National Action Plan on Combating Antimicrobial Resistance

1. Improving AMR awareness among professionals in different fields (e.g. physicians, pharmacists, dentists, healthcare workers, veterinarians, farmers, ecologists, and media specialists) through CME, AMR periodic informational SMS, lectures, etc. offered by Orders/Syndicates, addition to creating an AMR webpage as part of the official websites of MOH and MOA;

2. Preparation of broadcasting AMR awareness material to be diffused through the traditional media (radio and television) and social media (Facebook, Twitter, Instagram);

3. Raising and improving public awareness on AMR through periodic year-long advertisement and concentrated advertisement in and around the Global AMR Week in November using traditional media (radio, TV spots, interviews, talk shows), advertisement on social media networks and sending SMS periodically through national telecommunication companies;

4. Including AMR awareness in education curricula nationwide: a. Sensitization in school programs about AMR and Hygiene. b. Inclusion of AMR awareness in different levels in higher education programs depending on the major/specialty (medicine, dentistry, pharmacy, nursing, veterinary medicine, food chemistry/safety, agriculture, etc.) 6 Axis B: Surveillance of AMR

1. Pursing reporting AMR data to the Global Antimicrobial Resistance Surveillance System (GLASS) thus optimizing AMR surveillance in humans through: a. Mapping laboratories that can potentially provide microbiologically reliable and epidemiologically representative data. b. These labs start reporting their data to GLASS. c. Put a plan for capacity building for the labs that are chosen to be included in GLASS report in order to be epidemiologically representative.

2. Building the capacity of labs that are not ready yet to report to GLASS in an incremental plan through a. Enhancing the quality of used equipment b. Workshops c. Standardizing laboratory work guidelines d. External quality proficiency testing e. WHONET Training

3. Periodic issuing of an epidemiologically representative national AMR surveillance report with stratification of data according to local needs of scientists, physicians, pharmacists, and researchers (e.g. blood stream infections data, community-acquired resistance, hospital-acquired AMR, healthcare-associated AMR, etc.), in addition to posting this report on AMR webpages (MOH and MOA websites).

4. Improving AMR awareness in the veterinary, agriculture and environment fields a. Research project about AMR surveillance in these fields. b. To design an epidemiologically representative sample for AMR surveillance (cattle, poultry, companion animals, plants, crops, etc). c. Conduct AMR surveillance in these fields.

5. Creating/Assigning AMR reference lab(s) through a. Define TOR of AMR Reference Lab. b. Map potential lab(s). c. Task force to visits the potential lab(s). d. Nominate the reference lab(s) e. MOH signs a contract with the lab(s).

6. Enhance AMR-related research agenda a. Put and broadcast an AMR research agenda including research for alternative agents to antimicrobials. b. Build a platform for researchers to communicate expertise and subjects. c. A yearly or twice yearly meeting of AMR local researchers. d. Organize fund raising for AMR research. e. Provide help for writing proposals to bring national research funds for AMR. Axis C: Infection Prevention and Control (IPC)

1. Optimize IPC practices in hospitals through: a. Finalizing national IPC guidelines in hospitals, 7 b. Inclusion of IPC checklist into MOH Accreditation Standards for health institutions. c. Syndicate of hospitals recommends that each institution provides basic periodic IPC training to its employees.

2. Optimize IPC practices in long-term care facilities (LTCF) and in primary health care centers (PHCC) through: a. Establishing IPC Guidelines. b. Inclusion of IPC checklist into MOH licensing criteria. c. Syndicates of these facilities recommend that each provides basic periodic IPC training to its employees.

3. Providing basic IPC education and training of professionals a. Basic IPC practices, including standard isolation precautions, hand hygiene, etc. b. Make it mandatory and uniform in hospitals, LTCF, PHCC, (at differential level among employees). c. Make IPC training available in healthcare facilities, scientific societies, universities, etc.

4. Including basic IPC educational modules in school curricula of different majors (Medicine, Nursing, Pharmacy, Dentistry, Veterinary medicine, Agriculture, Food Safety)

5. Providing advanced IPC for professionals: a. Put TOR for IPC professionals in different healthcare facilities. b. Put prerequisite training/experience of IPC physicians, officers, and nurses. c. Make training available and affordable in universities and professional societies;

6. Establishing national key performance indicators (process indicators) in IPC through: a. Baseline evaluation of current situation at a national level (research project). b. National indicators to be incrementally applied with time (e.g. hand hygiene, standard isolation precautions, etc.)

7. Evaluation/Surveillance of nosocomial infection rates: a. Conduct a point prevalence study in Lebanese hospitals for the surveillance of nosocomial infections, based on the WHO project of global point prevalence surveys.

8. IPC in the veterinary world: a. To review the inclusion of OIE Biosafety recommendations and their availability in veterinary laws and monitor their application. Axis D: Antibiotics (ABX) Use

1. Improve quality control (QC) of ABX through: a. Supporting and including ABX as priority drugs in the pharmacovigilance project of the Lebanese University, b. Post marketing reporting of safety and efficacy issues of ABX. 8 c. Workshops for training personnel on reporting into the pharmacovigilance network. d. Organization of a national task force that is responsible for analyzing complaints regarding ABX.

2. Putting a list of Clinically Important Antimicrobial Molecules (CIAM).

3. Undergoing sentinel surveillance of ABX consumption in a network of hospitals and benchmark it with international data: a. Workshops for ABX consumption metrics. b. Compilation of data from hospitals.

4. Establishing Antimicrobial Stewardship (AMS) Programs in hospitals through a. Basic AMS training workshops. b. Establishment and dissemination of national treatment guidelines of infectious diseases. c. Inclusion of AMS programs as an accreditation standard. d. Audit of AMS during Accreditation with feedback to hospitals. e. Development of AMS website

5. Regulating ABX use in veterinary and agriculture fields through: a. Banning importation and use of CIAM in Lebanon. b. Surveillance of importation of regularly used ABX to Lebanon. c. Research study about ABX consumption. d. Research study about unofficial importation of ABX to Lebanon.

6. Restricting ABX dispensing in community pharmacies a. Meeting between a high-authority-level task force and the President of the Order of Pharmacists to agree over a plan on this issue. Axis E: Budget planning and fund attraction The plan for economic sustainability was replaced mainly by a plan for budget preparation and preparation of the ground for fund raising for the execution of the NAP.

1. Budget Allocation: a. Calculation of the budget for the whole plan. b. Identify funding gaps. c. Put a strategic plan to attract funds into the NAP The activities of different axes should be executed within the coming 5 years. One cannot deny the influence of the political instability in the country that might hinder the execution of the plan. The determination of many Lebanese scientists and professionals concerning the necessity to turn the tide in AMR, supported by the WHO, Ministry of Public Health (MOH), and the Ministry of Agriculture (MOA) are major contributors to the hoped success of this NAP. 9 Introduction The discovery of penicillin by Alexander Fleming in the middle of the 20th century has been one of the most important milestones in the history of evolution of mankind. Since then, antimicrobials have saved lives of millions and have had a direct impact on the longevity of the species. Like everything in nature, the use of antimicrobials has more than one dimension. On one hand, antimicrobials eradicate offensive organisms and help cure patients from infectious diseases. Meanwhile, other microorganisms were finding their way to escape the effect of these agents, and started building up AMR. In fact, the consumption of antimicrobials is closely correlated to the development of AMR (3-10,13,15). Antimicrobials are not only used in human medicine, but are also used in veterinary medicine (16), in agriculture (17) and in the environment (18). In order to turn the tide of AMR, a multifaceted approach is needed. IPC in healthcare facilities, in the community, and in the veterinary world are mandatory. The proper application of IPC practices in these settings will lead to an important decrease in antimicrobial utilization. In addition, the use of antimicrobials is a human behavior that needs to be put under control, whereby, awareness of the consequences of the excessive use or misuse is a major determinant in the tricyclic professional world and in the community. Subsequently, the use of antimicrobials in humans and animals cannot be left to chance. It should be structured and governed by laws and policies, and should be managed by stewards that are well versed in the fields of infectious diseases and clinical microbiology. All these efforts against AMR should be monitored by surveillance of the quantity and quality of resistance. Continuous research should be carried on to discover new modalities of resistance and alternative ways to fight offensive organisms. In 2015, the World Health Assembly adopted a global action plan to combat AMR, based on the “One Health” concept outlining five objectives. The goal of the WHO GAP is to ensure, if possible the continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them. (14) The GAP is a general plan that should be adapted to each country and modified according to each country’s situation based on its strengths, weaknesses, opportunities and barriers (NAP template). The national plan should be in line with the global plan and should have 5 major objectives:

1. To improve awareness and understanding of the professionals and the public on AMR through effective communication, education, and training. 10

