Philippine National Action Plan on Antimicrobial Resistance 2019-2023

Philippine National Action Plan on Antimicrobial Resistance 2019-2023 Inter-Agency Committee on Antimicrobial Resistance (ICAMR) Department of Agriculture Department of Health Food and Agriculture Organization World Health Organization This Philippine National Action Plan 2019-2023 was developed through the support of the World Health Organization. TABLE OF CONTENTS Message from the Secretary of Agriculture i Message from the Secretary of Health ii Index of Abbreviations iii Background 1 Status of Key Indicators 4 Achievements from 2014 to 2018 5 Synthesis of Challenges and Opportunities 9 Maximizing One Health Approach 9 Review of Mandates, Roles and Responsibilities of Partner Agencies 9 Need to Strengthen Surveillance Mechanisms, Monitoring and AMR Data to Guide Policy and Implementation 10 Need for Harmonized Policies, Protocols and Technical Guidance for Different Areas of AMR work 12 Need to Strengthen Resource Mobilization in Order to Meet Demands 12 Opportunity to Boost Research on AMR 13 Continue capacity building, education, awareness and advocacy 14 II. Methodology 14 Comparison between Original NAP (2014) and PNAP (2018) 16 III. Philippine National Action Plan 2019-2022 17 A. Vision, Mission, Targets and Indicators for 2019-2023 17 B. Outcome Indicators 18 Human Health Sector 18 Animal Health Sector 20 C. Stakeholders 22 D. Key Strategies, Objectives and Activities 24 Key Strategy 1. Commit to the Philippine Action Plan through multisectoral engagement and accountability 24 Key Strategy 2. Strengthen surveillance and laboratory capacity 26 Key Strategy 3. Ensure uninterrupted access to safe and quality-assured antimicrobials 31 Key Strategy 4: Regulate and promote the rational use of antimicrobials 34 Key strategy 5: Implement appropriate measures to reduce infection across all settings 38 Key Strategy 6: Promote innovation and research on AMR 40 Key Strategy 7: Improve awareness and understanding of antimicrobial resistance through effective communication and education 42 References 46 Annexes A A. List of Policies Related to AMR A1 B. Key Strategies, Objectives, Activities, Stakeholders, Timelines and Budget A5 C. Members of the Inter-Agency Committee on Antimicrobial Resistance (ICAMR) A50 D. Members of Department of Agriculture Technical Working Group A51 E. AMR-Related Research in Animal Health A51 F. AMR-Related Research in Human Health A63 G. Research Gaps A85 H. Provisional Research Agenda: Topics, Areas and Questions A87 I. Mapping of Regulation and Controls for the Antimicrobial Market in Animals and Humans A96 Message from the Secretary of Health In recent years, we have seen significant achievements on how the country works to reduce Antimicrobial Resistance. Initiatives such as the antimicrobial stewardship program in hospitals and prescription required for dispensing of antimicrobials have ensured better distribution of antimicrobials across the country. Antimicrobials are a previous resource for treatment of diseases and save lives. We take the challenge to ensure rational use of antimicrobials, ensure access and boost innovation in health care and the discovery of new drugs. These are essential components to ensure Universal Health Coverage and protect our people from financial risk. Together with the agriculture sector and many other stakeholders, I am honored to present this Philippine National Action Plan on AMR 2019-2023. Together, we can achieve more towards preventing the spread of AMR, and making sure that what we eat everyday are safe! [Signed] Francisco T Duque III, MD, MSc Secretary Department of Health Index of Abbreviations A.O. Administrative Order ADDL Animal Disease Diagnostic Laboratories AIHO Alliance for Improving Health Outcomes AIVSA Animal Industry and Veterinary Services Act AMC Antimicrobial Medicines Consumption AMR Antimicrobial Resistance AMS Antimicrobial Stewardship AMU Antimicrobial Use ANSORP Asian Network for Surveillance of Resistant Pathogens ARSP Antimicrobial Resistance Surveillance Program ASC Antimicrobial Stewardship Steering committee ASEAN Association of Southeast Asian Nations AST Antimicrobial Sensitivity Testing ATLASS Assessment Tool for Laboratory and Surveillance Systems BAHA Barangay Animal Health Aides BAI Bureau of Animal Industry BALA Barangay Animal Livestock Aides BFAR Bureau of Fisheries and Aquatic Resources BHFS Bureau of Health Facilities and Services CHED Commission on Higher Education CHD Centers for Health Development CLSI Clinical and Laboratory Standards Institute CPE Continuing Professional Education DA Department of Agriculture DENR Department of Environment and Natural Resources DepEd Department of Education DILG Department of Interior and Local Government DOLE Department of Labor and Employment DOST Department of Science and Technology DPCB Disease Prevention and Control Bureau DTI Department of Trade & Industry EB Epidemiology Bureau FAO Food and Agriculture Organization of the United Nations FDA Food and Drug Administration GAA General Appropriations Act GAHP Good Animal Husbandry Practices GAqP Good Aquaculture Practices GDP Gross Domestic Product GIA Grants-In-Aid HACCP Hazard Analysis and Critical Control Points HAI Healthcare-Associated Infections HERDIN Health Research and Development Information Network HFDB Health Facilities Development Bureau HFSRB Health Facility and Services Regulatory Bureau HOMIS Hospital Operation and Management Information System HPDPB Health Policy Development and Planning Bureau ICAMR Inter-agency Committee on Antimicrobial Resistance ICC Infection and Control Committees IEC Information, Education, and Communication IPC Infection Prevention and Control ISO International Organization for Standardization JBLMRH Jose B. Lingad Memorial Regional Hospital KAP Knowledge, Attitude, and Practice LGU Local government unit M&E Monitoring and Evaluation MOA Memorandum of Agreement MOP Manual of Procedures MRSA Methicillin-Resistant Staphylococcus aureus NAG National Antibiotic Guidelines NAGCom National Antibiotic Guidelines Committee NAP National Action Plan NASPCP National AIDS/STI Prevention and Control Program NCR National Capital Region NDA National Dairy Authority NDPCO National Drug Policy Compliance Officer NEC National Epidemiology Center NEQAS National External Quality Surveillance System NHLN National Health Laboratory Referral Network NMIS National Meat Inspection Service NTP National TB Control Program NUHL National Unit for Health Laboratories NUHRA National Unified Health Research Agenda OASR Office of Assistant Secretary for Regulations PCAARRD Philippine Council for Agriculture, Aquatic and Natural Resources Research and Development PCC Philippine Carabao Center PCHRD Philippine Council for Health Research and Development PD Pharmaceutical Division PGH Philippine General Hospital PhilPSP Philippine Practice Standards for Pharmacists PHRR Philippine Health Research Registry PHSR Pharmaceutical Health Research PMAS Post Marketing Alert System PNAP Philippine National Action Plan PRC Professional Regulatory Commission PSP Pharmacy Standards of Practice PVMA Philippine Veterinary Medical Association R&D Research and Development RHLN Regional Health Laboratory Network RITM Research Institute of Tropical Medicine RLNC Regional Laboratory Network Councils RO Regional Offices SLH San Lazaro Hospital TWG Technical Working Group UNICEF United Nations International Children's Emergency Fund UP University of the Philippines USAID United States Agency for International Development VDR Veterinary Drug Resistance WAAW World Antibiotics Awareness Week WHO World Health Organization P a g e | 1 I. Background Antimicrobial resistance (AMR) is a major public health concern; the misuse and overuse of antimicrobials in different sectors can gravely affect humans in ways that range from medical, social, and even economic. AMR develops when antimicrobials are misused and overused, and it can spread and can transfer to humans directly via direct contact to resistant organisms through ingestion of the products or through environmental runoff exposures. Moreover, runoff or wastes from manufacturing of antimicrobials and improper disposal by pharmaceutical companies can expose the environment to unnecessary drugs. Figure 1 depicts how this affects and leads to AMR in plants, animals, and humans. Aquatic animals and even the water sources can be affected, which again affect humans through aquatic products and water ingestion. Figure 1. Flow of Antimicrobials from Manufacturing, to Consumption, to the Environment Resistance can pass on from one person to another and spread beyond local borders, especially if proper infection control is not practiced. The spread of resistant organisms can strain and challenge the already dwindling antimicrobial options available. This can lead to what experts have termed as “post-antibiotic era” wherein even minor infections may lead to death. Medical management and surgeries will be difficult to perform because of possible infection during and after the procedures. The economic loss from the death of animals and humans due to AMR is huge. According 2 | P a g e to World Bank (2014), if AMR is not properly addressed, by 2050, 28 million people will be pushed into poverty and healthcare costs can reach up to USD 1 trillion per year. The Philippines has been a champion in initiatives to address AMR. The Inter-Agency Committee on Antimicrobial Resistance (ICAMR) was established in 2014. In the following year, the National Action Plan on AMR 2015-2017 was published. A game changing policy in the Philippines was Republic Act 10918 “No Prescription No Dispensing” Policy as implemented by the Food and Drug Administration. Annex A lists other policies related to AMR in animal and human health sectors. Table 1. Milestones on AMR Policy and Implementation in the Philippines Year Milestone 2013 Joint Administrative Order between DOH and DA for Registration of Veterinary Drugs and Products 2014 Formation of the Inter-Agency Committee on Antimicrobial Resistance (ICAMR) (DOH AO. No. 42) 2014 DA Special Order No. 695.2014 creating the DA TWG on AMR, amended in 2016 2014 FDA No Prescription No Dispensing Policy 2014 AO 2014-0006 Policy on the Establishment of Laboratory Networks 2014 Antimicrobial Resistance Surveillance Program (ARSP) started 2015 May Launch of the Philippine Action Plan to Combat AMR 2015 2017 P a g e | 3 2015 November First celebration of World Antimicrobial Awareness Week (WAAW) 2015 Antimicrobial Resistance Surveillance Program (ARSP) launched by RITM and ICAMR 2015 DOH AO 2015-0049 Rules and Regulations Governing the Antimicrobial Resistance Surveillance Program Accreditation of Bacteriology Laboratories in the Philippines for the PhilHealth Reimbursement of Select Antibiotics in the Philippine National Drug Formulary 2016 DOH AO 2016-0002 National Policy on Infection Prevention and Control in Health Care Facilities 2016 National Antibiotic Guidelines published 2016 Antimicrobial Stewardship (AMS) Trainings initiated 2016 DOH AO 2016-0002 Hospital Acquired Infections or ICP 2016 Food Safety Act of 2016 2017 ATLASS Mission conducted in the Philippines 2017 DOH-PD Point Prevalence Survey 2017 DA DO No. 4, s. 2017 Rationalization of all DA Laboratories 2017 Publication of the National Unified Health Research Agenda (NUHRA) 2017-2022 highlighting support for AMR and research on drug discovery, innovation and health technologies 4 | P a g e 2018 PhilHealth Circular No. 2018-0009 Use of Restricted Antimicrobials in PhilHealth-Accredited Health Care Institutions in Accordance with the ARSP 2018 Development of ARSP in Animals 2018 DA Initiates the IAMResponsible Campaign in the animal and agroculture sector Status of Key Indicators The 2014 National Action Plan on AMR identified five pathogens as potential targets to measure the impact of AMR interventions. The following targets are: ● Target 1: Reduce by 30% carbapenem-resistant Enterobacteriaceae (E. coli and Klebsiella spp.) infections acquired during hospitalization. ● Target 2: Maintain the 0% prevalence of ceftriaxone-resistant Neisseria gonorrhoeae. ● Target 3: Reduce by at least 30% the overall methicillin resistance in Staphylococcus aureus bloodstream infections compared to rates in 2014 ● Target 4: Reduce by 30% multidrug-resistant Pseudomonas spp infections acquired during hospitalization compared to estimates in 2014. ● Target 5: Reduce by 25% ciprofloxacin-resistant non-typhoidal Salmonella infections compared to 2014 The table below shows the status of the above targets: Table 2. Status of Accomplishment of Targets Baseline (2014) based on ARSP annual report Target by 2020 Target by 2020 (%R) 2017 % change compared with baseline Hospital Acquired Carbapenem Resistant Enterobacteriaceae (E 4.5 30% reduction 3.1 8.4 118 P a g e | 5 coli.) Hospital Acquired Carbapenem Resistant Enterobacteriaceae (Klebsiella pneumoniae) 7.9 30% reduction 5.5 11.2 30 Ceftriaxone-resistant Neisseria gonorrhoeae 0 Maintain at 0% 0 0 0 MRSA (blood) 60 30% reduction 42 55 -9 HA MDR pae (invasive) 21.6 30% reduction 15.1 20 -6 Ciprofloxacin-resistant non typhoidal Salmonella 21.6 25% reduction 16.2 9 -58 Reference: Research Institute for Topical Medicine Achievements from 2014 to 2018 The accomplishments and achievements based on Key Strategies (KS) of the Plan are summarized below. KS1: Commit to a comprehensive, financed national plan with accountability and civil society engagement In 2014, the Philippine government organized the Inter-Agency Committee on Antimicrobial Resistance (ICAMR). The committee was led by the Department of Health and co-led by the Department of Agriculture. The ICAMR facilitated the development of the National Action Plan to Combat AMR 2015-2017, which was launched in May 2015. Regular meetings were held to receive progress updates from all its members. The ICAMR ensured high-level support through the participation of the DOH Executive Committee members in key meetings and events. It also facilitated the organization of Antimicrobial Awareness Week Celebrations every November. As part of governance, DOH designated the National Drug Policy Compliance Officers (NDPCO) in DOH Regional Offices. The DOH Pharmaceutical Division is tasked to be the Secretariat of the ICAMR and prepares annual budgets covering AMR initiatives among others. To strengthen its intra-agency efforts, the Department of Agriculture (DA) organized the AMR Technical Working Group which was composed of the Bureau of Animal Industry, the National Meat Inspection Service (NMIS), the National Dairy Authority 6 | P a g e (NDA), the Philippine Carabao Center (PCC), and the Bureau of Fisheries and Aquatic Resources (BFAR). In 2015, the DA started a project with the Food and Agriculture Organization to support AMR efforts. The AMR budget is allocated under the Food Safety budget. Regional AMR Councils in the animal sector are being organized. KS2: Strengthen surveillance and laboratory capacity The Philippine AMR surveillance and laboratory capacity for microbial detection has been housed in Research Institute for Tropical Medicine (RITM), which serves as the national reference laboratory for communicable diseases and AMR. Microbiology surveillance has started since the 1980s. Currently, RITM facilitates the training of microbiology experts and laboratory personnel across the country. The DOH and RITM developed the Antimicrobial Resistance Surveillance Program (ARSP) which aims to monitor the resistance rates of organisms in the country. More hospitals are being added to the existing 30 accredited laboratories that will submit specimen to ARSP. The DOH and RITM, with the support of experts in infectious diseases, also developed training modules on Antimicrobial Stewardship (AMS), which aims to improve and measure antimicrobial use and prescription in hospitals. Hospitals with accredited ARSP-laboratory and functioning AMS program are allowed to prescribe advanced antibiotics. The DA made efforts to strengthen surveillance laboratory capacity. The DA Central Laboratories evaluated antimicrobial susceptibility testing (AST) and conducted detailed evaluation of the capacity of regional laboratories. Staff were sent abroad for advanced training through DA and FAO support. Moreover, the DA-BFAR initiated a National Residue Monitoring and Control Program. DA laboratories are being strengthened to adhere to standards of the Clinical Laboratory and Standards Institute (CLSI). LGUs are engaged in capacity building for local sample collection and processing. These samples are sent to regional laboratories for testing. The ARSP for Animal Health has been drafted and is being reviewed for approval. KS3: Ensure uninterrupted access to essential medicines of assured quality The Philippines already had policies to ensure access and quality of medicines prior to initiatives on AMR and the National Action Plan. Examples of these policies are the FDA circular 2013-008 (Adoption of the the ASEAN Post Marketing Alert System) and the FDA circular 2012-012 (guidelines for handling rapid alerts from quality defects). P a g e | 7 A key policy tackles the mainstreaming of antibiotic treatment with financing/ payments based on ARSP laboratory results (PhilHealth Circular 2006-0015). Annex A summarizes policies related to AMR. DOH is building partnerships with private sector and other development agencies to strengthen access to medicines and ensure uninterrupted supply through an effective supply chain and procurement system. Initiatives to strengthen access in animal sector is starting. Forging of partnerships with healthcare professionals, organizations, and consumer groups is ongoing and spearheaded by BAI and BFAR. KS4: Regulate and promote rational use of medicines, including in animal husbandry and ensure proper patient care In 2016, the Philippines issued RA 10918, otherwise known as the Pharmacy Law, requiring prescription for dispensing of antibiotics. Some LGUs have adopted policies on the Rational Use of Medicines at the local level to prevent sale of antibiotics outside of pharmacies. This policy is currently being implemented and monitored. DOH, RITM and experts have developed the Antimicrobial Stewardship Program for hospitals, which promotes building of teams of service providers, pharmacists and microbiologists by their specific tasks. This program has been rolled out in all Level 2 and Level 3 hospitals across the country. The Philippine AMS Program is being studied by other countries as a model to adopt. The Philippines has also developed National Antibiotic Guidelines as part of efforts to strengthen clinical practice guidelines. The Philippine Pharmacy Standards of Practice (PSP) has a training package being rolled out. Point Prevalence Surveys to assess the use of antimicrobials have been started. It is essential to monitor how these initiatives are being implemented and the impact they create in enhancing healthcare, improving rational antibiotic use and reducing AMR and hospital acquired infections. In the animal health sector, there is an ongoing review of the existing regulatory framework. Results of this review are expected to guide DA, FDA and DOH in delineating roles in regulating antimicrobials and the medicine supply chain. DA monitors for the banned antimicrobials animal feeds stores. Coordination and dialogue with LGUs, clients, stakeholders, and industry are ongoing to assess challenges and promote prudent use of antimicrobials in agriculture and farms 8 | P a g e KS5: Enhance infection prevention and control across all settings Much of the efforts on infection prevention and control are in hospitals ensuring quality and safety of services. In 2016, DOH issued the National Policy on Infection Prevention and Control (IPC) that outlines priority strategies. This is a development from the National IPC Standards in 2009. IPC Teams, training and indicators are included as a requirement in hospital licensing. The reduction of infection in animals is part of farming practices outlined in Good Animal Husbandry Practices (GAHP) and Good Aquaculture Practices (GAqP) that are being harmonized through the ASEAN cooperation. The Philippines promotes these standards to develop farms and ensure better products for domestic consumption and exportation. Agricultural farms who apply for roadshows usually have international trade relations, thereby ensuring good practices. The Philippine national standards for aquatic commodities (milkfish and tilapia; shrimp and crab) have been developed. KS6: Foster innovations, research and development Research on AMR in humans is led by microbiologists, infectious diseases specialists, universities and hospitals. AMR has been included in the National Unified Health Research Agenda 2017-2022 as part of research on responsiveness. In addition, the NUHRA is keen on innovation and R&D of medicines. AMR is also included in the Pharmaceutical Health Research agenda of the DOH Pharmaceutical Division. Research on AMR in animals is done by various agencies, such as PCC, UPLB and CLSU. The Department of Science and Technology has research councils for human health (PCHRD) and agriculture (PCARD), although AMR is largely housed in human health research. AIHO has collected recent AMR-related research and has identified potential research gaps (Annexes E, F and G). Desk review and consultations have also raised many research questions and these are listed in Annex H. KS7: Development of a Risk Communication Plan to Combat AMR The Philippines participated in the annual celebration of the World Antimicrobial Awareness Week from 2015 to 2018. ICAMR has developed information and P a g e | 9 education materials and infomercials and disseminated them in these events. DA also celebrated WAAW at the central level and in some regions. The focus of the 2018 event is on Food Safety. DA developed the IAMResponsible campaign targeting veterinarians, farmers, students and the general public. In 2018, DA conducts roadshows across the country. Further details on the status and achievements are described in the Implementation Report on the National Action Plan to Combat AMR 2015-2017. Annexes in this document contain further information on policies related to AMR (Annex A), Members of ICAMR and DA-TWG (Annex C and Annex D) and Research in Animal and Human Health (Annex E and F). Synthesis of Challenges and Opportunities This section summarizes the foreseen challenges and opportunities in facing antimicrobial resistance. The Implementation Report on the National Action Plan to Combat AMR 2015-2017 contains more detailed information on accomplishments, achievements and gaps. Maximizing One Health Approach One Health approach integrates the health aspects of the human, animal, and plant sectors. With this, there is recognition that the sectors are cognate and influence one another. Coordination between different sectors is always challenging. Although the ICAMR, under DOH and DA, have already defined composition of its members, participation has been varied. Engagement of key sectors should be strengthened including trade and industry, plant, aquaculture, education and local governments. There is an opportunity to strengthen the One Health Approach by increasing the involvement of the environment sector. Although civic society involvement was mentioned, there has been very limited engagement at present. There is also a great opportunity for the private sector, especially