progress of AMR activities in all sectors. Two types of M&E activities are proposed: i) routine monitoring, for example, in annual reports, and ii) special evaluations and surveys, for example, mid‐term and end‐of‐term reviews, national prevalence surveys and other special studies. A baseline evaluation of indicators is proposed for 2019 to determine the current status. Strategic areas and KRAs Proposed input and process indicators Proposed output indicators Strategic Area No 1. Governance and coordination to reduce AMR Strategic Objective 1. Ensure sustainable governance through effective coordination and partnerships Key Results Areas  Plan completed, approved, endorsed and disseminated KRA 1.1 Strengthen technical and political  AMR Technical Working Group coordination at local, national and membership representation international levels  Policy and legislative framework developed and endorsed by KRA 1.2 Strengthen policy and legislative stakeholders and partners frameworks to support AMR initiatives  Number of professional societies and hospitals developing programmes on KRA 1.3 Resource mobilization to support AMR with their own funding MSAP implementation  Mid‐term reviews conducted  AMR Technical Working Group KRA 1.4 M&E plans, indicators and meetings conducted regularly regular evaluations  Final MSAP review conducted Strategic Area 2. Evidence Generation through Surveillance and Laboratories 36 Strategic Objective 2. Strengthen evidence generation through functional human, agriculture and environment laboratories and effective surveillance mechanisms Key Results Areas  Number of new staff trained in  Number of human health CAVET-MAFF and FETP‐MOH laboratories reporting to AMR KRA 2.1 Levelling‐up existing surveillance  Number of new staff trained in surveillance and laboratory activities and systems to microbiology  Number of human health support AMR laboratories achieving level ____ in laboratory quality management KRA 2.2 Strengthening human capacity  Number of agriculture and for laboratories, information sharing, environment laboratories with surveillance and outbreak response capacity to conduct AST  Baseline AMR data KRA 2.3 Strengthen equipment and  Frequency of patients sampled supply systems in laboratories for per specimen type per population microbiology and surveillance  Frequency of patients with growth of non‐susceptible bacteria per specimen type, species and antibiotic  Proportion of sampled patients with positive culture of any susceptible, intermediate or resistant pathogenic bacteria per specimen type  Proportion of samples with growth of non‐susceptible bacteria of the species and antibiotic under surveillance per specimen type 37 Strategic Area 3. Rational use of antimicrobial medicines Strategic Objective 3. Develop and enforce regulation and strategies to ensure access to and rational use of antibiotics in human health, animal health and agriculture Key Results Areas  Staff knowledge of guidelines on AMR, AMS, IPC, GAP, GAHP, GAqP KRA 3.1 Guidance for and  Number of model farms using implementation of rational use of good practice guidelines antimicrobial medicines  AMS monitoring indicators  Stock‐out rates of antibiotics KRA 3.2 Regulation at different levels to  Rate of antibiotic prescribing support rational use  Antibiotic consumption KRA 3.3 Establish supply chain management for antimicrobials to ensure equitable and universal access for all citizens Strategic Area 4. Containing AMR through good practices Strategic Objective 4. Reduce the incidence of infection through effective sanitation, hygiene, food safety, waste management and infection prevention measures Key Results Areas  Number of hospital and health  Number of staff using guidelines facility staff trained and retrained for IPC KRA 4.1 Guidance for and for IPC  Number of model farms using implementation of good practices  Number of provincial agriculture good practice guidelines staff trained on good practices KRA 4.2 Ensure available technologies  Number of communities 38 and supplies to implement protocols and registered as model villages guidelines KRA 4.3 Monitoring water, food safety