1. To strengthen the knowledge and evidence base through surveillance and research

2. To reduce the incidence of infection through effective sanitation, hygiene and transmission prevention measures

3. To optimize the use of antimicrobials in human and animal health.

4. To develop the economic case for sustainable investment that takes account of the needs of all countries and to increase investment in new drugs, diagnostic tools, vaccines and other interventions. In Lebanon, AMR has been well documented by the scientific societies (10) and attempts at improving the situation are going on. A NAP that is in line with the GAP and that is owned by the official authorities of the country like the MOH and executed through cooperation between the private and the public sectors will definitely curb AMR. 11 Situation analyses and Assessment Lebanon is a relatively small country in the Eastern Mediterranean region with a known surface area of 10,452 km2. The population of Lebanon was estimated to be around 6 million inhabitants in 2016 (19) with additional 1.6 million refugees and asylum seekers from neighboring countries (Syria, Palestine and Iraq) due to wars and political conflicts, as of 2012. (20) Lebanon adult literacy rate (+15 years) was 94.1 % in 2015. (21) According to the MOH, Lebanon has 152 hospitals, 120 public and 32 private, including 6 major hospitals that have medical schools. Medical tourism is quite active in the country mainly from Iraq and other neighboring countries. Strengths A national official AMR committee appointed by the MOH exists. Substantial work on AMR has been done mainly on awareness and surveillance and has been achieved by scientists and academicians. Local expertise is available. What was achieved is the following: 1-Lab training for staff capacity building (covering 160 labs from governmental and private hospitals), 2-Proficiency testing (two cycles including unknowns of 5 pathogens each conducted for 33 labs, covering governmental and private labs), and 3-Producing a booklet about standardized methodology for antimicrobial susceptibility testing by disk diffusion. Weaknesses The AMR-NAP is not officially integrated into the national health plan, and there is no national progress report on implementation of the NAP that is published regularly with open access. There is an absence of a long-term technical and financial investment for implementation. The core components of the existing NAP include 2 to 3 major goals. The operational plan does not include milestones for the coming 1 to 2 years; it rather includes separate activities, where the available specific interventions are fragmented. Specific monitoring and budget plans referring to each operational activity is not available. Threats The political and economic situation of the country can be a major threat to the realization of the NAP to combat AMR, especially with the lack of funds in the MOH, MOA, and the Ministry of Finance. The deficiencies in the basic needs like electricity and waste management on the national level would make it difficult for AMR to become a priority at the high level especially for budget allocation in the cabinet of ministers. 12 Opportunities Several opportunities can be explored like the global interest in AMR, the affiliation of many members of the scientific societies to international organizations that can provide support to the NAP, like The European Society of Clinical Microbiology and Infectious Diseases (ESCMID), The Infectious Diseases Society of America (IDSA), The Food and Agriculture Organization (FAO) of the United Nations (UN), or Mérieux Foundation. The WHO GAP that supports national plans in the region is also a great opportunity for helping and supporting our plan in Lebanon. 13 Country Response The country response to the spread of AMR has started before the preparation of the current NAP, where members of the “Technical Committee on IHR” and “National AMR committee” have already been appointed (Appendix). The “Technical Committee on IHR” is the highest-level authority in charge of supporting legislations and policies requested by the “National AMR committee”. Currently, a NAP is being developed according to the WHO templates to be in line with WHO GAP. Governance Organogram The below diagram illustrates the suggested governance flow of the NAP in Lebanon as a beginning of execution of this plan. Multidisciplinary highest- level authority having the executive power to back up decisions of national Technical Committee on IHR committees in ministries and help introducing high-level decisions and policies -Organize the work and allocate tasks to different subcommittees related to National Committee on AMR AMR containment containment -Evaluate the functioning of subcommittees -Communicate the final decisions with the “Technical Committee on IHR” Economic Following up the Antimicrobi Awareness Surveillance IPC Axis sustainabilit execution of al Use Axis Axis (Focal Axis (Focal (Focal y Axis tasks in the (Focal Person + Person + Person + (Focal operational plans Person + Technical Technical Technical Person + of each of the 5 Technical Working Working Working Technical axes Working Group) Group) Group) Working Group) Group) 14 Axis A: Awareness Strategic plan Objective Activity Sub-activity Date Milestone A.1.1 Nominate a focal A.1 Organization of the person in charge of A.1.1 responsibilities for the following up the activities of time “zero” execution of the tasks the objectives of this axis A.1.2 Choose the members of the Awareness technical working group (Radio/TV Media, Social media expert, Technical, Pharmacist, ID, A.1.2 time “zero” A.1 three months from time Microbiologist, Veterinarian, zero Agriculture, MOH representative, WHO) and nominate them A.1.3 Put the terms of A.1.3 two months from time reference of this technical “zero” group according to NAP A.1.4 three months from A.1.4 Slogan for AMR time “zero” A.2.1.1 LSIDCM scheduled A.2.1 Raising AMR lectures in national A.2 Improving AMR awareness through conferences of the medical, A.2.1.1 awareness among syndicates, orders and A.2 pharmaceutical, nursing, two months from time professionals from different scientific societies 5 years veterinary, agricultural and “zero” sectors (CME, AMR periodic environmental fields across informational SMS, etc.) Lebanon 15 A.2.1.2 Ask syndicates/orders (human and animal health and agriculture) that for CME credits to be given for any A.2.1.2 lecture involving ABX use, Six months from time “zero” at least 2-3 slides should be put to increase awareness about AMR and the ways to prevent it including antimicrobial use. A.2.1.3 Ask orders of pharmacists, veterinarians, physicians, and dentists to send monthly SMS as A.2.1.3 reminders to health 36 months from time zero professionals about the dangers of AMR and/or AMR News. A.2.1.4 A.2.1.4 Workshops on AMR Beginning of November awareness to media each year over 5 years professionals A.2.1.5 Do one workshop per governorate per year to A.2.1.5 veterinarians and agriculture Six months from time zero specialists (Train the trainer) A.2.2.1 Create a webpage A.2.2 Raising AMR A.2.2.1 Three months from for AMR on the official awareness through Internet time “zero” websites of MOH and MOA 16 A.2.2.2 Use existing webpages of MOH and WHO and A.2.2.2 relevant societies on One year from time zero different social networks (Facebook, YouTube, Twitter, Instagram) A.3.1 Prepare broadcasting A.3 Involving traditional material that includes all (TV, radio) media and social sectors of the One health A.3.1 A.3 media (Facebook, approach for Six months from time zero Six months from time zero Instagram) in raising AMR Radio/TV/Social media awareness spots A.4 Raising and improving public awareness using A.4.1 Prepare a yearlong traditional media, social A.4.1 A.4 schedule for TV, Radio and media and Six months from time zero Two years from time zero social media advertisement. telecommunication companies A.4.2 AMR to be A.4.2 periodically discussed in One year from time zero highly watched talk shows A.4.3 Public figure(s) A.4.3 associated with AMR One year from time zero A.4.4 A.4.4 Politician(s) involved Two years from time zero in AMR A.4.5 SMS through national A.4.5 telecommunication Starting end of first year companies sent four times from time zero per year and during the 17 global AMR awareness week A.5 Raising/Improving A.5.1.1 Prepare a checklist A.5.1.1 Start 3 months from A.5.1 Sensitization about AMR awareness in including basic information time zero, A.5 AMR and hygiene in school education curricula on the about AMR that should be Ready at end of first year 9 months from time zero curricula national level included in school curricula from time zero A.5.1.2 Check available A.5.1.2 Start three months school curricula and ask to from time zero fill in the gaps when AMR Ready at 6 months from time information according to zero checklist is not available A.5.2 Inclusion of AMR awareness modules in in A.5.2.1 Prepare checklists A.5.2.1 Start 3 months from curricula of human health- for university curricula of time zero related specialties (medicine, these specialties each one Finalized 9 months from dentistry, pharmacy, separately time zero nursing) A.5.2.2 Check curricula of A.5.2.2 Start 3 months from health specialties to include time zero information on AMR Finalized 9 months from Include AMR tricyclic time zero education A.5.3 Inclusion of AMR A.5.3.1 Prepare a checklist awareness modules in for the needed information A.5.3.1 Three months from curricula of veterinary on AMR for veterinary time zero school school curricula A.5.3.2 Fill the gap in AMR A.5.3.2 information in veterinary Six months from time zero school curricula A.5.4 Inclusion of AMR A.5.4.1 A.5.4.1 awareness modules in Six months from time zero 18 curricula of agriculture Checklist for the needed school information on AMR for agriculture school curricula A.5.4.2 Fill the gap in AMR A.5.4.2 information in agriculture Six months from time zero school curricula A.6.1 MOH and MOA A.6 should advise Involvement of pharmaceutical companies pharmaceutical companies in (Human and Veterinary) to A.6.1 Starting end of first A.6 raising AMR awareness and include in every presentation year from time zero 1 year provide finding for related to antimicrobial use awareness activities at least 3 slides (5%) concerning AMR (Send one letter from each ministry) A.6.2.1 Meeting with CEO s of main A.6.2 Pharmaceutical companies Seek private funding from and working group and Pharmaceutical companies A.6.2 present the highlights of the for awareness activities 6 months AMR plan in general, targeting public and awareness specifically and professionals put plan of contribution to awareness activities 19 Operational plan and budget Sub- Responsibl Source Objective Activity Unit Quantity Date Location Cost Indicator activity e entity Of funding A.1.1 A.1.1 -WHO- Nominate a National focal Professiona person in l Officer A.1.1 A.1.1 A.1.1 charge of (Dr. A 0.25 time Letter of A.1.1 A.1.1 A.1.1 Focal following A.1.1 One Rady) employee appointmen time “zero” MOH MOH person up the (Secretarial t nominated activities of -MOH- functions) the General objectives Director A.1 of this axis (Dr. W Organizatio Ammar) n of the A.1.2 responsibili A.1.2 Choose the A.1.2 ties for the -One focal members of -WHO- execution person the National of the tasks -One Awareness A.1.2 Professiona A.1.2 technical technical -One focal l Officer Technical group working person A.1.2 (Dr. A group A.1.2 time group -One MOH Rady) A.1.2 None A.1.2 None formed and Suggestion “zero” (Radio/TV technical WHO posted on s: Media, group -MOH- AMR -Focal Social General website. person: media Director Dr. R expert, (Dr. W Hamra Technical, Ammar) Pharmacist, 20 ID, -Technical Microbiolo group gist, members: Veterinaria Dr. A n, Rady, Agriculture Dr. R , MOH Hamra, representati Dr. Z ve, WHO) Helou and Dr .A nominate Sirawan them Dr. M Matar Dr. Z Daoud, Dr. B Bazzal, WHO technical person. A.1.3 A.1.3 Put -Focal the terms of person A.1.3 A.1.3 TOR reference A.1.3 two -MOH A.1.3 A.1.3 of technical of this A.1.3 A.1.3 months -WHO- -WHO None None group technical Document One from time National -MOA posted on group “zero” Professiona website according l Officer to NAP (Dr. A Rady) 21 A.1.4 A.1.4 A.1.4 Awareness A.1.4 three A.1.4 A.1.4 Awareness A.1.4 None Slogan is technical A.1.4 months A.1.4 None Slogan for -MOH technical posted on working One from time AMR -WHO working AMR group “zero” group website (PAC) A.2.1.1 LSIDCM A.2.1 scheduled Raising lectures in AMR A.2.1.1 national A.2 awareness -LSIDCM conferences Improving through president of the A.2.1.1 - AMR syndicates, (Dr. Z A.2.1.1 medical, A.2.1.1 LSIDCM awareness orders and Helou) Official pharmaceut A.2.1.1 A.2.1.1 two months -MOH A.2.1.1 A.2.1.1 among scientific schedule ical, Schedule One from time -WHO None None professiona societies - from nursing, “zero” -MOA ls from (CME, Awareness LSIDCM veterinary, different AMR technical agricultural sectors periodic working and information group environmen al SMS, tal fields etc.) across Lebanon A.2.1.2 A.2.1.2 - A.2.1.2 A.2.1.2 Ask Focal Percentage depending syndicates/ A.2.1.2 A.2.1.2 A.2.1.2 person of lectures on number A.2.1.2 orders Letters to Six months Order of A.2.1.2 involving of None (human and syndicates/ from time physicians -LSIDCM None ABX that syndicates/ animal orders “zero” president contain the orders health and (Dr. Z message in agriculture) Helou) 2-3 slides 22 that for CME -President credits to of the be given Order of for any physicians lecture endorsed involving by the IHR ABX use, technical at least 2-3 committee slides should be put to increase awareness about AMR and the ways to prevent it including antimicrobi al use. A.2.1.3 A.2.1.3 Ask orders A.2.1.3 -Percentage A.2.1.3 of Letters to compliance Focal pharmacists orders from to this A.2.1.3 A.2.1.3 person , MOH/MO request of A.2.1.3 36 months -Order of endorsed A.2.1.3 A.2.1.3 veterinarian A to send sending three from time pharmacists by a None/MOH None s, SMS to monthly zero -MOA national physicians, health SMS to multisectori and dentists professiona health al group to send ls professiona monthly ls. 23 SMS as -Number of reminders months to health where SMS professiona were sent ls about the from each dangers of order/total AMR number of and/or months AMR audited News. A.2.1.4 -Focal person -MOH- Director of A.2.1.4 A.2.1.4 A.2.1.4 Public Percentage Workshops Beginning Relations of target on AMR A.2.1.4 of A.2.1.4 A.2.1.4 A.2.1.4 & Health A.2.1.4 media awareness Once/year November 2,000 Workshops Hotel Education AMR Fund personnel to media 5/5 years each year USD/year Dpts (Dr. R whom professiona over 5 Hamra) attend these ls years workshops. -MOH- Public Health Officer (Ms. H Semaha) A.2.1.5 A.2.1.5 A.2.1.5 A.2.1.5 A.2.1.5 A.2.1.5 A.2.1.5 A.2.1.5 A.2.1.5 Workshops MOA -MOA- 24 Do one Seven per Six months Head of 4000 USD -AMR Number of workshop year from time Animal per year Fund workshops per zero Health TOTAL: -MOA per governorate Service 4000X7= governorat per year to (Dr. B 28,000 $ e per year veterinarian Bazzal) s and agriculture -MOA- specialists Head of (Train the Poultry trainer) Husbandry Dpt (Eng. A Sirawan) A.2.2.1 -Focal person -MOH- A.2.2.1 Director of Create a Public A.2.2 A.2.2.1 A.2.2.1 webpage A.2.2.1 Relations Raising AMR blog A.2.2.1 AMR for AMR Three A.2.2.1 & Health A.2.2.1 AMR present on A.2.2.1 10,000 section is on the months -MOH Education AMR fund awareness websites of One USD put on official from time -MOA Dpts (Dr. R through MOH and -C/O MOH MOH/MO websites of “zero” Hamra) Internet MOA A websites MOH and MOA -MOH- Head of Preventive Medicine and Communic 25 able Diseases Dpts (Dr. A Berry) -MOH-IT specialist A.2.2.2 A.2.2.2 -Webpage Use designer existing webpages - of MOH Outsourcin and WHO g call for and A.2.2.2 cotations at A.2.2.2 A.2.2.2 A.2.2.2 relevant A.2.2.2 A.2.2.2 One year A.2.2.2 WHO Within her 5,000 USD Webpages societies on Webpages Four from time MOH job available different zero -MOH- social National E- networks Health (Facebook, Program YouTube, Director Twitter, (Mrs. L Instagram) Abou Mrad) A.3 A.3.1 A.3.1 A.3.1 All A.3.1 Involving Prepare Broadcastin A.3.1 A.3.1 broadcastin Broadcasti traditional broadcastin g material A.3.1 One set of Six months A.3.1 g messages A.3.1 ng material (TV, radio) g material for 15,000 material from time WHO will be WHO available, media and that Radio/TV/ USD zero prepared they are social includes all Social and tricyclic media sectors of media spots 26 (Facebook, the One supported Instagram) health by WHO in raising approach AMR for awareness Radio/TV/ Social media spots A.4 Raising and A.4.1 improving A.4.1 - Prepare a A.4.1 public MOH- yearlong 15,000 awareness Director of schedule A.4.1 USD per A.4.1 using Public for TV, A.4.1 Six months A.4.1 year A.4.1 Schedules traditional A.4.1 One Relations Radio and Schedule from time MOH TOTAL: WHO put and media, & Health social zero 60,000 spots social Education media USD media and Dpts (Dr. R advertisem telecommu Hamra) ent. nication companies A.4.2 AMR A.4.2 A.4.2 to be -Focal A.4.2 Number of periodically A.4.2 Talk A.4.2 person One year A.4.2 A.4.2 talk shows discussed shows Multiple A.4.2 None from time MOH None that discuss in highly -AMR zero AMR per watched Committee trimester talk shows members. A.4.3 A.4.3 A.4.3 A.4.3 Public A.4.3 -LSIDCM Number of A.4.3 A.4.3 One One year A.4.3 figure(s) MOH president A.4.3 None appearance Person or more from time None associated MOA (Dr. Z s in zero with AMR Helou) media/publ 27 ic to -MOH- discuss the Director of subject Public Relations & Health Education Dpts (Dr. R Hamra) A.4.4 A.4.4 Politicians A.4.4 A.4.4 Number of A.4.4 A.4.4 A.4.4 public Three from Two years appearance TV, Radio, -Focal Politician(s statements three from time A.4.4 A.4.4 s in social person ) involved on TV, different zero None None media/publ media -MOH in AMR radio or political ic to -WHO social sides discuss the media subject A.4.5 SMS A.4.5 through -MOH national telecommu A.4.5 -Ministry nication A.4.5 -MOH/ A.4.5 of companies -National -Ministry Starting Communic A.4.5 SMS sent four A.4.5 four telecommu A.4.5 of A.4.5 SMS end of first ation sent times per per year nication None Communic year from year and -MOH ation/ time zero -MOH- during the -MOA MOA General global -WHO Director AMR (Dr. W awareness Ammar) week 28 A.5.1.1 -Focal person -WHO- National A.5 A.5.1.1 Professiona Raising/Im Prepare a A.5.1.1 l Officer A.5.1.1 proving A.5.1 checklist Start 3 (Dr. A A.5.1 Documents A.5.1.1 AMR Sensitizatio including months Rady) Percentage : -Ministry awareness n about basic from time -MOA- of school Basic for A.5.1.1 of A.5.1.1 A.5.1.1 in AMR and information zero, Head of curricula schools One education None None education hygiene in about AMR Ready at Poultry that include (Based on -MOA curricula school that should end of first Husbandry the One Health -MOH on the curricula be included year from Dpt (Eng. message /E-health) national in school time zero A Sirawan) level curricula -Private sector, WHO consultant (Dr. P Abi Hanna) A.5.1.2 A.5.1.2 A.5.1.2 Check Start three A.5.1.2 -WHO- available months A.5.1.2 -Ministry National school from time Report and A.5.1.2 of Professiona A.5.1.2 A.5.1.2 curricula zero letter Two education l Officer None None and ask to Ready at 6 -MOA (Dr. A fill in the months -MOH Rady) gaps when from time AMR zero 29 information -Ms S according Najem to checklist (private is not sector) available -CERD A.5.2 Inclusion A.5.2 of AMR A.5.2.1 A.5.2.1 A.5.2.1 Percentage awareness Prepare Private A.5.2.1 Start 3 of curricula modules in checklists sector, Checklists A.5.2.1 months of health in curricula for A.5.2.1 WHO for Number of from time specialties of human university Universitie consultant, A.5.2.1 A.5.2.1 different curricula of zero that include health- curricula of s former 2,000 USD AMR fund curricula of health Finalized 9 chapters related these WHO LSIDCM health specialties months about specialties specialties president specialties from time AMR/IPC (medicine, each one (Dr. R zero according dentistry, separately Moghnieh) to checklist pharmacy, nursing) A.5.2.2 A.5.2.2 Check A.5.2.2 Report and A.5.2.2 curricula of Private detailed list Start 3 health sector, of months specialties WHO objectives from time A.5.2.2 to include A.5.2.2 consultant, A.5.2.2 A.5.2.2 that are to zero Universitie information One former 2,000 USD AMR fund be included Finalized 9 s on AMR LSIDCM and are months Include president missing in from time AMR (Dr. R each health zero tricyclic Moghnieh) curriculum education 30 A.5.3.1 Prepare a A.8.1 A.5.3 A.5.3 checklist -MOA- Inclusion Veterinary for the A.5.3.1 Head of of AMR A.5.3.1 school needed Three Animal A.5.3.1 awareness A.5.3.1 A.5.3.1 MOA A.5.3.1 curricula information months Health AMR fund modules in Checklist One 500 USD include on AMR from time Service curricula of chapters for zero (Dr. B veterinary about veterinary Bazzal) school AMR/IPC school curricula A.5.3.2 A.5.3.2 -MOA- Fill the gap A.5.3.2 A.5.3.2 Head of in AMR Report to A.5.3.2 Veterinary Animal information Lebanese A.5.3.2 Six months A.5.3.2 A.5.3.2 School- Health in University One from time 1,000 USD AMR fund Lebanese Service veterinary veterinary zero University (Dr. B school school Bazzal) curricula A.5.4.1 A.5.4 Checklist A.5.4.1 A.5.4.1 Inclusion for the Agriculture A.5.4.1 MOA-Head of AMR needed A.5.4.1 school -MOA of Poultry awareness information A.5.4.1 A.5.4.1 Six months A.5.4.1 A.5.4.1 curricula - Husbandry modules in on AMR Checklist One from time 500 USD AMR fund include Universitie Dpt (Eng. curricula of for zero chapters s A Sirawan) agriculture agriculture about school school AMR/IPC curricula A.5.4.2 A.5.4.2 A.5.4.2 A.5.4.2 A.5.4.2 A.5.4.2 A.5.4.2 A.5.4.2 One -MOA 1,000 USD AMR fund 31 Fill the gap Letter from Six months - MOA-Head in AMR the from time Universitie of Poultry information Ministries zero s Husbandry in of Health, Dpt (Eng. agriculture Education A Sirawan) school and curricula Agriculture to agriculture schools A.6.1 A.6.1 MOH and -MOH- MOA Director of should Public A.6 advice Relations Involvemen pharmaceut & Health A.6.1 t of ical Education Percentage pharmaceut companies Dpts (Dr. R of ical (Human A.6.1 A.6.1 Hamra) pharmaceut companies and Letters to Starting A.6.1 ical in raising Veterinary) Ministries A.6.1 A.6.1 Two end of first MOH -MOA- A.6.1 None companies AMR to include of Health MOH year from MOA Head of presentatio awareness in every and time zero Animal ns that and provide presentatio Agriculture Health include the finding for n related to Service message awareness antimicrobi (Dr. B about AMR activities al use at Bazzal) least 3 -MOA- slides (5%) Head of concerning Poultry AMR Husbandry (Send one 32 letter from Dpt (Eng. each A Sirawan) ministry) A.6.2.1 Meeting with CEO s of main A.6.2.1 A.6.2 Pharmaceut Percentage Seek ical of private companies pharmaceut funding and ical from working companies Pharmaceut group and A.6.2.1 that ical present the A.6.2.1 A.6.2.1 A.6.2.1 A.6.2.1 Technical A.6.2.1 A.6.2.1 promote companies highlights Meeting 1 or more 6 months MOH working 1,000 USD AMR Fund antimicrobi for of the group als that are awareness AMR plan contributin activities in general, g into the targeting awareness budget of public and specifically the professiona and put awareness ls plan of campaign contributio n to awareness activities 33 Monitoring and evaluation plan Objective Activity Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline A.1.1 A.1 Nominate a Organization focal person A.1.1, A.1.2 of the in charge of A.1.1 Organize and A.1.1, A.1.2 A.1.1, A.1.2 A.1.1, A.1.2 A.1.1, A.1.2 A.1.1, A.1.2 responsibiliti following up Focal person follow up the MOH Yes/No Once/5 years Appointment NA es for the the activities nominated tasks in the WHO execution of of the plan the tasks objectives of this axis A.1.2 Choose the members of the technical working group A.1.2 (Radio/TV Awareness Media, technical Social media working expert, group Technical, formed and Pharmacist, posted on ID, AMR Microbiologi website. st, Veterinarian, Agriculture, MOH representativ e, WHO) and 34 nominate them A.1.3 Put the terms of reference of A.1.3 TOR Awareness of technical A.1.3 A.1.3 A.1.3 A.1.3 A.1.3 technical working Specify its MOH A.1.3 NA Yes/No Once/5 years Document working group posted activities WHO group on website according to NAP A.1.4 Slogan is A.1.4 Slogan A.1.4 not A.1.4 A.1.4 A.1.4 MOH posted on A.1.4 Slogan A.1.4 NA for AMR applicable Yes/No Once/5 years WHO AMR website A.2.1.1 A.2.1 LSIDCM Raising scheduled A.2 AMR lectures in A.2.1.1 No Improving awareness national A.2.1.1 schedule A.2.1.1 AMR through conferences A.2.1.1 Having the available, Number of awareness syndicates, of the Official commitment A.2.1.1 talks lectures A.2.1.1 A.2.1.1 among orders and medical, schedule from every 6 concentrated given per LSIDCM Document professionals scientific pharmaceuti from LSIDCM in months in Beirut governorate from societies cal, nursing, LSIDCM giving these area, not to per year different (CME, AMR veterinary, lectures. all sectors periodic agricultural professionals informationa and l SMS, etc.) environment al fields 35 across Lebanon A.2.1.2 Ask syndicates/or ders (human and animal health and agriculture) that for CME credits to be A.2.1.2 A.2.1.2 given for any Percentage Number of lecture A.2.1.2 of lectures lectures with A.2.1.2 NAP involving Reminder of involving the A.2.1.2 audit of A.2.1.2 ABX use, at AMR in all A.2.1.2 NA ABX that message/nu every year lectures Audit least 2-3 ABX contain the mber of given slides should lectures. message in lectures be put to 2-3 slides audited*100 increase awareness about AMR and the ways to prevent it including antimicrobial use. A.2.1.3 Ask A.2.1.3 A.2.1.3 Orders of -Percentage Number of pharmacists, compliance A.2.1.3 months A.2.1.3 A.2.1.3 A.2.1.3 A.2.1.3 veterinarians to this Permanent where SMS every six Report from Orders NA , physicians, request of reminding were sent months Orders and dentists sending from each to send monthly Order/total 36 monthly SMS to number of SMS as health months reminders to professionals audited health . professionals -Number of about the months dangers of where SMS AMR and/or were sent AMR News. from each Order/total number of months audited A.2.1.4 Sensitize the A.2.1.4 media to A.2.1.4 Percentage propagate A.2.1.4 A.2.1.4 Workshops of target the message Number of A.2.1.4 Awareness A.2.1.4 on AMR media and gain attendees/nu A.2.1.4 Once per technical Data awareness to personnel their interest mber of NA year working collection media whom attend in bringing it target media group professionals these up in their personnel workshops. programs, sites, and newspapers A.2.1.5 A.2.1.5 A.2.1.5 A.2.1.5 Do one Raise post- Number of Number of workshop graduate A.2.1.5 workshops workshops A.2.1.5 A.2.1.5 A.2.1.5 per AMR MOA per per Once/year Workshop NA governorate awareness WHO governorate governorate per year to among per year per year veterinarians professionals 37 and agriculture specialists (Train the trainer) A.2.2.1 A.2.2 Create a A.2.2.1 Raising webpage for AMR A.2.2.1 A.2.2.1 A.2.2.1 AMR AMR on the section is put A.2.2.1 A.2.2.1 MOH Increase Section on A.2.2.1 NA awareness official on Yes/No Once/5 years MOA visibility website through websites of MOH/MOA Internet MOH and websites MOA A.2.2.2 Use existing webpages of A.2.2.2 MOH and Reach the WHO and young A.2.2.2 relevant A.2.2.2 A.2.2.2 population A.2.2.2 Awareness societies on Yes/No A.2.2.2 A.2.2.2 Webpages and broaden Every three technical different Presence of Webpage NA available the spectrum months working social webpages of people group networks receiving the (Facebook, message YouTube, Twitter, Instagram) A.3 A.3.1 A.3.1 A.3.1 A.3.1 A.3.1 A.3.1 Involving Prepare Percentage Yes/No A.3.1 Awareness Few TV Broadcasting A.3.1 traditional broadcasting of media For each every three technical spots material Counting (TV, radio) material that type for type of months working available available, media and includes all which media group regarding 38 social media sectors of the they are broadcasting human (Facebook, One health tricyclic messages health, not Instagram) approach for have been tricyclic. in raising Radio/TV/So prepared AMR cial media awareness spots A.4 Raising and A.4.1 improving Prepare a public A.4.1 A.4.1 yearlong A.4.1 awareness Emphasize Number of A.4.1 schedule for A.4.1 Awareness using the talk shows A.4.1 every A.4.1 Erratic, in TV, Radio Schedules technical traditional importance per 3 months three months Schedule few morning and social put and spots working media, social of the that discuss shows media group media and subject AMR advertisemen telecommuni t. cation companies A.4.2 AMR A.4.2 to be A.4.2 A.4.2 Number of periodically Number of A.4.2 every Awareness talk shows A.4.2 Reach A.4.2 Talk discussed in activities per three months technical A.4.2 NA that discuss more people show highly trimester per over 5 years working AMR per watched talk governorate group trimester shows A.4.3 Number of A.4.3 A.4.3 Public appearances A.4.3 A.4.3 every Awareness figure(s) A.4.3 Reach A.4.3 in Number of three months technical A.4.3 NA associated more people Statement media/public appearances over 5 years working with AMR to discuss group the subject 39 A.4.4 Number of A.4.4 A.4.4 appearances A.4.4 Reach A.4.4 A.4.4 every Awareness Politician(s) A.4.4 in more people Number of three months technical A.4.4 NA involved in Statement media/public appearances over 5 years working AMR to discuss group the subject A.4.5 SMS through national telecommuni cation A.4.5 A.4.5 companies A.4.5 SMS A.4.5 every Awareness A.4.5 Reach Number of A.4.5 sent four sent three months technical A.4.5 NA more people messages Message times per over 5 years working sent year and group during the global AMR awareness week A.5.1.1 Prepare a A.5 A.5.1 checklist Raising/Impr A.5.1 A.5.1 A.5.1 number of including oving AMR Sensitization Percentage Include curricula that A.5.1 A.5.1 basic awareness in about AMR of school AMR-related included the A.5.1 -Ministry of Checking A.5.1 information education and hygiene curricula that information message/ Once/5 years education and filling NA about AMR curricula on in school include the in school total number -WHO the gaps that should the national curricula message curricula of curricula be included level * 100 in school curricula 40 A.5.1.2 Check available school curricula and ask to fill in the gaps when AMR information according to checklist is not available A.5.2 Inclusion of AMR A.5.2.1 A.5.2 awareness Prepare Percentage A.5.2 A.5.2 modules in checklists of curricula Include number of A.5.2 - in curricula for of health AMR curricula that Ministry of A.5.2 A.5.2 of human university specialties modules in included the A.5.2 education Checking Partially health- curricula of that include curricula of message/ Once/5 years -Universities and filling available related these chapters health total number -MOH the gaps specialties specialties about AMR sciences of curricula -WHO (medicine, each one according to specialties * 100 dentistry, separately checklist pharmacy, nursing) A.5.2.2 Check curricula of health specialties to include 41 information on AMR Include AMR tricyclic education A.5.3.1 A.5.3 Prepare a A.5.3 A.5.3 Inclusion of checklist for Veterinary Include A.5.3 A.5.3 AMR A.5.3 the needed school AMR number of -Ministry of awareness A.5.3 Checking A.5.3 information curricula modules in curricula that education modules in Once/5 years and filling NA on AMR for include curricula of included the -Universities curricula of the gaps veterinary chapters veterinary message -WHO veterinary school about AMR school school curricula A.5.3.2 Fill the gap in AMR information in veterinary school curricula A.5.4 A.5.4.1 A.5.4.1 A.5.4 Inclusion of Checklist for Agriculture A.5.4 Include A.5.4 AMR the needed school -Ministry of A.5.4 AMR/IPC number of awareness information curricula A.5.4 education Checking modules in curricula that A.5.4 NA modules in on AMR for include Once/5 years -Universities and filling curricula of included the