private institutions and industry, to be more involved. The new Action Plan is framed to identify the potential areas of collaboration across these sectors. Review of Mandates, Roles and Responsibilities of Partner Agencies 10 | P a g e Even after three years, some roles are still unclear and need to be properly mapped. The roles of DTI and DILG, for example, are not sufficiently elaborated. Specific offices within DOH and DA which are supposed to be involved in the AMR program are not yet fully onboard, in part due to different priorities, roles and mandates that need to be defined. Skills mapping and adequate human resources are crucial requisites for AMR. In order to sufficiently address the current challenges, it is essential to have a strategy to ensure the ideal number of people who are skilled and knowledgeable in handling AMR needed to be deployed. This applies to all sectors involved, whether from human, animal, or environment sides. The DOH and DA have a temporary joint policy assigning offices responsible for certification of veterinary products with antimicrobials. This joint policy expired in September 2018 and should be renewed. The FDA plans to create a Veterinary Unit. This calls for urgent action from the FDA to establish the unit and secure adequate and competent workforce to oversee its activities. In terms of ensuring supply of medicines, there is still confusion about the extent of the roles of DOH, DA, and LGU. Currently, there is no veterinary formulary executive council to decide on the list of essential medicines for animals. This was already mentioned last PNAP 2015-2018. Annex I maps the regulation and control for the antimicrobial market in animals and humans. This information is developed to provide guidance to policy makers on the stakeholders, their roles, and the current policy gaps. Need to Strengthen Surveillance Mechanisms, Monitoring and AMR Data to Guide Policy and Implementation Surveillance and monitoring of AMR in human health are mainly done through RITM’s ARSP. On the other hand, hospitals and laboratories nationwide have an essential role to support this surveillance system. There is a need to determine target number of sentinel sites. In addition, the available data is not yet case-based which is important in determining actual cases and how these are managed. P a g e | 11 There is no system yet in monitoring, regulating and evaluating antibiotics in hospitals that are subsidized by PhilHealth. The gap in data and knowledge in this area further compounds the challenges in determining the appropriateness of the number and type of antimicrobial prescribed versus the disease and/or pathogen. The data system for AMR is a key area for improvement. An online database of different AMR indicators is not yet available and not integrated. Indicators that point to progress of the program are also undefined, such that monitoring and evaluation are still limited to process inputs and program outputs. Although a database of antimicrobials for human use is available online, this has yet to be done in the veterinary sector. Surveillance within the entire agricultural sector is not yet unified, as some private companies conduct their own surveillance activities. A platform for stakeholders to communicate data is also not yet available that can inform both animal and human health sectors. Despite the numerous training and development programs offered by the various offices involved, the fast turnover of manpower limits the implementation of what they have learned. Monitoring of how these trainings have improved AMR strategies is also not in place. Regional laboratory capacity for AMR detection needs to be built and fully assessed for both animal and human sectors. An integrated surveillance system for AMC, AMU, and HAI is yet to be developed, as well as the protocols to analyze, synthesize, and use these data. Furthermore, the data collected in the animal sector can be expanded to include information such as clinical breakpoints of pathogens, masterlist of farms including backyard farms, farm supplies, animal feed stores, and private laboratories in all LGUs, etc. The vast data, information, indicators, targets and inter-related systems required to monitor AMR shows a need for an overall M&E framework for humans, animals and their points of interaction. Different types of data and information, sources, stakeholders and processes should be described in this framework. 12 | P a g e Need for Harmonized Policies, Protocols and Technical Guidance for Different Areas of AMR work There are a number of policies that are essential in addressing AMR, especially coming from the animal sector. One major policy is the banning of antimicrobials as growth promoters in animal industry. Its use has a grave impact on the food consumed by humans. A Philippine Practice Standards for Veterinarians in relation to Rational Dispensing of Antimicrobials, as well as a National Antibiotic Guidelines for animal health are also needed. Part of the guidelines for its rational use should also include the use of antimicrobials only with a prescription from a veterinarian, similar to human health where antimicrobials cannot be readily bought if a physician’s prescription is not available. The ASEAN Guidelines for Prudent Use of Antimicrobials in Livestock has yet to be adapted locally. Implementation and monitoring of good animal husbandry and aquaculture practices should be strengthened. In terms of infection prevention and control, much is yet to be done in the animal sector. A national IPC program in backyard and industry farms needs to be developed, as well as clinical guidelines for livestock infection prevention and control. For human health, policies related to food safety and AMR need to be further elucidated and specified. Disease-specific treatment guidelines should also be in place. Additionally, an issuance by the DOH requiring different levels of health facilities to adhere to the AMS program needs to be released. The rigorous monitoring of the implementation of the different policies related to AMR is a crucial point of focus. Meanwhile, policies that are in the pipeline also need to have a strong monitoring and evaluation component incorporated. Finally, crafting an integrated protocol for AMR response is crucial, particularly in cases of outbreaks. Need to Strengthen Resource Mobilization in Order to Meet Demands Since 2014, the GAA has not mentioned any line items to address AMR specifically. The financing for AMR-related activities is fragmented; budgets may reflect allocations for antibiotics, infection control in hospitals, IEC, etc, but do not include P a g e | 13 specific allocations for AMR . Hence, there is difficulty ascertaining the exact expenditure for AMR the past years. Meanwhile, financing for AMR cases through the Philhealth has not yet been finalized. Hence, the burden to patients remains immense, especially for indigents. To mitigate this, the Philhealth Outpatient Benefit package must be scaled up. Furthermore, the monitoring and evaluation of Philhealth Circular No. 15, s. 2006 and DOH AO 2015 0049 are necessary steps. Opportunity to Boost Research on AMR Philippine research on AMR is currently limited. Most research focus on tuberculosis (TB), as it is commonly granted funding from donors. Available data and research are limited for other pathogens like Streptoccus sp., E. coli, Klebsiella sp., MRSA, A. baumanii, etc. AMR detection, prevention, and control specific to animal health have not been specifically mentioned in the National Unified Health Research Agenda (NUHRA); only a general statement on AMR was mentioned. Other concerns that need more research and funding for both sectors are supply chain, policy, community, and behavior. Currently, most research activities are related to microbiology, surveillance and clinical studies. There is also scarcity in the development of new antibiotics, especially in the country. In relation to this, the private sector buy in needs to be strengthened to increase their investments on antimicrobials, especially at the R&D level. In cases where researches are available, accessing these can be difficult. Research database/repository for Philippine studies on AMR in animal health has not been developed, leaving many studies unpublished. Hence, there should also be a push to improve the publication rate of researches and build the local database. Antimicrobial residues in the environment can affect both animal and human health through the food chain, however, no research is available in the country on environmental impact of manufacturing and agricultural runoffs. There is a general lack of data on the level of antimicrobials in rivers, seas, as well as the soil. There are still a lot of research that needs to be done in order for the country to have 14 | P a g e better scientific evidence and data to manage AMR. Annex E and Annex F lists all recent research done in Animal Health and Human Health Respectively. Annex G identifies potential research gaps. A list of possible research questions can be found in Annex H. Continue capacity building, education, awareness and advocacy Although there is increasing awareness of AMR, there is still much to be done in this area. No survey has been conducted to assess how much the campaigns of the DOH has reached the general public and how this has changed their behavior. The ongoing campaign of DA, IAMResponsible, also needs to be assessed. Specific key messages for consumers, livestock stakeholders, health professionals need to be developed. Risk communication strategies should also be prepared. Consumer groups need to be involved so that they are empowered in making better choices for their families. Primary healthcare facilities should also have IEC materials on AMR. In both the animal and human sectors, the training and development of health workers need to include AMR awareness and response. To this end, DepEd, CHED, and PRC should be onboard. There is also a need to train LGU staff and volunteers for the proper handling and collection of respiratory samples for surveillance of diseased animals at the grassroots level. II. Methodology From July to August 2018, the ICAMR, through the support of WHO Philippines, conducted a review of the implementation of the previous National Action Plan from 2015-2017. Consultants from the Alliance for Improving Health Outcomes (AIHO) facilitated data gathering, including desk reviews, interviews and consultations with different stakeholders from government agencies, non-government organizations, professional societies, and partners. On September 26, 2018, an initial consultation with the Department of Agriculture (DA), its involved subunits, and a representative from the agriculture private sector P a g e | 15 was organized in order to review the key result areas and objectives and subsequently deliberate on potential activities for inclusion in the next action plan. The DA had representatives from the following agencies: Bureau of Animal Industry (BAI), National Dairy Authority (NDA), Bureau of Fisheries and Aquatic Resources (BFAR), National Meat Inspection Services (NMIS), and the Philippine Carabao Center (PCC). Meanwhile, the private sector was represented by the Philippine Veterinary Medical Association. For the DOH and its involved institutions, the consultation was held on October 3, 2018. Attendees from the Department of Health were from the Pharmaceutical Division (PD), Epidemiology Bureau (EB), Health Facility Development Bureau (HFDB), Health Facilities & Services Regulatory Bureau (HFSRB) and Disease Prevention & Control Bureau (DPCB). The hospitals were represented as well, with participants coming from Research Institute for Tropical Medicine (RITM), Jose B. Lingad Memorial Regional Hospital (JBLMRH), San Lazaro Hospital (SLH) and Philippine General Hospital (PGH). Moreover, experts from the National Antibiotic Guidelines Committee (NAGCom) and the Antibiotic Stewardship Steering Committee (ASC) were also present to guide the discussions especially on the technical aspect of antimicrobial stewardship. Lastly, the World Health Organization Philippine Country Office provided technical guidance as well especially on linking animal health initiatives to human health AMR developments. On 16 October 2018, participants from Animal Health and Human Health sectors gathered for a national consultation and strategic planning on AMR. The Department of Agriculture and Department of Health, through the support of the Alliance for Improving Health Outcomes (AIHO), presented accomplishments, challenges and gaps on AMR based on the review of the implementation of the 2015-2017 Philippine Action Plan. The participants reviewed and finalized the seven key strategies and objectives for 2019-2023. Part III of this document outlines these strategies, objectives and activities. Timelines, responsible agencies, measurement and budget are enumerated in Annex B. Table 3. Strategic Areas and Key Strategies Strategic Areas Key Strategies 16 | P a g e Implementation of the PNAP Commit to the Philippine National Action Plan through multisectoral engagement and accountability. Surveillance and laboratory Strengthen surveillance and laboratory capacity Access to antimicrobials Ensure uninterrupted access to safe and quality-assured antimicrobials Optimal use of antimicrobials Regulate and promote the optimal use of antimicrobials Reduction of infection Implement appropriate measures to reduce infection across all settings Innovation and research Promote innovation and research on AMR Awareness, communication and education Improve awareness and understanding of antimicrobial resistance through effective communication and education. Comparison between Original NAP (2014) and PNAP (2018) The current plan maintains the key strategies from the original NAP. However, some words are refined to better reflect that this plan is about AMR. For example, instead of using the term “essential medicines”, the new plan uses the term “antimicrobials”. More sectors and agencies need to be involved in this program, hence the inclusion of “multisectoral engagement” in lieu of “civic society engagement.” Finally, there is recognition that communication does not only involve “risks”, hence the KS is revised to “effective communication”. The table below shows the previous strategies and the revised strategies for 2019-2023. Table 4. Comparison between the NAP and PNAP Philippine Action Plan to Combat AMR 2015-2017 Philippine National Action Plan on AMR 2019-2023 P a g e | 17 Commit to a comprehensive, financed national plan with accountability and civic society engagement Commit to the Philippine National Action Plan through multisectoral engagement and accountability. Strengthen surveillance and laboratory capacity Strengthen surveillance and laboratory capacity Ensure uninterrupted access to essential medicines of assured quality Ensure uninterrupted access to safe and quality-assured antimicrobials Regulate and promote rational use of medicines, including in animal husbandry and ensure proper patient care Regulate and promote the optimal use of antimicrobials Enhance infection prevention and control across all settings Implement appropriate measures to reduce infection across all settings Foster innovations, research and development Promote innovation and research on AMR Development of a Risk Communication Plan to Combat AMR Improve awareness and understanding of antimicrobial resistance through effective communication and education. Aside from the words used, indicators are also enhanced to reflect conditions in animal sector, as well as the environmental indicators. All of these are made in relation to food safety indicators. In terms of stakeholders, more agencies are included to reflect the multisectoral nature in addressing AMR. III. Philippine National Action Plan 2019-2022 A. Vision, Mission, Targets and Indicators for 2019-2023 Vision A nation protected against the threats of antimicrobial resistance Mission 18 | P a g e To implement an integrated, comprehensive, and sustainable national program to address antimicrobial resistance geared towards safeguarding human and animal health, and preventing interference in agricultural, food, trade, communication and environmental sector activities. General indicators These are the recommended new set of indicators for 2023 based on 2017 baseline. ● Target 1: Reduce by 10% carbapenem-resistant Enterobacteriaceae (E. coli and Klebsiella spp.) infections acquired during hospitalization. ● Target 2: Maintain the 0% prevalence of ceftriaxone-resistant Neisseria gonorrhoeae. ● Target 3: Reduce by at least 10% the overall methicillin resistance in Staphylococcus aureus bloodstream infections compared to rates in 2017. ● Target 4: Reduce by 10% multidrug-resistant Pseudomonas spp infections acquired during hospitalization compared to estimates in 2017. ● Target 5: Reduce by 25% ciprofloxacin-resistant non-typhoidal Salmonella infections compared to 2017. ● Target 6: 10% reduction in use of antibiotics in humans and animals. ● Target 7: Identify baseline AMR and use in animal sector. The new indicators were set during the Technical Consultation with DA, DOH and AMR experts on 7 November 2018. B. Outcome Indicators Human Health Sector The following table summarizes resistance rates of antimicrobials in 2014 and 2017. The ICAMR has set targets by 2023 based on track record observation and expert opinion. This list is adopted from WHO Recommendations on Critical, High Priority and Medium Priority microbes and resistance for Monitoring. The ICAMR with infectious disease experts conducted a consultation on these indicators on 7 November 2018. Table 5. Resistance Rates in 2014 and 2017, with 2023 Targets, based on the WHO Priority Pathogen List Priority Microbe Resistance 2014 2017 2023 (target) P a g e | 19 Critical Acinetobacter baumannii carbapenem-resistant imipenem n.a. **57% 51.3% meropenem n.a. **56% 52.2% Pseudomonas aeruginosa carbapenem-resistant imipenem n.a. 17% 15.3% meropenem 45.30% 14% 12.6% High Staphylococcus aureus methicillin-resistant, vancomycin-intermediate and resistant MRSA RATE 60.30% 57% 39.9% vancomycin n.a. 2% 1.4% Salmonellae fluoroquinolone-resistant Nontyphoidal Salmonella ciprofloxacin 21% 9% 6.75% Neisseria gonorrhoeae cephalosporin resistant,fluoroquinolone resistant penicillin *89.1% 85% 76.5% ciprofloxacin *84.8% 67% 60.3% Medium Streptococcus pneumoniae (using meningitis breakpoints penicillin-non-susceptible penicillin 7% 10% 8.9% Haemophilus influenzae ampicillin-resistant ampicillin 12% 14% 12.6% Shigella spp. fluoroquinolone-resistant 20 | P a g e ciprofloxacin *13.8% 11% 9.9% *2011-2014 because of the number of isolates submitted**In 50% of all reported isolates **Currently not collected for the ARSP Notes: 1. Table is based on WHO Recommendations. The following were removed: Enterobacteriaceae, Enterococcus faecium, Helicobacter pylori and Campylobacter spp. 2. The targets are based on the 10% reductions set. 3. For ciprofloxacin resistance for non-typhoidal Salmonella, the target is 25% reduction. Animal Health Sector The Animal Health Sector is developing the system for AMR surveillance. Three Components have been identified with target population, target bacterial species and target antibiotics. The Animal Health Sector aims to improve the system and establish a baseline by 2020. These targets are from the Antimicrobial Resistance Surveillance Plan for Animal Health. Component 1: Healthy Food Animals Target Population: Pigs and Poultry Table 6. Target Bacterial Species for Healthy Food Animals Zoonotic bacteria 1. Salmonella spp. 2. Campylobacter spp.* Commensal bacteria 1. Escherichia coli 2. Enterococcus faecium* 3. Enterococcus faecalis* *AST for these bacteria will be as per recovered isolates (no set sample size), while improved capacity for isolation of these organisms will be pursued P a g e | 21 Target Antibiotics: Minimum Inhibitory Concentration data will be generated for the following antimicrobials by the NMIS and the BAI Table 7. Target Antibiotics Azithromycin Ampicillin Cefotaxime Ceftazidime Chloramphenicol Ciprofloxacin Colistin Gentamicin Meropenem Nalidixic acid Streptomycin Sulfamethoxazole Tetracycline Trimethoprim Component 2: Diseased Livestock Target Population a. Pigs and poultry with respiratory illnesses b. Dairy animals (cattle, water buffalo) with clinical and subclinical mastitis Target Bacterial Species Table 8. Target Bacterial Species for Diseased Livestock Swine* 1. Actinobacillus pleuropneumoniae 2. Pasteurella multocida 3. Bordetella bronchiseptica 4. Streptococcus suis Poultry** 1. Mycoplasma 2. Pasteurella multocida 3. Haemophilus paragallinarum Dairy Cattle & Water Buffaloes 1. Staphylococcus aureus 2. Streptococcus agalactiae 3. Escherichia coli *Haemophilus suis and other economically significant respiratory pathogens in swine will be considered, however their critical breakpoints have not yet been defined. **Clinical breakpoints have not been set for these pathogens Component 3: Diseased Aquatic Animals Table 9. Target Population and Bacterial Species for Diseases Aquatic Animals 22 | P a g e Target Population Target Bacterial Species Tilapia Streptococcus agalactiae Streptococcus iniae* Milkfish and Shrimp Vibrio parahaemolyticus *S. iniae is also an emerging human pathogen, aside from being a major pathogen in fish. C. Stakeholders The Department of Health and Agriculture play critical roles in this new plan since human and animal health are the ones that ultimately suffer from effects of AMR. In addition, DENR, DTI, DILG, DepEd and CHED are all given bigger roles. DENR is essential in completing the environmental arm of the One Health approach. The antimicrobial residues found in the environment, as well as the microbes that can be changed because of these residues, can only be fully addressed if DENR is fully onboard. Its monitoring and policing powers, especially with industry-related pollutants, are instrumental to creating a better environment. DTI, on the other hand, can ensure that the products that get into the country are safe and of good quality. This has implications most especially on food safety. Meanwhile, DILG, has a crucial role in local policy development, implementation, and monitoring. This plan aims to strengthen the capacity of local governments to support efforts to control AMR. PRC, CHED, and DepEd are included in this plan to emphasize their fundamental roles in educating and increasing the awareness of the health workers and the general public about AMR. The methods of preventing AMR like hand washing, vaccination, etc. can also be disseminated at different levels. The human health and animal health private sectors have huge roles in AMR implementation. They are essential partners for surveillance and monitoring, trainings, delivery of services, professional and public education, effective supply chain, advocacy and research. Private partners, professional societies and the civil P a g e | 23 society are also key partners in the training and production of professional workforce that are better equipped to implement safe and secure services, as well as in managing AMR. More specifically, the Pediatric Infectious Disease Society of The Philippines (PIDSP), Philippine Pharmacists Association (PPhA), Philippine Hospital Infection Control Nurses Association (PHICNA), and Philippine Hospital Infection Control Society (PHICS) as members of the Antimicrobial Stewardship Steering committee (ASC) are active in the Philippine AMR initiatives. But as the PNAP 2019 2023 rolls out, greater involvement of other professional organizations such as the Philippine Society of Public Health Physicians (PSPHP) and patient organizations such as the Philippine Alliance of Patient Organizations (PAPO) is needed. Table 10. Stakeholders per Key Strategy Key Strategies Stakeholders 1. Commit to the Philippine National Action Plan through multisectoral engagement and accountability. ● Animal Health: DA, academe, private sector, PRC ● Human Health: DOH, FDA, PhilHealth, academe, private sector, PRC ● Relevant sectors: DILG, DENR, DTI, DepEd, CHED 2. Strengthen surveillance capacity ● Animal Health: DA ● Human Health: DOH, hospitals ● Environment: DENR 3. Ensure uninterrupted access to safe and quality-assured antimicrobials ● Animal Health: DA, FDA, DTI, LGUs, farmers, animal producers, professionals, private sector ● Human Health: DOH, FDA, PhilHealth, DTI, hospitals, LGUs, professional societies, private sector (suppliers) 24 | P a g e 4. Regulate and promote the rational use of antimicrobials ● Animal Health: DA, FDA, LGUs, farmers, animal producers, professionals, private sector, academe ● Human Health: DOH, FDA, hospitals, LGUs, professional societies, private sector (retail stores) 5. Reduce incidence of infection through sanitation, hygiene and infection prevention and control across all settings ● Animal Health: DA, LGUs, farmers, animal producers, professionals, private sector ● Human Health: DOH, hospitals, LGUs, professional societies, private sector 6. Promote innovation and research on AMR ● Animal Health: DA, DOST, academe, private sector, professional societies ● Human Health: DOH, hospitals, DOST PCHRD, academe, professional societies, private sector 7. Improve awareness and understanding of antimicrobial resistance through effective communication and education. ● Animal Health: DA, LGUs ● Human Health: DOH, hospitals ● Education: DepEd, CHED D. Key Strategies, Objectives and Activities Key Strategy 1. Commit to the Philippine Action Plan through multisectoral engagement and accountability P a g e | 25 Key Strategy 1 establishes enabling mechanisms to formulate and mobilize resources for the Philippine National Action Plan on AMR. These enabling mechanisms are articulated into the following objectives and activities, namely: Objectives: 1.1 To forge a joint action plan to combat AMR for 2019-2023, including an agreement involving national agencies. 