and waste management Strategic Area 5. Increase public awareness Strategic Objective 5. Strengthen communication for public education and awareness Key Results Areas  Awareness Week Celebrations  Positive changes in knowledge,  IEC materials distributed attitudes and practices after three KRA 5.1 Increase public awareness  Number of community dialogues years through traditional media and social  Number of dialogues with media partners and stakeholders KRA 5.2 Integrate AMR communications in programmes and activities Strategic Area 6. Building capacity for AMR Strategic Objective 6. Strengthen capacity of professionals and staff for AMR advocacy and support all areas of work Key Results Areas  Number of curricula with AMR,  Number of national and local staff microbiology and rational use of with advanced training in AMR KRA 6.1 Integrate AMR, microbiology, antibiotics integrated specialties (e.g. microbiology, rational drug use and related areas in  Number of published technical clinical pharmacy, AMR, AMR pre‐service training curriculum and materials surveillance and response) resources  Number of activities conducted by 39 and with professional societies KRA 6.2 Develop training resources and  Number of AMR training build capacity on AMR, microbiology, programmes conducted rational drug use and related areas in in‐  Number of professional societies service training and capacity building and hospitals developing AMR programmes with their own KRA 6.3 Collaboration with professional funding societies and academics to integrate AMR and related issues for capacity building, advocacy, research and education Strategic Area 7. Research and innovation for AMR Strategic Objective 7. Build research and innovation to support policy, good practice, implementation, monitoring and evaluation of AMR activities Key Results Areas  Number of research studies  National prevalence rate conducted on topics related to identified through surveys and KRA 7.1 Identifying AMR research gaps AMR surveillance systems and priorities on AMR in areas from  Number of local and international  Number of local and international natural sciences, applied sciences, social research partnerships presentations on AMR topics sciences, economics and management  Number of research studies on AMR topics peer‐reviewed and KRA 7.2 Training and capacity building of published national staff for AMR and related research KRA 7.3 Implementation and dissemination of AMR research 40 Annex C. Stakeholders in functions and initiatives related to antimicrobial resistance in Cambodia Ministry of Agriculture, Forestry and Fisheries (MAFF) Institution Name Position Contact General Directorate of Animal Health and Production (GDAHP), MAFF H.E. Tan Phannara Director General tan.phannara@gmail.com MAFF Dr. Sar Chetra Deputy Secretary General chetrass@gmail.com Department of Agro‐Industry (DAI), MAFF Mr. Kong Pheach Director peachkong@gmail.com National Animal Health Production Research Institute, GDAHP, MAFF Dr. Tum Sothyra Director sothyratum@gmail.com National Animal Health Production Research Institute, GDAHP, MAFF Mr. Rortana Chea Technical officer rortanachea@gmail.com Department of Public Health and Veterinary Public Health, GDAHP, MAFF Dr. Tep Bengthay Deputy Director bengthay@gmail.com Department of Crop Protection, Sanitation and Phyto‐Sanitation, General Directorate of Agriculture, MAFF Dr. Ny Vuthy Deputy Director n.vuthy@yahoo.com Department of Agriculture Legislation (DAL), MAFF Dr. Moch Chantha Deputy Director chanthamoch@gmail.com Department of Agro‐Industry (DAI), MAFF Mrs. Chuon Mony Chief of Laboratory Lab chuonmony@yahoo.com Department of Agro‐Industry (DAI), MAFF Mr. Phon Reno Vice Chief of Laboratory ai_reno@yahoo.com Department of Agro‐Industry (DAI), MAFF Ms. Kong Vouchsim Technical Official kongvouchsim@gmail.com Department of Processing Technology and Quality, FiA, MAFF Mr. Chab Piseth Deputy Director pisethchap@gmail.com Office of Aquaculture, Department of Aquaculture Development, Fisheries Administration (FiA), MAFF Mr. Neang Savuthdy Vice Chief of Office vuthdynady@yahoo.com Department of Aquaculture Development, FiA, MAFF