curricula of agriculture chapters -MOA the gaps agriculture message agriculture school about -WHO school school curricula AMR/IPC A.5.4.2 42 Fill the gap in AMR information in agriculture school curricula A.6.1 MOH and MOA should advice A.6 pharmaceuti Involvement cal A.6.1 A.6.1 of companies involving A.6.1 Percentage pharmaceuti (Human and pharmaceuti number of of cal Veterinary) cal presentations pharmaceuti companies in to include in companies in including A.6.1 cal A.6.1 A.6.1 raising AMR every raising AMR message/ MOH A.6.1 Letter companies Once/5 years Sporadic awareness presentation awareness total number MOA presentations and provide related to among of that include finding for antimicrobial professionals presentations the message awareness use at least 3 in all health *100 about AMR activities slides (5%) fields concerning AMR (Send one letter from each ministry) A.6.2 A.6.2.1 A.6.2.1 A.6.2.1 A.6.2.1 Seek private Percentage Involving Number of A.6.2.1 Once A.6.2.1 Meeting A.6.2.1 A.6.2.1 funding from of pharmaceuti companies or more/5 MOH with CEO s Meeting(s) NA Pharmaceuti pharmaceuti cal contributing years MOA of main cal cal companies in to the 43 companies Pharmaceuti companies raising AMR project/total for cal that promote awareness number of awareness companies antimicrobial among companies activities and working s that are professionals promoting targeting group and contributing in all health ABX public and present the into the fields professionals highlights of budget of the the AMR awareness plan in campaign general, awareness specifically and put plan of contribution to awareness activities 44 Axis B: Surveillance Strategic Plan Objective Activity Sub-activity Date from operational plan Milestone B.1.1 Appointment of focal B.1 Organization of the B.1.1.1 person n charge of following B.1.1.1 B.1 responsibilities for the Empower up the activities of the three months from time zero three months from time zero execution of the tasks ESU director as focal person objectives of this axis B.1.2 Appointment of the members of the technical B.1.2 working group along with its three months from time zero TOR B.2.1 B.2.1.1 Mapping of labs that can Make a list of laboratories potentially provide that will ultimately form an B.2 B.2.1.1 microbiologically reliable epidemiologic representation B.2 Reporting of AMR data to Three months from time and epidemiologically of the country and that will 5 years GLASS zero representative data. be sequentially entered into These labs start reporting GLASS after capacity their data to the (GLASS). building B.2.2 Put a plan for capacity B.2.2.1 building for the labs that are Organize a nationwide B.2.2.1 chosen to be included in workshop about GLASS and Three months from time GLASS report in order to be the plan of inclusion in zero epidemiologically GLASS and introduction to representative based on an WHONET incremental plan B.2.2.2 B.2.2.2 45 -Evaluate the quality of End of first year from time work in the selected zero: 4 laboratories laboratories (visit), -Check 8 laboratories per Second year from time zero: year, 4 laboratories -Select the ones that can immediately report to Each year 4 laboratories GLASS, -Put a plan for 4 laboratories that will undergo improvement in their capacity during coming year, then repeat the same the following year, then the following years B.2.2.3 Do a start up WHONET B.2.2.3 training for the 8 Three months from time laboratories that were chosen zero for the coming 2 years every 2 years B.2.2.4 Do 3 laboratory visits for B.2.2.4 capacity building/year for 4 Three visits per lab each laboratories in different year for 4 laboratories areas for building capacity starting year 1 and WHONET training B.2.2.5 External quality control B.2.2.5 twice per year for the 8 Six months from time zero laboratories chosen for the 2 years, then to add the ones of 46 the following 2 years, after the 2nd year. B.2.3.1 B.2.3.1 B.2.3 Data collection from mature Start end of 1st year from Data Entry in GLASS laboratories time zero B.2.3.2 B.2.3.2 Data cleaning and entry into Start end of 1st year from GLASS time zero B.3.1 -This report is based on WHONET data, according B.3 to local needs of physicians, Periodic issuing of an pharmacists and researchers B.3.1 epidemiologically (stratification of data based B.3 Once/year starting end of 1st representative national AMR on the type of priority 1 year year surveillance report in organisms, site/region of humans infection or acquisition, etc.) -This report is posted on AMR webpages (MOH and MOA websites) B.4 B.4.1 Optimize AMR surveillance Research project about AMR B.4 B.4.1 in the agricultural, food, surveillance in the veterinary 2 years 6 months from time zero veterinary, and field. environmental fields B.4.2 Design an epidemiologically representative sample for B.4.2 9 months from time AMR surveillance (cattle, zero poultry, companion animals). 47 B.4.3 Put a list of AMR priority organisms and B.4.3 6 months from time related resistance genes for zero surveillance in these fields B.4.4 -Assessment of LARI, agriculture laboratory, and the chamber of manufacturing and B.4.4 commerce in Tripoli for the Six months from time zero analysis of surveillance and completed nine months specimens in agricultural, from time zero food, veterinary, and environmental fields -Suggestion of a plan of the microbiology work in this surveillance B.4.5 -Report results of ABX use and resistance surveillance in agriculture and veterinary B.4.5 world First report should be ready -Send a yearly report with at end of year 2 from time recommendations to the zero animal drug registry about ABX purchasing in the country during the coming 2 years B.5 B.5.1 B.5.1 B.5 Create/Appoint AMR Define TOR of AMR 3 months from time zero 9 months from time zero reference lab(s) reference lab B.5.2 B.5.2 48 Map potential lab(s) across Start at time zero Lebanon Mapping finalized 3 months from time zero B.5.3 Task force to visits the B.5.3 potential lab(s) (WHO 5 months from time zero EMRO) to be discussed with Dr A. Rady B.5.4 B.5.4 Nominate the reference 6 months from time zero lab(s) B.5.5 MOH to sign a B.5.5 9 months from time contract with the lab(s) zero B.6.1 B.6.1 B.6 Enhance research Put and broadcast an AMR B.6 1st agenda sent activities in AMR Research Agenda including 1.5 years from time zero 1.5s year from time zero surveillance research for alternative agents to antimicrobials. 49 Operational Plan Responsibl Source Sub- Objective Activity Unit Quantity Date Location e Cost Of Indicator activity Entity Funding B.1.1.1 B.1.1 -WHO- Appointme National B.1.1.1 B.1 nt of focal Professiona Empower Organizatio person n B.1.1.1 B.1.1.1 l Officer B.1.1.1 ESU B.1.1.1 n of the charge of Appointme B.1.1.1 three B.1.1.1 (Dr. A ½ time director as Focal responsibili following nt One months MOH Rady) extra B.1.1.1 focal person ties for the up the from time ESU employee MOH person. nominated execution activities of zero -MOH- for ESU of the tasks the General objectives Director of this axis (Dr. W Ammar) B.1.2 -WHO- B.1.2 National Appointme Professiona nt of the B.1.2 l Officer B.1.2 B.1.2 members of B.1.2 three B.1.2 (Dr. A ½ time Technical the B.1.2 B.1.2 Appointme months MOH Rady) extra working technical One MOH nt from time ESU employee group working zero -MOH- for ESU assigned group General along with Director its TOR (Dr. W Ammar) B.2 B.2.1 B.2.1.1 B.2.1.1 B.2.1.1 B.2.1.1 B.2.1.1 B.2.1.1 B.2.1.1 B.2.1.1 B.2.1.1 50 Reporting Mapping of Make a list List One Three MOH -Focal None None List of AMR labs that of months ESU person available to data to can laboratories from time technical GLASS potentially that will zero - working provide ultimately group microbiolo form an gically epidemiolo reliable and gic epidemiolo representati gically on of the representati country and ve data. that will be These labs sequentiall start y entered reporting into their data to GLASS the after (GLASS). capacity building B.2.2 B.2.2.1 Put a plan Organize a for capacity nationwide building for B.2.2.1 workshop the labs B.2.2.1 -Technical about B.2.2.1 that are B.2.2.1 Three working B.2.2.1 GLASS B.2.2.1 B.2.2.1 1,800 USD B.2.2.1 chosen to one every 5 months group Workshop and the Workshop WHO per AMR Fund be included years from time -Focal given plan of workshop in GLASS zero Person inclusion in report in GLASS order to be and epidemiolo introductio gically 51 representati n to ve based on WHONET an incremental plan B.2.2.2 -Evaluate the quality of work in the selected laboratories (visit), B.2.2.2 -Check 8 B.2.2.2 B.2.2.2 laboratories 8 End of first -List of per year, laboratories year from B.2.2.2 laboratories -Select the per 2 years time zero: 4 B.2.2.2 500 USD that will ones that Total= laboratories B.2.2.2 Technical per visit B.2.2.2 immediatel can 20 The chosen working Total: Laboratory B.2.2.2 y report is immediatel laboratories Second laboratories group 500*8= visits AMR Fund listed on y report to in 5 years year from helped by 4,000 USD website GLASS, from time zero: 4 laboratory per 2 years -Schedule -Put a plan different laboratories technicians In 5 years: for other for 4 governorate 8,000 USD laboratories laboratories s Each year 4 is put that will laboratories undergo improveme nt in their capacity during coming year, then 52 repeat the same the following year, then the following years B.2.2.3 B.2.2.3 -Private Do a start sector, up WHO WHONET consultant B.2.2.3 training for (Dr. Z B.2.2.3 Three the 8 B.2.2.3 Daoud) B.2.2.3 B.2.2.3 B.2.2.3 One every months B.2.2.3 laboratories WHO AMR Workshop Workshop two years from time 2,000 USD that were -Private Fund is done zero chosen for sector (Dr. the coming G Matar) 2 years every 2 - years Technician s B.2.2.4 B.2.2.4 B.2.2.4 Do 3 B.2.2.4 3 capacity Number of laboratory B.2.2.4 Three visits building laboratories visits for Three visits per lab B.2.2.4 B.2.2.4 workshops that are B.2.2.4 B.2.2.4 capacity per lab each year The chosen Technical per year passing the Laboratory AMR building/ye each year for 4 laboratories working 5 years: external visits Fund ar for 4 for 4 laboratories group 15 QC / Total laboratories laboratories starting workshop external in different year 1 800 USD QC tests areas for per sent*100 53 building workshop = capacity 12,000 and USD WHONET training B.2.2.5 External quality control twice per B.2.2.5 B.2.2.5 B.2.2.5 B.2.2.5 year for the Years 1 &2 Send the 100 USD Number of 8 year: 8 quality B.2.2.5 B.2.2.5 B.2.2.5 /specimen laboratories laboratories Years 3 & B.2.2.5 control Six months Reference Technical (8+8+4)*2 having chosen for 4:16 AMR specimens from time laboratory working = external the 2 years, Year: 5 Fund and collect zero (ies) group 4,000 QC then to add 24 them USD/5 the ones of years the following 2 years, after the 2nd year. B.2.3.1 B.2.3.1 B.2.3 Data B.2.3 B.2.3.1 Start end of Number of collection B.2.3.1 B.2.3.1 B.2.3.1 B.2.3.1 B.2.3.1 Data Entry Data 1st year laboratories from Once/year ESU ESU None None in GLASS collection from time reporting to mature zero GLASS laboratories B.2.3.2 B.2.3.2 B.2.3.2 B.2.3.2 B.2.3.2 B.2.3.2 Data Data B.2.3.2 ½ time B.2.3.2 Start end of ESU -ESU cleaning cleaning Once/year Extra MOH 1st year and entry and entry employee 54 into from time -MOH- GLASS zero Head of Epidemiolo gical Surveillanc e Program (Dr. N Ghosn) B.3.1 -This report is based on WHONET data, according B.3 to local Periodic B.3.1 needs of issuing of Technical physicians, B.3.1 an working pharmacists Epidemiolo epidemiolo B.3.1 B.3.1 B.3.1 group or and gic report gically B.3.1 Once/year Once/year University interested B.3.1 B.3.1 researchers posted on representati Report starting end starting end hospitals researchers None None (stratificati AMR ve national of 1st year of 1st year LSIDCM assigned by on of data website AMR technical based on yearly surveillanc working the type of e report in group priority humans organisms, site/region of infection or acquisition, etc.) 55 -This report is posted on AMR webpages (MOH and MOA websites) B.4.1 -AUB-Dpt of Agriculture (Dr. M Farran) B.4 -MOA- Optimize B.4.1 Head of AMR Research Animal B.4.1 surveillanc project Health B.4.1 B.4.1 MOA e in the about AMR Service Surveillanc B.4.1 B.4.1 6 months Department B.4.1 B.4.1 agricultural surveillanc (Dr. B e report Project One from time of None None , food, e in the Bazzal) every 2 zero agriculture veterinary, veterinary years (AUB) and field. -MOA- environmen Head of tal fields Poultry Husbandry Dpt (Eng. A Sirawan) -MOH- Head of Epidemiolo 56 gical Surveillanc e Program (Dr. N Ghosn) B.4.2 - B.4.2 MOA-Head Design an of Animal epidemiolo Health gically Service representati B.4.2 B.4.2 9 (Dr. B ve sample Organizatio months Bazzal) B.4.2 1,000 B.4.2 AMR B.4.2 one B.4.2 MOA B.4.2 None for AMR n project from time USD/year fund surveillanc zero -MOA- e (cattle, Head of poultry, Poultry companion Husbandry animals). Dpt (Eng. A Sirawan) B.4.3 Put a B.4.3 - list of MOA-Head AMR of Animal priority Health B.4.3 6 B.4.3 - organisms Service months MOA B.4.3 B.4.3 and related B.4.3 List B.4.3 One (Dr. B B.4.3 None from time -MOH 1,000 USD AMR fund resistance Bazzal) zero -WHO genes for surveillanc -Technical e in these working fields group B.4.4 B.4.4 B.4.4 B.4.4 B.4.4 B.4.4 B.4.4 B.4.4 B.4.4 three -LARI AMR 57 - Visits to Six months -Tripoli -Technical 500 USD Fund Report Assessment three from time chamber of working per visit about the of LARI, laboratories zero and manufactur group Total: 3 capacity of agriculture with audit completed ing and visits these laboratory, result nine commerce -LARI 1,500 USD laboratories and the months -Bekaa to do AMR chamber of from time AUB -Tripoli surveillanc manufactur zero laboratory chamber of e in the ing and manufactur veterinary commerce ing and world in Tripoli commerce for the analysis of -Bekaa surveillanc AUB e laboratory specimens in agricultural , food, veterinary, and environmen tal fields -Suggestion of a plan of the microbiolo gy work in this surveillanc e B.4.5 B.4.5 B.4.5 B.4.5 B.4.5 B.4.5 B.4.5 B.4.5 B.4.5 58 -Report Report Once every First report MOA -MOA- 3,000 AMR Fund Quantity of results of 2 years should be Head of USD/report purchased ABX use ready at Animal (Every 2 ABX that and end of year Health years) are listed in resistance 2 from time Service Total the surveillanc zero (Dr. B 7,000 “restricted e in Bazzal) USD/5 use list” in agriculture years the and -Technical veterinary veterinary working world world group -Send a yearly report with recommend ations to the animal drug registry about ABX purchasing in the country during the coming 2 years B.5.1 B.5 B.5 Define B.5.1 B.5.1 B.5.1 Reference Create/App TOR of B.5.1 B.5.1 3 months ESU Technical B.5.1 B.5.1 laboratory/l oint AMR AMR Document 1 from time MOH working None None aboratories reference reference zero group appointed lab(s) lab and 59 contracts done B.5.2 B.5.2 Start at B.5.2 Map time zero ESU B.5.2 potential B.5.2 B.5.2 Mapping MOH Technical B.5.2 B.5.2 lab(s) List One finalized 3 Potential working None None across months laboratories group Lebanon from time zero B.5.3 Task force to visits the B.5.3 potential B.5.3 one to each B.5.3 lab(s) B.5.3 Visit done potential 5 months B.5.3 B.5.3 B.5.3 (WHO Potential by EMRO reference from time EMRO 3,000 USD EMRO EMRO) to laboratories consultant laboratory zero be discussed with Dr A. Rady B.5.4 B.5.4 One B.5.4 B.5.4 B.5.4 Nominate B.5.4 nomination 6 months EMRO EMRO B.5.4 B.5.4 the Nominatio of one or from time WHO WHO None None reference n more zero MOH MOH lab(s) laboratories B.5.5 MOH B.5.5 B.5.5 9 B.5.5 - to sign a one or B.5.5 months MOH- contract more B.5.5 MOH B.5.5 None B.5.5 None Contract from time General with the depending zero Director lab(s) on number 60 of chosen (Dr. W reference Ammar) laboratories B.6.1 Put and broadcast B.6 B.6.1 B.6.1 an AMR B.6.1 Enhance 1st agenda MOH B.6.1 Research Research research B.6.1 sent WHO Technical Agenda B.6.1 B.6.1 B.6.1 agenda activities in One/2 1.5 years ESU working including Agenda None None listed on AMR years from time Universitie group research for AMR surveillanc zero s ESU