1.2 To elevate AMR as a national priority 1.3 To uphold accountability among various sectors in fulfilling their roles in the prevention and reduction of AMR 1.4 To allocate adequate resources for AMR initiatives in all relevant sectors 1.5 To continue collaboration for the achievement of key performance indicators Partners: ● Animal Health: DA, academe, private sector, PRC ● Human Health: DOH, FDA, PhilHealth, academe, private sector, PRC ● Relevant sectors: DILG, DENR, DTI, DepEd, CHED All Sectors: Animal Health, Human Health, Education, Trade, Professional Regulation, Other Relevant Sectors Table 11. Objectives and Activities for Key Strategy 1 Objectives Activities 1.1 To forge a joint action plan to combat AMR for 2019-2023, including an agreement involving national agencies. 1. Conduct ICAMR strategic planning, as well as development of the 2019-2023 action plan to combat AMR 2. Conduct regular meetings to monitor implementation of the plan 3. Publish an ICAMR annual report 1.2 To elevate AMR as a national priority 1. Draft and subsequently approve updated/ revised of joint policy; Issuance of an administrative order to include other government stakeholders (i.e. DepED, DENR and PRC) in ICAMR 2. Advocate AMR as a food safety issue of prime 26 | P a g e importance 1.3 To uphold accountability among various sectors in fulfilling their roles in the prevention and reduction of AMR 1. Establish subcommittees within ICAMR (e.g. surveillance, research, financing) 2. Provide authority to the ICAMR Secretariat to ensure goals are met by the different stakeholders 1.4 To allocate adequate resources and expertise for AMR initiatives in all relevant sectors 1. Include AMR in annual budget planning of the different agencies involved 2. Identify priority areas for international cooperation 3. Enhance international partnerships for AMR initiatives in human and animal health 1.5 To continue collaboration for the achievement of key performance indicators 1. Regularly submit reports/required information of ICAMR member agencies identified in this action plan to the ICAMR secretariat Key Strategy 2. Strengthen surveillance and laboratory capacity Surveillance is the continuous, systematic collection, analysis and interpretation of health-related data for the purposes of planning, implementation, and evaluation of public health practice (WHO, 2018). Surveillance can serve (a) as the early warning system for emerging public health problems; (b) as data necessary for monitoring and evaluation (M&E) of public health interventions; and (c) to monitor and clarify the epidemiology of recognized health problems (WHO, 2018). Recognizing the crucial role surveillance plays in the development of evidence-based policies for AMR and informing stakeholders, Key Strategy 2 aims to bolster the important elements of AMR surveillance as expressed in the following objectives and activities: Objectives: 2.1 To improve the surveillance and diagnostic capabilities of hospitals, and laboratories P a g e | 27 2.2 To capacitate health workers based on required competencies for different areas of AMR work 2.3 To institutionalize well-developed reporting, monitoring and surveillance systems/ networks at all levels in health, agriculture and environment sectors Partners: ● Animal Health: DA ● Human Health: DOH, hospitals, PhilHealth ● Environment: DENR Table 12. Objectives and Activities for Key Strategy 2 (Animal Health) Objectives Activities 2.1 To improve the surveillance and diagnostic capabilities of hospitals, and laboratories 1. Finalize, institutionalize and implement of ARSP in animals 2. Regularly perform assessments and inventory of resources for monitoring, surveillance and testing (including price reference of laboratory supplies and equipment) 3. Conduct leveling of capacities of DA to perform laboratory analysis for AMR 4. Organize regional laboratory capacity-building activities for AMR detection 2.2 To capacitate health workers based on required competencies for different areas of AMR work 1. Assess skill mix and quantity of human resources for animal health surveillance and laboratories 2. Hire and subsequently train technical/laboratory personnel on monitoring, surveillance and testing methods and the operation of laboratories, including compliance to 28 | P a g e accreditation standards (PNS ISO1/IEC 170252, PNS ISO 151893, PNS ISO/IEC 170204, Codex5, CLSI6) 3. Develop skills of LGU veterinary service staff for sampling and surveillance 2.3 To institutionalize well developed reporting, monitoring and surveillance systems/ networks at all levels in health, agriculture and environment sectors 1. Finalize and approve surveillance and monitoring plan for animal health 2. Establish a national coordinating center for AMR within the animal health sector 3. Create master list of all veterinary feeds, farms, and drug establishments 4. Implement surveillance and monitoring systems for AMR and AMU in food-producing animals and their products: meats, fish & fishery products, milk, eggs, and honey 5. Develop formal document for monitoring and quantification of AMR and AMU trends in food producing animals 6. Perform sampling and testing analysis for antibiotic susceptibility testing based on internationally accepted standards (i.e. CLSI) 7. Conduct data collection, sampling, testing, and analysis for veterinary drug residues in meat products, and connect findings with AMR.7 1 The International Organization for Standardization (ISO) is an independent non-governmental organization composed of 162 national standard bodies developing over 22,000 international standards covering nearly all aspects of technology and manufacturing. 2 ISO/IEC 17025 indicates requirements for the competence of testing and calibration laboratories 3 IEC 15189 outlines standards for quality and competence in medical laboratories. 4 IEC 17020 specifies standards for operation of different types of institutions performing inspection. 5 Codex Alimentarius is a group of internationally recognized standards, guidelines, policies, recommended practices on food, food production, and food safety. 6 The Clinical Laboratory Standards Institute (CLSI) is a non-profit international organization composed more than 1,400 organizations from over 60 countries setting and upholding the standards towards improvement of the quality test results, patient care delivery, and public health. 7 Residues are not part of AMR data. P a g e | 29 Table 13. Objectives and Activities for Key Strategy 2 (Human Health) Objectives Activities 2.1 To improve the surveillance and diagnostic capabilities of hospitals, and laboratories 1. Ensure sufficient laboratory human capacity and other resources through planning and resource allocation 2. Explore potential areas to strengthen financing of laboratory tests in public and private sectors 3. Expand ARSP training and accreditation to non tertiary hospitals 4. Strengthen Luzon, Visayas and Mindanao reference laboratories to detect and monitor AMR surveillance 2.2 To capacitate health workers based on required competencies for different areas of AMR work 1. Assess skill mix and quantity of human resources for human health surveillance and laboratories, e.g. infectious disease specialists, clinical pharmacists, medical technologists, etc. 2. Send technical personnel to relevant local and foreign trainings on monitoring, surveillance and testing methods and the operation of laboratories, including compliance to accreditation standards (PNS ISO/IEC 17025, PNS ISO 15189, PNS ISO/IEC 17020, Codex) 2.3 To institutionalize well developed reporting, monitoring and surveillance systems at all levels in health, agriculture and environment sectors 1. Integrate AMR in the strategies of the National and Regional Health Laboratory Network 2. Designate EB as the national coordinating center for AMR surveillance within the human health sector 3. Develop protocol to monitor, manage, analyze, and utilize HAI data from local, regional to national levels 4. Expand annual point prevalence surveys (PPS) 30 | P a g e utilizing prescription data a. Develop WHO methodology on antimicrobial use b. Develop e-prescription system that will include the collection of data on antimicrobial use c. Training on e-prescription system (integrated with pharmacovigilance) d. Adopt e-prescription system in DOH hospitals 5. Establish a case-based AMR surveillance to enable quantifiable burden of disease 6. Develop an integrated system for AMR, AMU, and HAI8 7. Develop an IT platform to communicate data on AMR to stakeholders Table 14. Objectives and Activities for Key Strategy 2 (Environment Sector) Objectives Activities 2.1 To improve the surveillance and diagnostic capabilities of hospitals, and laboratories 1. Engage with environment laboratories and relevant offices 2. Assess capacities of environment laboratories 3. Conduct environmental monitoring for AMR in residue 4. Ensure proper disposal of waste and hazardous materials 5. Enhance technologies and capabilities of environmental laboratories for monitoring 6. Monitor implementation of protocols on waste disposal from hospitals, health facilities, clinics, animal clinics 8 A similar system is employed in the USA. This is the National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS), which tracks antimicrobial susceptibility of certain enteric (intestinal) bacteria found in ill people, retail meats, and food animals. Established in 1996, NARMS is a partnership between US state and local public health departments, Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and the U.S. Department of Agriculture (USDA). P a g e | 31 2.2 To capacitate health workers based on required competencies for different areas of AMR work 1. Train staff for environmental monitoring of residue Key Strategy 3. Ensure uninterrupted access to safe and quality assured antimicrobials Access to quality antimicrobials plays a role in the emergence of antimicrobial resistance because inadequate access can entail patients missing or taking improper doses. Therefore, ensuring access to quality antimicrobials policies that encourage adequate supply of quality antimicrobials, an efficient antimicrobial supply chain system and a public financing mechanism to ensure availability. Access to quality antimicrobials is embodied by the following objectives and activities: Objectives: 3.1 To improve the registration, marketing authorization and post-marketing surveillance of antimicrobials 3.2 To monitor availability and affordability of quality antimicrobials at all levels of care 3.3 To develop a sustainable and effective supply chain management for antimicrobials Partners: ● Animal Health: DA, FDA, DTI, LGUs, farmers, animal producers, professionals, private sector ● Human Health: DOH, FDA, PhilHealth, DTI, hospitals, LGUs, professional societies, private sector (suppliers) Table 15. Objectives and Activities for Key Strategy 3 (Animal Health) Objectives Activities 3.1 To improve the registration, marketing 1. Review and assess current policies related to the use and other regulations of 32 | P a g e authorization and post marketing surveillance of antimicrobials antimicrobials, as well as issuances related to access to antimicrobials (especially in the distribution and sale in outlets) 2. Issue Sanitary Phytosanitary Import Clearance 3. Issue Administrative Order on the Prudent Use of Veterinary Drugs 4. Create a joint regulatory framework with the FDA 5. Establish a unit within FDA to regulate veterinary drugs 6. Develop a database of registered antimicrobials, including quantitative production and importation 7. Perform quality monitoring of veterinary drugs 8. Monitor and penalize of use of unregistered antimicrobials in animal husbandry and aquaculture 9. Strictly enforcement and incentivize adherence to regulations on antibiotic prescription, dispensing, and use in animal husbandry 10. Require all antimicrobials to adhere to Good Manufacturing Practices9 Table 16. Objectives and Activities for Key Strategy 3 (Human Health) Objectives Activities 3.1 To improve the registration, marketing authorization and post marketing surveillance of 1. Monitor the quality of registered antimicrobials in the market 2. Process streamlining of review and release of 9 Good Manufacturing Practice (GMP) minimizes risks in pharmaceutical production by ensuring products are produced consistently and in accordance to quality standards. P a g e | 33 antimicrobials marketing authorization of new antibiotics that address priority infectious diseases in the country10 3. Forge an agreement on regulatory control over drugs used in aquaculture (FDA and DA) 4. Harmonize regulatory framework in the production and use of antimicrobials in humans and animals (FDA and DA) 5. The use of technologies to increase surveillance and detect falsified and substandard drugs in the market 3.2 To monitor availability and affordability of quality antimicrobials at all levels of care 1. Conduct representative drug availability surveys 2. Conduct representative survey of pricing of essential antimicrobials 3. Conduct representative supply chain studies11 (from forecasting to distribution) 4. Update the National Antibiotic Guidelines 3.3 To develop a sustainable and effective supply chain management for antimicrobials 1. Improve public medicine logistics and procurement system to prevent stock out of drugs, particularly antimicrobials in government health facilities 2. Ensure quality of antimicrobials at every step of the supply chain 3. Expand of Philhealth reimbursement to non restricted antimicrobials 4. Develop PhilHealth benefit packages for antimicrobial resistance 10 During the 2018 DOH-DA strategic planning, stakeholders articulated the need for FDA to facilitate easier registration and approval processes for antibiotics. For instance, out of 10 new antimicrobials in the global market, only one (1) is approved in the Philippines. 11 A study assessing the impact of current reforms of supply chain management should be conducted if supply chain has improved. 34 | P a g e 5. Implement PhilHealth benefit packages for antimicrobial resistance Key Strategy 4: Regulate and promote the rational use of antimicrobials AMR can occur because of the ability of the organism to neutralize the effect of antimicrobials. However, emergence of AMR is exacerbated by irrational use of antibiotics (WHO, 2018). In fact, during his 1945 Nobel Prize acceptance speech, Alexander Fleming warned that AMR will be brought about by the cavalier use of antimicrobials once they are made available freely in the market (Government of Japan, 2016). Irrational use of antimicrobials is made possible when antimicrobials are obtained without prescription or prescribed in conditions where antimicrobials are not indicated. The use of antimicrobials to promote growth in livestock is also an area of concern. The Philippines’ initiatives toward the prudent use of antimicrobials are articulated by the following objectives and activities: Objectives: 4.1 To fully implement guidelines for rational use of antimicrobials 4.2 To create an enabling environment for the rational use of antimicrobials 4.3 To track policy enforcement on rational use of antimicrobials in markets, farms and communities Partners ● Animal Health: DA, FDA, LGUs, farmers, animal producers, professionals, private sector, academe ● Human Health: DOH, FDA, hospitals, LGUs, professional societies, private sector (retail stores) ● Education, Trade and other sectors: DTI, DOLE, CHED, DepEd Table 17. Objectives and Activities for Key Strategy 4 (Animal Health) P a g e | 35 Objectives Activities 4.1 To fully implement guidelines for prudent use of antimicrobials 1. Review existing regulations and regulatory controls for registration, advertising, importation and end use12 2. Revive the Veterinary Formulary Executive Council 3. Develop National Antibiotic Guidelines for Animal Health 4. Development of national guidelines based on international or regional guidelines for an Antimicrobial Stewardship Program in animal health 5. Translate GAHP and GAqP into technical regulations 6. Documentation of good practices of GAHP and GAqP 7. Institutionalize Philippine Practice Standards for Veterinarians in relation to Prudent Prescribing of Antimicrobials 8. Ensure DTI labelling on meat products are pursuant to newly developed national guidelines 9. Conduct monitoring and surveillance of animal feeds and veterinary drug establishments 4.2 To create an enabling environment for the prudent use of antimicrobials 1. Assign regional coordinators on AMR activities 2. Develop and subsequently implement a strategy for regulation of the use of antibiotics common to both human and animal health as growth promoters and the continuous 12 Ensuring ethical marketing of medicines, medical representatives need to secure license from Professional Regulation Commission (PRC) to practice their profession. However, no similar regulatory instrument for animal health exist. 36 | P a g e monitoring of banned antimicrobials13 3. Register existing aquafarms' sources of raw materials, as well as swine and poultry feeds, in processing plants 4. Registration of VDAP establishments and products 5. Strict enforcement of existing regulations regarding medicated feeds 6. Development of guidelines for the regulation of antimicrobials in drinking water 7. Incentivize practitioners on the prudent use of antibiotics 8. Incentivize farms and operations by rewarding approvals for labelling their meat products with an official marketing tagline14 4.3 To track policy enforcement on rational use of antimicrobials in markets, farms and communities 1. Conduct dialogue with clients, stakeholders, industry and LGUs 2. Develop a system for monitoring implementation of issued regulations 3. Engage LGUs in the implementation of regulations, especially in use of antimicrobials in backyard farms Table 18. Objectives and Activities for Key Strategy 4 (Human Health) Objectives Activities 4.1 To fully implement guidelines for rational use of antimicrobials 1. Develop a prescription audit system for antimicrobials ○ Assessment workshop ○ Identify existing information systems 13 The OIE’s terrestrial code includes a list of allowed antibiotics with evidence that they are not a threat to AMR 14 Subject to labelling guidelines; e.g. “approved by DA / BAI & NMIS” P a g e | 37 ○ Pilot prescription audit system ○ Implementation (including training) ○ Integrate system in HOMIS or other hospital IT systems 2. Integrate antimicrobials, AMR and AMS principles and concepts in higher education curricula and in the continuing professional education (CPE) for health professionals 3. Actively coordinate with LGUs on the dissemination and implementation of policies through the National Drug Policy Compliance Officers (NDPCO) per region 4.2 To create an enabling environment for the rational use of antimicrobials 1. Strictly enforce regulations on antibiotic prescription and use 2. Continue rolling out AMS program in Level 1 hospitals & RHUs 3. Document and disseminate best practices in AMS 4. Develop, improve, adopt and roll-out E-AMS in hospitals that have been piloted 5. Monitor AMS program including the PhilPSP and the dissemination of NAG in all health facilities 6. Policy to create/ require plantilla positions for clinical pharmacists in both public and private facilities 7. Roll out AMS Fellowship Program for Hospital Pharmacists Table 18. Objectives and Activities for Key Strategy 4 (Education, Trade and other sectors) Objectives Activities 38 | P a g e 4.1 To fully implement guidelines for rational use of antimicrobials 1. Integrate antimicrobials, AMR and AMS principles and concepts in higher education curricula and in the continuing professional education (CPE) for health professionals 4.2 To create an enabling environment for the rational use of antimicrobials 1. Training/ CPD on antimicrobial resistance and the National Antibiotic Guidelines for company/school physicians and nurses. Key strategy 5: Implement appropriate measures to reduce infection across all settings Reducing infection will also reduce the need for utilization for antimicrobials since treatment of infections often include the use of antimicrobials. Therefore, it is imperative to decrease antimicrobial consumption because it can limit the improper use of antimicrobials (WHO, 2018). Infection prevention and control also plays a role in the prudent use of antimicrobials in the agriculture sector since it removes the need to use antimicrobials as growth promoters. Food production should follow international standards in good animal husbandry and aquaculture practices and biosecurity. This is important to boost production for local consumption and exportation of animal food. Infection prevention and control including initiatives promoting biosecurity, sanitation, hygiene are expressed in the objectives and activities below. Objectives: 5.1 To enhance capacities of health personnel, facility, and community for infection prevention, sanitation and hygiene 5.2 To implement coordinated programs on sanitation, hygiene and infection prevention and control in hospitals, health facilities, animal clinics and farms 5.3 To improve good animal husbandry practices and biosecurity in animal farms Partners: ● Animal Health: DA, LGUs, farmers, animal producers, professionals, private sector ● Human Health: DOH, hospitals, LGUs, professional societies, private sector P a g e | 39 Table 19. Objectives and Activities for Key Strategy 5 (Animal Health) Objectives Activities 5.1 To enhance capacities of health personnel, facility, and community for infection prevention, sanitation and hygiene 1. Implement Good Animal Husbandry Practices and Good Aquaculture Practices as Philippine National Standards 2. Strengthen animal health system capacity 5.2 To improve good animal husbandry practices and biosecurity in animal farms 1. Ensure strict implementation of biosecurity measures in agriculture and aquaculture farms, with adherence to GAHP 2. Implement HACCP System in processing plants 3. Implementation of GMP for feed mills, importers, manufacturers, and suppliers Table 20. Objectives and Activities for Key Strategy 5 (Human Health)15 Objectives Activities 5.1 To enhance capacities of health personnel, facility, and community for infection prevention, sanitation and hygiene 1. Conduct basic and continuous training of ICC personnel (IPC, and surveillance of HAI and other diseases) 2. Integrate infection prevention and control in other existing public health programs 3. Conduct effective IPC education and promotion at the community level 5.2 To implement coordinated programs on sanitation, hygiene and infection prevention and control in hospitals, health facilities, and other settings 1. Enforcement of licensing standards on IPC 2. Monitor compliance of health facilities with the National Infection Prevention and Control Policy 3. Conduct mentoring activities of health facilities on 15 It should be noted that DOH-HFDB has a plan for IPC in hospitals including budget provisions. 