Mrs. Phuong Sengheang Technical Officer heangfia@gmail.com Department of Planning and Statistics, MAFF Mrs. So Sreymom Deputy Director sreymomso88@gmail.com Ministry of Health (MOH) Institution Name Position Contact MOH Prof. Eng Huot Secretary of State Department of Communicable Disease Control (CCDC), MOH Dr. Ly Sovann Director sovann_ly@yahoo.com 41 Department of Communicable Disease Control (CCDC), MOH Dr. Krang Sidonn Deputy Director sidonnkrang@yahoo.com soksrun@online.com.kh Department of Health Services, MOH Dr. Sok Srun Director soksrun@gmail.com Department of Health Services, MOH Prof. Kim Savuon Deputy Director Department of Health Services – Bureau of Medical Laboratory Services (BMLS), MOH Dr. Sau Sokunna Deputy Director sintouch358@gmail.com Department of Health Services, MOH Dr. Cheu Sivuthy National Institute of Public Health (NIPH), MOH Prof. Chhea Chhorvann Director cchhorvann@niph.org.kh National Institute of Public Health (NIPH), MOH Mr. Nov Vandarith Official nvandasrith@niph.org.kh National Centre for Health Promotion, MOH Dr. Chhea Chhor Daphea Director Department of Human Resources (DHR), MOH Dr. Touch Sokneang Director touchsokneang@yahoo.com International Cooperation Department, MOH Dr. Sung Vinntak Director sungvinntak@yahoo.com National Centre for HIV/AIDS, Dermatology and STDs (NCHADS) (STD Program) MOH Dr. Lon Say Heng Head of STD Unit MOH Department of Drug and Food (DDF) Prof. Heng Bunkiet Director hengbunkiet@yahoo.com Department of Drug and Food (DDF), MOH Dr. Yang Daravuth Deputy Director yangdaravuth@gmail.com Department of Preventive Medicine, MOH Dr. Hak Sithan Deputy Director sithan_hak@yahoo.com National Centre for Tuberculosis and Leprosy Control (CENAT), MOH Dr. Huot Chanyuda Deputy Director Centre National pour Malaria (CNM), MOH Dr. Lek Dysoley Deputy Director soleycnm@gmail.com Ministry of Environment (MOE) Institution Name Position Contact National Council for Sustainable Development (NCSD), MOE H.E. E Vuthy Deputy Secretary General evuthy@gmail.com General Directorate of Environmental Protection (GDEP), MOE H.E. Heng Nareth Director General heng.nareth@online.com.kh General Directorate of Environmental knowledge and Information(GDEKI), MOE Dr Meas Chanthyda Deputy Director General Measchanthyda39@gmail.com Department of Hazardous Waste Management, GDEP, MOE Mr. Chuop Sivutha Deputy Director Sivuthachuop097@gmail.com Laboratory Department, GDEP Mr. Aing Haypheng Laboratory Officer hayphengaing@gmail.com GDEP Mr. Chea Leng Deputy Director lengmoe@gmail.com GDEP Mr. Bol Nget Deputy Director ngetbol@gmail.com 42 Institution Name Position Contact GDEP Mr. Huot Syradoth Vice‐chief Bureau syradoth_huot4@yahoo.com GDEP Mr. Say Vorng Vice‐chief Bureau sayvorng@ymail.com MOE Mr. Pen Viseth Vice Chief Bureau + 885 85 777 275 MOE Mr. Suon Sokun Vice Chief Bureau + 885 93 852 003 Other Ministries Institution Name Position Contact Ministry of Rural Development Mr. Thay Chanto thaychanto@gmail.com Hospitals Institution Name Position Contact Calmette Hospital Dr. Huot Sotheara Medical Director hsotheara@yahoo.com sotharith_bory@yahoo.com; Calmette Hospital Dr. Sotharith Bory Infectious Disease 012632868 Calmette Hospital Ph. Ho Seanghuoy Chief of Infectious Unit No 31A, Rue de France (St. 47), National Maternal and Child Health Center Dr. Tung Rathavy Director 12202, Phnom Penh 100 Russion Federation Boulevard, Phnom Penh; +855 23 National Pediatric Hospital Dr. Nhep Angkeabos Director 884 137 Sihanouk Hospital Centre of Hope Dr. Phe Thong Director thongphe@sihosp.org pheaktra@angkorhospital.org; Tep Vong (Achamean) Road & Oum Chhay Street, Svay Angkor Hospital for Children Dr. Ngoun Chanpheaktra Medical Executive Director Dangkum, Siem Reap miliya_thyl@angkorhospital.org Angkor Hospital for Children Dr. Miliya Thyl Clinical Microbiologist 089 287 059 Schools Institution Name Position Contact #73, Preah Monivong Blvd, University of Health Sciences Dr. Saphonn Vonthanak Rector Sangkat Sras Chak, Khan Daun 43 Penh, Phnom Penh; Tel +855 (0) 23 430 559 cmonnidarin@uhs.edu.kh, University of Health Sciences, Faculty of Pharmacy Prof. Chou Monidiarin Vice