alternative website e agents to antimicrobi als. 61 Monitoring and evaluation plan Objective Activity Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline B.1.1 Appointment B.1 of focal Organization B.1.1.1 person n B.1.1.1 of the Empower B.1.1.1 B.1.1.1 B.1.1.1 charge of Follow up on B.1.1.1 B.1.1.1 B.1.1.1 responsibiliti ESU director Focal person MOH Partially, following up the activities Yes/No Once/5 years Letter es for the as focal nominated WHO unofficially the activities of this axis execution of person of the the tasks objectives of this axis B.1.2 Appointment B.1.2 B.1.2 of the Technical Execution of B.1.2 members of B.1.2 B.1.2 B.1.2 B.1.2 working most of the MOH the technical Yes/No Once/5 years Letter NA group activities of WHO working assigned the axis group along with its TOR B.2.1.1 B.2.1 B.2.1.1 Make a list Mapping of Mapping of of labs that can B.2.1.1 potential laboratories B.2 potentially List laboratories that will B.2.1.1 Reporting of provide available to and in order B.2.1.1 B.2.1.1 B.2.1.1 B.2.1.1 ultimately ESU AMR data to microbiologi technical to have an Yes/No Once/4 years Listing NA form an MOH GLASS cally reliable working epidemiologi epidemiologi and group cally c epidemiologi representativ representatio cally e sample n of the 62 representativ country and e data. that will be These labs sequentially start entered into reporting GLASS after their data to capacity the building (GLASS). B.2.2 Put a plan B.2.2.1 for capacity B.2.2.1 Introduction building for Organize a to GLASS the labs that nationwide and the plan, are chosen to workshop mainly be included about because in GLASS B.2.2.1 B.2.2.1 B.2.2.1 GLASS and recruitment B.2.2.1 B.2.2.1 B.2.2.1 report in Workshop WHO Done the plan of of the Yes/No Once/5 years workshop order to be given MOH partially inclusion in laboratories epidemiologi GLASS and is based on cally introduction voluntary representativ to enrollment e based on WHONET into the an project incremental plan B.2.2.2 B.2.2.2 -Evaluate the B.2.2.2 -List of B.2.2.2 B.2.2.2 quality of Organization B.2.2.2 laboratories Schedule is B.2.2.2 -WHO B.2.2.2 work in the of the work Laboratory that will put. Once/year -Chosen NA selected and a 4 year visits immediately Yes/No laboratories laboratories schedule report is (visit), 63 -Check 8 listed on laboratories website per year, -Schedule -Select the for other ones that can laboratories immediately is put report to GLASS, -Put a plan for 4 laboratories that will undergo improvement in their capacity during coming year, then repeat the same the following year, then the following years B.2.2.3 B.1.1.4 B.2.2.3 Do a start up WHONET Once done WHONET B.2.2.3 training for B.2.2.3 B.2.2.3 B.2.2.3 B.2.2.3 not focused training for Workshop is laboratories Once every WHO Yes/No Workshop to the 8 done that will two years MOH laboratories laboratories report to that will that were GLASS 64 chosen for enter the coming 2 GLASS years every 2 years B.2.2.4 Do 3 laboratory B.2.2.4 B.2.2.4 visits for Number of Number of capacity laboratories laboratories B.2.2.4 building/year that are that are Recommend B.2.2.4 B.2.2.4 for 4 passing the passing the B.2.2.4 B.2.2.4 ation for -Chosen Laboratory laboratories external QC external QC Once/Year NA GLASS laboratories visits in different / Total / Total entry areas for external QC external QC building tests tests capacity and sent*100 sent*100 WHONET training B.2.2.5 External quality control twice B.2.2.5 B.2.2.5 B.2.2.5 per year for Number of B.2.2.5 Send the B.2.2.5 Number of B.2.2.5 the 8 laboratories Measure the quality Few labs in quality B.2.2.5 Reference laboratories having progress of control the country control Once/year laboratory chosen for external QC the capacity specimens have it specimen (ies) the 2 years, building. and collect sent /year then to add them the ones of the following 2 65 years, after the 2nd year. B.2.3 Two laboratories B.2.3 have already B.2.3.1 B.2.3 B.2.3 Reach B.2.3 submitted B.2.3 Data Number of Number of B.2.3 epidemiologi B.2.3 Data data to Data Entry collection laboratories laboratories WHO c Once/Year collection GLASS. in GLASS from mature reporting to reporting to MOH representativ and entry Not laboratories GLASS GLASS eness epidemiologi cally representativ e B.2.3.2 Data cleaning and entry into GLASS B.3.1 B.3 -This report Periodic is based on issuing of an WHONET B.3.1 epidemiologi data, Epidemiolog B.3.1 B.3.1 cally according to ic report Improve Compilation B.3.1 B.3.1 B.3.1 B.3.1 representativ local needs posted on awareness in of University Once/5 years Project NA e national of AMR scientific WHONET hospital(s) AMR physicians, website society data surveillance pharmacists yearly report in and humans researchers (stratificatio 66 n of data based on the type of priority organisms, site/region of infection or acquisition, etc.) -This report is posted on AMR webpages (MOH and MOA websites) B.4 Optimize B.4.1 AMR Research B.4.1 surveillance project about B.4.1 Standardized B.4.1 in the AMR Surveillance AMR B.4.1 B.4.1 every Agriculture agricultural, surveillance B.4.1 Project B.4.1 NA report every surveillance Yes/No two years school food, in the 2 years in cattle and MOA veterinary, veterinary poultry and field. environment al fields B.4.2 Design an epidemiologi B.4.2 None cally representativ 67 e sample for AMR surveillance (cattle, poultry, companion animals). B.4.3 Put a list of AMR priority organisms and related B.4.3 None resistance genes for surveillance in these fields B.4.4 -Assessment of LARI, B.4.4 agriculture B.4.4 Report about laboratory, B.4.4 -LARI the capacity and the Standardized -Tripoli of these chamber of AMR chamber of laboratories B.4.4 B.4.4 once/5 manufacturin surveillance manufacturin B.4.4 Report B.4.4 NA to do AMR Yes/No years g and in the g and surveillance commerce in veterinary commerce in the Tripoli for world -Bekaa AUB veterinary the analysis laboratory world of surveillance specimens in 68 agricultural, food, veterinary, and environment al fields -Suggestion of a plan of the microbiolog y work in this surveillance B.4.5 -Report results of ABX use and B.4.5 resistance Quantity of surveillance purchased B.4.5 in ABX that are Control B.4.5 agriculture listed in the ABX use in Quantity of B.4.5 Once and B.4.5 MOA B.4.5 Report B.4.5 NA “restricted the purchased every 2 years veterinary use list” in veterinary ABX world the world -Send a veterinary yearly report world with recommenda tions to the animal drug registry 69 about ABX purchasing in the country during the coming 2 years B.5 Have a B.5 reference for B.5 B.5 Reference difficult B.5.1 No of Create/Appo laboratory/la situations B.5 Define TOR specimens/ac B.5 B.5 int AMR boratories and catch -WHO B.5 NA of AMR tivities of Once/Year Appointment reference appointed alarming and MOH reference lab reference lab(s) and contracts emerging Lab in AMR done resistance trends B.5.2 Map potential lab(s) across Lebanon B.5.3 Task force to visits the potential lab(s) (WHO EMRO) to be discussed with Dr A. Rady B.5.4 70 Nominate the reference lab(s) B.5.5 MOH to sign a contract with the lab(s) B.6.1 Put and B.6.1 broadcast an Involve and AMR B.6 Enhance B.6.1 update Research research Research concerned B.6.1 B.6.1 MOH Agenda B.6.1 Once/2 B.6.1 activities in agenda listed facilities in number of WHO B.6.1 NA including years Agenda AMR on AMR research projects ESU research for surveillance website activities in alternative surveillance agents to antimicrobial s. 71 Axis C: Infection prevention and control (IPC) Strategic plan Objective Activity Sub-activity Date (operational plan) Milestone C.1.1 Appointment of focal C.1 Organization of the person n charge of following C.1 three months from “time C.1 three months from “time responsibilities for the up the activities of the zero” zero” execution of the tasks objectives of this axis C.1.2 Appointment of the members of the technical group along with its TOR C.2.1.1 To finalize national IPC guidelines; guidelines to C.2 Optimize IPC practices C.2.1 Improve IPC practices be all-inclusive including C.2.1.1 three months from C.2 in Hospitals, long term care in Hospitals requirements and “time zero” 3 years facilities and PHCC qualifications of IPC officer and physician and checklist C.2.1.2 Inclusion of the C.2.1.2 six months from checklist of the guidelines in “time zero” accreditation standards C.2.1.3 Follow up and feedback on IPC practices in C.2.1.3 three years from hospitals after each “time zero” accreditation C.2.1.4 Syndicate of hospitals recommends periodic IPC training and C.2.1.4 workshops to employees 1,5 years from “time zero” hosted by scientific societies, universities, etc. 72 C.2.2.1 To review and update C.2.2.1 C.2.2 Improve IPC practices guidelines of IPC in long- three months from “time in long-term care facilities term care facilities that are zero” available in Ministry of Social Affairs C.2.2.2 Inclusion of IPC checklist in the MOH C.2.2.2 six months from licensing criteria of these “time zero” facilities C.2.3 Improve IPC practices C.2.3.1 Establish guidelines C.2.3.1 six months from in PHCC on IPC in the PHCC “time zero” C.2.3.2 Inclusion of IPC checklist in the MOH C.2.3.2 nine months from licensing criteria of these “time zero” facilities C.3.1 Include IPC-related educational modules in human-health related majors C.3 (physicians, nurses, C.3.1 C.3 Enhance IPC education midwives, physiotherapists, one year from “time zero” 2 years from “time zero” different majors pharmacists, dentists, lab technicians, radiologists, nutrition, medical and paramedical schools) C.3.2.1 Check the current C.3.2 Include IPC-related situation of IPC in the C.3.2.1 three months from educational modules in ongoing veterinary “time zero” veterinary schools curricula curriculum 73 C.3.2.2 Review of IPC in C.3.2.2 three months from regional and global “time zero” veterinary curricula C.3.2.3 Prepare a proposal for veterinary school for C.3.2.3 six months from deficit in curricula “time zero” improvement, if need be. C.3.3.1 C.3.3 IPC-related Mapping of IPC in three educational modules in university curricula C.3.3.1 curricula of three schools (Agriculture, Nutrition, six months from “time zero” (Agriculture, Nutrition, Environment) Environment) C.3.3.2 Review global and regional recommendations on IPC in C.3.3.2 curricula of agriculture, six months from “time zero” nutrition and environment, and formulate what should be included in them C.3.3.3 Include the recommended C.3.3.3 tricyclic AMR and IPC in 2 years from “time zero” curricula when not available C.4.1 -Put TOR for IPC professionals in different C.4.1.1 C.4 healthcare facilities. Include in the national IPC C.4.1.1 C.4 Advanced IPC training for -Put prerequisite Guidelines the TOR of the 3 months 3 months IPC professionals training/experience of IPC professionals physicians, officers, and nurses 74 C.4.2.1 MOH Sends letters to Ministry of Higher C.4.2 Education and to Order of Make training available and C.4.2.1 physicians explaining the affordable in universities and 3 months need and recommending professional societies training specialization opportunities and courses related to IPC C.5.1 C.5 Baseline evaluation of C.5.1 C.5 National Process Indicators current situation at a national One year from “time zero” Four years from “time zero” in IPC level (research project) and make it a continuous process C.5.2 National indicators to be incrementally applied C.5.2 with time (hand hygiene, Four years from “time zero” PPE, isolation, other standard precautions, etc) C.6.1 C.6 Conduct a point prevalence C.6.1 C.6 Survey of Nosocomial study on nosocomial 2 years 2 years Infections in hospitals infections in Lebanese hospitals C.7.1 C.7 C.7.1 C.7 Review the OIE biosafety IPC in the veterinary world 3 months 6 months recommendations C.7.2 Check the availability in of C.7.2 these recommendations in 5 months local veterinary laws C.7.3 C.7.3 C.7.3 75 Monitor the application of MOH recommends to MOA 6 months these laws to follow up on the related activities of IPC in Veterinary world 76 Operational plan and budget Sub- Responsibl Source Objective Activity Unit Quantity Date Location Cost Indicator activity e entity Of funding C.1 -MOH- General Director C.1.1 (Dr. W Appointme Ammar) C.1 nt of focal appoints of Organizatio person n C.1 One C.1 C.1 three the n of the charge of C.1 person and C.1 One Appointme months technical C.1 AMR responsibili following Appointme one C.1 MOH full time nt letter from “time working Fund ties for the up the nt technical employee with job zero” group execution activities of group description -Focal of the tasks the person is objectives appointed of this axis by the technical working group C.1.2 Appointme nt of the members of the IPC technical working group along with its TOR 77 C.2.1.1 To finalize national IPC C.2 guidelines; Optimize guidelines IPC C.2.1 to be all- C.2.1.1 C.2.1.1 C.2.1.1 practices in Improve inclusive three C.2.1.1 C.2.1.1 -MOH C.2.1.1 C.2.1.1 Guidelines Hospitals, IPC including C.2.1.1 one months AMR Document -LSIDCM IPC expert 2,000 USD on MOH long term practices in requiremen from “time Fund -WHO site care Hospitals ts and zero” facilities qualificatio and PHCC ns of IPC officer and physician and checklist C.2.1.2 C.2.1.2 Inclusion -IPC expert of the C.2.1.2 C.2.1.2 six C.2.1.2 C.2.1.2 checklist of -MOH- C.2.1.2 Letter from C.2.1.2 months -MOH AMR the C.2.1.2 one Project 1,000 USD team to Checklist from “time -LSIDCM Fund guidelines Coordinato IPC zero” -WHO in r Officer accreditatio (Eng. S n standards Akkoum) C.2.1.3 C.2.1.3 C.2.1.3 Follow up C.2.1.3 -IPC C.2.1.3 Percentage C.2.1.3 one C.2.1.3 and C.2.1.3 three years C.2.1.3 coordinator Syndicate of hospitals every 5 3,000 USD feedback Report from “time MOH or of hospitals with years on IPC zero” temporary acceptable practices in consultant results for 78 hospitals - IPC in after each Accreditati accreditatio accreditatio on team n n C.2.1.4 Syndicate of hospitals C.2.1.4 recommend -MOH- s periodic Head of IPC C.2.1.4 Preventive C.2.1.4 training C.2.1.4 Hospitals Medicine Number of and C.2.1.4 1,5 years C.2.1.4 C.1.1.4 C.2.1.4 one Universitie and IPC workshops Schedule from “time None None s Communic workshops to zero” able per year employees Diseases hosted by Dpts (Dr. A scientific Berry) societies, universities , etc. C.2.2.1 To review C.2.2.1 C.2.2 and update -Order of Improve guidelines C.2.2.1 nurses (Ms C.2.2.1 IPC of IPC in C.2.2.1 three C.2.2.1 C.2.2.1 M Said) C.2.2.1 Updated practices in long-term Guidelines months C.2.2.1 One MOH AMR fund guidelines long-term care from “time 2,000 USD -Private on website care facilities zero” sector (Dr. facilities that are M Youssef) available in Ministry of 79 Social Affairs C.2.2.2 Inclusion C.2.2.2 of IPC -MOH- C.2.2.2 C.2.2.2 six checklist in Project Checklist C.2.2.2 C.2.2.2 months C.2.2.2 C.2.2.2 C.2.2.2 the MOH Coordinato of IPC in Checklist One from “time MOH None None licensing r accreditatio zero” criteria of (Eng. S n standards these Akkoum) facilities C.2.3.1 Private Sector C.2.3 C.2.3.1 (Dean of C.2.3.1 six C.2.3.1 C.2.3.1 C.2.3.1 Improve Establish School of C.2.3.1 C.2.3.1 months -MOH 3,000 USD C.2.3.1 Guidelines IPC guidelines Nursing- Guidelines One from “time -LSIDCM AMR fund on website practices in on IPC in Saint zero” -WHO PHCC the PHCC Joseph University) (Dr. C Zablit) C.2.3.2 C.2.3.2 Inclusion Private C.2.3.2 of IPC C.2.3.2 Sector Checklist checklist in nine (Dean of C.2.3.2 C.2.3.2 C.2.3.2 C.2.3.2 C.2.3.2 of IPC in the MOH months School of Checklist One MOH 1,000 USD AMR fund accreditatio licensing from “time Nursing- n criteria of zero” Saint standards. these Joseph facilities University) 80 (Dr. C Zablit) C.3.1 One appointed C.3.1 consultant Include helped by: IPC-related educational -Order of modules in nurses- human- C.3.1 Director health -Basic (Ms. N C.3.1 related recommend Richa) one per C.3.1 majors ations to be year Percentage C.3 (physicians included C.3.1 -Order of of health Enhance , nurses, -IPC C.3.1 Midwives- C.3.1 C.3.1 2 types: curricula IPC midwives, Letters one year Ministry of member 15,000 AMR