40 | P a g e IPC by professional societies and model hospitals 4. Improve biosecurity measures 5. Develop a protocol for AMR outbreaks (for hospitals) 6. To develop a national system to monitor selected hospital acquired-infections and assess the effectiveness of interventions. Key Strategy 6: Promote innovation and research on AMR The problem of antimicrobial resistance is twofold: (1) the improper use of antimicrobials exacerbates the development of microbes’ resistance to existing antibiotics; and (2) the drying up of the antibiotics pipeline means that in the long run, the biological arms race against the microbes will be lost. Therefore, in order to address AMR, there is a need to develop evidence-based policies and initiatives to alter improper use of antimicrobials as well as develop incentives for the development of new antimicrobials. Annexes E and F contain AMR-related researches completed or ongoing in the Philippines in the last five years. Annexes G and H list research gaps and potential research questions and areas as guidance for researchers. Objectives: 6.1 To create a supportive and sustainable environment for AMR research 6.2 To disseminate information on AMR 6.3 To promote development of innovative technologies and knowledge translation of AMR research Partners: ● Animal Health: DA, DOST, academe, private sector, professional societies ● Human Health: DOH, hospitals, DOST-PCHRD, academe, professional societies, private sector Table 21. Objectives and Activities for Key Strategy 6 (Animal Health) Objectives Activities P a g e | 41 6.1 To create a supportive and sustainable environment for AMR research 1. Develop an integrated, targeted AMR Research Agenda for animal health and animal products (meats, milk, eggs, and honey) and other related areas 2. Establish comprehensive database for AMR research; Upgrade existing IT system on AMR research 3. Coordinate with public and private research agencies, think tanks, academe and professional societies to strengthen research collaboration 4. Conduct AMR research in different fields microbiology, genetics & molecular studies, agriculture, animal production and husbandry, behavioural, market, innovation, supply chain, etc. 6.2 To disseminate information on AMR 1. Include new discoveries and data in the iAMResponsible campaign, ensuring understanding by general public 2. Present research results and conclusions to stakeholders and industry to augment policy formation 3. Publish research results in peer-reviewed, scientific journals (considering CLSI Standards) 4. Develop inventory of AMR-related research on animals and their products (meats, milk, eggs, honey, etc.) 6.3 To promote development of innovative technologies and knowledge translation of AMR research 1. Prioritize research that benefit small hold farmers (i.e. concepts and technology they could use in their farms) 2. Conduct research on good animal husbandry practices and alternatives to antimicrobial agents 3. Strengthen inter-agency collaboration for the conduct of research with DOST-PCARD, DOH and industry 42 | P a g e Table 22. Objectives and Activities for Key Strategy 6 (Human Health) Objectives Activities 6.1 To create a supportive and sustainable environment for AMR research 1. Mobilize budget and other resources for AMR research and development from various sources 2. Develop an integrated AMR research agenda prioritizing the development of new types of antimicrobials,novel therapies, genetic and molecular basis & trends of AMR, system, supply chain, economic studies, policy, community, patient level, provider level and behavior researches 6.2 To disseminate information on AMR 1. Update database of local researches related to AMR available to all 2. Translate and disseminate AMR research into information for professionals and general public 6.3 To promote development of innovative technologies and knowledge translation of AMR research 1. Identify fields related to AMR and antibiotic research that have potential for translation and commercialization 2. Establish an AMR innovation fund 3. Support universities, think tanks, experts and researchers who conduct innovation technologies for AMR and antibiotics 4. Encourage private sector collaboration to increase investments in R&D for antimicrobials Key Strategy 7: Improve awareness and understanding of antimicrobial resistance through effective communication and education Effective communication is an integral part of every public health initiative. Along with altering the behavior of the target population, effective communication fosters P a g e | 43 participation and cooperation of stakeholders. The Philippines’ initiative to improve awareness and understanding of antimicrobial resistance through effective communication and education is articulated in the objectives and activities below. Objectives: 7.1 To increase public awareness on the rational use of antibiotics 7.2 To integrate AMR prevention and reduction in pre-service training of health and agriculture professionals Partners: ● Animal Health: DA, LGUs ● Human Health: DOH, hospitals ● Education: DepEd, CHED Table 23. Objectives and Activities for Key Strategy 7 (Animal Health) Objectives Activities 7.1 To increase public awareness on the rational use of antibiotics 1. Conduct KAP studies for farmers, nutritionists, feed millers, and other stakeholders on prudent antimicrobial use and/or the impact of uncontrolled use of antimicrobials 2. Develop and subsequently implement the IAMResponsible campaign for different sectors (consumers, farmers, veterinarians, etc.) 3. Conduct nationwide advocacy campaign on prudent use of antimicrobials and food safety 4. Improve communication means (e.g. social media) for AMR awareness campaigns and/or public notifications 5. Conduct advocacy meetings with stakeholders 44 | P a g e 6. Produce IEC materials for distribution to stakeholders 7. Produce and disseminate (social media) documentary films on food production and safety with information on AMR 7.2 To integrate AMR prevention and reduction in pre-service training of health and agriculture professionals 1. Implement risk communication plan specifically anchored to good veterinary practices targeting veterinarians, nutritionists, feed millers, suppliers, and farm owners 2. Integrate AMR awareness, prevention and reduction in school curriculum for pre service training of health and agriculture professionals Table 24. Objectives and Activities for Key Strategy 7 (Human Health) Objectives Activities 7.1 To increase public awareness on the rational use of antibiotics 1. Update localized IEC materials on AMR 2. Continuously implement general IEC and advocacy activities in different settings especially in communities to affect behavior change 3. Conduct effective, targeted health promotion and communication initiatives about AMR, AMU, and AMS in various settings (e.g. health facilities, schools, work place) through various channels (social media, television, print media, theaters, etc.) directed towards consumers. 4. Develop an evaluation mechanism for promotion and communication initiatives on P a g e | 45 AMR, AMU, AMS 5. Engage with LGUs on AMR advocacy 6. Develop a risk communication plan for AMR 7.2 To integrate AMR prevention and reduction in pre-service training of health and agriculture professionals 1. Integrate AMR awareness, prevention and reduction in school curriculum for pre service training of health and agriculture professionals Table 25. Objectives and Activities for Key Strategy 7 (Education) Objectives Activities 7.2 To integrate AMR prevention and reduction in pre-service training of health and agriculture professionals 1. Conduct dialogue with DepEd and CHED officials/ focal points 2. Integrate AMR awareness, prevention and reduction in school curriculum for pre service training of health and agriculture professionals 46 | P a g e References Centers for Disease Control and Prevention. (2018). Antibiotic Prescribing and Use in Doctor's Offices. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/antibiotic-use/community/about/fast-facts.html Food and Agricultural Organization of the United Nations. (2016). The FAO Action Plan on Antimicrobial Resistance 2016-2020. Retrieved from http://www.fao.org/3/a-i5996e.pdf Jayasree K. Iyer, A. M. (2018, February). Access to Medicine Foundation. Retrieved from Access to Medicine Foundation: https://accesstomedicinefoundation.org/media/atmf/Access-to-Medicine Foundation Indian-pharma-industry-and-AMR Briefing-Paper.pdf Lansang, M., Lucas-Aquino, R., Tupasi, T., Mina, V., Salazar, L., Juban, N., Kunin, C. (1990). Purchase of antibiotics without prescription in Manila, the Philippines. Inappropriate choices and doses. Journal of Clinical Epidemiology. Philippine Council for Health Research and Development. (2016). Call for Proposals for Pharmaceutical Health Services Research. Retrieved from Philippine Council for Health Research and Development: http://www.pchrd.dost.gov.ph/index.php/news/5572-call-for proposals-for-doh-pharmaceutical-health-services-research Research Institute for Tropical Medicine. (2014). Antimicrobial Resistance Surveillance Program 2014 Data Summary. Research Institute for Tropical Medicine. (2015). Antimicrobial Resistance Surveillance Program 2015 Data Summary. Research Institute for Tropical Medicine. (2016). Antimicrobial Resistance Surveillance Program 2016 Data Summary. Research Institute for Tropical Medicine. (2017). Antimicrobial Resistance Surveillance Program 2017 Data Summary. Research Institute for Tropical Medicine. (n.d.). National Reference Laboratories. Retrieved from: http://ritm.gov.ph/reference-laboratories/national-reference laboratories/antimicrobial-resistance-surveillance-reference-laboratory-program/ The Inter-Agency Committee on Antimicrobial Resistance. (2015). The Philippine Action Plan to Combat Antimicrobial Resistance: One Health Approach. The Government of Japan. (2016). National Action Plan on Antimicrobial Resistance (AMR) 2016-2020. The Government of Japan http://www.cdc.gov/antibiotic-use/community/about/fast-facts.html http://www.fao.org/3/a-i5996e.pdf http://www.pchrd.dost.gov.ph/index.php/news/5572-call-for-proposals-for-doh-pharmaceutical-health-services-research http://www.pchrd.dost.gov.ph/index.php/news/5572-call-for-proposals-for-doh-pharmaceutical-health-services-research http://ritm.gov.ph/reference-laboratories/national-reference-laboratories/antimicrobial-resistance-surveillance-reference-laboratory-program/ http://ritm.gov.ph/reference-laboratories/national-reference-laboratories/antimicrobial-resistance-surveillance-reference-laboratory-program/ P a g e | 47 The Government of Thailand. (2017). Thailand's National Strategic Plan on Antimicrobial Resistance 2017-2021. World Bank. (2017). Drug-Resistant Infections: A Threat to Our Economic Future. Washington, DC: World Bank. License: Creative Commons Attribution CC BY 3.0 IGO. Retrieved from http://www.worldbank.org/en/news/press-release/2016/09/18/by-2050-drug-resistant infections-could-cause-global-economic-damage-on-par-with-2008-financial-crisis World Health Organization. (2016). Philippines insight: A three decades engagement against Antimicrobial Resistance. Retrieved from World Health Organization Western Pacific Region: https://sites.wpro.who.int/antibiotic awareness/?p=2980 World Health Organization. (2018). About AMR. Retrieved from WHO Regional Office for Europe: http://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial resistance/about-amr World Health Organization. (2018). Antimicrobial Resistance: Infection Prevention and Control. Retrieved from World Health Organization: http://www.who.int/antimicrobial resistance/global-action-plan/infection-prevention-control/en/#content World Health Organization. (2017). Integrated Surveillance of Antimicrobial Resistance in Foodborne Bacteria: Application of a One Health Approach. Retrieved from https://www.who.int/foodsafety/publications/agisar guidance2017/en/ World Health Organization. (2018). Philippines Joint external evaluation: Prevent: Antimicrobial Resistance presentation. World Health Organization (WHO). Health Topics: Public Health Surveillance; 2018. Accessed from: http://www.who.int/topics/public health surveillance/en/ World Health Organization. (2018). Clean Care is Safe Care. Retrieved from http://www.who.int/gpsc/country work/gpsc ccisc fact sheet en.pdf World Health Organization. (2018). Health Topics: Public Health Surveillance. Retrieved from World Health Organization: http://www.who.int/topics/public health surveillance/en/ https://sites.wpro.who.int/antibiotic awareness/?p=2980 http://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/about-amr http://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/about-amr http://www.who.int/antimicrobial-resistance/global-action-plan/infection-prevention-control/en/#content http://www.who.int/antimicrobial-resistance/global-action-plan/infection-prevention-control/en/#content https://www.who.int/foodsafety/publications/agisar guidance2017/en/ http://www.who.int/topics/public health surveillance/en/ http://www.who.int/gpsc/country work/gpsc ccisc fact sheet en.pdf http://www.who.int/topics/public health surveillance/en/ Annexes A. List of Policies Related to AMR B. Key Strategies, Objectives, Activities, Stakeholders, Timelines and Budget C. Members of the Inter-Agency Committee on Antimicrobial Resistance (ICAMR) D. Members of Department of Agriculture Technical Working Group E. AMR-Related Research in Animal Health F. AMR-Related Research in Human Health G. Research Gaps H. Provisional Research Agenda: Topics, Areas and Questions I. Mapping of Regulation and Controls for the Antimicrobial Market in Animals and Humans A1 | P a g e A nn ex A . L is t o f P ol ic ie s R el at ed to A M R A ni m al H ea lt h P ol ic y N um be r T it le A ge nc y R ep ub lic A ct N o. 9 71 1 Fo od a nd D ru g A dm in is tr at io n (F D A ) A ct o f 20 09 Fo od a nd D ru g A dm in is tr at io n R ep ub lic A ct N o. 1 06 11 Fo od S af et y A ct o f 20 13 Fo od a nd D ru g A dm in is tr at io n R ep ub lic A ct N o. 6 67 5 G en er ic s A ct o f 19 88 Fo od a nd D ru g A dm in is tr at io n Jo in t A .O . 2 01 3 00 26 R ul es o n th e R eg ul at io n of V et er in ar y D ru gs a nd P ro du ct s, V et er in ar y B io lo gi ca l P ro du ct s, a nd V et er in ar y D ru gs Es ta bl is hm en ts D ep ar tm en t o f A gr ic ul tu re & F oo d an d D ru g A dm in is tr at io n FD A A dv is or y N o. 2 01 3 00 6 T he R is k of In di sc rim in at e U se o f A nt im ic ro bi al s in A ni m al s Fo od a nd D ru g A dm in is tr at io n D A A .O . # 40 a nd D O H A .O . # 11 1 C , s . 1 99 0 R ul es a nd R eg ul at io ns o n D is pe ns in g of V et er in ar y D ru gs a nd P ro du ct s D ep ar tm en t o f A gr ic ul tu re D A A .O . # 33 a nd D O H A .O . # 11 1 A , s . 1 99 1 R ul es a nd R eg ul at io ns o n R eg is tr at io n of V et er in ar y D ru gs a nd P ro du ct s D ep ar tm en t o f A gr ic ul tu re D A A .O . # 39 a nd D O H A .O . # 11 1 B , s . 1 99 1 R ul es a nd R eg ul at io ns to Im pl em en t P re sc rib in g R eq ui re m en ts fo r t he V et er in ar y D ru gs a nd P ro du ct s D ep ar tm en t o f A gr ic ul tu re A .O . N o. 1 4 s. 20 06 Im pl em en ta tio n of th e na tio na l v et er in ar y dr ug re si du es co nt ro l p ro gr am a nd c re at io n of th e in te ra ge nc y co m m itt ee D ep ar tm en t o f A gr ic ul tu re A .O . N o. 2 4 s. 2 00 9 Im pl em en ta tio n of th e ve te rin ar y dr ug re si du es c on tr ol D ep ar tm en t o f A gr ic ul tu re A2 | P a g e pr og ra m in f oo ds A .O . N o. 1 4 s. 20 06 Im pl em en ta tio n of th e na tio na l v et er in ar y dr ug re si du es co nt ro l p ro gr am a nd c re at io n of th e in te ra ge nc y co m m itt ee D ep ar tm en t o f A gr ic ul tu re H um an H ea lt h P ol ic y N um be r T it le A ge nc y R ep ub lic A ct N o. 9 50 2 U ni ve rs al ly A cc es si bl e C he ap er a nd Q ua lit y M ed ic in es A ct o f 20 08 D ep ar tm en t o f H ea lth R ep ub lic A ct N o. 6 67 5 G en er ic s A ct o f 19 88 D ep ar tm en t o f H ea lth R ep ub lic A ct N o. 9 71 1 Fo od a nd D ru g A dm in is tr at io n (F D A ) A ct o f 20 09 Fo od a nd D ru g A dm in is tr at io n R ep ub lic A ct N o. 1 09 18 N o P re sc rip tio n N o D is pe ns in g P ol ic y Fo od a nd D ru g A dm in is tr at io n A O N o. 2 01 5 00 49 R ul es a nd R eg ul at io ns G ov er ni ng th e A nt im ic ro bi al R es is ta nc e Su rv ei lla nc e P ro gr am A cc re di ta tio n of B ac te rio lo gy L ab or at or ie s in th e P hi lip pi ne s fo r t he P hi lH ea lth R ei m bu rs em en t o f Se le ct A nt ib io tic s in th e P hi lip pi ne N at io na l D ru g Fo rm ul ar y D ep ar tm en t o f H ea lth A O N o. 2 01 6 00 02 N at io na l P ol ic y on In fe ct io n P re ve nt io n an d C on tr ol in H ea lth ca re Fa ci lit ie s D ep ar tm en t o f H ea lth A3 | P a g e A O N o. 4 2 C re at in g an d In te r ag en cy C om m itt ee f or th e Fo rm ul at io n an d Im pl em en ta tio n of a N at io na l A ct io n P la n T o C om ba t A nt im ic ro bi al R es is ta nc e in th e P hi lip pi ne s O ff ic e of th e P re si de nt P hi lh ea lth C irc ul ar N o. 2 01 8 00 09 U se o f R es tr ic te d A nt im ic ro bi al s in P hi lh ea lth a cc re di te d H ea lth C ar e In st itu tio ns in A cc or da nc e w ith th e A nt im ic ro bi al R es is ta nc e Su rv ei lla nc e P ro gr am (A R S P ) P hi lip pi ne H ea lth In su ra nc e C or po ra tio n P hi lh ea lth C irc ul ar N o. 1 5, s 2 00 6 R ei m bu rs em en t o f C la im s fo r P N D F D ru gs U se d on ly in H os pi ta ls A cc re di te d U nd er th e D O H A nt im ic ro bi al R es is ta nc e S ur ve ill an ce P ro gr am P hi lip pi ne H ea lth In su ra nc e C or po ra tio n A O N o. 2 01 4 42 45 C re at io n of th e N at io na l A nt ib io tic G ui de lin es C om m itt ee (N A G C om ) D ep ar tm en t o f H ea lth FD A M em or an du m C irc ul ar N o. 20 14 0 15 D is pl ay o f A nt im ic ro bi al R es is ta nc e (A M R ) In fo m er ci al Fo od a nd D ru g A dm in is tr at io n FD A A dv is or y N o. 2 01 4 05 7 P at ie nt C ou ns el lin g by P hy si ci an s an d P ha rm ac is ts Fo od a nd D ru g A dm in is tr at io n FD A A dv is or y N o. 2 01 3 06 9 C on su m er T ip s on B uy in g M ed ic in es f ro m D ru g O ut le ts Fo od a nd D ru g A dm in is tr at io n FD A A dv is or y N o. 2 01 3 05 7 C on su m er W ar ni ng in s el f m ed ic at io n Fo od a nd D ru g A dm in is tr at io n FD A A dv is or y N o. 2 01 3 05 4 G ui de lin es f or D on or s of M ed ic in es P ub lic T ip s on U si ng M ed s Fo od a nd D ru g A dm in is tr at io n FD A A dv is or y N o. 2 01 3 00 6 T he R is k of In di sc rim in at e U se o f A nt im ic ro bi al s in A ni m al s Fo od a nd D ru g A dm in is tr at io n D O H F D A A dv is or y N 0. 2 01 2 01 7 A nt im ic ro bi al R es is ta nc e D ep ar tm en t o f H ea lth Fo od a nd D ru g A dm in is tr at io n A4 | P a g e FD A c irc ul ar 2 01 3 00 8 A do pt io n of th e A ss oc ia tio n of th e So ut he as t A si an N at io ns (A S EA N ) P os t M ar ke tin g A le rt S ys te m ( P M A S) f or D ef ec tiv e or U ns af e P ro ce ss ed F oo d P ro du ct s, P ha rm ac eu tic al P ro du ct s, T ra di tio na l M ed ic in es a nd H ea lth S up pl em en ts , a nd C os m et ic an d H ou se ho ld H az ar do us P ro du ct s an d D ev ic es Fo od a nd D ru g A dm in is tr at io n FD A c irc ul ar 2 01 2 01 2 G ui de lin es f or H an dl in g R ap id A le rt s A ris in g fr om Q ua lit y D ef ec ts Fo od a nd D ru g A dm in is tr at io n A O 2 01 4 00 06 G ui de lin es o n th e es ta bl is hm en t o f la bo ra to ry n et w or ks D ep ar tm en t o f H ea lth A5 | P a g e A nn ex B . K ey S tr at eg ie s, O bj ec tiv es , A ct iv iti es , R es po ns ib le A ge nc ie s, T im el in es a nd B ud ge t N ot e: T he ti m el in es , m ea su re m en ts , r es po ns ib le a ge nc ie s an d es tim at e bu dg et in th is a nn ex a re s til l p ro po se d. T he se w ill b e re vi ew ed b y IC A M R fo r a pp ro va l i n Q 1 20 19 . K ey S tr at eg y 1. C om m it to th e P hi lip pi ne A ct io n P la n th ro ug h m ul tis ec to ra l e ng ag em en t an d ac co un ta bi lit y A ni m al H ea lth , H um an H ea lth , E nv iro nm en t, Tr ad e an d C om m er ce , E du ca tio n, P ro fe ss io na l R eg ul at io n an d R el ev an t Se ct or s O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ o ut pu t R es po ns ib le A ge nc y B ud ge t 1. 1 T o fo rg e a jo in t ac tio n pl an to c om ba t A M R f or 2 01 9 20 23 , in cl ud in g an ag re em en t i nv ol vi ng na tio na l a ge nc ie s. 1. C on du ct IC A M R st ra te gi c pl an ni ng , a s w el l a s de ve lo pm en t o f th e 20 19 2 02 3 ac tio n pl an to c om ba t A M R 2. C on du ct re gu la r Q 4 20 18 Q ua rt er ly 1. 20 19 2 02 3 ac tio n pl an to co m ba t A M R . 2. M in ut es o f m ee tin g 3. Y ea rly pu bl ic at io n of IC A M R , D A , D O H , F A O , W H O D IL G , D EN R , D T I, D ep Ed , C H ED , F D A , P hi lH ea lth P 25 0, 00 0. 00 P 20 0, 00 0. 00 (f ou r m ee tin gs e ve ry y ea r f or fiv e ye ar s) IC A M R re po rt o nl in e A6 | P a g e m ee tin gs to m on ito r im pl em en ta tio n of th e pl an 3. P ub lis h an IC A M R an nu al re po rt Y ea rly IC A M R re po rt . A ca de m e, pr iv at e se ct or pu bl ic at io n 1. 