Dean 016 306 668 Royal University of Agriculture ‐ Faculty of Veterinary Medicine Prof. Kang Kroesna Dean kkroesna@rua.edu.kh Royal University of Agriculture ‐ Faculty of Veterinary Medicine Dr. Ven Vutey Vice Dean vennvutey@rua.edu.kh Royal University of Agriculture ‐ Faculty of Animal Science Dr. Te Kuyhor Dean tkuyhor@yahoo.com Laboratories Institution Name Position Contact 5 Monivong Boulevard, PO Box 983, Phnom Penh; Institute Pasteur du Cambodge Dr. Didier Fontenille Director accueil@pasteur‐kh.org Institute Pasteur du Cambodge Agathe de Lauzanne adelauzanne@pasteur‐kh.org Diagnostic Microbiology Development Program (DMDP) Joanne Letchford Country Director joanne.letchford@dmdp.org Diagnostic Microbiology Development Program (DMDP) Joe Hessell Clinical Pharmacist Diagnostic Microbiology Development Program (DMDP) Oeng Sopheap oeng.sopheap@dmdp.org National Institute of Public Health, #80, 289 Samdach Penn Nouth St. (289), Phnom Penh, US Communicable Disease Control – Cambodia Robert Newman Country Director Cambodia US Communicable Disease Control – Cambodia Dr. Michael Kinzer DGHP Program Director mnk6@cdc.gov US Communicable Disease Control – Cambodia Dr. Bun Sreng iiy0@cdc.gov US Communicable Disease Control – Cambodia Dr. Sar Boran iez8@cdc.gov Cambodia‐Oxford Medical Research Unit Prof. Paul Turner Director & Clinical Microbiologist pault@tropmedres.ac Armed Force Research Institutes of Medical Sciences chanthapl.ca@afrims.org (AFRIMS) Mr. Lon Chanthap Chief Field Operations 012 976 799 Partners 44 Institution Name Position Contact FAO Regional Office for Asia and the Pacific Dr. Katinka De Balogh Senior Animal Health and Katinka.DeBalogh@fao.org Production Officer FAO Cambodia Dr. Kristina Osbjer ECTAD Team Leader kristina.osbjer@fao.org FAO Cambodia Dr. Sokerya Seng National coordinator on AMR sokerya.seng@fao.org WHO Cambodia Dr. Kumanan Rasanathan Health Systems Team Lead rasanathank@who.int WHO Cambodia Lkhagvadorj Vanchinsuren Technical Officer for Medicines lkhagvadorjv@who.int lester.geroy@upou.edu.ph, WHO Cambodia Dr. Lester S A Geroy AMR Consultant lelim22@yahoo.com WHO Western Pacific Region Dr. Ketevan Kandelaki Technical Officer kandelakik@who.int WHO Western Pacific Region Dr. Escalante Socorro Team Coordinator escalantes@who.int WHO Secretariat (Bangkok) Dr. David Sutherland sutherlandda@who.int World Organisation for Animal Health Dr. Hirofumi Kugita h.kugita@oie.int 220 611; No. 100 A, Preah Norodom Boulevard, Khan Daun Penh, 12207 Phnom Penh European Union H.E. George Edgar Ambassador + 855 23 216 996 USAID Ms. Polly Dunford Mission Director Development Assistance Specialist USAID Sotheara Nop for Infectious Diseases snop@usaid.gov Exchange Square Building, No. 19‐ 20, Street 106, Sangkat Wat Country Director for Myanmar, Phnom, Khan Daun Penh, Phnom World Bank Ellen Goldstein Cambodia and Lao PDR Penh No. 29 Suramarit Blvd. (268/19) Sangkat Chaktomuk, Khan Daun Penh, Phnom Penh, Cambodia; + ADB Cambodia Mr. Samiuela T. Tukuafu Country Director 855 23 215805, 215806, 216417 16B National Assembly St, Sangkat Tonle Bassac, Khan Chamkamon, Australia Department of Foreign Affairs and Trade Ms. Angela Corcoran Ambassador to Cambodia Phnom Penh; +855 23 213 470 cambodia@koica.go.kr; Phnom Penh Tower, 12th Floor, #445, Monivong Blvd, Corner Street 232, Korean International Cooperation Agency Yun Gil Jeong Representative Sangkat Boeung Prolet, Khan 7 45 Institution Name Position Contact Makara, Phnom Penh, Cambodia 6th,7th,8th Floors, Building #61‐ 64, Preah Norodom Blvd, Phnom Japan International Cooperation Agency (JICA) Yuichi Sogano Chief Representative Penh, Cambodia GIZ‐kambodscha@giz.de; #17, Street 306; Phnom Penh; GIZ Thomas Waldraff Country Director +855(23)86011 Global Fund Malaria Consortium Yves Bourny Director y.bourny@malariaconsortium.org Malaria Consortium Dyna Doum d.doum@malariaconsortium.org Malaria Consortium Prudence Hamade p.hamade@malariaconsortium.org Malaria Consortium Sergio Lopes s.lopes@malariaconsortium.org University Research Council (URC) Dr. Som Hun shun@URC‐CHS.COM Phnom Penh Post Yesenia Amaro Journalist m.yesenia.amaro@gmail.com 46