1.General that education physiothera from from “time Education (Ms. M USD Fund

2.Specific contain different pists, Ministry of zero” MOH Romeh) to nurses, IPC majors pharmacist education midwives modules s, dentists, to different -MOH- medical lab teaching PHC Dpt- students. technicians, establishme Dental radiologists nts Coordinato , nutrition, r (Dr M medical Msallem) and paramedica -Technical l schools) Schools (Ms. S Younes) 81 ”2h/speciali st” C.3.2.1 C.3.2 C.3.2.1 -MOA- Include Check the C.3.2.1 Head of IPC-related current three Animal educational situation of C.3.2.1 C.3.2.1 C.3.2.1 C.3.2.1 C.3.2.1 months Health C.3.2.1 modules in IPC in the Report One MOA AMR fund None from “time Service 500 USD veterinary ongoing zero” (Dr. B schools veterinary Bazzal) curricula curriculum C.3.2.2 C.3.2.2 -MOA- Review of C.3.2.2 Head of IPC in three Animal C.3.2.2 C.3.2.2 C.3.2.2 C.3.2.2 C.3.2.2 C.3.2.2 regional months Health Report One MOA 1,000 USD AMR fund None and global from “time Service veterinary zero” (Dr. B curricula Bazzal) C.3.2.3 C.3.2.3 -MOA- Prepare a Head of C.3.2.3 proposal Animal Proposal is for C.3.2.3 six Health sent to veterinary C.3.2.3 C.3.2.3 months C.3.2.3 Service C.3.2.3 C.3.2.3 veterinary school for Proposal One from “time MOA (Dr. B 3,500 USD AMR fund school, and deficit in zero” Bazzal) IPC curricula included in improveme -AUB-Dpt program nt, if need of be. Agriculture 82 (Dr. M Farran) C.3.3 C.3.3 IPC- C.3.3.1 IPC related Mapping of module to educational IPC in C.3.3.1 be included modules in three C.3.3.1 -MOA- in the three curricula of university C.3.3.1 MOH Head of C.3.3.1 curricula of three curricula C.3.3.1 C.3.3.1 six months C.3.3.1 Agriculture Poultry AMR fund sent from schools (Agricultur Report One from “time 1,000 USD schools Husbandry respective (Agricultur e, zero” (AUB, LU) Dpt (Eng. ministries e, Nutrition, A Sirawan) as Nutrition, Environme recommen Environme nt) dation to nt) the schools C.3.3.2 Review global and regional recommend C.3.3.2 ations on -AUB-Dpt C.3.3.2 IPC in C.3.3.2 of MOH curricula of C.3.3.2 C.3.3.2 six months Agriculture C.3.3.2 C.3.3.2 Agriculture agriculture, Report One from “time (Dr. M 1,000 USD AMR fund schools nutrition zero” Farran) (AUB, LU) and environmen t, and formulate what should be 83 included in them C.3.3.3 C.3.3.3 -MOA- Include the Head of recommend C.3.3.3 Poultry C.3.3.3 C.3.3.3 ed tricyclic MOH Husbandry Memo to C.3.3.3 2 years C.3.3.3 C.3.3.3 AMR and Agriculture Dpt (Eng. Ministry of One from “time 2,000 USD AMR fund IPC in schools A Sirawan) Education zero” curricula (AUB, LU) when not -Private available sector (Ms. S Najem) C.4.1 -Put TOR for IPC professiona C.4.1.1 ls in C.4.1.1 C.4 Include in different TOR of Advanced the national healthcare C.4.1.1 IPC IPC IPC C.4.1.1 C.4.1.1 C.4.1.1 facilities. C.4.1.1 C.4.1.1 Within cost C.4.1.1 professiona training for Guidelines Part of IPC MOH Same as -Put 1 3 months of AMR Fund ls are IPC the TOR of guidelines WHO guidelines prerequisite guidelines included in professiona the training/ex the IPC ls professiona perience of guidelines ls IPC physicians, officers, and nurses C.4.2 C.4.2.1 C.4.2.1 C.4.2.1 C.4.2.1 C.4.2.1 C.4.2.1 C.4.2.1 C.4.2.1 Make MOH C.4.2.1 Letter 1 3 months MOH None None None training Sends 84 available letters to Technical and Ministry of working affordable Higher group in Education NMCG universities and to and Order of professiona physicians l societies explaining the need and recommend ing training specializati on opportuniti es and courses related to IPC C.5.1 C.5.1 Baseline -Private evaluation sector, of current WHO C.5 situation at consultant, C.5.1 C.5.1 C.5.1 National a national C.5.1 former C.5.1 Results are C.5.1 One year MOH C.5.1 Process level Research LSIDCM Fund posted on One from “time LSIDCM 2,000 USD Indicators (research project president raising AMR zero” Hospitals in IPC project) (Dr. R website and make it Moghnieh) a continuous -Private process sector, 85 former LSIDCM president (Dr. R Husni) -Private sector (Dr. M Youssef) -ESU C.5.2 National indicators to be incremental C.5.2 ly applied Percentage with time C.5.2 C.5.2 Four C.5.2 MOH C.5.2 C.5.2 C.5.2 of hospitals (hand Research C.5.2 One years from LSIDCM -LSIDCM 20,000 Fund that report hygiene, project “time zero” Hospitals -ESU USD raising results of PPE, process isolation, indicators other standard precautions , etc) C.6.1 C.6 Conduct a C.6.1 C.6.1 Survey of C.6.1 point C.6.1 C.6.1 C.6.1 Technical C.6.1 C.6.1 Results of Nosocomia Lebanese prevalence Survey 1 2 years working 3,000 USD AMR Fund study l Infections Hospitals study on group published in hospitals nosocomial 86 infections in Lebanese hospitals C.7.1 C.7 Review the C.7.1 IPC in the OIE C.7.1 C.7.1 C.7.1 C.7.1 Technical C.7.1 C.7.1 C.7.1 veterinary biosafety Report 1 3 months MOA working None None None world recommend group ations C.7.2 C.7.2 -Technical Check the working availability group in of these -MOA- C.7.2 C.7.2 C.7.2 C.7.2 C.7.2 C.7.2 C.7.2 recommend Head of Report 1 5 months MOA 1,000 USD AMR Fund None ations in Animal local Health veterinary Service laws (Dr. B Bazzal) C.7.3 MOH recommend C.7.3 s to MOA C.7.3 Monitor the to follow Technical C.7.3 C.7.3 C.7.3 C.7.3 C.7.3 C.7.3 C.7.3 application up on the working Letter 1 6 months MOH None None None of these related group laws activities of IPC in Veterinary world 87 Monitoring and evaluation plan Frequency Data Objective Activity Sub-activity Indicator Purpose Calculation Of Data Method Baseline Source collection C.1.1 Appointment C.1 of focal Organization C.1 person n of the Appointment C.1 Follow charge of C.1 Not responsibiliti letter with up on C.1 Letter C.1 NA C.1 NA C.1 NA following up appointed es for the job activities the activities execution of description of the the tasks objectives of this axis C.1.2 Appointment of the members of the technical group along with its TOR C.2.1.1 To finalize C.2 national IPC Optimize C.2.1 guidelines; C.2.1.1 IPC practices C.2.1.1 C.2.1.1 C.2.1.1 Improve IPC guidelines to Update and C.2.1.1 C.2.1.1 C.2.1.1 In in Hospitals, Guidelines International Scientific practices in be all- standardizati Yes/no Once/5 years progress long term on MOH site guidelines review Hospitals inclusive on of IPC care facilities including and PHCC requirements and 88 qualification s of IPC officer and physician and checklist C.2.1.2 C.2.1.2 Inclusion of C.2.1.2 C.2.1.2 Audit IPC the checklist C.2.1.2 Letter Letter from during the C.2.1.2 C.2.1.2 C.2.1.2 of the Accreditatio Meeting team to IPC accreditation Yes/No Once/5 years Partial guidelines in n checklists Accreditatio Officer audit in accreditation n committee hospitals standards C.2.1.3 C.2.1.3 C.2.1.3 C.2.1.3 Percentage Increase the Follow up (Number of of hospitals number of and feedback compliant C.2.1.3 C.2.1.3 with hospitals that on IPC hospitals/Tot C.2.1.3 Accreditatio Checklist in C.2.1.3 Not acceptable are practices in al number of Once/3 years n audit accreditation started yet results for compliant hospitals audited results audit IPC in with national after each hospitals) accreditation IPC accreditation x100 guidelines. C.2.1.4 C.2.1.4 Syndicate of C.2.1.4 Have hospitals Number of qualified recommends C.2.1.4 workshops/ C.2.1.4 HCW in periodic IPC Number of Number of C.2.1.4 C.2.1.4 Workshops charge of C.2.1.4 training and IPC universities International Scientific are being IPC, and Once/5 years workshops workshops providing standards review done but not have more to employees per year health followed up efficient hosted by sciences programs in scientific programs hospitals societies, 89 universities, etc. C.2.2.1 To review and update C.2.2 guidelines of Improve IPC C.2.2.1 C.2.2.1 C.2.2.1 IPC in long- C.2.2.1 practices in Updated Standardize C.2.2.1 C.2.2.1 Ministry of C.2.2.1 term care Review and long-term guidelines IPC in long Yes /no Once social affairs NA facilities that update care on website term Guidelines are available facilities in Ministry of Social Affairs C.2.2.2 Inclusion of C.2.2.2 C.2.2.2 IPC C.2.2.2 Improve -Long term checklist in Checklist of C.2.2.2 Yes C.1.2.2 application care facilities C.1.2.2 NA the MOH IPC in /no C.2.2.2 Once Letter of -MOH licensing accreditation Meeting IPC in these -Ministry of criteria of standards facilities social affairs these facilities C.2.3.1 C.2.3 C.2.3.1 C.2.3.1 C.2.3.1 Establish Improve IPC Guidelines Standardize C.2.3.1 C.2.3.1 Once Guidelines C.2.3.1 guidelines C.2.3.1 NA practices in on website IPC in Yes/No per 6 months AMS/AMR Checking on IPC in the PHCC PHCC website PHCC C.2.3.2 C.2.3.2 C.2.3.2 C.2.3.2 Inclusion of Checklist of C.2.3.2 Letter Improve C.2.3.2 C.2.3.2 Once IPC IPC in Accreditatio Meeting C.2.3.2 NA application Yes/No per 6 months checklist in accreditation n guidelines Accreditatio of the MOH standards. n committee 90 licensing IPC in these criteria of facilities these facilities C.3.1 Include IPC- related educational modules in human- health C.3.1 related (Number of C.3.1 majors C.3.1 curricula that C.3.1 C.3 Percentage (physicians, Include IPC have IPC C.3.1 IPC included Enhance IPC of health C.3.1 nurses, in basic module/Tota C.3.1 Curricula but non- education curricula that Letters to midwives, education of l number of Once/5 years IPC standardized different contain IPC universities physiotherap health health guidelines and majors modules ists, professionals sciences unorganized pharmacists, curricula) dentists, lab *100 technicians, radiologists, nutrition, medical and paramedical schools) C.3.2 C.3.2.1 Include IPC- Check the related current C.3.2.1 None educational situation of modules in IPC in the veterinary ongoing 91 schools veterinary curricula curriculum C.3.2.2 Review of IPC in regional and C.3.2.2 None global veterinary curricula C.3.2.3 Prepare a C.3.2.3 proposal for Proposal is C.3.2.3 C.3.2.3 veterinary sent to Improve IPC C.3.2.3 C.3.2.3 Veterinary school for veterinary education in C.3.2.3 Once Check if C.3.2.3 NA Yes/No school deficit in school, and veterinary proposal sent MOA curricula IPC included school improvement in program , if need be. C.3.3 C.3.3 C.3.3 IPC- C.3.3.1 IPC module Number of related Mapping of to be university C.3.3 educational IPC in three included in programs Improve IPC modules in university the three that include C.3.3 education in C.3.3 curricula of curricula curricula of IPC C.3.3 C.3.3 In a Agriculture, The 3 three schools (Agriculture, sent from according to Once/year Checking superficial Nutrition, schools (Agriculture, Nutrition, respective recommenda way Environment Nutrition, Environment ministries as tion/Total Schools Environment ) recommenda number of ) tion to the audited schools programs C.3.3.2 92 Review global and regional recommenda tions on IPC in curricula of agriculture, nutrition and environment, and formulate what should be included in them C.3.3.3 Include the recommende d tricyclic AMR and IPC in curricula when not available C.4.1.1 C.4.1.1 C.4.1 Include in C.4.1.1 To C.4 -Put TOR for the national TOR of IPC standardize Advanced IPC C.4.1.1 IPC professionals the work and C.4.1.1 C.4.1.1 C.4.1.1 C.4.1.1 IPC training professionals MOH Guidelines are included follow-up on Yes/No Once Checking NA for IPC in different WHO the TOR of in the IPC the professionals healthcare the guidelines performance facilities. professionals 93 -Put prerequisite training/expe rience of IPC physicians, officers, and nurses C.4.2.1 MOH Sends letters to Ministry of Higher C.4.2 Education Make and to Order training of physicians available and explaining C.4.2.1 affordable in the need and None universities recommendi and ng training professional specializatio societies n opportunities and courses related to IPC C.5.1 C.5.1 C.5.1 C.5 Baseline C.5.1 C.5.1 Hospitals Percentage National evaluation of Results are Have a that are of hospitals C.5.1 C.5.1 C.5.1 Process current posted on baseline epidemiologi that do have Once Project NA Indicators in situation at a AMR evaluation cally milestones of IPC national website representativ IPC level e 94 (research project) and make it a continuous process C.5.2 National indicators to be incrementall C.5.2 C.5.2 For C.5.2 y applied Percentage C.5.2 each process Hospitals with time of hospitals improve indicator that are C.5.2 Once/3 C.5.2 (hand that report application 5 hospitals epidemiologi C.5.2 NA years Project hygiene, results of of IPC that have a cally PPE, process principles follow up of representativ isolation, indicators the indicator e other standard precautions, etc) C.6.1 C.6.1 Conduct a To join the C.6 point WHO point C.6.1 Survey of prevalence prevalence C.6.1 Results of C.6.1 C.6.1 C.6.1 C.6.1 Nosocomial study on HAI study, Hospitals study NA Once Study NA Infections in nosocomial and MOH published hospitals infections in benchmark Lebanese with global hospitals data C.7.1 C.7.1 C.7 Review the None OIE 95 IPC in the biosafety veterinary recommenda world tions C.7.2 Check the availability in of these C.7.2 recommenda None tions in local veterinary laws C.7.3 MOH recommends C.7.3 to MOA to Monitor the follow up on C.7.3 application the related None of these laws activities of IPC in Veterinary world 96 Axis D: Antibiotic use Strategic plan Major objective Activity Sub-activity Date (operational plan) Milestone D.1.1 Appointment of focal person n charge of following D.1.1 three months from D.1 Organization of the up the activities of the time zero responsibilities for the objectives of this axis D.1 three months from time execution of the tasks D.1.2 Appointment of the zero members of the technical D.1.2 three months from working group along with its time zero TOR D.2.1 To support and include ABX as priority drugs in the D.2 pharmacovigilance project D.2.1 D.2 Improve ABX quality of the Lebanese University One year from time zero One year from time zero control and the adverse drug event reporting program of the Order of Pharmacists D.3 Control the use of critically important D.3.1.1 Three months from D.3 Six months from time D.3.1 Define CIAM D.3.1.1 Literature search antimicrobial molecules time zero zero (CIAM) in humans D.3.1.2 D.3.1.2 Formulate the list Six months from time zero D.4 Sentinel Surveillance of D.4.1 D.4.1 D.4 ABX (CIAM) consumption Workshops on metrics for Six months from time zero 5 years from a network of hospitals ABX use measurement and 1 year from time zero 97 and benchmark with international data D.4.2.1 Determine the D.4.2 epidemiologically D.4.2.1 Compilation of data from representative sample of three months from time zero hospitals hospitals for surveillance of ABX D.4.2.2 -Validate the measurement of hospital consumption by DDD/1000 patient days in a D.4.2.2 batch of 4 hospitals per year One year and three months -Include the hospitals with from time zero and continue adequate measurements in a yearly for 5 years sequential manner into the surveillance list and data -Advice to hospitals that don’t have adequate data D.4.2.3 Surveillance of ABX use in D.4.2.3 Lebanese hospitals by auto 1.5 years from time zero reporting then yearly for 5 years DDDs D.5 Prepare hospitals and D.5.1 build their capacity for D.5.1 Workshops on AMS D.5 Six months from time zero Antimicrobial stewardship twice per year 5 years then yearly for 5 years (AMS) programs D.5.2 D.5.2.1 Preparation and D.5.2.1 Put a list of essential dissemination of national six months from time zero guidelines treatment guidelines on 98 infectious diseases to standardize the strategies of ABX use based on local epidemiology D.5.2.2 D.5.2.2 Prepare the missing Finalize within 1 year from guidelines time zero D.5.2.3 Prepare and follow a schedule for the presentation D.5.2.3 of the guidelines in the Starting 1 year from time respective scientific societies zero and finalized 3 years meeting and for the from time zero endorsement of these guidelines with the respective societies D.5.2.4 D.5.2.4 Post these guidelines on the 1.5 years from time zero AMR/AMS website D.5.3 D.5.3.1 Inclusion of AMS programs Three months from time among hospital accreditation