2 T o el ev at e A M R a s a na tio na l p rio rit y 1. D ra ft a nd s ub se qu en tly ap pr ov e up da te d/ re vi se d jo in t p ol ic y; Is su an ce o f an ad m in is tr at iv e or de r t o in cl ud e ot he r go ve rn m en t st ak eh ol de rs (e .g ., D ep Ed , D EN R a nd P R C ) in IC A M R 2. M ai ns tr ea m A M R in th e fo od s af et y ac tio n pl an 20 19 20 18 1. Is su an ce o f jo in t p ol ic y in cl ud in g ot he r go ve rn m en t st ak eh ol de rs (e .g ., D ep Ed , D EN R a nd P R C ) in IC A M R 2. In cl us io n of A M R in th e fo od s af et y ac tio n pl an . IC A M R , D A , D O H FD A , D A P 20 0, 00 0. 00 f or la un ch P ar t o f N o. 1 1. 3 T o up ho ld ac co un ta bi lit y am on g va rio us s ec to rs in 1. Es ta bl is h te ch ni ca l w or ki ng g ro up s w ith in IC A M R ( e. g. 20 19 1. A ct iv ity re po rt an d m in ut es of m ee tin g of IC A M R , D A , D O H P 5 ,0 00 p er T W G p er qu ar te rly m ee tin g A7 | P a g e fu lfi lli ng th ei r r ol es in th e pr ev en tio n an d re du ct io n of A M R su rv ei lla nc e, re se ar ch , fin an ci ng ) 2. P ro vi de a ut ho rit y to th e IC A M R S ec re ta ria t t o en su re g oa ls a re m et b y th e di ff er en t st ak eh ol de rs 20 19 es ta bl is he d te ch ni ca l w or ki ng gr ou ps . A dd iti on al H R a t P 30 0, 00 0. 00 p er y ea r 1. 4 T o al lo ca te ad eq ua te re so ur ce s an d ex pe rt is e fo r A M R in iti at iv es in a ll re le va nt se ct or s 1. In cl ud e A M R in a nn ua l bu dg et p la nn in g of th e di ff er en t a ge nc ie s in vo lv ed 2. Id en tif y pr io rit y ar ea s fo r i nt er na tio na l co op er at io n 3. En ha nc e in te rn at io na l pa rt ne rs hi ps f or A M R in iti at iv es in h um an a nd an im al h ea lth Ev er y ye ar 20 19 20 19 1. In cl us io n of A M R in th e an nu al ap pr ov ed bu dg et o f IC A M R m em be r ag en ci es . 2. R ep or ts , te ch ni ca l ad vi so rie s 3. M in ut es o f m ee tin gs 4. C ol la bo ra tio n pr oj ec ts w ith ot he r co un tr ie s on IC A M R , D A , D O H P ar t o f an nu al b ud ge tin g cy cl e B ud ge t i nc lu de d in re se ar ch A8 | P a g e A M R 1. 5 T o co nt in ue co lla bo ra tio n fo r t he ac hi ev em en t o f ke y pe rf or m an ce in di ca to rs 1. R eg ul ar ly s ub m it re po rt s/ re qu ire d in fo rm at io n of IC A M R m em be r a ge nc ie s id en tif ie d in th is a ct io n pl an to th e IC A M R se cr et ar ia t T B D 1. R eg ul ar su bm is si on o f re po rt s/ re qu ir ed in fo rm at io n of IC A M R m em be r ag en ci es . IC A M R , D A , D O H C ol la bo ra tio n m ee tin gs P 50 0, 00 0. 00 K ey S tr at eg y 2. S tr en gt he n su rv ei lla nc e an d la bo ra to ry c ap ac ity A ni m al H ea lth O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ O ut pu t R es po ns ib le A ge nc y B ud ge t 2. 1 T o im pr ov e th e su rv ei lla nc e an d di ag no st ic c ap ab ili tie s of h os pi ta ls , a nd 1. Fi na liz e, in st itu tio na liz e an d im pl em en t o f A R SP in a ni m al s 20 19 on w ar ds 1. Q ua rt er ly A R S P re su lts D A B A I D A N M IS D A B FA R P 5, 00 0, 00 0 pe r y ea r Th is it em re qu ire s A9 | P a g e la bo ra to rie s 2. R eg ul ar ly p er fo rm as se ss m en ts a nd in ve nt or y of re so ur ce s fo r m on ito rin g, su rv ei lla nc e an d te st in g (in cl ud in g pr ic e re fe re nc e of la bo ra to ry su pp lie s an d eq ui pm en t) 3. C on du ct le ve lin g of ca pa ci tie s of D A to pe rf or m la bo ra to ry an al ys is f or A M R 4. O rg an iz e re gi on al la bo ra to ry c ap ac ity bu ild in g ac tiv iti es f or A M R d et ec tio n 20 20 20 19 20 20 2. P ric e su rv ey 3. A ss es sm en t a nd /o r su rv ey o f la bo ra to rie s’ ca pa ci tie s 4. T ra in in g on A M R de te ct io n D A P C C pl an ni ng a nd b ud ge t re vi ew fr om D A o ff ic es w ith la bo ra to rie s. 2. 2 T o ca pa ci ta te h ea lth w or ke rs b as ed o n re qu ire d co m pe te nc ie s fo r d iff er en t a re as o f A M R w or k 1. A ss es s sk ill m ix a nd qu an tit y of h um an re so ur ce s fo r a ni m al he al th s ur ve ill an ce a nd la bo ra to rie s e. g. in fe ct io us d is ea se 20 19 20 20 1. A ss es sm en t o f cu rr en t sk ill m ix o f pe op le w or ki ng in la bo ra to rie s D A B A I P 1, 60 0 x 30 x 3 d ay s x 3 ba tc he s = P 43 2, 00 0. 00 T ra in in g pr og ra m A10 | P a g e sp ec ia lis ts , c lin ic al ph ar m ac is ts , e tc . 2. H ire a nd s ub se qu en tly tr ai n te ch ni ca l/ la bo ra to ry pe rs on ne l o n m on ito rin g, su rv ei lla nc e an d te st in g m et ho ds a nd th e op er at io n of la bo ra to rie s, in cl ud in g co m pl ia nc e to ac cr ed ita tio n st an da rd s (P N S IS O 1 / IE C 1 70 25 2 , P N S IS O 1 51 89 3 , P N S IS O /I EC 1 70 20 4 , C od ex 5 , C LS I6 ) 3. D ev el op s ki lls o f LG U ve te rin ar y se rv ic e st af f 20 21 2. A d oc um en t di sc us si ng th e sk ill m ix an d nu m be r of th es e st af f ne ed ed f or be tt er su rv ei lla nc e 3. La bo ra to ry pe rs on ne l hi re d 4. La bo ra to ry pe rs on ne l tr ai ne d on di ff er en t to pi cs P 18 ,0 00 .0 0 x 1 2 x 10 pe rs on s = R ec ru itm en t P 1, 60 0 x 30 x 3 d ay s x 3 ba tc he s = P 43 2, 00 0. 00 T ra in in g pr og ra m 1 Th e In te rn at io na l O rg an iz at io n fo r S ta nd ar di za tio n (IS O ) i s an in de pe nd en t n on g ov er nm en ta l o rg an iz at io n co m po se d of 1 62 n at io na l s ta nd ar d bo di es d ev el op in g ov er 2 2, 00 0 in te rn at io na l s ta nd ar ds c ov er in g ne ar ly a ll as pe ct s of te ch no lo gy a nd m an uf ac tu rin g. 2 IS O /IE C 1 70 25 in di ca te s re qu ire m en ts fo r t he c om pe te nc e of te st in g an d ca lib ra tio n la bo ra to rie s 3 IE C 1 51 89 o ut lin es s ta nd ar ds fo r q ua lit y an d co m pe te nc e in m ed ic al la bo ra to rie s. 4 IE C 1 70 20 s pe ci fie s st an da rd s fo r o pe ra tio n of d iff er en t t yp es o f i ns tit ut io ns p er fo rm in g in sp ec tio n. 5 C od ex A lim en ta riu s is a g ro up o f i nt er na tio na lly re co gn iz ed s ta nd ar ds , g ui de lin es , p ol ic ie s, re co m m en de d pr ac tic es o n fo od , f oo d pr od uc tio n, a nd fo od s af et y. 6 Th e C lin ic al L ab or at or y S ta nd ar ds In st itu te (C LS I) is a n on p ro fit in te rn at io na l o rg an iz at io n co m po se d m or e th an 1 ,4 00 o rg an iz at io ns fr om o ve r 6 0 co un tri es s et tin g an d up ho ld in g th e st an da rd s to w ar ds im pr ov em en t o f t he q ua lit y te st re su lts , p at ie nt c ar e de liv er y, a nd p ub lic h ea lth . A11 | P a g e fo r s am pl in g an d su rv ei lla nc e in cl ud in g ac cr ed ita tio n st an da rd s 5. T ra in in g of LG U s ta ff on s am pl in g an d su rv ei lla nc e 2. 3 T o in st itu tio na liz e w el l-d ev el op ed re po rt in g, m on ito rin g an d su rv ei lla nc e sy st em s at a ll le ve ls in he al th , a gr ic ul tu re a nd en vi ro nm en t s ec to rs 1. Fi na liz e an d ap pr ov e su rv ei lla nc e an d m on ito rin g pl an f or an im al h ea lth 2. Es ta bl is h a na tio na l co or di na tin g ce nt er (N C C ) fo r A M R w ith in th e an im al h ea lth s ec to r 3. C re at e m as te r l is t o f al l ve te rin ar y fe ed s, f ar m s, an d dr ug e st ab lis hm en ts 4. Im pl em en t s ur ve ill an ce an d m on ito rin g sy st em s fo r A M R a nd A M U in 20 19 20 20 20 19 20 20 1. Si gn ed a nd pu bl is he d su rv ei lla nc e an d m on ito rin g pl an 2. N C C es ta bl is he d 3. M as te r l is t cr ea te d 4. Su rv ei lla nc e an d m on ito rin g do cu m en t in f oo d pr od uc in g D A B A I D A N M IS D A B FA R D A P C C O ng oi ng P 3, 00 0, 00 0 to c ov er f or co or di na tin g ce nt er , m as te r l is t a nd su rv ei lla nc e an d m on ito rin g sy st em s pl an ni ng , d es ig n an d ba si c eq ui pm en t A12 | P a g e fo od p ro du ci ng a ni m al s an d th ei r p ro du ct s: m ea ts , f is h & f is he ry pr od uc ts , m ilk , e gg s, a nd ho ne y 5. D ev el op f or m al do cu m en t f or m on ito rin g an d qu an tif ic at io n of A M R a nd A M U tr en ds in fo od p ro du ci ng a ni m al s7 6. P er fo rm s am pl in g an d te st in g an al ys is f or an tib io tic s us ce pt ib ili ty te st in g ba se d on in te rn at io na lly a cc ep te d st an da rd s (i. e. C LS I) 7. C on du ct d at a co lle ct io n, sa m pl in g, te st in g, a nd an al ys is f or v et er in ar y dr ug re si du es in m ea t 20 20 20 20 20 19 an im al s 5. R ep or t o n A M U a nd A M R in an im al s 6. Sa m pl in g an d an al ys is f or an tib io tic su sc ep tib ili t y do ne 7. R ep or t o n D ru g re si du e te st in g B ud ge t f or s am pl in g an d te st in g an al ys is : P 50 0, 00 0. 00 p er y ea r (B A I t o co nf irm b ud ge t) R ou tin e ac tiv ity 7 T he p ro ce ss o f d ev el op in g a fo rm al , p ub lic d oc um en t m us t f irs t u nd er go d is cu ss io n w ith th e an im al h ea lth T W G , a s w el l a s un de rg o a ris k an al ys is to e ns ur e pr op er c om m un ic at io n A13 | P a g e pr od uc ts , a nd c on ne ct fin di ng s w ith A M R .8 H um an H ea lth O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ O ut pu t R es po ns ib le A ge nc y B ud ge t 2. 1 T o im pr ov e th e su rv ei lla nc e an d di ag no st ic c ap ab ili tie s of h os pi ta ls , a nd la bo ra to rie s 1. En su re s uf fic ie nt la bo ra to ry hu m an c ap ac ity a nd o th er re so ur ce s th ro ug h pl an ni ng an d re so ur ce a llo ca tio n 2. P re pa re In ve st m en t P la n fo r A M R m on ito rin g an d su rv ei lla nc e 3. Ex pl or e po te nt ia l a re as to st re ng th en f in an ci ng o f la bo ra to ry te st s in p ub lic an d pr iv at e se ct or s 20 20 2 02 3 20 19 20 19 20 20 2 02 3 1. H um an re so ur ce s pl an ou tli ni ng w ha t s ki lls ar e ne ed ed an d ho w m an y ar e ne ed ed f or ea ch 2. In ve st m en t P la n dr af te d D O H P D R IT M In ve st m en t P la nn in g P 40 0, 00 0. 00 D et ai le d co st in g st ud y is re qu ire d fo r i nv es tm en t in la bo ra to rie s at na tio na l a nd re gi on al le ve ls . F or c on su lta tio n w ith R IT M a nd E B . In di ca tiv e bu dg et to s et up re gi on al la bo ra to rie s P 50 ,0 00 ,0 00 .0 0 fo r t hr ee ye ar s 8 R es id ue s ar e no t p ar t o f A M R d at a. A14 | P a g e 4. Ex pa nd A R S P tr ai ni ng a nd ac cr ed ita tio n to n on t er tia ry ho sp ita ls 5. St re ng th en L uz on , V is ay as an d M in da na o re fe re nc e la bo ra to rie s to d et ec t a nd m on ito r A M R s ur ve ill an ce 20 23 3. A R S P tr ai ni ng o f Le ve l I I an d I ho sp ita ls 4. A R S P A cc re di ta ti on o f Le ve l II an d I ho sp ita ls 5. V is ay as an d M in da na o re fe re nc e la bo ra to rie s id en tif ie d 2. 2 T o ca pa ci ta te he al th w or ke rs b as ed on re qu ire d co m pe te nc ie s fo r di ff er en t a re as o f A M R w or k 1. A ss es s sk ill m ix a nd qu an tit y of h um an re so ur ce s fo r h um an h ea lth su rv ei lla nc e an d la bo ra to rie s, e .g . i nf ec tio us di se as e sp ec ia lis ts , c lin ic al ph ar m ac is ts , 20 19 20 19 2 02 3 N ee ds a ss es sm en t N um be r a nd ti tle o f D O H P D R IT M H os pi ta ls P 1, 50 0, 00 0. 00 C on su lta nc y/ F ea si bi lit y st ud y P 5, 00 0 pe r d ay x 2 0 A15 | P a g e 2. Se nd te ch ni ca l p er so nn el to re le va nt lo ca l a nd f or ei gn tr ai ni ng s on m on ito rin g, su rv ei lla nc e an d te st in g m et ho ds a nd th e op er at io n of la bo ra to rie s, in cl ud in g co m pl ia nc e to a cc re di ta tio n st an da rd s (P N S IS O /I EC 17 02 5, P N S IS O 1 51 89 , P N S IS O /I EC 1 70 20 , C od ex , tr ai ni ng s at te nd ed , an d by w ho m da ys x 5 p er so nn el = P 50 0, 00 0 pe r y ea r 2. 3 T o in st itu tio na liz e w el l-d ev el op ed re po rt in g, m on ito rin g an d su rv ei lla nc e sy st em s/ n et w or ks a t al l l ev el s in h ea lth , ag ric ul tu re a nd en vi ro nm en t s ec to rs 1. In te gr at e A M R in th e st ra te gi es o f th e N at io na l an d R eg io na l H ea lth La bo ra to ry N et w or k 2. D es ig na te E B a s th e na tio na l c oo rd in at in g ce nt er f or A M R s ur ve ill an ce w ith in th e hu m an h ea lth se ct or 3. D ev el op p ro to co l t o m on ito r, m an ag e, a na ly ze , an d ut ili ze H A I d at a fr om 20 19 20 19 20 19 20 20 2 02 1 In cl us io n of A M R in th e EB a nd P ID S R f ra m ew or k A O d es ig na tin g EB as N C C P ro to co l o n m on ito rin g, m an ag in g, an al yz in g, a nd ut ili zi ng H A I d at a D O H P D H FD B R IT M H os pi ta ls EB EB , H FD B , D P C B P 50 0, 00 0. 00 P 50 0, 00 0. 00 P 50 0, 00 0. 00 A16 | P a g e lo ca l, re gi on al to n at io na l le ve ls 4. Ex pa nd a nn ua l p oi nt pr ev al en ce s ur ve ys (P P S) ut ili zi ng p re sc rip tio n da ta a. D ev el op W H O m et ho do lo gy o n an tim ic ro bi al u se b. D ev el op e pr es cr ip tio n sy st em th at w ill in cl ud e th e co lle ct io n of d at a on a nt im ic ro bi al us e c. T ra in in g on e pr es cr ip tio n sy st em (in te gr at ed w ith ph ar m ac ov ig ila nc e) d. A do pt e pr es cr ip tio n sy st em in D O H h os pi ta ls 5. Es ta bl is h a ca se b as ed A M R s ur ve ill an ce to e na bl e qu an tif ia bl e bu rd en o f 20 19 2 02 3 20 20 20 20 20 19 20 19 20 20 2 02 1 A M U S ur ve ill an ce sy st em in st itu tio na liz ed C as e ba se d A M R su rv ei lla nc e pr ot oc ol d ev el op ed Sy st em f or in te gr at ed P D , P hi lh ea lth , FD A R IT M , E B , P D , D P C B R IT M , E B , P D , P 5, 00 0, 00 0. 00 a nn ua lly P 5 00 ,0 00 .0 0 P 5 00 ,0 00 .0 0 (w ith p ilo t) P 2 ,0 00 ,0 00 .0 0 P 5 00 ,0 00 .0 0 C on su lta nc y an d m ee tin gs A17 | P a g e di se as e 6. D ev el op a n in te gr at ed sy st em f or A M R , A M U , a nd H A I9 7. D ev el op a n IT p la tf or m to co m m un ic at e da ta o n A M R to s ta ke ho ld er s 8. W or ks ho p/ tr ai ni ng s on IT fo r h os pi ta ls a nd h ea lth ca re pr ac tit io ne rs in p riv at e an d pu bl ic s ec to rs 20 20 20 19 20 21 su rv ei lla nc e in st itu tio na liz ed w ith re gu la r re po rt s di ss em in at ed N o. o f tr ai ni ng s co nd uc te d, p eo pl e tr ai ne d, h os pi ta ls pa rt ic ip at ed D P C B , H FD B IC A M R IC A M R IC A M R P 5 00 ,0 00 .0 0 P 1 ,0 00 ,0 00 .0 0 Fo r c on su lta tio n w ith EB , n ee d to in te gr at e/ ha rm on iz e w ith P ID S R P 1, 00 0, 00 0. 00 a nn ua lly En vi ro nm en ta l S ec to r 9 A s im ila r s ys te m is e m pl oy ed in th e U S A . T hi s is th e N at io na l A nt im ic ro bi al R es is ta nc e M on ito rin g S ys te m fo r E nt er ic B ac te ria (N A R M S ), w hi ch tr ac ks a nt im ic ro bi al su sc ep tib ili ty o f c er ta in e nt er ic (i nt es tin al ) b ac te ria fo un d in il l p eo pl e, re ta il m ea ts , a nd fo od a ni m al s. E st ab lis he d in 1 99 6, N A R M S is a p ar tn er sh ip b et w ee n U S s ta te a nd lo ca l pu bl ic h ea lth d ep ar tm en ts , C en te rs fo r D is ea se C on tro l a nd P re ve nt io n (C D C ), th e U .S . F oo d an d D ru g A dm in is tra tio n (F D A ), an d th e U .S . D ep ar tm en t o f A gr ic ul tu re (U S D A ). A18 | P a g e O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ O ut pu t R es po ns ib le A ge nc y B ud ge t 2. 1 T o im pr ov e th e su rv ei lla nc e an d di ag no st ic c ap ab ili tie s of h os pi ta ls , a nd la bo ra to rie s 1. En ga ge w ith e nv iro nm en t la bo ra to rie s 2. A ss es s ca pa ci tie s 3. C on du ct e nv iro nm en ta l m on ito rin g fo r A M R in re si du e 4. En su re p ro pe r d is po sa l o f w as te a nd h az ar do us m at er ia ls 5. En ha nc e te ch no lo gi es a nd ca pa bi lit ie s of e nv iro nm en ta l la bo ra to rie s fo r m on ito rin g 6. M on ito r i m pl em en ta tio n of pr ot oc ol s on w as te d is po sa l fr om h os pi ta ls , H F, c lin ic s, an im al c lin ic s 20 19 20 20 O ng oi ng O ng oi ng 20 20 20 20 20 23 1. M O A /M O U 2. T ec hn ic al re po rt s 3. M on ito rin g re po rt s on A M R in re si du e 4. M on ito rin g re po rt s on co m pl ia nc e to p ro pe r di sp os al o f w as te a nd ha za rd ou s m at er ia ls 5. T B D 6. M on ito rin g re po rt s on w as te di sp os al fr om D EN R M ee tin gs P 50 0, 00 0. 00 co ns ul ta nc y O ng oi ng R ou tin e P 3, 00 0, 00 0. 00 in di ca tiv e bu dg et B ud ge t t o be id en tif ie d A19 | P a g e ho sp ita ls , H F, c lin ic s, an im al cl in ic s 2. 2 T o ca pa ci ta te he al th w or ke rs b as ed on re qu ire d co m pe te nc ie s fo r di ff er en t a re as o f A M R w or k 1. T ra in s ta ff f or e nv iro nm en ta l m on ito rin g of re si du e 20 20 1. N um be r o f st af f tr ai ne d by fa ci lit y D EN R P 2, 00 0 x 20 p ar tic ip an ts x 5 da ys x 3 b at ch es = P 60 0, 00 0. 00 T ra in in g K ey S tr at eg y 3. E ns ur e un in te rr up te d ac ce ss to s af e, e ff ec tiv e an d qu al ity a ss ur ed an tim ic ro bi al s A ni m al H ea lth O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ O ut pu t R es po ns ib le A ge nc y B ud ge t 3. 1 T o im pr ov e th e re gi st ra tio n, m ar ke tin g au th or iz at io n an d 1. R ev ie w a nd a ss es s cu rr en t po lic ie s re la te d to th e us e an d 20 19 P ol ic y re vi ew co nd uc te d D A T W G FD A P 50 0, 00 0. 00 A20 | P a g e po st m ar ke tin g su rv ei lla nc e of an tim ic ro bi al s ot he r r eg ul at io ns o f an tim ic ro bi al s, a s w el l a s is su an ce s re la te d to a cc es s to an tim ic ro bi al s (e sp ec ia lly in th e di st rib ut io n an d sa le in ou tle ts ) 2. Is su e Sa ni ta ry P hy to sa ni ta ry Im po rt C le ar an ce 3. Is su e A dm in is tr at iv e O rd er o n th e P ru de nt U se o f V et er in ar y D ru gs 4. C re at e a jo in t r eg ul at or y fr am ew or k w ith th e FD A 5. Es ta bl is h a un it w ith in F D A to re gu la te v et er in ar y dr ug s 6. D ev el op a d at ab as e of re gi st er ed a nt im ic ro bi al s, in cl ud in g qu an tit at iv e pr od uc tio n an d im po rt at io n 20 19 20 19 20 19 20 20 20 20 20 20 K ey p ol ic ie s de ve lo pe d, ap pr ov ed a nd di ss em in at ed A O e st ab lis hi ng V et er in ar y U ni t i n FD A O nl in e D at ab as e of re gi st er ed an tim ic ro bi al s Q ua lit y as se ss m en t st ud ie s of d iff er en t ve te rin ar y an tim ic ro bi al s R ou tin e 11 In cl ud e in m ee tin gs In cl ud e in m ee tin gs P 2, 00 0, 00 0. 00 p er ye ar ( co nf irm w ith FD A ) P 50 0, 00 0. 00 IT s ys te m / co ns ul ta nt P 1, 00 0, 00 0. 00 p er ye ar P 50 0, 00 0. 00 p er ye a 11 T he is su an ce o f S P S im po rt cl ea ra nc e is a re gu la r a ct iv ity o f q ua ra nt in e. A21 | P a g e 7. P er fo rm q ua lit y m on ito rin g of ve te rin ar y dr ug s 8 . M on ito r a nd p en al iz e of u se o f un re gi st er ed a nt im ic ro bi al s in an im al h us ba nd ry a nd aq ua cu ltu re 9. St ric tly e nf or ce a nd in ce nt iv iz e ad he re nc e to re gu la tio ns o n an tib io tic pr es cr ip tio n, d is pe ns in g, a nd us e in a ni m al h us ba nd ry 10 . R eq ui re a ll an tim ic ro bi al s to ad he re to G oo d M an uf ac tu rin g P ra ct ic es 10 20 21 20 19 2 02 3 20 19 2 02 3 P re sc rip tio n st ud ie s G M P s ea l i n an tim ic ro bi al s so ld in th e m ar ke t R ou tin e P 50 0, 00 0. 00 p er ye ar R ou tin e R ou tin e H um an H ea lth 10 G oo d M an uf ac tu rin g P ra ct ic e (G M P ) m in im iz es ri sk s in p ha rm ac eu tic al p ro du ct io n by e ns ur in g pr od uc ts a re p ro du ce d co ns is te nt ly a nd in a cc or da nc e to q ua lit y st an da rd s. A22 | P a g e O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ O ut pu t R es po ns ib le A ge nc y B ud ge t 3. 1 T o im pr ov e th e re gi st ra tio n, m ar ke tin g au th or iz at io n an d po st m ar ke tin g su rv ei lla nc e of an tim ic ro bi al s 1. M on ito r t he q ua lit y of re gi st er ed a nt im ic ro bi al s in th e m ar ke t 2. P ro ce ss s tr ea m lin in g of re vi ew an d re le as e of m ar ke tin g au th or iz at io n of n ew an tib io tic s th at a dd re ss p rio rit y in fe ct io us d is ea se s in th e co un tr y1 2 3. Fo rg e an a gr ee m en t o n re gu la to ry c on tr ol o ve r d ru gs us ed in a qu ac ul tu re (F D A a nd D A ) 4. H ar m on iz e re gu la to ry fr am ew or k in th e pr od uc tio n an d us e of a nt im ic ro bi al s in 20 19 2 02 3 20 19 20 19 2 02 0 20 19 2 02 0 1. P M S re po rt o n th e qu al ity o f re gi st er ed an tim ic ro bi al s an d th e pr es en ce of u nr eg is te re d an tim ic ro bi al s. 2. P ro to co ls f or fa ci lit at ed pr oc es se s of re vi ew a nd m ar ke tin g au th or iz at io n of ne w a nt ib io tic s av ai la bl e in w eb si te s; is su an ce o f FD A FD A FD A , D A P 1 ,0 00 ,0 00 .0 0 C on fir m b ud ge t w ith F D A P 20 0, 00 0. 00 P 20 0, 00 0. 00 le ga l co ns ul ta nt a nd m ee tin gs In cl ud e in N o. 3 12 D ur in g th e 20 18 D O H D A s tra te gi c pl an ni ng , s ta ke ho ld er s ar tic ul at ed th e ne ed fo r F D A to fa ci lit at e ea si er re gi st ra tio n an d ap pr ov al p ro ce ss es fo r a nt ib io tic s. F or in st an ce , o ut of 1 0 ne w a nt im ic ro bi al s in th e gl ob al m ar ke t, on ly o ne (1 ) i s ap pr ov ed in th e P hi lip pi ne s. A23 | P a g e hu m an s an d an im al s (F D A a nd D A ) ce rt if ic at e of pr od uc t re gi st ra tio n, lic en se to op er at e fo r an tim ic ro bi al s an d im po rt at io n cl ea ra nc e. 3. 2 T o m on ito r av ai la bi lit y an d af fo rd ab ili ty o f qu al ity an tim ic ro bi al s at a ll le ve ls o f ca re 1. C on du ct re pr es en ta tiv e dr ug av ai la bi lit y su rv ey s 2. C on du ct re pr es en ta tiv e su rv ey of p ric in g of e ss en tia l an tim ic ro bi al s 3. C on du ct re pr es en ta tiv e su pp ly ch ai n st ud ie s1 3 (f ro m fo re ca st in g to d is tr ib ut io n) 4. U pd at e th e N at io na l A nt ib io tic G ui de lin es 20 19 2 02 2 20 19 2 02 0 20 19 2 02 0 20 20 2 02 3 R ed uc tio n of A M U b y 10 % (T ar ge t N 0. 6 ) P D P D P D N at io na l A nt ib io tic s G ui de lin e C om m itt ee P 5, 00 0, 00 0. 00 f or le ve ls I, II , I II, (2 01 9 20 22 ) P ar t o f N o. 1 P 1 ,5 00 ,0 00 .0 0 C on su lta nc y P 2, 00 0, 00 0. 00 3. 3 T o de ve lo p a 1. Im pr ov e pu bl ic m ed ic in e 20 19 2 02 1 5% s to ck ou t r at e D O H P D P 2, 00 0, 00 0. 00 13 A s tu dy a ss es si ng th e im pa ct o f c ur re nt r ef or m s of s up pl y ch ai n m an ag em en t w ill b e co nd uc te d if su pp ly c ha in im pr ov ed . A24 | P a g e su st ai na bl e an d ef fe ct iv e su pp ly c ha in m an ag em en t f or an tim ic ro bi al s lo gi st ic s an d pr oc ur em en t sy st em to p re ve nt s to ck ou t o f dr ug s, p ar tic ul ar ly an tim ic ro bi al s in g ov er nm en t he al th f ac ili tie s 2 . En su re q ua lit y of an tim ic ro bi al s at e ve ry s te p of th e su pp ly c ha in 3 . Ex pa ns io n of P hi lh ea lth re im bu rs em en t t o no n re st ric te d an tim ic ro bi al s 4. D ev el op P hi lH ea lth b en ef it pa ck ag es f or a nt im ic ro bi al re si st an ce 5. Im pl em en t P hi lH ea lth b en ef it pa ck ag es f or a nt im ic ro bi al re si st an ce 20 19 2 02 1 20 19 20 20 20 21 D oc um en ts o n qu al ity as se ss m en t a nd m on ito rin g P hi lh ea lth c irc ul ar o n re im bu rs em en t o f us e of an tim ic ro bi al s P hi lh ea lth b en ef it pa ck ag e fo r A M R de ve lo pe d P hi lH ea lth B en ef it pa ck ag e fo r A M R de ve lo pe d an d im pl em en te d in 1 0 ho sp ita ls D O H B A C P hi lH ea lth P ro cu re m en t an d Su pp ly C ha in M an ag em en t T ea m P riv at e se ct or H os pi ta ls FD A P hi lH ea lth P hi lH ea lth P hi lH ea lth C on su lta nc y P ar t o f N o. 1 P 2, 00 0, 00 0. 00 f or T A P ar t o f N o. 3 P 5, 00 0, 00 0. 