zero standards D.5.4 D.5.4 Auditing the AMS practices 2021 and after each during MOH accreditation accreditation audit for 5 with feedback to hospitals. years D.5.5 Development of AMS D.5.5 webpage in the MOH six months from time zero website D.6 D.6.1 D.6.1 D.6 99 Organize the dispensing of Nominate a task group for 3 month 3 months antimicrobials in the the meeting between MOH community pharmacies including Dr. W Ammar and the Order of pharmacists D.6.2 Meeting between a high-authority-level task force and the President of D.6.2 To be finalized 3 the Order of Pharmacists to months from time zero agree over a plan to restrict dispensing of ABX D.7 Control and regulate the D.7.1.1 The CIAM list will use of ABX in the D.7.1 Banning importation D.7.1.1 be sent to the minister to ban D.7 Two years from time veterinary, agriculture, food and use of CIAM in the Will be sent nine months their importation for zero production and environment veterinary field from time zero veterinary use sectors D.7.1.2 The veterinary drug D.7.1.2 one year from time office will not import these zero agents D.7.2.1 -Review the list of drugs and D.7.2 Check if CIAM are pesticides officially D.7.2.1 nine months from used in agriculture and imported in agriculture. time zero environment -Check if CIAM are included in this list. D.7.2.2 Check if any of these molecules are used in D.7.2.2 two years from time agriculture or environment zero from outside the official import channel. D.7.2.3 Get results of ABX D.7.2.3 three months from residues in food items being time zero done in Lebanon 100 D.7.3 Surveillance of D.7.3.1 Form a registry of D.7.3.1 Six months from importation of regularly used imported ABX in veterinary time zero ABX to Lebanon world D.7 4.1 D.7.4 D.7 4.1 Research project by one of Research study about ABX starting at time zero for one Masters Student at Beirut consumption year Arab University (BAU) D.7 4.2 Research project in D.7 4.2 Agriculture school (Quantify Two years from time zero the use of ABX in poultry farms nationally) D.7.5 Research study about D.7.5 Research project in D.7.5 Two years from time unofficial importation of Agriculture school zero ABX to Lebanon 101 Operational plan and budget Responsibl Source Major Sub- Activity Unit Quantity Date Location e Cost Of Indicator objective activity Entity Funding D.1.1 D.1.1 -WHO- Appointme National D.1 nt of focal Professiona Organizatio person n l Officer D.1.1 three D.1.1 n of the charge of (Dr. A D.1.1 months D.1.1 Focal responsibili following D.1.1 One Rady) D.1.1 None D.1.1 None Letter from time MOH person ties for the up the zero nominated execution activities of -MOH- of the tasks the General objectives Director of this axis (Dr. W Ammar) D.1.2 -WHO- D.1.2 National Appointme Professiona nt of the l Officer D.1.2 members of D.1.2 three (Dr. A Technical the D.1.2 months D.1.2 D.1.2 One Rady) D.1.2 None D.1.2 None working technical Letter from time MOH group working zero -MOH- assigned group General along with Director its TOR (Dr. W Ammar) 102 D.2.1 D.2.1 -MOH- To support Head of and include Preventive ABX as Medicine priority and D.2.1 drugs in the Communic Number of pharmacovi able generic gilance Diseases antibiotics D.2 project of Dpts (Dr. A D.2.1 that are Improve the Berry) D.2.1 D.2.1 One year D.2.1 D.2.1 D.2.1 tested by ABX Lebanese Network One from time MOH None None the quality University -MOH- zero pharmacovi control and the Quality gilance adverse Assurance programs drug event of reporting Pharmaceut program of ical the Order Products of Program Pharmacist Director s (Dr. R Karam) D.3 Control D.3.1.1 the use of -Private D.3.1 critically D.3.1.1 sector, List of important D.3.1 D.3.1.1 D.3.1.1 Three D.3.1.1 D.3.1.1 WHO D.3.1.1 D.3.1.1 CIAM antimicrobi Define Literature List months One MOA consultant, None None posted on al CIAM search from time former AMR/AMS molecules zero LSIDCM website (CIAM) in president humans 103 (Dr. R Moghnieh) D.3.1.2 -MOA- Head of Animal Health Service (Dr. B Bazzal) -Private D.3.1.2 D.3.1.2 D.3.1.2 D.3.1.2 - sector, D.3.1.2 National D.3.1.2 Six months D.3.1.2 Formulate MOH WHO 2,000 USD list of One from time AMR Fund the list -MOA consultant, CIAM zero former LSIDCM president (Dr. R Moghnieh) -Private sector (Dr S. Kanj, Dr G. Matar) D.4 D.4.1 D.4.1 D.4.1 Sentinel Workshops 2 in Beirut, D.4.1 D.4.1 Six months Surveillanc on metrics D.4.1 D.4.1 1 in Bekaa, D.4.1 20,000 Percentage from time D.4.1 e of ABX for ABX Workshops Six 1 in the Focal USD of hospitals zero and 1 AMR fund (CIAM) use North, 1 in person (6 that sent year from consumptio measureme the South workshops) attendees time zero n from a nt and 1 in 104 network of Mount hospitals Lebanon and benchmark with internationa l data D.4.2.1 -MOH- D.4.2.1 Head of Determine pharmacy the service (Dr. D.4.2 epidemiolo D.4.2.1 C Reaydi) D.4.2.1 Compilatio gically three D.4.2.1 D.4.2.1 D.4.2.1 D.4.2.1 D.4.2.1 The list is n of data representati months -MOH- List One MOH None None available from ve sample from time Head of hospitals of hospitals zero Epidemiolo for gical surveillanc Surveillanc e of ABX e Program (Dr. N Ghosn) D.4.2.2 D.4.2.2 -Validate D.4.2.2 One year the Hospital and three D.4.2.2 measureme D.4.2.2 data months D.4.2.2 D.4.2.2 1,000 USD nt of Four per D.4.2.2 D.4.2.2 assessment from time -MOH AMS per year for hospital year over 5 AMR fund None 4 times per zero and -WHO expert 5 years = consumptio years year over 5 continue 5,000 USD n by years yearly for 5 DDD/1000 years patient 105 days in a batch of 4 hospitals per year -Include the hospitals with adequate measureme nts in a sequential manner into the surveillanc e list and data -Advice to hospitals that don’t have adequate data D.4.2.3 D.4.2.3 Surveillanc -MOH- D.4.2.3 D.4.2.3 e of ABX Head of Report on 1.5 years use in D.4.2.3 D.4.2.3 pharmacy ABX use D.4.2.3 from time D.4.2.3 D.4.2.3 Lebanese Once per -MOH service (Dr. for Report zero then None None hospitals year -WHO C Reaydi) 2019/2020 yearly for 5 by auto posted on years reporting -MOH- website DDDs Head of 106 Epidemiolo gical Surveillanc e Program (Dr. N Ghosn) D.5.1 -Private D.5 Prepare sector, (Dr. hospitals S Kanj) and build D.5.1 D.5.1 D.5.1 their D.5.1 two Six months D.5.1 -Private D.5.1 Workshops Number of capacity for D.5.1 per year from time -MOH sector, 4,000 USD D.5.1 AMR on AMS workshops Antimicrob Workshops over 5 zero then -WHO WHO *2= 8,000 fund twice per on AMS ial years yearly for 5 -LSIDCM consultant, USD/year year per year stewardship years former (AMS) LSIDCM programs president (Dr. R Moghnieh) D.5.2 D.5.2.1 Preparation -Private D.5.2.1 and sector, (Dr. D.5.2.2 disseminati S Kanj) Number of on of D.5.2.1 D.5.2.1 D.5.2.1 D.5.2.1 -Private guidelines national Put a list of D.5.2.1 D.5.2.1 six months 2-3 D.5.2.1 -WHO sector, published treatment essential List One from time guidelines AMR fund -LSIDCM WHO and posted guidelines guidelines zero 3,500 USD consultant on on (Dr. A AMR/AMS infectious Bizri, Dr. J website diseases to Mokhbat) standardize 107 the strategies of ABX use based on local epidemiolo gy D.5.2.2 D.5.2.2 Focal D.5.2.2 D.5.2.2 Finalize D.5.2.2 person will Prepare the D.5.2.2 D.5.2.2 Included in D.5.2.2 within 1 -WHO distribute missing List One D.5.2.1 AMR fund year from -LSIDCM the tasks guidelines time zero according to the list. D.5.2.3 Prepare and follow a schedule for the D.5.2.3 D.5.2.3 presentatio D.5.2.3 Starting 1 Percentage n of the -Focal D.5.2.3 year from of guidelines person Workshops time zero D.5.2.3 guidelines in the D.5.2.3 D.5.2.3 3 times per D.5.2.3 and MOH endorsed respective Schedule One -LSIDCM year (1,200 AMR fund finalized 3 by scientific president USD per years from respective societies (Dr. Z workshop) time zero scientific meeting Helou) societies and for the endorseme nt of these guidelines with the 108 respective societies D.5.2.4 D.5.2.4 D.5.2.4 Post these D.5.2.4 D.5.2.4 Number of -Focal guidelines D.5.2.4 to be 1.5 years D.5.2.4 D.5.2.4 D.5.2.4 guidelines person on the Guidelines assigned from time MOH None None posted on -IT AMR/AMS later zero AMR/AMS consultant website website. D.5.3.1 -Private sector, WHO consultant, D.5.3 former Inclusion D.5.3.1 D.5.3.1 D.5.3.1 LSIDCM of AMS AMS and AMS Three D.5.3.1 president programs D.5.3.1 D.5.3.1 D.5.3.1 its checklist checklist in months MOH (Dr. R among One None None available in accreditatio from time Moghnieh) hospital accreditatio n zero accreditatio n standards -MOH- n standards Project Coordinato r (Eng. S Akkoum) D.5.4 D.5.4 D.5.4 Auditing 2021 and D.5.4 Number of the AMS D.5.4 D.5.4 after each D.5.4 MOH D.5.4 D.5.4 feedback practices Report One accreditatio MOH accreditatio None None given/num during n audit for n team ber of MOH 5 years hospitals accreditatio 109 n with feedback to hospitals. D.5.5 D.5.5 Developme D.5.5 AMS D.5.5 D.5.5 D.5.5 nt of AMS D.5.5 six months D.5.5 D.5.5 section AMS on -MOH IT webpage in One from time 5,000 USD AMR fund present on website -MOA consultant the MOH zero AMR/MO website H website D.6.1 Nominate a D.6 task group Organize for the the meeting D.6.1 dispensing between D.6.1 D.6.1 D.6.1 D.6.1 Technical D.6.1 D.6.1 D.6.1 of MOH MOH Group 1 3 months working None None None antimicrobi including group als in the Dr. W community Ammar and pharmacies the Order of pharmacists D.6.2 D.6.2 Meeting -MOH- between a Head of D.6.2 To be D.6.2 high- pharmacy D.6.2 finalized 3 -MOH authority- D.6.2 service (Dr. Agenda for D.6.2 One months -Order of D.6.2 None D.6.2 None level task Meeting C Reaydi) collaborati from time Pharmacist force and on put zero s the -MOH- President General of the Director 110 Order of (Dr. W Pharmacist Ammar) s to agree over a plan -Private to restrict sector, dispensing WHO of ABX consultant, former LSIDCM president (Dr. R Moghnieh) - MOH- Director of Public Relations & Health Education Dpts (Dr. R Hamra) D.7 Control D.7.1.1 The D.7.1 and D.7.1 CIAM list -MOA- regulate the Banning will be sent D.7.1.1 Head of D.7.1 DDD use of ABX importation to the Will be Animal of CIAM in the and use of minister to D.7.1.1 D.7.1.1 sent nine D.7.1.1 D.7.1 3,000 D.7.1 AMR Health molecules veterinary, CIAM in ban their Letter One months MOA USD fund Service imported agriculture, the importation from time (Dr. B per year food veterinary for zero Bazzal) production field veterinary and use 111 environmen -FAO t sectors representati ve D.7.1.2 The veterinary drug office D.7.1.2 one D.7.1.2 D.7.1.2 D.7.1.2 will not year from Memo One MOA import time zero these agents D.7.2.1 -Review D.7.2.1 D.7.2 the list of D.7.2 Report on Check if drugs and -MOA- D.7.2.1 antimicrobi CIAM are pesticides Head of nine als used in officially D.7.2.1 D.7.2.1 D.7.2.1 Poultry D.7.2 1,000 D.7.2 AMR months officially agriculture imported in List One MOA Husbandry USD fund from time imported and agriculture. Dpt (Eng. zero for environmen -Check if A Sirawan) agriculture t CIAM are use included in this list. D.7.2.2 Check if any of these D.7.2.2 D.7.2.2 two molecules D.7.2.2 D.7.2.2 D.7.2.2 None years from are used in List One MOA time zero agriculture or environmen t from 112 outside the official import channel. D.7.2.3 D.7.2.3 Get -MOA- results of D.7.2.3 Head of ABX three D.7.2.3 D.7.2.3 D.7.2.3 D.7.2.3 D.7.2.3 D.7.2.3 Animal residues in months None None None Report One MOA Health food items from time Service being done zero (Dr. B in Lebanon Bazzal) D.7.3.1 D.7.3 D.7.3.1 D.7.3.1 -MOA- Surveillanc Form a Presence of D.7.3.1 Six Head of e of registry of annual data D.7.3.1 D.7.3.1 months D.7.3.1 Animal D.7.3.1 D.7.3.1 importation imported of imported Registry One from time MOA Health None None of regularly ABX in veterinary zero Service used ABX veterinary ABX on (Dr. B to Lebanon world registry Bazzal) D.7 4.1 D.7 4.1 -BAU- Research coordinator D.7.4 project by D.7 4.1 of Masters D.7 4.1 Research one of starting at D.7 4.1 degree in None D.7 4.1 D.7 4.1 study about D.7 4.1 D.7 4.1 Masters time zero -BAU Food (Human None None ABX Project One Student at for one -MOA Safety and resources consumptio Beirut Arab year Analysis from BAU) n University (Dr .N El (BAU) Darra) 113 -Private sector, WHO consultant, former LSIDCM president (Dr. R Moghnieh) -MOA- Head of Animal Health Service (Dr. B Bazzal) D.7 4.2 -LSIDCM D.7 4.2 Member Research project in D.7 4.2 D.7 4.2 -AUB-Dpt Agriculture D.7 4.2 -MOA Report on of D.7 4.2 school Two years - D.7 4.2 the national D.7 4.2 D.7 4.2 Agriculture None (man (Quantify from time Agriculture AUB use of Project One (Dr. M power) the use of zero school Research ABX in Farran) ABX in (AUB) poultry poultry -LSIDCM farms -MOA- farms Head of nationally) Poultry Husbandry 114 Dpt (Eng. A Sirawan) D.7.5 D.7.5 Report on D.7.5 D.7.5 Research D.7.5 the -MOA AUB-Dpt D.7.5 None study about Research D.7.5 Two unofficial D.7.5 - of (man D.7.5 AUB unofficial project in D.7.5 One years from ABX Project Agriculture Agriculture power) Research importation Agriculture time zero importation school (Dr. M of ABX to school used in (AUB) Farran) Lebanon veterinary world 115 Monitoring and evaluation plan Frequency Major Data Activity Sub-activity Indicator Purpose Calculation of Data Method Baseline objective Source collection D.1.1 Appointment D.1 D.1 Follow of focal Organization up of person n of the D.1.1 activities and D.1 charge of D.1 Once/5 responsibiliti Focal person to be in D.1 Yes/No MOH D.1 Letter D.1 NA following up years es for the nominated charge of WHO the activities execution of some of of the the tasks them objectives of this axis D.1.2 Appointment D.1.2 of the Technical members of working the technical group working assigned group along with its TOR D.2.1 D.2.1 D.2.1 To support Number of Evaluate and include generic post- D.2.1 D.2 ABX as antibiotics marketing No of reports D.2.1 Improve D.2.1 D.2.1 D.2.1 priority that are efficacy and /month AMS ABX quality Once/5 years Network NA drugs in the tested by the safety of (Including website control pharmacovig pharmacovig generic ABX Zero report) ilance ilance that are project of the programs licensed by 116 Lebanese MOH and University used in and the Lebanon adverse drug event reporting program of the Order of Pharmacists D.3 Control the use of D.3.1 D.3.1 critically List of D.3.1.1 Make sure it D.3.1 important D.3.1 Define CIAM D.3.1 D.3.1 Literature is prepared Literature D.3.1 Search D.3.1 NA antimicrobial CIAM posted on Yes/No Once/5 years search and accessed search molecules AMR/AMS by all (CIAM) in website humans D.3.1.2 Formulate the list D.4 Sentinel Surveillance D.4.1 of ABX Number of (CIAM) D.4.1 D.4.1 D.4.1 hospitals that consumption Workshops Percentage To sent from a D.4.1 D.4.1 D.4.1 D.4.1 on metrics of hospitals standardize attendees/ network of Once/5 years Workshop Workshop NA for ABX use that sent measurement number of hospitals and measurement attendees in Lebanon invited benchmark hospitals*10 with 0 international data 117 D.4.2.1 Determine D.4.2.1 the Establish D.4.2 epidemiologi D.4.2.1 epidemiologi D.4.2.1 D.4.2.1 Compilation cally The list is cally D.4.2.1 D.4.2.1 -MOH D.4.2.1 Epidemiolog of data from representativ available representativ Yes/No Once/5 years -ESU NA ic sampling hospitals e sample of e hospitals for surveillance surveillance of AMR of ABX D.4.2.2 -Validate the measurement of hospital consumption by DDD/1000 patient days in a batch of 4 hospitals per year D.4.2.2 -Include the None hospitals with adequate measurement s in a sequential manner into the surveillance list and data 118 -Advice to hospitals that don’t have adequate data D.4.2.3 -Baseline D.4.2.3 evaluation Surveillance D.4.2.3 D.4.2.3 and follow of ABX use Report on Compilation up D.4.2.3 D.4.2.3 in Lebanese ABX use for D.4.2.3 of results D.4.2.3 -In June every Lebanese hospitals by 2019/2020 Yes /No from NA preparation year hospitals auto posted on hospital for national reporting website reports outcome DDDs AMS indicators D.5 Prepare hospitals and D.5.1 D.5.1 D.5.1 D.5.1 build their Standardizati Workshops Number of Number of D.5.1 capacity for on of AMS D.5.1 AMS D.5.1 on AMS workshops workshops D.5.1 Yearly Sporadic Antimicrobia and follow focal person Workshop twice per on AMS per twice per availability l stewardship up of year year year (AMS) indicators. programs D.5.2 D.5.2.1 D.5.2.1 D.5.2.1 D.5.2.1 D.5.2.1 Preparation D.5.2.2 D.5.2.2 D.5.2.2 D.5.2.2 D.5.2.2 and D.5.2.1 Standardize D.5.2.1 The Number of Number of International D.5.2.1 disseminatio Put a list of ABX D.5.2.2 available guidelines guidelines guidelines D.5.2.2 n of national essential prescription Once/5 years national published published plus local Writing treatment guidelines habits guidelines and posted and posted epidemiolog guidelines among are in on on y from on infectious professionals complete 119 diseases to AMR/AMS AMR/AMS surveillance standardize website website reports the strategies of ABX use based on local epidemiolog y D.5.2.2 Prepare the missing guidelines D.5.2.3 Prepare and follow a schedule for the D.5.2.3 presentation (Number of of the scientific D.5.2.3 D.5.2.3 guidelines in target Percentage Improve the societies that D.5.2.3 of guidelines application D.5.2.3 respective endorse D.5.2.3 Meetings D.5.2.3 endorsed by of these Scientific scientific these Once/5 years Lectures NA respective guidelines societies societies guidelines/ Workshops scientific by meeting and Number of societies professionals for the target endorsement societies) of these *100 guidelines with the respective societies 120 D.5.2.4 D.5.2.4 D.5.2.4 D.5.2.4 Post these Number of Once/5 years D.5.2.4 Improve the D.5.2.4 guidelines guidelines D.5.2.4 reviewing Posting on D.5.2.4 visibility of AMS on the posted on Yes/No and updating MOH NA these Website AMR/AMS AMR/AMS guidelines if website guidelines website website. needed D.5.3 Inclusion of D.5.3.1 AMS AMS and its D.5.3.1 D.5.3.1 programs checklist D.5.3.1 D.5.3.1 D.5.3.1 D.5.3.1 Standardizati Accreditatio among available in Yes /No Once/5 years Checking NA on n standards hospital accreditation accreditation standards standards D.5.4 D.5.4 Auditing the D.5.4 Every 3 AMS D.5.4 Number of D.5.4 D.5.4 years practices Number of feedback Accreditatio D.5.4 Improve depending D.5.4 during MOH feedback given/numbe n audit data analysis AMS work on the NA accreditation given/numbe r of results and report in hospitals frequency of with r of hospitals hospitals*10 analysis accreditation feedback to 0 renewal hospitals. D.5.5 D.5.5 Improve D.5.5 -Yes/No D.5.5 visibility of D.5.5 Developmen -Report of AMS section AMS and -Once/5 D.5.5 t of AMS anonymous D.5.5 D.5.5 present on make years MOH webpage in hospitals Checking NA AMR/MOH guidelines -Yearly Website the MOH -National website available to reports website indicators all results professionals 121 D.6.1 Nominate a D.6 task group Organize the for the dispensing meeting of between D.6.1 antimicrobial MOH None s in the including Dr. community W Ammar pharmacies and the Order of pharmacists D.6.2 Meeting D.6.2 between a Discuss and high- D.6.2 put a plan authority- Previous that is D.6.2 level task work with D.6.2 acceptable Minutes of force and the pharmacists Agenda for by meeting and D.6.2 D.6.2 D.6.2 President of at lower collaboration pharmacists activities Once Meeting Meeting the Order of levels that put about added to the Pharmacists did not lead dispensing plan to agree over to official of ABX a plan to action over-the- restrict counter dispensing of ABX D.7 Control D.7.1 D.7.1.1 The D.7.1 DDD D.7.1 D.7.1 Once D.7.1 Report D.7.1 and regulate Banning CIAM list of CIAM Establish for D.7.1 on 2017 and Research the use of importation will be sent molecules baseline and 2017/2018 Veterinary D.7.1 NA 2018 data project for 1 ABX in the and use of to the imported per follow up of then every drug office year veterinary, CIAM in the minister to year the quantity year 122 agriculture, veterinary ban their and type of Veterinary food field importation ABX used in ABX production for the country registry and veterinary per year. available and environment use yearly report sectors posted on AMR website D.7.1.2 The veterinary drug office will not import these agents D.7.2.1 -Review the list of drugs D.7.2.1 D.7.2 Check and Report on D.7.2.1 To if CIAM are pesticides D.7.2.1 antimicrobial check the used in officially D.7.2.1 D.7.2.1 D.7.2.1 Research s officially extent of the D.7.2.1 NA agriculture imported in Report Once/year MOA project for 1 imported for use CIAM in and agriculture. year agriculture agriculture environment -Check if use CIAM are included in this list. D.7.2.2 Check if any D.7.2.2 of these None molecules are used in agriculture 123 or environment from outside the official import channel. D.7.2.3 Get results of ABX D.7.2.3 residues in None food items being done in Lebanon D.7.3.1 D.7.3 D.7.3.1 D.7.3.1 Yearly report Surveillance Form a Presence of of imported of registry of annual data D.7.3.1 D.7.3.1 ABX in D.7.3.1 D D.7.3.1 importation imported of imported Yearly Veterinary D.7.3.1 NA veterinary Yes/No Registry of regularly ABX in veterinary report. drug office world on used ABX to veterinary ABX on AMR Lebanon world registry website D.7 4.1 Research D.7.4 project by Research one of D.7 4.1 study about Masters None ABX Student at consumption Beirut Arab University (BAU) D.7 4.2 D.7 4.2 D.7 4.2 D.7 4.2 D.7 4.2 D.7 4.2 D.7 4.2 D.7 4.2 Yes/No Once Project 124 Research Report on Determine Poultry Partially project in the national baseline farms available not Agriculture use of ABX ABX use in standardized school in poultry poultry in surveillance (Quantify farms Lebanon. the use of ABX in poultry farms nationally) D.7.5 Report D.7.5 D.7.5 on the Research D.7.5 Evaluate the unofficial study about Research ABX D.7.5 D.7.5 ABX D.7.5 unofficial project in purchases D.7.5 Once Veterinary Market D.7.5 NA importation Yes/No importation Agriculture outside the pharmacies research used in of ABX to school official veterinary Lebanon routing world 125 Axis E: Budget Planning and Fund Attraction The plan for economic sustainability was replaced mainly by a plan for budget preparation and preparation of the ground for fund raising for the execution of the NAP. Strategic plan Date (from operational Objective Activity Sub-activity Mile stone plan) E.0.1 Nominate a focal person in charge of E.0.1 three months from E.0 Organization of the following up the activities of time zero E.0 three months from time responsibilities for the the objectives of this axis zero execution of the tasks E.0.2 Nominate members of E.0.2 three months from the technical working group time zero E.1.1 E.1.1 E.1.1 Budget for each activity of Budget for every sub- Ready at “time zero” the plan has been studied activity is put in the NAP E.1 AMR budget planning E.1.2 E.1 Finalized February 2019 E.1.2 Meeting between Dr. A E.1.2 Overall budget of the plan Rady and Dr. R Moghnieh to 20th December 2018 has been assessed finalize the budget E.2.1.1 Financing from E.2.1.1 six months from E.2.1 WHO discussed “time zero” E.2 Looking for sources of Meeting with WHO, MOH, E.2.1.2 Financing from E.2.1.2 six months from E.2 Nine months from “time funding for NAP MOA, NGOs to check for MOH discussed “time zero” zero” investment in NAP E.2.1.3 Financing from E.2.1.3 MOA discussed 1st Jan 2019 126 E.2.1.4 Financing from NGO (FAO, Fondation E.2.1.4 six months from Merieux) discussed “time zero” E.2.2.1 E.2.2.1 Allocate a professional that Three months from “time will prepare proposals for zero” funding E.2.2.2 The allocated E.2.2 professional E.2.2.2 Six months from Look for other funding prepares the general “time zero” sources (agencies or bodies proposal or countries) E.2.2.3 Allocate a E.2.2.3 Three months from specialized person to do “time zero” mapping of funders E.2.2.4 Send proposals to E.2.2.4 Nine months from agencies or organizations “time zero” that are potential funders E.2.3.1 E.2.3.1 Mapping of private E.2.3 Three months from “time organizations interested in Include private organizations zero” AMR interested in AMR into the E.2.3.2 Present collaboration NAP proposals to these E.2.3.2 Six months from organizations “time zero” E.3 Mapping of E.3.1.1 Nominate the person E.3.1 Mapping of organizations for potential who will be in charge of E.3.1.1 international organizations collaboration in the doing this mapping and 3 three months from “time /countries for potential E.3 Nine months from “time investigation of natural having a list of these zero collaboration in the zero” sources of biodiversity and organizations investigation of natural biorepositories as sources of E.3.1.2 Do the mapping plus E.3.1.2 sources of biodiversity and new antimicrobial molecules list Six months from “time zero” 127 biorepositories as sources of E.3.1.3 Approach these new antimicrobial molecules organizations through showing them the achieved E.3.1.3 research in Lebanon as well Nine months from “time as potential for benefit zero” sharing with these organizations E.3.2.1 Communication with LAS to organize a yearly meeting E.3.2.1 where researchers in 3 three months from “time E.3.2 Lebanon expose and discuss zero” Mapping of existing or their studies in the field of ongoing local research that biodiversity for alternatives deals with biodiversity as to ABX source of antimicrobial E.3.2.2 molecules Create a section of AMR E.3.2.2 three months from Website where local studies, “time zero” posters, articles, projects in biodiversity are posted E.4.1 E.4.1.1 LSIDCM to host Establish a network of yearly workshop for E.4.1.1 three months from researchers in public and researchers to discuss AMR “time zero” private sectors research E.4 Establishing E.4.2.1 Nominate the person E.4.2.1 Three months from E.4.2 Mapping of potential communication with public who will do the mapping “time zero” E.4 One year from “time private partners to encourage and private sector for E.4.2.2 Produce a list of E.4.2.2 zero” research collaboration to NAP potential partners Six months from “time zero” E.4.3 Establish E.4.3.1 communication and Preparation of specific E.4.3.1 collaboration with private proposals for collaboration Nine months from “time partners with specific partners zero” 128 E.4.3.2 Establish communication E.4.3.2 and collaboration with these One year from “time zero” private partners 129 Operational plan and budget Sub- Responsibl Source of Objective Activity Unit Quantity Date Location Cost Indicator activity e entity funding E.0.1 -WHO- National E.0.1 Professiona Nominate a l Officer focal (Dr. A person in Rady) E.0.1 three E.0.1 charge of months E.0.1 E.0.1 Focal following E.0.1 Letter E.0.1 One E.0.1 MOH -MOH- from time None None person up the General zero nominated activities of Director E.0 the (Dr. W Organizatio objectives Ammar) n of the of this axis responsibili -MOA ties for the general execution director of the tasks E.0.2 -WHO- E.0.2 National Nominate Professiona E.0.2 E.0.2 three members of l Officer Technical months E.0.2 the E.0.2 Letter E.0.2 One E.0.2 MOH (Dr. A E.0.2 None working from time None technical Rady) group zero working assigned group -MOH- General Director 130 (Dr. W Ammar) -MOA general director 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Retrieved 20 December 2018. 146 Acknowledgement We would like to acknowledge the following persons for attending the consultative workshops and participating in the discussion:  Dr. Adla Jammal (Ministry of Agriculture- Lebanese Agricultural Research Institute-Head of Antibiotic Residue Department)  Dr. Alissar Rady (World Health Organization-National Professional Officer)  Dr. Bassel Bazzal (Ministry of Agriculture-Head of Animal Health Service)  Dr. Ghassan Matar (American University of Beirut-Professor)  Dr. Jacques Mokhbat (Lebanese American University-Microbiologist and Infectious Diseases Specialist)  Dr. Marianne Msallem (Ministry of Health-Primary Health Care Department- Dental Coordinator)  Dr. Mary Deeb (Lebanese American University-School of Medicine-Professor of Epidemiology)  Dr. Mohamad Farran (American University of Beirut-Department of Agricultural Engineering-Professor)  Dr. Monzer Hamze (Lebanese University-Professor)  Dr. Nada El Darra (Beirut Arab University-Coordinator of Masters degree in Food Safety and Analysis)  Dr. Oussayma Droubi (Rafik Hariri University Hospital- Infectious Diseases Specialist)  Dr. Pascale Salameh (Lebanese University-Professor of Epidemiology)  Dr. Rajaa Fakhoury (Beirut Arab University-Dean of the Faculty of Sciences)  Dr. Rida El Mays (General Cooperative Union-Chairman)  Dr. Rola Husni Samaha (Lebanese American University Medical Center Rizk Hospital-Head of Infectious Diseases Division and Infection Control Program)  Dr. Samir Hadjiabduli (International Organization for Migration-Chief Medical Officer)  Dr. Souha Kanj (American University of Beirut Medical Center-Head of Division of Infectious Diseases)  Dr. Ziad Daoud (University of Balamand- Professor and Head of Laboratory)  Eng. Abir Sirawan (Ministry of Agriculture-Head of Poultry Husbandry Department)  Eng. Salma Al Asmar (Libanvet-Agricultural Engineer)  Eng. Sizar Akkoum (Ministry of Health-Project Coordinator)  Mr. Nacif Rihani (Food and Agriculture Organization-Senior Livestock Officer)  Ms. Erwina Zoghbi (World Health Organization-Public Health Officer)  Ms. Hajar Semaha (Ministry of Health-Public Health Officer)  Ms. Josette Najjar (Fondation Mérieux-Representative)  Ms. Loubna Al-Batlouni (World Health Organization- Public Health Officer) 147 Appendix Technical Committee on IHR Suggested members: 1- Core group -Head of prevention MOH Dr. Assaad Khoury, president -Head of Communicable Diseases division MOH Dr. Nabil Salam -Head of surveillance unit MOH Dr. Nada Ghosn - Head of Preventive Medicine Department Dr. Atika Berry -Quality control officer at Central Public Health Laboratory to be determined -WHO focal point for IHR Dr. Alissar Rady -FAO focal point for IHR to be determined 2- Technical support group - Head of quarantine unit at Airports Dr. Nasser Chahine - Head of quarantine unit at Beirut port Dr. Mohammad Sreij - Representative of Society of Infectious Diseases to be determined - Representative of Ministry of Interior Security /Municipalities to be determined - Head of medical department at Internal Security Forces to be determined - Head of medical department at General Security Forces to be determined - Representative of syndicate of laboratories to be determined - Representative of syndicate of hospitals to be determined - Head of veterinary department MOA Dr. Ghazi Hakim - Head of agriculture lab at MOA to be determined - Environmental hazards specialist at Ministry of Environment to be determined - Representative of the Higher Commission for relief to be determined - Representative of the Order of pharmacists to be determined National Committee on AMR containment  President: Dr. Atika Berry (Ministry of Public Health, Head of Preventive Medicine Department)  Vice President: Dr. Jacques Mokhbat (Lebanese American University, Microbiologist and Infectious Diseases Specialist)  Members (by alphabetical order of family names): Dr. Georges Araj (American University of Beirut Medical Center, Head of Laboratory Medicine) Dr. Ghada Asmar (Lebanese University, School of Dentistry) Dr. Bassel Bazzal (Ministry of Agriculture, Head of Animal Health Services) Dr. Nada Ghosn (Ministry of Public Health, Head of Epidemiology Surveillance Unit) Dr. Rasha Hamra (Ministry of Public Health, Director of Public Relations and Health Education Departments) Dr. Rola Husni Samaha (Lebanese American University Medical Center- Rizk Hospital, Head of Infectious Diseases Division and Infection Control Program) Dr. Rima Moghnieh (Makassed General Hospital, Head of Antimicrobial Stewardship Program) 148 Dr. Alissar Rady (World Health Organization-National Professional Officer) Dr. Georges Salem (Lebanese Pediatric Society) Dr. Dolla Sarkis (Saint Joseph University, Vice President for Research) Eng. Abir Sirawan (Ministry of Agriculture, Head of Poultry Husbandry Department) Dr. Rony Zeinni (Lebanese Order of Pharmacists) 149