00 a s in iti al s up po rt A25 | P a g e K ey S tr at eg y 4: R eg ul at e an d pr om ot e th e ra tio na l u se o f a nt im ic ro bi al s A ni m al H ea lth O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ O ut pu t R es po ns ib le A ge nc y B ud ge t 4. 1 T o fu lly im pl em en t gu id el in es f or p ru de nt us e of a nt im ic ro bi al s 1. R ev ie w e xi st in g re gu la tio ns an d re gu la to ry c on tr ol s fo r re gi st ra tio n, a dv er tis in g, im po rt at io n an d en d us e1 4 2. R ev iv e th e V et er in ar y Fo rm ul ar y Ex ec ut iv e C ou nc il 3. D ev el op N at io na l A nt ib io tic G ui de lin es f or A ni m al H ea lth 4. D ev el op m en t o f na tio na l gu id el in es b as ed o n in te rn at io na l o r r eg io na l gu id el in es f or a n 20 19 20 20 20 20 20 20 D ev el op ed N A G f or an im al h ea lth C on te xt ua liz at io n of G A H P a nd G A qP in to P hi lip pi ne co nt ex t U pd at ed P hi lip pi ne P ra ct ic e G ui de lin es fo r V et er in ar ia ns D A T W G B A I B FA R P C C P 1, 00 0, 00 0. 00 P 50 0, 00 0. 00 P 3, 00 0, 00 0. 00 P 2, 00 0, 00 0. 00 14 E ns ur in g et hi ca l m ar ke tin g of m ed ic in es , m ed ic al re pr es en ta tiv es n ee d to s ec ur e lic en se fr om P ro fe ss io na l R eg ul at io n C om m is si on (P R C ) t o pr ac tic e th ei r p ro fe ss io n. H ow ev er , n o si m ila r r eg ul at or y in st ru m en t f or a ni m al h ea lth e xi st . A26 | P a g e A nt im ic ro bi al S te w ar ds hi p P ro gr am in a ni m al h ea lth 5. T ra ns la te G A H P a nd G A qP in to te ch ni ca l r eg ul at io ns 6. D oc um en ta tio n of g oo d pr ac tic es o f G A H P a nd G A qP 7. In st itu tio na liz e P hi lip pi ne P ra ct ic e St an da rd s fo r V et er in ar ia ns in re la tio n to P ru de nt P re sc rib in g of A nt im ic ro bi al s 8. En su re D T I l ab el lin g on m ea t pr od uc ts a re p ur su an t t o ne w ly d ev el op ed n at io na l gu id el in es 9. C on du ct m on ito rin g an d su rv ei lla nc e of a ni m al f ee ds an d ve te rin ar y dr ug es ta bl is hm en ts 20 19 20 20 20 20 20 21 20 20 co nd uc t pi lo t A do pt ed g ui de lin es St ud ie s co nd uc te d P ol ic y or p ro to co l M on ito rin g of po lic y M on ito rin g re po rt of p ilo t s ha re d P 1, 00 0, 00 0. 00 P 50 0, 00 0. 00 P 1, 00 0, 00 0. 00 R ou tin e P 20 0, 00 0. 00 4. 2 T o cr ea te a n en ab lin g en vi ro nm en t 1. A ss ig n re gi on al c oo rd in at or s on A M R a ct iv iti es 20 20 B as el in e ra te o f A M U in f ar m s by D A T W G B A I A nn ua l b ud ge tin g of ne w s ta ff A27 | P a g e fo r t he p ru de nt u se o f an tim ic ro bi al s 2. D ev el op a nd s ub se qu en tly im pl em en t a s tr at eg y fo r re gu la tio n of th e us e of an tib io tic s co m m on to b ot h hu m an a nd a ni m al h ea lth a s gr ow th p ro m ot er s an d th e co nt in uo us m on ito rin g of ba nn ed a nt im ic ro bi al s1 5 3. R eg is te r e xi st in g aq ua fa rm s' so ur ce s of ra w m at er ia ls , a s w el l a s sw in e an d po ul tr y fe ed s, in p ro ce ss in g pl an ts 4. R eg is tr at io n of V D A P es ta bl is hm en ts a nd p ro du ct s 5. St ric t e nf or ce m en t o f ex is tin g re gu la tio ns re ga rd in g m ed ic at ed f ee ds 6. D ev el op m en t o f gu id el in es fo r t he re gu la tio n of an tim ic ro bi al s in d rin ki ng 20 20 20 20 20 20 20 21 20 22 20 20 20 20 R ed uc tio n of u se by 1 0% in 2 02 3 B FA R P C C P 3, 00 0, 00 0. 00 C on su lta nc y/ T A P 2, 00 0, 00 0. 00 T A R ou tin e R ou tin e P 1, 00 0, 00 0. 00 T A P 1, 00 0, 00 0. 00 15 T he O IE ’s te rr es tri al c od e in cl ud es a li st o f a llo w ed a nt ib io tic s w ith e vi de nc e th at th ey a re n ot a th re at to A M R A28 | P a g e w at er 7. In ce nt iv iz e pr ac tit io ne rs o n th e pr ud en t u se o f an tib io tic s 8. In ce nt iv iz e fa rm s an d op er at io ns b y re w ar di ng ap pr ov al s fo r l ab el lin g th ei r m ea t p ro du ct s w ith a n of fic ia l m ar ke tin g ta gl in e 16 20 20 P 1, 00 0, 00 0. 00 P ro m ot io n an d or ie nt at io n 4. 3 T o tr ac k po lic y en fo rc em en t o n ra tio na l u se o f an tim ic ro bi al s in m ar ke ts , f ar m s an d co m m un iti es 1. C on du ct d ia lo gu e w ith cl ie nt s, s ta ke ho ld er s, in du st ry an d LG U s 2. D ev el op a s ys te m f or m on ito rin g im pl em en ta tio n of is su ed re gu la tio ns 3. En ga ge L G U s in th e im pl em en ta tio n of re gu la tio ns , e sp ec ia lly in u se of a nt im ic ro bi al s in b ac ky ar d fa rm s 20 19 20 20 20 19 2 02 3 B as el in e da te o n an tim ic ro bi al u se in m ar ke ts a nd f ar m s D A T W G B A I P 50 0, 00 0. 00 C on su lta nc y P 1, 00 0, 00 0. 00 P 2, 00 0, 00 0. 00 16 S ub je ct to la be lli ng g ui de lin es ; e .g . “ ap pr ov ed b y D A / B A I & N M IS ” A29 | P a g e H um an H ea lth O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ O ut pu t R es po ns ib le A ge nc y B ud ge t 4. 1 T o fu lly im pl em en t gu id el in es f or ra tio na l us e of a nt im ic ro bi al s 1. D ev el op a p re sc rip tio n au di t sy st em f or a nt im ic ro bi al s ○ A ss es sm en t w or ks ho p ○ Id en tif y ex is tin g in fo rm at io n sy st em s ○ P ilo t p re sc rip tio n au di t s ys te m ○ Im pl em en ta tio n (in cl ud in g tr ai ni ng ) ○ In te gr at e sy st em in H O M IS o r o th er ho sp ita l I T s ys te m s 2. In te gr at e an tim ic ro bi al s, A M R 20 19 2 02 3 20 19 20 19 20 20 20 21 20 20 P re sc rip tio n A ud it sy st em d ev el op ed , pi lo te d, a nd im pl em en te d A M R a nd A M S di sc us se d in co lle ge s, e sp ec ia lly in h ea lth r el at ed P D H FD B H FS R B H os pi ta ls K M IT S C H ED P 1, 00 0, 00 0. 00 p er ye ar P 50 0, 00 0. 00 A30 | P a g e an d A M S pr in ci pl es a nd co nc ep ts in h ig he r e du ca tio n cu rr ic ul a an d in th e co nt in ui ng pr of es si on al e du ca tio n (C P E) fo r h ea lth p ro fe ss io na ls 3. A ct iv el y co or di na te w ith L G U s on th e di ss em in at io n an d im pl em en ta tio n of p ol ic ie s th ro ug h th e N at io na l D ru g P ol ic y C om pl ia nc e O ff ic er s (N D P C O ) pe r r eg io n 20 21 fie ld s A M R a s on e of th e to pi cs in d iff er en t so ci et ie s’ C P E LG U s ha vi ng lo ca l ru le s an d/ or ac tiv iti es th at su pp or t a nt i-A M R ca m pa ig n C H D s, D IL G P 50 0, 00 0. 00 O rie nt at io n m ee tin gs 4. 2 T o cr ea te a n en ab lin g en vi ro nm en t fo r t he ra tio na l u se o f an tim ic ro bi al s 1. St ric tly e nf or ce re gu la tio ns o n an tib io tic p re sc rip tio n an d us e 2. C on tin ue r ol lin g ou t A M S pr og ra m in L ev el 1 h os pi ta ls & R H U s 3. D oc um en t a nd d is se m in at e be st p ra ct ic es in A M S 4. D ev el op , i m pr ov e, a do pt a nd ro ll ou t E A M S in h os pi ta ls 20 20 20 19 2 02 0 20 20 A M S pr og ra m in 2 00 Le ve l 1 h os pi ta ls E A M S im pl em en te d in 1 0 ho sp ita ls 90 % o f L3 h os pi ta ls FD A P D , H FD B , H FS R B , H os pi ta ls P D P D H FS R B , C H D s P 2, 00 0, 00 0. 00 P 10 ,0 00 ,0 00 .0 0 pe r ye ar P 5, 00 0, 00 0. 00 P 5, 00 0, 00 0. 00 A31 | P a g e th at h av e be en p ilo te d 5. M on ito r A M S pr og ra m in cl ud in g th e P hi lP S P a nd th e di ss em in at io n of N A G in a ll he al th f ac ili tie s 6. P ol ic y to c re at e/ re qu ire pl an til la p os iti on s fo r c lin ic al ph ar m ac is ts in b ot h pu bl ic an d pr iv at e fa ci lit ie s 7. R ol l o ut A M S Fe llo w sh ip P ro gr am f or H os pi ta l P ha rm ac is ts 20 21 20 20 20 20 w ith c lin ic al ph ar m ac is ts 60 % o f L2 h os pi ta ls w ith c lin ic al ph ar m ac is ts H H R D B , H FD B , P D , D IL G , D B M P D C oo rd in at io n w ith H FD B P 1, 00 0, 00 0. 00 p er ye ar Ed uc at io n, T ra de a nd o th er s ec to rs O bj ec ti ve s T im el in e M ea su re m en t/ R es po ns ib le A ge nc y B ud ge t A32 | P a g e A ct iv it ie s O ut pu t 4. 1 T o fu lly im pl em en t gu id el in es f or ra tio na l us e of a nt im ic ro bi al s 1. In te gr at e an tim ic ro bi al s, A M R a nd A M S pr in ci pl es a nd co nc ep ts in h ig he r e du ca tio n cu rr ic ul a an d in th e co nt in ui ng p ro fe ss io na l ed uc at io n (C P E) f or h ea lth pr of es si on al s 20 21 2 02 3 In cl us io n in cu rr ic ul a D T I, P D , F D A , D ep Ed , C H ED , D O LE M ee tin gs o nl y 4. 2 T o cr ea te a n en ab lin g en vi ro nm en t fo r t he ra tio na l u se o f an tim ic ro bi al s 1. T ra in in g/ C P D o n an tim ic ro bi al re si st an ce a nd th e N at io na l A nt ib io tic G ui de lin es f or co m pa ny /s ch oo l p hy si ci an s an d nu rs es . 20 19 2 02 3 5 C P D tr ai ni ng s co nd uc te d ev er y ye ar D T I, P D , F D A , D ep Ed , C H ED , D O LE , P ro fe ss io na l so ci et ie s O ng oi ng w ith pr of es si on al so ci et ie s A33 | P a g e K ey s tr at eg y 5: Im pl em en t a pp ro pr ia te m ea su re s to re du ce in fe ct io n ac ro ss a ll se tt in gs A ni m al H ea lth O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ O ut pu t R es po ns ib le A ge nc y B ud ge t 5. 1 T o en ha nc e ca pa ci tie s of h ea lth pe rs on ne l, fa ci lit y, a nd co m m un ity f or in fe ct io n pr ev en tio n, sa ni ta tio n an d hy gi en e 1. Im pl em en t G oo d A ni m al H us ba nd ry P ra ct ic es a nd G oo d A qu ac ul tu re P ra ct ic es a s P hi lip pi ne N at io na l S ta nd ar ds 2. St re ng th en a ni m al h ea lth sy st em c ap ac ity 20 19 2 02 3 G A H P a nd G A qP ad op te d in to P hi lip pi ne c on te xt an d di ss em in at ed B A I B FA R P C C LG U P 1, 60 0. 00 x 3 0 pa rt ic ip an ts x 3 da ys x 6 b at ch es = P 86 4, 00 0. 00 p er ye ar P ar t o f N o. 1 bu dg et 5. 2 T o im pr ov e go od an im al h us ba nd ry pr ac tic es a nd bi os ec ur ity in a ni m al fa rm s 1. En su re s tr ic t im pl em en ta tio n of bi os ec ur ity m ea su re s in ag ric ul tu re a nd aq ua cu ltu re f ar m s, w ith ad he re nc e to G A H P 20 20 2 02 3 80 % o f co m m er ci al fa rm s w ith bi os ec ur ity m ea su re s B A I B FA R P C C LG U P 50 0, 00 0. 00 p er ye ar f or m on ito rin g A34 | P a g e 2. Im pl em en t H A C C P Sy st em in p ro ce ss in g pl an ts 3. Im pl em en ta tio n of G M P fo r f ee d m ill s, im po rt er s, m an uf ac tu re rs , a nd su pp lie rs G M P o bs er ve d in 60 % o f fe ed m ill s, im po rt er s, m an uf ac tu re rs a nd su pp lie rs P ar t o f bu dg et P 50 0, 00 0. 00 p er ye ar f or o rie nt at io n m ee tin gs H um an H ea lth 17 O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ O ut pu t R es po ns ib le A ge nc y B ud ge t 5. 1 T o en ha nc e ca pa ci tie s of h ea lth pe rs on ne l, fa ci lit y, a nd co m m un ity f or in fe ct io n pr ev en tio n, sa ni ta tio n an d hy gi en e 1. C on du ct b as ic a nd co nt in uo us tr ai ni ng o f IC C p er so nn el (I P C , a nd su rv ei lla nc e of H A I a nd ot he r d is ea se s) 20 19 2 02 3 20 20 IP C p re ve nt io n an d co nt ro l p ro gr am s in H FD B D P C B H os pi ta ls P 1, 60 0. 00 x 3 0 pa rt ic ip an ts x 5 d ay s x 10 b at ch es = P 2, 40 0, 00 0. 00 p er y ea r P 2, 50 0, 00 0. 00 p er y ea r T A a nd tr ai ni ng s 17 It s ho ul d be n ot ed th at D O H H F D B h as a p la n fo r IP C in h os pi ta ls in cl ud in g bu dg et p ro vi si on s. A35 | P a g e 2. In te gr at e in fe ct io n pr ev en tio n an d co nt ro l i n ot he r e xi st in g pu bl ic he al th p ro gr am s 3. C on du ct e ff ec tiv e IP C ed uc at io n an d pr om ot io n at th e co m m un ity le ve l 20 21 al l L ev el 1 f ac ili tie s P 2, 50 0, 00 0. 00 p er y ea r 5. 2 T o im pl em en t co or di na te d pr og ra m s on s an ita tio n, h yg ie ne an d in fe ct io n pr ev en tio n an d co nt ro l i n ho sp ita ls , he al th f ac ili tie s, a nd ot he r s et tin gs a nd en su re th ei r su st ai na bi lit y 1. En fo rc em en t o f lic en si ng st an da rd s on IP C 2. M on ito r co m pl ia nc e of he al th f ac ili tie s w ith th e N at io na l I nf ec tio n P re ve nt io n an d C on tr ol P ol ic y 3. C on du ct m en to rin g ac tiv iti es o f he al th fa ci lit ie s on IP C b y pr of es si on al s oc ie tie s an d m od el h os pi ta ls 4. Im pr ov e bi os ec ur ity m ea su re s 20 19 2 02 3 20 19 2 02 3 20 19 2 02 3 20 19 2 02 3 B as el in e da ta a nd an nu al m on ito rin g of IP C c om pl ia nc e P ro to co l f or A M R ou tb re ak s de ve lo pe d an d H FD B D P C B H FS R B H os pi ta ls R IT M C A M R , E B , R IT M P 2, 00 0, 00 0. 00 p er y ea r P 1, 00 0, 00 0. 00 p er y ea r P 1, 00 0, 00 0. 00 p er y ea r P ar t o f tr ai ni ng P 2, 00 0, 00 0. 00 f or co ns ul ta nc y/ T A A36 | P a g e 5. D ev el op a p ro to co l f or A M R o ut br ea ks ( fo r ho sp ita ls ) 6. T o de ve lo p a na tio na l sy st em to m on ito r se le ct ed h os pi ta l ac qu ire d in fe ct io ns an d as se ss th e ef fe ct iv en es s of in te rv en tio ns di ss em in at ed In cl ud ed in N o. 5 N ot e: D O H H FD B h as a p la n fo r I P C in h os pi ta ls in cl ud in g bu dg et p ro vi si on s. K ey S tr at eg y 6: P ro m ot e in no va tio n an d re se ar ch o n A M R A ni m al H ea lth O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ O ut pu t R es po ns ib le A ge nc y B ud ge t A37 | P a g e 6. 1 T o cr ea te a su pp or tiv e an d su st ai na bl e en vi ro nm en t f or A M R re se ar ch 1. D ev el op a n in te gr at ed , ta rg et ed A M R R es ea rc h A ge nd a fo r an im al h ea lth a nd an im al p ro du ct s (m ea ts , m ilk , e gg s, a nd ho ne y) a nd o th er re la te d ar ea s 2. Es ta bl is h co m pr eh en si ve da ta ba se f or A M R re se ar ch ; U pg ra de ex is tin g IT s ys te m o n A M R re se ar ch 3. C oo rd in at e w ith p ub lic an d pr iv at e re se ar ch ag en ci es , t hi nk ta nk s, ac ad em e an d pr of es si on al s oc ie tie s to s tr en gt he n re se ar ch co lla bo ra tio n 4. C on du ct A M R re se ar ch in d iff er en t f ie ld s 20 19 20 20 20 19 2 02 0 20 19 2 02 3 1. A M R R es ea rc h ag en da de ve lo pe d 2. A M R re se ar ch da ta ba se re ad ily ac ce ss ib le fr om IC A M R an d B A I 3. A t l ea st 2 0 re se ar ch pr oj ec ts co m pl et ed ba se d on A M R R es ea rc h A ge nd a D A T W G D A R es ea rc h P C A R D A ca de m e P 50 0, 00 0. 00 f or re se ar ch a ge nd a se tt in g P 50 0, 00 0. 00 P 5, 00 0, 00 0. 00 p er y ea r bu dg et a s pa rt o f 2% M O O E A38 | P a g e m ic ro bi ol og y, g en et ic s & m ol ec ul ar s tu di es , ag ric ul tu re , a ni m al pr od uc tio n an d hu sb an dr y, b eh av io ur al , m ar ke t, in no va tio n, su pp ly c ha in , e tc . 6. 2 T o di ss em in at e in fo rm at io n on A M R 1. In cl ud e ne w di sc ov er ie s an d da ta in th e iA M R es po ns ib le ca m pa ig n, e ns ur in g un de rs ta nd in g by ge ne ra l p ub lic 2. P re se nt re se ar ch re su lts a nd co nc lu si on s to st ak eh ol de rs a nd in du st ry to a ug m en t po lic y fo rm at io n 3. P ub lis h re se ar ch re su lts in p ee r re vi ew ed , s ci en tif ic 20 19 20 19 2 02 3 20 19 2 02 3 P re se nt at io n of re se ar ch d ur in g W A A W , a nd o th er di ss em in at io n ac tiv iti es A t l ea st 1 0 pu bl is he d re se ar ch pr oj ec ts D A T W G B A I P riv at e se ct or A ca de m e P 50 0, 00 0. 00 P 50 0, 00 0. 00 p er y ea r P 50 0, 00 0. 00 p er y ea r A39 | P a g e jo ur na ls ( co ns id er in g C LS I S ta nd ar ds ) 4. D ev el op in ve nt or y of A M R r el at ed re se ar ch on a ni m al s an d th ei r pr od uc ts (m ea ts , m ilk , eg gs , h on ey , e tc .) 20 20 U pd at ed in ve nt or y by 2 02 3 P 50 0, 00 0. 00 6. 3 T o pr om ot e de ve lo pm en t o f in no va tiv e te ch no lo gi es a nd kn ow le dg e tr an sl at io n of A M R re se ar ch 1. P rio rit iz e re se ar ch th at be ne fit s m al l h ol d fa rm er s (i. e. c on ce pt s an d te ch no lo gy th ey co ul d us e in th ei r fa rm s) 2. C on du ct re se ar ch o n go od a ni m al h us ba nd ry pr ac tic es a nd al te rn at iv es to an tim ic ro bi al a ge nt s 3. St re ng th en in te r ag en cy c ol la bo ra tio n fo r t he c on du ct o f re se ar ch w ith D O ST 20 20 20 20 2 02 3 20 19 1. A t l ea st 1 re se ar ch th at c an be a pp lie d in f ar m s 2. A t l ea st 1 re se ar ch in al te rn at iv e s to an tim ic ro b ia ls D A T W G D A R es ea rc h P C A R D P 50 0, 00 0. 00 P 50 0, 00 0. 00 p er y ea r P 50 0, 00 0. 00 p er y ea r A40 | P a g e P C A R D , D O H a nd in du st ry H um an H ea lth O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ O ut pu t R es po ns ib le A ge nc y B ud ge t 6. 1 T o cr ea te a su pp or tiv e an d su st ai na bl e en vi ro nm en t f or A M R re se ar ch 1. M ob ili ze b ud ge t a nd ot he r r es ou rc es f or A M R re se ar ch a nd de ve lo pm en t f ro m va rio us s ou rc es 2. D ev el op a n in te gr at ed A M R re se ar ch a ge nd a pr io rit iz in g th e de ve lo pm en t o f ne w di ag no st ic te st s to de te ct A M R , t yp es o f an tim ic ro bi al s, n ov el th er ap ie s, g en et ic a nd m ol ec ul ar b as is & 20 19 2 02 3 20 19 N um be r o f re se ar ch p ro je ct s fu nd ed a cc or di ng to re se ar ch a ge nd a P D P C H R D P riv at e se ct or A ca de m e P 1 0, 00 0, 00 0. 00 P 50 0, 00 0. 00 f or re se ar ch a ge nd a se tt in g A41 | P a g e tr en ds o f A M R , s ys te m , su pp ly c ha in , e co no m ic st ud ie s, p ol ic y, co m m un ity , p at ie nt le ve l, pr ov id er le ve l a nd be ha vi or re se ar ch es 6. 2 T o di ss em in at e in fo rm at io n on A M R 1. U pd at e da ta ba se o f lo ca l r es ea rc he s re la te d to A M R a va ila bl e to a ll 2. T ra ns la te a nd di ss em in at e A M R re se ar ch in to in fo rm at io n fo r pr of es si on al s an d ge ne ra l p ub lic 20 20 20 19 2 02 3 In fo gr ap hi cs a nd / or la ym an iz ed ab st ra ct d is tr ib ut ed P D P C H R D A ca de m e H P C S P 2, 00 0, 00 0. 00 P 5, 00 0, 00 0. 00 a nn ua lly 6. 3 T o pr om ot e de ve lo pm en t o f in no va tiv e te ch no lo gi es a nd kn ow le dg e tr an sl at io n of A M R re se ar ch 1. Id en tif y fie ld s re la te d to A M R a nd a nt ib io tic re se ar ch th at h av e po te nt ia l f or tr an sl at io n an d co m m er ci al iz at io n 2. Es ta bl is h an A M R 20 19 20 20 2 02 3 D oc um en t id en tif yi ng th es e op po rt un iti es N um be r o f re se ar ch es a nd P D P C H R D A ca de m e P riv at e se ct or IC A M R P ar t o f 6. 1. 2 P 15 ,0 00 ,0 00 .0 0 pe r y ea r fo r h um an h ea lth A42 | P a g e in no va tio n fu nd 3. Su pp or t u ni ve rs iti es , th in k ta nk s, e xp er ts a nd re se ar ch er s w ho co nd uc t i nn ov at io n te ch no lo gi es f or A M R an d an tib io tic s 4. En co ur ag e pr iv at e se ct or c ol la bo ra tio n to in cr ea se in ve st m en ts in R & D f or a nt im ic ro bi al s 20 19 2 02 3 in st itu tio ns su pp or te d by th e fu nd P C H R D P D P D , F D A , P H A P P 2, 00 0, 00 0. 00 p er y ea r K ey S tr at eg y 7: I m pr ov e aw ar en es s an d un de rs ta nd in g of a nt im ic ro bi al re si st an ce th ro ug h ef fe ct iv e co m m un ic at io n an d ed uc at io n A ni m al H ea lth O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ O ut pu t R es po ns ib le A ge nc y B ud ge t A43 | P a g e 7. 1 T o in cr ea se pu bl ic a w ar en es s on th e ra tio na l us e of a nt ib io tic s 1. C on du ct K A P s tu di es fo r f ar m er s, nu tr iti on is ts , f ee d m ill er s, a nd o th er st ak eh ol de rs o n pr ud en t a nt im ic ro bi al us e an d/ or th e im pa ct o f un co nt ro lle d us e of an tim ic ro bi al s 2. D ev el op a nd su bs eq ue nt ly im pl em en t t he iA M R es po ns ib le ca m pa ig n fo r di ff er en t s ec to rs (c on su m er s, f ar m er s, ve te rin ar ia ns , e tc .) 3. C on du ct n at io nw id e ad vo ca cy c am pa ig n on p ru de nt u se o f 20 19 20 19 20 19 on w ar ds 1. K A P s tu dy co m pl et ed 2. iA M R es po ns ib le ca m pa ig n re po rt co nt ai ni ng ac tiv iti es fo r di ff er en t se ct or s 3. C am pa ig n m at er ia ls 4. A M R H ea lth pr om ot io n P la n de ve lo pe d an d im pl em en t ed 5. A dv oc ac y D A T W G , F A O P 2, 00 0, 00 0. 00 P 2, 00 0, 00 0. 00 p er ye ar P 1, 00 0, 00 0. 00 p er ye ar A44 | P a g e an tim ic ro bi al s an d fo od s af et y 4. Im pr ov e co m m un ic at io n m ea ns (e .g . s oc ia l m ed ia ) f or A M R aw ar en es s ca m pa ig ns a nd /o r pu bl ic n ot ifi ca tio ns 5. C on du ct a dv oc ac y m ee tin gs w ith st ak eh ol de rs 6. P ro du ce IE C m at er ia ls f or di st rib ut io n to st ak eh ol de rs 7. P ro du ce a nd di ss em in at e (s oc ia l m ed ia ) d oc um en ta ry fil m s on f oo d pr od uc tio n an d sa fe ty 20 20 20 19 2 02 3 20 20 20 20 m ee tin gs co nd uc te d 6. IE C m at er ia ls di st rib ut ed 7. D oc um en t ar y fil m s di ss em in a te d in so ci al m ed ia P 1, 00 0, 00 0. 00 p er ye ar P 50 0, 00 0. 00 p er y ea r P 1, 00 0, 00 0. 00 p er ye ar P 2, 00 0, 00 0. 00 A45 | P a g e w ith in fo rm at io n on A M R 7. 2 T o in te gr at e A M R p re ve nt io n an d re du ct io n in pr e se rv ic e tr ai ni ng o f h ea lth an d ag ric ul tu re pr of es si on al s 1. Im pl em en t r is k co m m un ic at io n pl an sp ec ifi ca lly a nc ho re d to g oo d ve te rin ar y pr ac tic es ta rg et in g ve te rin ar ia ns , nu tr iti on is ts , f ee d m ill er s, s up pl ie rs , a nd fa rm o w ne rs 2. In te gr at e A M R aw ar en es s, pr ev en tio n an d re du ct io n in s ch oo l cu rr ic ul um f or p re se rv ic e tr ai ni ng o f he al th a nd a gr ic ul tu re pr of es si on al s 20 20 20 21 1. R is k co m m un ic at io n pl an fo r a ni m al se ct or de ve lo pe d an d di ss em in a te d 2. A M R in te gr at ed in s ch oo l cu rr ic ul um of p re se rv ic e tr ai ni ng D A T W G In cl ud e in m ee tin gs In cl ud e in m ee tin gs A46 | P a g e H um an H ea lth O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ O ut pu t R es po ns ib le A ge nc y B ud ge t 7. 1 T o in cr ea se pu bl ic aw ar en es s on th e ra tio na l u se of a nt ib io tic s 1. U pd at e lo ca liz ed IE C m at er ia ls o n A M R 2. D ev el op A dv oc ac y P la n an d H ea lth P ro m ot io n P la n fo r A M R 3. C on tin uo us ly im pl em en t ge ne ra l I EC a nd ad vo ca cy a ct iv iti es in di ff er en t s et tin gs es pe ci al ly in co m m un iti es 4. C on du ct e ff ec tiv e, ta rg et ed h ea lth pr om ot io n an d co m m un ic at io n in iti at iv es a bo ut A M R , 20 19 20 19 2 02 0 20 19 2 02 3 20 19 2 02 3 20 20 2 02 3 1. IE C m at er ia ls di ss em in a te d 2. H ea lth P ro m ot io n an d A dv oc ac y P la n 3. A nn ua l ce le br at io n of W A A W in R eg io ns 4. C on du ct of aw ar en es s P D , H P C S D O H , D O H C H D s P 2, 00 0, 00 0. 00 P 1, 50 0, 00 0. 00 f or co ns ul ta nt a nd m ee tin gs P 5, 00 0, 00 0. 00 an nu al ly P 2, 00 0, 00 0. 00 p er ye ar P 2, 00 0, 00 0. 00 p er A47 | P a g e A M U , A M S in v ar io us se tt in gs (e .g . h ea lth fa ci lit ie s, s ch oo ls , w or kp la ce ) t hr ou gh va rio us c ha nn el s (s oc ia l m ed ia , t el ev is io n, p rin t m ed ia , t he at er s, e tc .) di re ct ed to w ar ds co ns um er s. 5. D ev el op a n ev al ua tio n m ec ha ni sm f or pr om ot io n an d co m m un ic at io n in iti at iv es o n A M R , A M U , A M S 6. En ga ge w ith L G U s on A M R a dv oc ac y 7. D ev el op a ri sk co m m un ic at io n pl an f or A M R 20 20 20 21 20 20 ac tiv iti es in sc ho ol s, he al th fa ci lit ie s an d w or kp la ce s. 5. M & E pl an fo r A M R pr om ot io n 6. LG U le ve l ac tiv iti es 7. R is k co m m un i ca tio n pl an de ve lo pe d ye ar P 50 0, 00 0. 00 P 1, 00 0, 00 0. 00 P 1, 00 0, 00 0. 00 T A / co ns ul ta nc y A48 | P a g e 7. 2 T o in te gr at e A M R p re ve nt io n an d re du ct io n in pr e se rv ic e tr ai ni ng o f he al th a nd ag ric ul tu re pr of es si on al s 1. In te gr at e A M R aw ar en es s, p re ve nt io n an d re du ct io n in s ch oo l cu rr ic ul um f or p re se rv ic e tr ai ni ng o f he al th an d ag ric ul tu re pr of es si on al s 20 20 1. A M R in te gr at ed in p re tr ai ni ng cu rr ic ul u m c on te nt C H ED P 1, 00 0, 00 0. 00 Ed uc at io n an d ot he r s ec to rs O bj ec ti ve s A ct iv it ie s T im el in e M ea su re m en t/ O ut pu t R es po ns ib le A ge nc y B ud ge t 7. 2 T o in te gr at e A M R pr ev en tio n an d re du ct io n in pr e se rv ic e tr ai ni ng o f he al th a nd 1. C on du ct d ia lo gu e w ith D ep Ed a nd C H ED of fic ia ls / fo ca l p oi nt s 2. In te gr at e A M R aw ar en es s, p re ve nt io n an d re du ct io n in s ch oo l 20 19 20 20 1. U pd at ed in fo rm at io n an d IE C m at er ia ls pu bl is he d on IC A M R w eb si te , so ci al 1. P D , F D A , D ep Ed , C H ED , a nd H P C S 2. D O H , D A , C H ED (& P R C ?) M ee tin gs P 50 0, 00 0. 00 M ee tin gs A49 | P a g e ag ric ul tu re pr of es si on al s cu rr ic ul um f or p re s er vi ce tr ai ni ng o f h ea lth a nd ag ric ul tu re p ro fe ss io na ls m ed ia pl at fo rm s, pr in t m ed ia , po st er s in ph ar m ac ie s , a nd a ire d in th ea te rs an d T V st at io ns 2. T ra in in g m od ul es an d m on ito rin g re po rt s A50 | P a g e A nn ex C . M em be rs o f t he In te r A ge nc y C om m itt ee o n A nt im ic ro bi al R es is ta nc e (I C A M R ) ● D ep ar tm en t o f H ea lt h ○ D is ea se P re ve nt io n an d C on tr ol B ur ea u ○ Ep id em io lo gy B ur ea u ○ Fo od a nd D ru g A dm in is tr at io n ○ H ea lth F ac ili tie s D ev el op m en t B ur ea u ○ H ea lth F ac ili ty a nd S er vi ce s R eg ul at or y B ur ea u ○ H ea lth P ro m ot io n an d C om m un ic at io n Se rv ic e ○ P ha rm ac eu tic al D iv is io n ○ R es ea rc h In st itu te f or T ro pi ca l M ed ic in e / N at io na l R ef er en ce L ab or at or y ● D ep ar tm en t o f A gr ic ul tu re ○ A SE C L iv es to ck ○ B ur ea u of A ni m al In du st ry ○ B ur ea u of F is he rie s an d A qu at ic R es ou rc es ○ N at io na l M ea t I ns pe ct io n S er vi ce ○ O P P A51 | P a g e ○ O SE C ○ P hi lip pi ne C ar ab ao C en te r ● D ep ar tm en t o f S ci en ce a nd T ec hn ol og y ○ P hi lip pi ne C ou nc il fo r H ea lth R es ea rc h an d D ev el op m en t ○ P hi lip pi ne C ou nc il fo r A gr ic ul tu re , A qu at ic a nd N at ur al R es ou rc es R es ea rc h an d D ev el op m en t ● D ep ar tm en t o f In te ri or a nd L oc al G ov er nm en t ● D ep ar tm en t o f T ra de a nd In du st ry A nn ex D . M em be rs o f D A T W G 1. B ur ea u of A ni m al In du st ry ( B A I) 2. N at io na l M ea t I ns pe ct io n S er vi ce (N M IS ) 3. N at io na l D ai ry A ut ho rit y (N D A ) 4. P hi lip pi ne C ar ab ao C en te r ( P C C ) 5. B ur ea u of F is he rie s an d A qu at ic R es ou rc es (B FA R ) A nn ex E . A M R R el at ed R es ea rc h in A ni m al H ea lth T hi s A nn ex is in cl ud ed in th e P la n to p ro vi de g ui da nc e to d ec is io n m ak er s an d pl an ne rs o n w ha t r es ea rc he rs a nd in fo rm at io n ar e al re ad y av ai la bl e in th e P hi lip pi ne s. It a ls o gi ve s id ea o f in st itu tio ns in vo lv ed a nd e xp er ts . T IT LE A U T H O R /S IN S T IT U T IO N /S JO U R N A L / Y EA R A52 | P a g e P U B LI C A T IO N U N P U B LI S H ED /O N G O IN G En ga gi ng th e fo od a nd a gr ic ul tu re s ec to rs in s ub S ah ar an A fr ic a an d so ut h an d so ut he as t A si a in th e gl ob al e ff or ts to co m ba t A nt im ic ro bi al re si st an ce u si ng O ne H ea lth A pp ro ac h (G C P /G LO /7 10 /U K ) FA O H Q , F A O R A P , F A O P H , D A B A I 20 17 M ar ch 20 21 Su rv ei lla nc e of a nt im ic ro bi al re si st an t E . C ol i a nd S al m on el la in li ve st oc k fa rm s an d m ar ke ts W H O A G IS A R , P hi lip pi ne C ar ab ao C en te r, R es ea rc h C en te r f or Z oo ne s C on tr ol Ja pa n T he P hi lip pi ne s' p ilo t s ur ve ill an ce o n th e ex te nt o f an tim ic ro bi al re si st an ce in co m m en sa l a nd e nt er ic z oo no tic b ac te ria is ol at es f ro m li ve st oc k an d th e fa rm en vi ro nm en t D A B io te ch ; N M IS ; P hi lip pi ne C ar ab ao C en te r P re va le nc e, m ol ec ul ar e pi de m io lo gy , a nd an tib io tic re si st an ce p ro fil es o f m et hi ci lli n re si st an t S ta ph yl oc oc cu s au re us (M R SA ) fr om m ilk a nd ru ra l s am pl es o f da iry bu ff al oe s B ad ua , A .T ., & M in ga la , C .N . P hi lip pi ne C ar ab ao C en te r; C ha ng M ai U ni ve rs ity T ha ila nd Id en tif ic at io n, m ol ec ul ar c ha ra ct er iz at io n, an d ris k fa ct or a na ly si s of a nt im ic ro bi al re si st an ce , v iru le nc e fa ct or s an d ge ne tic ch ar ac te ris tic s of K le bs ie lla p ne um on ia e fr om d ai ry c at tle f ar m s in B at an ga s, Fl or M ar ie Im m an ue lle , R af al lo P ila pi l-A m an te A53 | P a g e P hi lip pi ne s St re ng th en in g ca pa ci tie s, p ol ic ie s an d na tio na l a ct io n pl an s on p ru de nt a nd re sp on si bl e us e of a nt im ic ro bi al s in fis he rie s M el ba G . B on da d R ea nt as o FA O A qu at ic A M R P ro je ct (F M M /R A S/ 29 8) Q ua nt ifi ca tio n of a nt ib io tic r es id ue s an d id en tif ic at io n of a nt ib io tic r es is ta nc e ge ne s of m ic ro or ga ni sm s in ra w c hi ck en fr om w et m ar ke ts in Q ue zo n C ity , P hi lip pi ne s P ro fe ss or L ev i L et le t H . La rc ia II , P ro fe ss or Jo an na V . T or al ba , M s. M el an ie V . S al in as U ni ve rs ity o f th e P hi lip pi ne s M an ila C ol le ge o f P ub lic H ea lth A54 | P a g e Su rv ei lla nc e of a nt im ic ro bi al re si st an ce in th e P hi lip pi ne s D ep ar tm en t o f H ea lth N at io na l C en te r f or D is ea se P re ve nt io n an d C on tr ol (N C D P C ) N at io na l E pi de m io lo gy C en te r ( N EC ) N at io na l C en te r f or H ea lth F ac ili ty D ev el op m en t N at io na l C en te r f or H ea lth P ro m ot io n B ur ea u of Q ua ra nt in e H ea lth E m er ge nc y M an ag em en t S ta ff S an L az ar o H os pi ta l R es ea rc h In st itu te f or T ro pi ca l M ed ic in e (R IT M ) C en te rs f or H ea lth D ev el op m en t ( C H D s) N at io na l C en te r f or P ha rm ac eu tic al A cc es s & M an ag em en t (N C P A M ) D ep ar tm en t o f A gr ic ul tu re B ur ea u of A ni m al In du st ry ( B A I) N at io na l M ea t I ns pe ct io n Se rv ic e (N M IS ) D ep ar tm en t o f En vi ro nm en t a nd N at ur al R es ou rc es P hi lip pi ne A ni m al W el fa re B ur ea u P hi lip pi ne In te r ag en cy C om m itt ee o n Z oo no se s U ni ve rs ity o f th e P hi lip pi ne s C ol le ge o f P ub lic H ea lth P hi lip pi ne H os pi ta l I nf ec tio n C on tr ol S oc ie ty P hi lip pi ne C ou nc il fo r Q ua lit y A ss ur an ce in C lin ic al L ab or at or ie s Su rv ei lla nc e an d ch ar ac te riz at io n of an tim ic ro bi al re si st an t E sc he ric hi a co li an d Sa lm on el la fr om li ve st oc k fa rm s, e gg , m ilk an d m ea t i n th e P hi lip pi ne s P C C ; H ok ka id o U ni ve rs ity A55 | P a g e P he no ty pi c an d ge no ty pi c an tim ic ro bi al re si st an ce o f Es ch er ic hi a co li is ol at ed f ro m he al th y bu ff al oe s, c at tle , p ig s, a nd ch ic ke ns a nd e nv iro nm en ta l s ou rc es in m aj or li ve st oc k pr od uc in g re gi on s in th e P hi lip pi ne s (o ld ti tle ) P ad ill a, M .A ., et a l. P U B LI S H ED Is ol at io n an d m ol ec ul ar C ha ra ct er iz at io n of s tr ep to co cc al s pe ci es re co ve re d fr om cl in ic al in fe ct io ns in f ar m ed N ile ti la pi a sp ec ie s (O re oc hr om is n ilo tiu s) in th e P hi lip pi ne s Le ga rio , F .S ., C ho re sc a, C .H ., T ur nb ul l, J. F. , a nd C ru m lis h, M . In st itu te o f A qu ac ul tu re , F ac ul ty o f N at ur al S ci en ce s, U ni ve rs ity o f St irl in g (U K )/ N at ur al S ci en ce s D ep ar tm en t, Ili Ilo S ci en ce n ad T ec hn ol og y U ni ve rs ity / N at io na l F is he rie s R es ea rc h an d D ev el op m en t I ns tit ut e Fi sh er ie s B io te ch no lo gy C en te r ( D A ) Jo ur na l o f Fi sh D is ea se , D O I:1 0. 11 11 /j fd .1 32 47 Se pt . 1 4, 20 20 A nt im ic ro bi al u se d in b ac ky ar d an d co m m er ci al p ou ltr y an d sw in e fa rm s in th e P hi lip pi ne s: A q ua lit at iv e pi lo t s tu dy B ar ro ga , T .R ,M , M or al es , R .G ., B en ig no , C .C ., C as tr o, S .J .M ., C an ib an , M .M ., C ab ul lo , M .F .B ., A gu no s, A ., de B ar lo gh , K ., an d D or ad o G ar ci a, A . Fo od a nd A gr ic ul tu re O rg an iz at io n of th e U ni te d N at io ns (G C P /G LO /7 10 /U K ), B ur ea u of A ni m al In du st ry D ep ar tm en t o f A gr ic ul tu re , N at io na l M ea t I ns pe ct io n S er vi ce D ep ar tm en t o f A gr ic ul tu re , F oo d an d A gr ic ul tu re O rg an iz at io n of th e U ni te d N at io ns R eg io na l O ff ic e of A si a an d th e P ac ifi c, F oo d an d A gr ic ul tu re O rg an iz at io n of th e U ni te d N at io ns Fr on tie rs o f V et er in ar y Sc ie nc e D oi :1 0. 33 89 /f ve ts .2 02 0. 00 32 9 20 20 A56 | P a g e R om e, It al y M ul tid ru g re si st an t S al m on el la s er ot yp e an at um in tr av el er s an d se af oo d fr om A si a, U ni te d St at es K ar p, B .E ., Le ep er , M .M ., C he n, J .C ., T ag g, K .A ., Fr cn co is W at ki ns , L .K ., an d Fr ie dm an , C .R . C en te rs f or D is ea se C on tr ol a nd P re ve nt io n, A tla nt a, G eo rg ia , U SA Em er gi ng In fe ct io us D is ea se s, 2 6( 5) :1 03 0 10 33 20 20 P re va le nc e, a nt ib io gr am , a nd re si st an ce pr of ile o f ex te nd ed s pe ct ru m b et a la ct am as e pr od uc in g E. c ol i i so la te s fr om pi gs f ar m s in L uz on , P hi lip pi ne s G un dr an , R .S ., C ar de ni o, P .A ., S al va do r, R .T ., Si so n, F .B ., B en ig no , C .C ., K re au su ko n, K ., P ic hp ol D ., P un ya po rn w ith ay a, V . C ol le ge o f V et er in ar y S ci en ce a nd M ed ic in e C en tr al L uz on S ta te U ni ve rs ity , P hi lip pi ne C ol le ge o f V et er in ar y Ep id em io lo gi st a nd P H IL V ET H ea lth S er vi ce s, F ac ul ty o f V et er in ar y M ed ic in e C hi an g M ai U ni ve rs ity M ic ro bi al D ru g R es is ta nc e D O I:1 0. 10 89 /m dr .2 01 9. 0 01 9 20 19 D ra ft g en om e se qu en ce o f m ul tid ru g re si st an t V ib rio p ar ah em ol yt ic us s tr ai n P H 69 8, in fe ct in g pe na ei d sh rim p in th e P hi lip pi ne s Sa lo m a, C .P ., P en ir, S. M .U ., A za nz a, J .M .r ., de la P en a, L .D ., U se ro , R .C . e t a l N at io na l I ns tit ut e of M ol ec ul ar B io lo gy an d B io te ch no lo gy U ni ve rs ity o f th e P hi lip pi ne s D ili m an , P hi lip pi ne g en om e C en te r U ni ve rs ity o f th e P hi lip pi ne s D ili m an , S ou th ea st A si a Fi sh er ie s D ev el op m en t C en te r A qu ac ul tu re D ev el op m en t C en te r, N eg ro s P ra w n P ro du ce rs C oo pe ra tiv e M ic ro bi ol re so ur ce A nn ou nc 8 :e 01 04 0 19 ht tp s: // do i.o rg /1 0. 11 28 / M R A .0 10 40 1 9. 20 19 P re va le nc e an d di st rib ut io n of b la C T X M , bl aS H V , b la T EM g en es in e xt en de d sp ec tr um b et a la ct am as e pr od uc in g E co li is ol at ed f ro m b ro ile r f ar m s in th e G un dr an , R .S ., C ar de ni o, P .A ., V ill an ue va , M .A ., Si so n, F .B ., B en ig no . C .C ., K re au su ko n, K ., C ol le ge o f V et er in ar y S ci en ce a nd M ed ic in e C en tr al L uz on S ta te U ni ve rs ity , L iv es to ck B io te ch no lo gy C en te r D ep ar tm en t o f A gr ic ul tu re , B M C V et er in ar y R es ea rc h 15 (2 27 ) ht tp s: // do i.o rg /1 0/ 11 86 / s1 29 17 0 19 1 97 5 9 20 19 A57 | P a g e P hi lip pi ne s P ic jp ol , D ., an d P un ya po rn w ith ay a, V . Fo od a nd A gr ic ul tu re O rg an iz at io n of th e U ni te d N at io ns R eg io na l O ff ic e fo r A si a an d th e P ac ifi c, F ac ul ty o f V et er in ar y M ed ic in e C hi an g M ai U ni ve rs ity O cc ur re nc e an d an tib io tic s en si tiv ity o f E. co li an d Sa lm on el la s pp . I n re ta il ch ic ke n m ea t a t s el ec te d m ar ke ts in V el en ci a C ity , B uk id no n, P hi lip pi ne s El um ba , Z .S ., A lle ra , M .L .M , T ag an as , R .R .R . D ep ar tm en t o f B io lo gy C en tr al M in da na o U ni ve rs ity A si an J ou rn al o f B io lo gi ca l a nd L ife Sc ie nc es , 7 (2 ):5 3 58 20 18 A nt ib io tic s us ce pt ib ili ty p at te rn s of ba ct er ia is ol at ed f ro m c ru st ac ea ns st ra nd ed in th e P hi lip pi ne s O bu sa n, M .C .M ., A ra go ne s, L .V ., R iv er a, W .L ., an d Si rin ga n. M .A .T . In st itu te o f B io lo gy U ni ve rs ity o f th e P hi lip pi ne s D ili m an , I ns tit ut e of En vi ro nm en ta l S ci en ce s an d M et eo ro lo gy U ni ve rs ity o f th e P hi lip pi ne s D ili m an , N at ur al S ci en ce s R es ea rc h In st itu te U ni ve rs ity o f th e P hi lip pi ne s D ili m an A qu at ic M am m al s, 44 (5 ):5 68 5 79 20 18 D et ec tio n of Q ui no lo ne re si st an ce th ro ug h am pl ifi ca tio n of th e gy rA g en e of th e M yc ob ac te riu m s pe ci es f or m H um an a nd A ni m al S ou rc es G ar ci a, G .G ., Es pi no sa , R .K .M ., M ig ue l, M ., B er na rd in o, M .L ., A qu in o, M .A .D ., an d M in ga la , C .N . C ol le ge o f V et er in ar y S ci en ce a nd M ed ic in e C en tr al L uz on S ta te U ni ve rs ity , B io sa fe ty a nd En vi ro nm en ta l S ec tio n P hi lip pi ne C ar ab ao C en te r, T ro pi ca l D is ea se Fo un da tio n P hi lip pi ne In st itu te o f T ub er cu lo si s In te rn at io na l J ou rn al o f V et er in ar y S ci en ce , 7( 4) :1 90 1 94 . 20 18 SM ol ec ul ar d et ec tio n of te tr ac yc lin e an d su lfo na m id e re si st an ce g en es in G ar ci a, G .G ., Fr an ci a, A .J .e ., C os ta le s, K .B ., C ol le ge o f V et er in ar y S ci en ce a nd M ed ic in e C en tr al L uz on S ta te In te rn at io na l J ou rn al o f V et er in ar y M ed ic in e, 20 18 A58 | P a g e re sp ira to ry a nd g as tr oi nt es tin al b ac te ria l is ol at es o f ru m in an ts B al bi n, M .M . a nd M in ga la , C .N . U ni ve rs ity , B io sa fe ty a nd En vi ro nm en ta l S ec tio n P hi lip pi ne C ar ab ao C en te r 8( 1) :1 9 M ul tip le re si st an ce to m ed ic al ly im po rt an t an tim ic ro bi al s of c om m en sa l E . c ol i is ol at ed f or m d re ss es b ro ile r c hi ck en s in C A LA B A R Z O N , P hi lip pi ne s T or io , H .E ., an d P ad ill a, M .A . C ol le ge o f V et er in ar y M ed ic in e N ue va V iz ca ya S ta te U ni ve rs ity , C ol le ge o f V et er in ar y M ed ic in e U ni ve rs ity o f th e P hi lip pi ne s Lo s B an os P hi lip pi ne J ou rn al o f V et er in ar y M ed ic in e, 55 (2 ):9 5 10 6 20 18 A nt ib io tic re si st an ce a nd e xt en de d sp ec tr um b et a la ct am as e pr od uc tio n of E . co li is ol at ed f or m ir rig at io n w at er s in se le ct ed u rb an f ar m s in M et ro M an ila , P hi lip pi ne s V ita l, P .G ., Z ar a, E .S ., P ar ao an , C .E .M ., D im as up il, M .A .Z ., A be llo , J .J .M ., S an to s, I.T .G ., an d R iv er a, W .L . In st itu te o f B io lo gy U ni ve rs ity o f th e P hi lip pi ne s D ili m an , N at ur al S ci en ce s R es ea rc h In st itu te U ni ve rs ity o f th e P hi lip pi ne s D ili m an W at er , 1 0( 54 8) D oi :1 0. 33 90 /w 10 05 05 48 2 01 8 H ig h le ve l r es is ta nc e an d m ul ti re si st an ce to m ed ic al ly im po rt an t a nt im ic ro bi al s in E . co li is ol at ed f ro m h ea lth y pi gs a t s la ug ht er in L ag un a, P hi lip pi ne s P ad ill a, M .A ., an d A m at or io , M .Q . C ol le ge o f V et er in ar y M ed ic in e U ni ve rs ity o f th e P hi lip pi ne s Lo s B an os , C ol le ge o f V et er in ar y M ed ic in e B en gu et S ta te U ni ve rs ity P hi lip pi ne J ou rn al o f V et er in ar y M ed ic in e, 54 (1 ):3 6 45 20 17 M ul tip le a nt im ic ro bi al re si st an ce o f th e E. co li is ol at ed f ro m n ile ti la pi a so ld in w et m ar ke ts in M et ro M an ila a nd th ei r co nj ug at iv e tr an sf er ab ili ty if d ru g re si st an ce Jo se , M .A .I. , a nd C ab re ra , E .C . D ep ar tm en t o f B io lo gy D e La S al le U ni ve rs ity , D ep ar tm en t o f B io lo gi ca l Sc ie nc es M SU Il ig an In st itu te o f T ec hn ol og y D LS U R es ea rc h C on gr es s 20 17 A nt im ic ro bi al re si st an ce in E sc he ric hi a co li an d Sa lm on el la s pp . i so la te s fr om f re sh pr od uc e an d th e im pa ct to f oo d sa fe ty V ita l, P . G ., C ab al le s, M . B . D ., & R iv er a, W . L . In st itu te o f B io lo gy , C ol le ge o f Sc ie nc e, U ni ve rs ity o f th e P hi lip pi ne s D ili m an , Q ue zo n C ity , P hi lip pi ne s J En vi ro n S ci H ea lth B . 52 (9 ):6 83 6 89 . do i:1 0. 10 80 /0 36 01 23 4. 2 01 7. 13 31 67 6 Se pt em be r 2 01 7 A59 | P a g e M ol ec ul ar c ha ra ct er iz at io n an d an tim ic ro bi al re si st an ce o f Sa lm on el la en te ric a fr om s w in e sl au gh te re d in tw o di ff er en t t yp es o f P hi lip pi ne a ba tt oi r C al ay ag , A .M .B ., P ac lib ar e, P .A .P ., Sa nt os , P .D .M ., B au tis ta , C .A .C ., R iv er a, W .L . In st itu te o f B io lo gy , C ol le ge o f Sc ie nc e, U ni ve rs ity o f th e P hi lip pi ne s D ili m an , Q ue zo n C ity , P hi lip pi ne s Fo od M ic ro bi ol . 6 5: 5 1 56 . d oi : 10 .1 01 6/ j.f m .2 01 7. 01 .0 1 6 A ug us t 20 17 D et ec tio n of C la ss I an d II in te gr on s fo r t he as se ss m en t o f an tib io tic a nd m ul tid ru g re si st an ce a m on g Es ch er ic hi a co li is ol at es fr om a gr ic ul tu ra l i rr ig at io n w at er s in B ul ac an , P hi lip pi ne s P ar ao an , C .E .M ., R iv er a, W .L ., V ita l, P .G . In st itu te o f B io lo gy , C ol le ge o f Sc ie nc e, U ni ve rs ity o f th e P hi lip pi ne s D ili m an , Q ue zo n C ity , P hi lip pi ne s J En vi ro n S ci H ea lth B . 52 (5 ):3 06 3 13 . D O I: 10 .1 08 0/ 03 60 12 34 .2 01 7 .1 28 16 47 M ay 2 01 7 M ic ro bi al P la te c ou nt a nd d et ec tio n of E . co li in in p or k m ea t s am pl es f or m s ta lls in a pu bl ic w et m ar ke t i n C eb u, P hi lip pi ne s Y an du g, B .S ., V en tu ra , D .C ., Y ba ne s, R .H .D ., an d Y ba ne z, A .P . So ut hw es te rn U ni ve rs ity , B io lo gy a nd En vi ro nm en ta l S tu di es P ro gr am U ni ve rs ity o f th e P hi lip pi ne s C eb u, G al la s C ol le ge o f M ed ic in e U ni ve rs ity of th e V is ay as , U ni ve rs ity o f So ut he rn P hi lip pi ne s Fo un da tio n In te rn at io na l r es ea rc h Jo ur na l o f In te rd is ci pl in ar y an d M ul tid is ci pl in ar y St ud ie s, 2( 2) :6 5 72 IS SN :2 39 4 79 69 (o nl in e) ; 2 39 4 79 50 (p rin t) 20 16 H ig h ra te s of c on ta m in at io n of p ou ltr y m ea t p ro du ct s w ith d ru g re si st an t C am py lo ba ct er in M et ro M an ila , P hi lip pi ne s Li m , P .W ., T ia m L ee , D .C ., P ac lib ar e, P .A ., Su be ja no , M .S ., C ab er o P al m a, J .A ., P en ul ia r G .M . In st itu te o f B io lo gy , C ol le ge o f Sc ie nc e, U ni ve rs ity o f th e P hi lip pi ne s D ili m an , Q ue zo n C ity , P hi lip pi ne s Jp n J In fe ct D is . 70 (3 ):3 11 3 13 . d oi : 10 .7 88 3/ yo ke n. JJ ID .2 01 6. 30 9 O ct ob er 20 16 A60 | P a g e P er sp ec tiv e on A nt im ic ro bi al R es is ta nc e in Li ve st oc k an d Li ve st oc k pr od uc ts in A SE A N c ou nt rie s A rc ha w ak ul at he p, A ., K im , C .T .T ., M eu ns en e, D ., H an di ja tn o, D ., H as si m , H .A ., R ov ira , H .R .G ., et a l. V ar io us V et er in ar y In st itu tio n an d U ni ve rs iti es in S ou th ea st A si a T ha i J ou rn al o f V et er in ar y M ed ic in e, 44 (1 ):5 1 3 20 14 Lo ad s an d an tim ic ro bi al re si st an ce o f C am py lo ba ct er s pp . o n fr es h ch ic ke n m ea t in N ue va E ci ja , P hi lip pi ne s Si so n, F .B ., C ha is ow w on g, W ., A lte r, T ., T iw an an th ag or n, S ., P ic hp ol , D ., La m pa ng , K .N ., B au m an n, M .P ., G öl z, G . Fr ei e U ni ve rs itä t B er lin , G er m an y; C hi an g M ai U ni ve rs ity , T ha ila nd ; D ep ar tm en t o f P at ho bi ol og y, C ol le ge of V et er in ar y S ci en ce a nd M ed ic in e, C en tr al L uz on S ta te U ni ve rs ity P ou lt Sc i. 93 (5 ):1 27 0 3. ht tp s: // do i.o rg /1 0. 33 82 / ps .2 01 3 03 79 1 M ay 2 01 4 A nt im ic ro bi al re si st an ce o f Sa lm on el la en te ric a is ol at es f ro m to ns il an d je ju nu m w ith ly m ph n od e tis su es o f sl au gh te re d sw in e in M et ro M an ila , P hi lip pi ne s N g, K .C ., R iv er a, W .L . In st itu te o f B io lo gy , C ol le ge o f Sc ie nc e, U ni ve rs ity o f th e P hi lip pi ne s, D ili m an , Q ue zo n C ity IS R N M ic ro bi ol . 20 14 :3 64 26 5. D O I: 10 .1 15 5/ 20 14 /3 64 26 5 M ar ch 20 14 M ic ro bi ol og ic al q ua lit y of f re sh p ro du ce fr om o pe n ai r m ar ke ts a nd s up er m ar ke ts in th e P hi lip pi ne s V ita l, P .G ., D im au sa y, K .G .B ., W id m er , K .W ., an d R iv er a, W .L . In st itu te o f B io lo gy U ni ve rs ity o f th e P hi lip pi ne s D ili m an , N at ur al S ci en ce s R es ea rc h In st itu te U ni ve rs ity o f th e P hi lip pi ne s D ili m an , I nt er na tio na l En vi ro nm en ta l A na ly si s an d Ed uc at io n C en te r G w an gj u In st itu te o f Sc ie nc e an d T ec hn ol og y T he S ci en tif ic W or ld Jo ur na l ht tp :/ /d x. do i.o rg /1 0/ 11 5 5/ 20 14 /2 19 53 4 20 14 M ic ro bi ol og ic al q ua lit y of c hi ck en a nd po rk b as ed s tr ee t ve nd ed f oo ds f ro m T ai ch un g, T ai w an , a nd L ag un a, P hi lip pi ne s M an gu ia t, L. S. , F an g, T .J . D ep ar tm en t o f Fo od S ci en ce a nd B io te ch no lo gy , N at io na l C hu ng H si ng U ni ve rs ity , T ai w an ; Fo od M ic ro bi ol . 36 (1 ):5 7 62 . d oi : 10 .1 01 6/ j.f m .2 01 3. 04 .0 0 O ct ob er 20 13 A61 | P a g e D ep ar tm en t o f N ut rit io n, C hi na M ed ic al U ni ve rs ity , T ai w an 5 R el at io ns hi p be tw ee n m ul ti re si st an ce o f P hi lip pi ne Is ol at es C am py lo ba ct er je ju ni an d an tim ic ro bi al u sa ge B al dr ia s, L .R . C ol le ge o f V et er in ar y M ed ic in e U ni ve rs ity o f th e P hi lip pi ne s Lo s B an os P hi lip p J. V et M ed , 50 (2 ):1 04 1 11 20 13 Es tim at ed m ax im um d ai ly in ta ke o f St re pt om yc in re si du e in p or t c on su m ed b y ag e an d ge nd er g ro up s in th e P hi lip pi ne s V ut ey , V ., B al dr ia s, L .R ., D iv in a, B .P ., an d D uc us in , R .J .T . R oy al U ni ve rs ity o f A gr ic ul tu re P ho m P he n C am bo di a, C ol le ge o f V et er in ar y M ed ic in e U ni ve rs ity o f th e P hi lip pi ne s Lo s B an os In te rn at io na l J ou rn al o f En vi ro nm en ta l a nd R ur al D ev el op m en t 3 (1 ):6 2 67 20 12 In v itr o se ns iti vi ty a nd re si st an ce o f 46 Le pt os pi ra s tr ai ns is ol at ed f ro m ra ts in th e P hi lip pi ne s to 1 4 an tim ic ro bi al a ge nt s C ha kr ab or ty , A ., M iy ah ar a, S ., V ill an ue va , S. Y ., G lo ria ni , N .G ., Y os hi da , S . D ep ar tm en t o f B ac te rio lo gy , G ra du at e Sc ho ol o f M ed ic al S ci en ce s, K yu sh u U ni ve rs ity ; D ep ar tm en t o f M ed ic al M ic ro bi ol og y, C ol le ge o f P ub lic H ea lth , U ni ve rs ity o f th e P hi lip pi ne s— M an ila , M an ila , P hi lip pi ne s A nt im ic ro b A ge nt s C he m ot he r. 54 (1 2) :5 40 3 5. D O I: 10 .1 12 8/ A A C .0 09 73 1 0 D ec em be r 20 10 A62 | P a g e Id en tif ic at io n an d ch ar ac te riz at io n of C la ss 1 in te gr on re si st an ce g en e ca ss et te s am on g Sa lm on el la s tr ai ns is ol at ed f ro m im po rt ed s ea fo od K ha n, A .A ., P on ce , E ., N aw az , M .S ., C he ng , C .M ., K ha n, J .A ., W es t, C .S . D iv is io n of M ic ro bi ol og y, N at io na l C en te r f or T ox ic ol og ic al R es ea rc h, U .S . Fo od a nd D ru g A dm in is tr at io n; C en tr o de In ve st ig ac io ´n C ie nt íf ic a y de E du ca ci o´ n Su pe rio r d e En se na da (C IC ES E) , D ep ar ta m en to d e B io te cn ol og ía M ar in a, M ex ic o; P ac ifi c R eg io na l L ab or at or y So ut hw es t, U .S . F oo d an d D ru g A dm in is tr at io n; D ep ar tm en t o f C ar di ol og y, U ni ve rs ity of A rk an sa s fo r M ed ic al S ci en ce s A pp l E nv iro n M ic rio bi ol . 75 (4 ):1 19 2 6. D O I: 10 .1 12 8/ A EM .0 20 54 0 8 Fe br ua ry 20 09 Le ve l a nd p er ce nt ag e re co ve ry o f re si st an ce to o xy te tr ac yc lin e an d ox ol in ic ac id o f ba ct er ia f ro m s hr im p po nd s T en de nc ia , E .A ., & d el a P eñ a, L .D . A qu ac ul tu re D ep ar tm en t, S ou th ea st A si an F is he rie s D ev el op m en t C en te r A qu ac ul tu re . 2 13 (1 4 ):1 13 . d oi : 1 0. 10 16 /S 00 44 84 86 (0 2) 00 01 7 0 20 02 A63 | P a g e A nn ex F . A M R R el at ed R es ea rc h in H um an H ea lth T hi s A nn ex is in cl ud ed in th e P la n to p ro vi de g ui da nc e to d ec is io n m ak er s an d pl an ne rs o n w ha t r es ea rc he rs a nd in fo rm at io n ar e al re ad y av ai la bl e in th e P hi lip pi ne s. It a ls o gi ve s id ea o f in st itu tio ns in vo lv ed a nd e xp er ts . T hi s lis t o f A M R r el at ed s tu di es e xc lu de s st ud ie s on T B d ru g re si st an ce T it le A ut ho r/ s In st it ut io n/ s Jo ur na l/ P ub lic at io n Y ea r Fu nd in g ag en cy Fo un d us in g A c as e of m ul ti dr ug re si st an t ty ph oi d fe ve r: pr ol ife ra tio n vs . er ad ic at io n M en ad ro M . Sa nd ov al T he F ili pi no Fa m ily P hy si ci an 19 95 H ER D IN A64 | P a g e A c ro ss s ec tio na l s tu dy o n th e an tim ic ro bi al s en si tiv ity p ro fil e of m ul ti dr ug re si st an t g ra m ne ga tiv e ba ct er ia f ro m in pa tie nt s an d ou tp at ie nt s at a te rt ia ry h os pi ta l i n C ag ay an d e O ro C ity , J an ua ry N ov em be r 20 06 D ar el G re sa n C . Q ui si l, C an dy T . C ah ilo g, J ea ne tt e A . V en an ci o, C le va T er es ita M . A la ba , M ar co P o D . D el a C ru z, P au l C ar lo P . A ra ne ta , C el es te A . C or in al es , M el is sa T . S y, H en is sa B . Ed ro zo , A rn ol d C . P er ez T he X av ie r U N iv er si ty Jo ur na l o f M ed ic in e 20 07 H ER D IN A65 | P a g e A M ul tic en te r, R an do m iz ed , D ou bl e bl in d, P ar al le l-g ro up C lin ic al S tu dy o f S 64 92 66 C om pa re d w ith M er op en em f or th e T re at m en t o f H os pi ta l ac qu ire d B ac te ria l P ne um on ia , V en til at or a ss oc ia te d B ac te ria l P ne um on ia , o r H ea lth ca re as so ci at ed B ac te ria l P ne um on ia C au se d by G ra m ne ga tiv e P at ho ge ns 1. R on al d A lla n R . P ay um o, M D 2. L al ai ne Ll am id o M or te ra , M D 3. M al ba r G . Fe rr er , M D 4. J oe l M . Sa nt ia gu el , M D 5. M ar ie G ra ce D aw n T . I si dr o, M D 6. R on ni e Z . Sa m or o, M D 7. J ov en R oq ue V . G on on g, M D 8. A lb er t A lb ay , Jr . M D 9. M yl a M . C as til lo , M D 1. M ar y Jo hn st on H os pi ta l 2. M an ila C en tr al U ni ve rs ity Fi le m on D . T an ch oc o M ed ic al Fo un da tio n 3. S t. P au l's H os pi ta l Ilo ilo 4. Q ui rin o M em or ia l M ed ic al C en te r 5. W es t V is ay as S ta te U ni ve rs ity M ed ic al C en te r 6. W es t V is ay as S ta te U ni ve rs ity M ed ic al C en te r 7. L un g C en te r o f th e P hi lip pi ne s 8. P hi lip pi ne G en er al H os pi ta l 9. D r. J os e N . R od rig ue z M em or ia l H os pi ta l N /A O n go in g Sh io no gi & C o. , L td P hi lip pi ne H ea lth R es ea rc h R eg is tr y A66 | P a g e A P ha se 3 P ro sp ec tiv e, R an do m iz ed , M ul tic en te r, O pe n La be l, C en tr al A ss es so r B lin de d, P ar al le l G ro up , C om pa ra tiv e S tu dy to D et er m in e th e Ef fic ac y, S af et y an d T ol er ab ili ty o f A zt re on am A vi ba ct am ( A T M A V I) ±M et ro ni da zo le ( M T Z ) ve rs us M er op en em ±C ol is tin (M ER ±C O L) f or th e T re at m en t of S er io us In fe ct io ns d ue to G ra m N eg at iv e B ac te ria , In cl ud in g M et al lo B L ac ta m as e (M B L) – P ro du ci ng M ul tid ru g R es is ta nt P at ho ge ns , f or W hi ch T he re A re L im ite d or N o T re at m en t O pt io ns 1. C am ilo C . R oa Jr ., M D 2. A lb er t A lb ay , Jr . M D 3. L al ai ne Ll am id o M or te ra , M D 4. M ar ie G ra ce D aw n T . I si dr o, M D 1. P hi lip pi ne G en er al H os pi ta l 2. P hi lip pi ne G en er al H os pi ta l 3. M an ila C en tr al U ni ve rs ity Fi le m on D . T an ch oc o M ed ic al Fo un da tio n H os pi ta l 4. W es t V is ay as S ta te U ni ve rs ity M ed ic al C en te r N /A P en di ng P fiz er In c. P hi lip pi ne H ea lth R es ea rc h R eg is tr y A67 | P a g e A ra nd om iz ed tr ia l o f ci pr of lo xa ci n ve rs us c ef ix im e fo r t re at m en t o f go no rr he a af te r r ap id e m er ge nc e of go no co cc al c ip ro flo xa ci n re si st an ce in th e P hi lip pi ne s A pl as ca , M .R ., P at o M es ol a, V ., K la us ne r, J. D ., M an al as ta s, R ., W i, T ., T ua zo n, C .U ., D al la be tt a, G ., W hi tt in gt on , W .L ., H ol m es , K .K . C lin In fe ct D is . 32 (9 ):1 31 3 8 20 01 D A P C C A n O pe n La be l, R an do m iz ed , M ul tic en te r, P ha se II I S tu dy o f C ef ta zi di m e A vi ba ct am (C A Z A V I, Fo rm er ly C A Z 10 4) a nd B es t A va ila bl e T he ra py f or th e T re at m en t o f In fe ct io ns D ue to C ef ta zi di m e R es is ta nt G ra m N eg at iv e P at ho ge ns A rm an do C ris os to m o, M D P hi lip pi ne G en er al H os pi ta l O n go in g A st ra Z en ec a A B P hi lip pi ne H ea lth R es ea rc h R eg is tr y A68 | P a g e A nt ib ac te ria l a ct iv iti es o f et ha no l e xt ra ct s of P hi lip pi ne m ed ic in al p la nt s ag ai ns t m ul tid ru g re si st an t b ac te ria D em et rio L . V al le Jr ., Je an ni e I. A nd ra de , J ul ia na Ja ne t M . P uz on , Es pe ra nz a C . C ab re ra , W in de ll L. R iv er a A si an P ac ifi c Jo ur na l o f T ro pi ca l B io m ed ic in e 20 15 H ER D IN A nt ib io tic p ol ic y in P G H D ru g B ul l P G H 19 90 H ER D IN A nt ib io tic re si st an t b ac te ria in ra w c hi ck en m ea t s ol d in a pu bl ic m ar ke t i n Q ue zo n C ity , P hi lip pi ne s M ar ga re t L . d e G uz m an , R iz za M ae E . M an za no , Je ss am ae F ra nc e B . M on ja rd in D ep ar tm en t o f B io lo gy , C ol le ge o f A rt s an d Sc ie nc es U ni ve rs ity o f th e P hi lip pi ne s M an ila , D ep ar tm en t o f S ci en ce an d B io lo gy , C ol le ge o f A rt s an d Sc ie nc es M iri am C ol le ge , Q ue zo n C ity P hi lip pi ne Jo ur na l o f H ea lth R es ea rc h an d D ev el op m en t 20 16 H ER D IN A69 | P a g e A nt im ic ro bi al a nd A nt ip ar as iti c C on st itu en t( s) o f M or in ga ol ei fe ra L am 1. F lo re ci ta S . D e G uz m an , P hD 2. W in de ll L. R iv er a, P hD 3. J os e M an ue l L . G ut ie rr ez 1. U ni ve rs ity o f th e P hi lip pi ne s D ili m an , In st itu te o f B io lo gy 2. U ni ve rs ity o f th e P hi lip pi ne s D ili m an , In st itu te o f B io lo gy 3. U ni ve rs ity o f th e P hi lip pi ne s D ili m an , In st itu te o f C he m is tr y O n go in g P hi lip pi ne C ou nc il fo r H ea lth R es ea rc h an d D ev el op m e nt , D ep ar tm en t o f Sc ie nc e an d T ec hn ol og y P hi lip pi ne H ea lth R es ea rc h R eg is tr y B ac te re m ia c au se d by m ul ti re si st an t s al m on el la A th er ap eu tic p ro bl em O fe lia C as tr o T ab la n A ct a M ed ic a P hi lip pi na 19 80 H ER D IN A70 | P a g e B ac te ric id al P ro pe rt y of Z in gi be r o ff ic in al e (G in ge r) A ga in st S ta ph yl oc oc cu s au re us , M et hi ci lli n R es is ta nt St ap hy lo co cc us a ur eu s, Es ch er ic hi a co li an d Ex te nd ed Sp ec tr um B et a La ct am as e Es ch er ic hi a co li. A lfr ed o V . C or pu z U ni ve rs ity o f N or th er n P hi lip pi ne s M ai n N /A O n go in g P hi lip pi ne C ou nc il fo r H ea lth R es ea rc h an d D ev el op m e nt , D ep ar tm en t o f Sc ie nc e an d T ec hn ol og y P hi lip pi ne H ea lth R es ea rc h R eg is tr y B io ac tiv e M et ab ol ite S cr ee ni ng of N ep hr ol ep is c or di fo lia P la nt an d its A ss oc ia te d Fu ng al En do ph yt es A ga in st M et hi ci lli n R es is ta nt St ap hy lo co cc us a ur eu s Ju de e N og od ul a U ni ve rs ity o f th e Im m ac ul at e C on ce pt io n N /A O n go in g P hi lip pi ne C ou nc il fo r H ea lth R es ea rc h an d D ev el op m e nt , D ep ar tm en t o f Sc ie nc e P hi lip pi ne H ea lth R es ea rc h R eg is tr y A71 | P a g e an d T ec hn ol og y C ef ta zi di m e A vi ba ct am f or th e T re at m en t o f In fe ct io ns D ue to C ef ta zi di m e R es is ta nt P at ho ge ns A rm an do C ris os to m o, M D P hi lip pi ne G en er al H os pi ta l ( P G H ) N /A O n go in g A st ra Z en ec a A B P hi lip pi ne H ea lth R es ea rc h R eg is tr y C om m un ity a cq ui re d m et hi ci lli n re si st an t St ap hy lo co cc us a ur eu s py om yo si tis : A c as e re po rt V in ce nt P au l C . G od in ez , C he rr y T ag ui an g A bu D e La S al le U ni ve rs ity M ed ic al C en te r T he P hi lip pi ne Jo ur na l o f M ic ro bi ol og y an d In fe ct io us D is ea se s 20 08 H ER D IN A72 | P a g e C om pa ra tiv e st ud y of c o tr im ox az ol e an d te tr ac yc lin es in th e tr ea tm en t o f pe ni ci lli n re si st an t g on or rh ea La o LM , B au tis ta A , F ra nc is co M , Jo ur na l o f th e P hi lip pi ne M ed ic al A ss oc ia tio n 19 79 H ER D IN C or re la te s of g on oc oc ca l in fe ct io n an d of a nt im ic ro bi al re si st an t N ei ss er ia go no rr ho ea e am on g fe m al e se x w or ke rs , R ep ub lic o f th e P hi lip pi ne s, 1 99 6 19 97 K la us ne r, J. D ., A pl as ca , M .R ., M es ol a, V .P ., B ol an , G ., W hi tt in gt on , W .L ., H ol m es , K .K . J In fe ct D is . 17 9( 3) :7 29 3 3 19 99 D A P C C D ev el op m en t o f an an tib ac te ria l I H M P G 01 C ec ili a N el ia C . M ar am ba La za rt e, M D N at io na l I ns tit ut es o f H ea lth U ni ve rs ity o f th e P hi lip pi ne s M an ila , In st itu te o f H er ba l M ed ic in e N /A O n go in g P hi lip pi ne C ou nc il fo r H ea lth R es ea rc h an d D ev el op m e nt , D ep ar tm en t o f Sc ie nc e P hi lip pi ne H ea lth R es ea rc h R eg is tr y A73 | P a g e an d T ec hn ol og y D ev el op m en t o f N ew A nt im ic ro bi al A no pl in Li po pe pt id es 1. P or tia M ah al G . Sa bi do , P hD 2. W in de ll L. R iv er a, P hD 3. M ar ia M . A be 1. U ni ve rs ity o f th e P hi lip pi ne s D ili m an , In st itu te o f C he m is tr y 2. U ni ve rs ity o f th e P hi lip pi ne s D ili m an , In st itu te o f B io lo gy U ni ve rs ity o f th e P hi lip pi ne s D ili m an , In st itu te o f C he m is tr y O n go in g P hi lip pi ne C ou nc il fo r H ea lth R es ea rc h an d D ev el op m e nt , D ep ar tm en t o f Sc ie nc e an d T ec hn ol og y P hi lip pi ne H ea lth R es ea rc h R eg is tr y A74 | P a g e D is tr ib ut io n w ith in a te rt ia ry ho sp ita l o f of lo xa ci n re si st an t P se ud om on as a er ug in os a se ro ty pe s G ar ve z M D J r, Fr an ci sc o R C , T up as i T E T he P hi lip pi ne Jo ur na l o f M ic ro bi ol og y an d In fe ct io us D is ea se s ca n' t ac ce ss H ER D IN D ru g re si st an t S al m on el la ty ph i T he lm a E. T up as i , R od rig o Lu is C . R om ul o , V ilm a M . C o , E lla m ae D . S or on go n M ak at i M ed ic al C en te r P ro ce ed in gs 19 94 H ER D IN Ex tr ac tio n, P ur ifi ca tio n an d P re lim in ar y T ox ic ity a nd A nt io xi da nt P ot en tia l A ss es sm en t o f th e P hy to ch em ic al s fr om S el ec te d M ed ic in al P la nt s of M in da na o 1. M yl en e M . U y, P hD 2. A ni ta P . R iv er a M in da na o St at e U ni ve rs ity Ili ga n In st itu te o f T ec hn ol og y, C ol le ge o f S ci en ce a nd M at he m at ic s O n go in g P hi lip pi ne C ou nc il fo r H ea lth R es ea rc h an d D ev el op m e nt , D ep ar tm en t o f Sc ie nc e an d T ec hn ol og y P hi lip pi ne H ea lth R es ea rc h R eg is tr y A75 | P a g e In v itr o ac tiv ity o f pi pe ra cc ili n ta zo ba ct am o n pi pe ra ci lli n re si st an t o rg an is m s C o V M , T ol en tin o LE , L az o JM , B ae s LC M M C P ro c 19 95 H ER D IN In v itr o ev al ua tio n of b ro ad sp ec tr um b et a la ct am s in th e P hi lip pi ne s m ed ic al c en te rs : ro le o f fo ur th g en er at io n ce ph al os po rin s Jo hn so n, D .M ., B ie de nb ac h, D .J ., Jo ne s, R .N . T he P hi lip pi ne s A nt im ic ro bi al R es is ta nc e St ud y G ro up D ia gn M ic ro bi ol In fe ct D is . 35 (4 ):2 91 7 19 99 D A P C C In v itr o ev al ua tio n of T in os po ra ru m ph ii B oe rla ge ( M ak ab uh ay ) st em e xt ra ct a s an A nt im ic ro bi al A ge nt a ga in st St ap hy lo co cc us a ur eu s, St ep to co cc us p yo ge ne s an d P se ud om on as a er ug in os a 1. D ia ne V . La gd a, M D 2. J oh an ne s F. D ay rit , M D , F P D S 3. M a. T er es ita G . G ab rie l, M D , FP D S 4. C at he rin a Je ss ic a Su ta nt oy o, M D R es ea rc h In st itu te f or T ro pi ca l M ed ic in e C om pl et ed P hi lip pi ne C ou nc il fo r H ea lth R es ea rc h an d D ev el op m e nt , D ep ar tm en t o f Sc ie nc e an d T ec hn ol og y P hi lip pi ne H ea lth R es ea rc h R eg is tr y A76 | P a g e 5. G ra ce M on ic a P . I ba vi os a, M D In V itr o st ud y of th e P ot en tia l A nt i-m ic ro bi al p ro pe rt ie s of "M ot i-M ot i" Ja sm en P as ia Sa n P ed ro C ol le ge C om pl et ed P hi lip pi ne C ou nc il fo r H ea lth R es ea rc h an d D ev el op m e nt , D ep ar tm en t o f Sc ie nc e an d T ec hn ol og y P hi lip pi ne H ea lth R es ea rc h R eg is tr y A77 | P a g e K ey in fo rm an t i nt er vi ew o n an tim ic ro bi al re si st an ce ( A M R ) in s om e co un tr ie s in th e w es te rn p ac ifi c re gi on Y ur i L ee a nd M am i W ak ab ay as hi 1. H ea lth S er vi ce s D ev el op m en t U ni t, W or ld H ea lth O rg an iz at io n, W es te rn P ac ifi c R eg io na l O ff ic e, U ni te d N at io ns A ve nu e, P .O . B ox 2 93 2, M an ila , 1 00 0, P hi lip pi ne s 2. In st itu te o f H ea lth Se rv ic es R es ea rc h, Y on se i U ni ve rs ity , S eo ul , So ut h K or ea G lo ba liz at io n an d H ea lth 20 13 G oo gl e S ch ol ar A78 | P a g e M ul tid ru g re si st an t M yc ob ac te riu m le pr ae f ro m pa tie nt s w ith le pr os y. M ae da , S ., M at su ok a, M ., N ak at a, N ., K ai , M ., M ae da , Y ., H as hi m ot o, K ., K im ur a, H ., K ob ay as hi , K . K as hi w ab ar a, Y . A nt im ic ro b A ge nt s C he m ot he r. 45 (1 2) :3 63 5 9 20 01 D A P C C M ul tid ru g re si st an t St ap hy lo co cc us a ur eu s fr om w as te p ic ke rs o f Ili ga n C ity Lu ci ly n D . La ho yl ah oy , Le on el l A lb er t L . Q ui to s, E rm ee G ild S . C al um ba M in da na o St at e U ni ve rs ity Il ig an In st itu te o f T ec hn ol og y 2n d In te rZ on al R es C on gr es s fo r V is ay as & M in da na o ca n' t ac ce ss H ER D IN O rig in a nd d is se m in at io n of ch lo ro qu in e re si st an t P la sm od iu m f al ci pa ru m w ith m ut an t p fc rt a lle le s in th e P hi lip pi ne s C he n, N an hu a, K yl e, D en ni s, B el l, D av id , W ils on , D an ny W , C he ng , Q in , M ar tin , L au ra B , P as ay , C ie lo D ep ar tm en t o f D ru g R es is ta nc e an d D ia gn os tic s, A us tr al ia n A rm y M al ar ia In st itu te , Q ue en sl an d, A us tr al ia A nt im ic ro bi al A ge nt s an d C he m ot he ra py 20 05 H ER D IN A79 | P a g e P re fo rm ul at io n an d Fo rm ul at io n S tu di es o f th e A lc oh ol ic E xt ra ct o f P un ic a gr an at um L ., Ex oc ar p as A nt im ic ro bi al O in tm en t A nn a M ur ie l T . Ja ci nt o U ni ve rs ity o f P er pe tu al H el p Sy st em D A LT A La s P iñ as N /A O n go in g P hi lip pi ne C ou nc il fo r H ea lth R es ea rc h an d D ev el op m e nt , D ep ar tm en t o f Sc ie nc e an d T ec hn ol og y P hi lip pi ne H ea lth R es ea rc h R eg is tr y P re va le nc e an d co rr el at es o f an tib io tic s ha rin g in th e P hi lip pi ne s: a nt ib io tic m is co nc ep tio ns a nd co m m un ity le ve l a cc es s to no n m ed ic al s ou rc es o f an tib io tic s B ar be r D A , C as qu ej o E, Y ba ñe z P L, P in ot e M T , C as qu ej o L, P in ot e LS , Es to rg io M , Y ou ng A M 1. D ep ar tm en t o f Ep id em io lo gy , U ni ve rs ity of K en tu ck y, L ex in gt on , K Y , U SA . 2. Is la nd V en tu re s, In c. , La pu L ap u C ity , C eb u, P hi lip pi ne s. T ro pi ca l M ed ic in e & In te rn at io na l H ea lth 20 17 G oo gl e S ch ol ar A80 | P a g e P re va le nc e of M er cu ry R es is ta nt a nd A nt ib io tic R es is ta nt B ac te ria f ou nd in D en ta l A m al ga m Si tt ie R oh an a D . P un do ga r, Ji ng . B au tis ta , F ra nc o G . T ev es D ep ar tm en t o f B io lo gi ca l S ci en ce s, C ol le ge o f S ci en ce a nd M at he m at ic s M in da na o St at e U ni ve rs ity Il ig an In st itu te o f T ec hn ol og y, D ep ar tm en t o f B io lo gi ca l S ci en ce s, C ol le ge o f S ci en ce a nd M at he m at ic s M in da na o St at e U ni ve rs ity Il ig an In st itu te o f T ec hn ol og y, D ep ar tm en t o f B io lo gi ca l S ci en ce s, C ol le ge o f S ci en ce a nd M at he m at ic s M in da na o St at e U ni ve rs ity Il ig an In st itu te o f T ec hn ol og y In te rn at io na l R es ea rc h Jo ur na l o f B io lo gi ca l Sc ie nc es 20 14 H ER D IN A81 | P a g e P re va le nc e of m et hi ci lli n re si st an t S ta ph yl oc oc cu s au re us a nd m et hi ci lli n re si st an t co ag ul as e ne ga tiv e st ap hy lo co cc us in a te rt ia ry ho sp ita l C hu a, J en ni fe r A , A til an o, M ar ia A rle e, C or on el , R em ed io s F, P en a, A dr ia n C Se ct io n of In fe ct io us D is ea se s, D ep ar tm en t o f M ed ic in e, S t. Lu ke 's M ed ic al C en te r, SL M C T he P hi lip pi ne Jo ur na l o f M ic ro bi ol og y an d In fe ct io us D is ea se s 20 01 H ER D IN P ur ch as e of a nt ib io tic s w ith ou t pr es cr ip tio n in M an ila , t he P hi lip pi ne s. In ap pr op ria te ch oi ce s an d do se s La ns an g M A , Lu ca s A qu in o R , T up as i T E, M in a V S, S al az ar L S, Ju ba n N , L im jo co T T , N is pe ro s LE , K un in C M D ep ar tm en t o f M ed ic in e, U ni ve rs ity o f th e P hi lip pi ne s C ol le ge o f M ed ic in e, P hi lip pi ne G en er al H os pi ta l, M an ila Jo ur na l o f C lin ic al Ep id em io lo gy 19 90 G oo gl e S ch ol ar R at io na l u se o f an tim ic ro bi al s Jo se G . V ill al ob os D e La S al le U ni ve rs ity Em ili o A gu in al do C ol le ge T he M ed ic al Jo ur na l o f D LS U E A C M 19 88 H ER D IN R at io na l u se o f an tim ic ro bi al s in p re gn an cy M an al as ta s R J r P O G S 19 92 A nn ua l C on ve nt io n an d 46 th 19 92 H ER D IN A82 | P a g e A nn iv er sa ry C el eb ra tio n Se e an d Se qu en ce '-G en om ic su rv ei lla nc e of a nt im ic ro bi al re si st an t a nd h ig h ris k pa th og en ic c lo ne s w ith in th e P hi lip pi ne s 1. C el ia C . C ar lo s, M D 2. M a. C ha rm ia n M . H uf an o, M D 3. M ar ie tt a L. La gr ad a, R M T 4. A gn et ta h M . O lo ro sa , R M T 5. J un e M . G ay et a 6. K ar is L ee M . D el C as til lo 7. L ai la T . F lo re s 8. D av id A an en se n, P hD 9. S ilv ia A rg im on , P hD R es ea rc h In st itu te f or T ro pi ca l M ed ic in e (R IT M ) N /A O n go in g P hi lip pi ne C ou nc il fo r H ea lth R es ea rc h an d D ev el op m e nt , D ep ar tm en t o f Sc ie nc e an d T ec hn ol og y P hi lip pi ne H ea lth R es ea rc h R eg is tr y A83 | P a g e 10 . J oh n St el lin g, M D A84 | P a g e St ud ie s of re si st an ce to ch lo ro qu in e, q ui ni ne , am od ia qu in e an d m ef lo qu in e am on g th e P hi lip pi ne s tr ai ns o f P la sm od iu m f al ci pa ru m Sm rk ov sk i L I, U yl an gc o C V , R od rig ue z C S, A lc an ta ra A K , B uc k R L T ra ns R oy al S o T ro p M ed H yg ca n' t ac ce ss H ER D IN Sy nt he si s of Im id az ol e ba se d A nt ifu ng al A ge nt s 1. S us an D . A rc o, P h. D 2. E du ar do C . A ta yd e Jr . 3. R ac he lle A nn e G el in e P . U re ta U ni ve rs ity o f th e P hi lip pi ne s D ili m an , In st itu te o f C he m is tr y O n go in g P hi lip pi ne C ou nc il fo r H ea lth R es ea rc h an d D ev el op m e nt , D ep ar tm en t o f Sc ie nc e an d T ec hn ol og y P hi lip pi ne H ea lth R es ea rc h R eg is tr y W ar ni ng o n m is us e of an tib io tic s T he F ili pi no Fa m ily P hy si ci an 19 88 H ER D IN A85 | P a g e A nn ex G . R es ea rc h G ap s T hi s is a n ov er vi ew o f re se ar ch g ap s in th e P hi lip pi ne s ba se d on c ur re nt p ub lis he d re se ar ch a va ila bl e. R es ea rc h A re a H um an H ea lt h A ni m al H ea lt h M ic ro bi ol og y st ud ie s S tu di es a va ila bl e, n ee ds to b e co nt in ue d O ng oi ng s tu dy , n ee ds to b e co nt in ue d G en et ic , m ol ec ul ar , p hy si ol og ic s tu di es Li m ite d O ng oi ng s tu dy , n ee ds to b e co nt in ue d C om m un ity / fa rm k no w le dg e, p er ce pt io ns an d pr ac tic es / be ha vi ou r N on e O ng oi ng s tu dy , n ee ds to b e co nt in ue d D is tr ib ut io n of a nt im ic ro bi al s, p re sc rip tio n pr ac tic es , m ar ke tin g N on e O ng oi ng s tu dy , n ee ds to b e co nt in ue d S up pl y ch ai n an d pr oc ur em en t s tu di es V er y lim ite d Li m ite d st ud y, n ee ds to b e co nt in ue d P ric in g, d ru g av ai la bi lit y su rv ey s lim ite d N on e S tu di es o n us e of a nt im ic ro bi al s Li m ite d P P S s ur ve ys O ng oi ng s tu dy , n ee ds to b e co nt in ue d A86 | P a g e Ec on om ic s tu di es , c os ts o f A M R re si st an ce , e co no m ic p ro je ct io ns O ng oi ng s tu dy o n co st o f A M R re si st an ce in h os pi ta ls ; n ee d to h av e m or e N on e S tu di es f ro m e nv iro nm en ta l s am pl es / is ol at es N on e O ng oi ng s tu dy , n ee ds to b e co nt in ue d R & D a nd in no va tio n on a nt im ic ro bi al s M os tly b io eq ui va le nc e Li m ite d A lte rn at iv es to a nt im ic ro bi al s N on e Li m ite d; P ro bi ot ic s, tr ad iti on al m ed ic in e (m ed ic in al p la nt s an d ac up un ct ur e) D ia gn os tic / de te ct io n te ch no lo gi es N on e Li m ite d A87 | P a g e A nn ex H . P ro vi si on al R es ea rc h A ge nd a: T op ic s, A re as a nd Q ue st io ns T hi s is a ra pi d lis tin g of A M R R el at ed R es ea rc h N ee ds b as ed o n co ns ul ta tio ns h el d fr om J ul y to O ct ob er 2 01 8 du rin g th e A M R 2 01 5 20 17 Im pl em en ta tio n R ev ie w a nd p la nn in g fo r t he 2 01 9 20 23 P hi lip pi ne N at io na l A ct io n P la n. T hi s lis t ca n gu id e pl an ne rs , a dv oc at es a nd re se ar ch er s on w ha t t op ic s ar e im po rt an t f or re se ar ch a nd u se fu l f or p ol ic y an d pr og ra m d ev el op m en t. T he se a re ra w id ea s an d re fe re nc es f or A M R re se ar ch a ge nd a. A ni m al H ea lt h R es ea rc h A re a P os si bl e T op ic s R es ea rc h qu es ti on s ra is ed M ic ro bi ol og y st ud ie s G en et ic , m ol ec ul ar , p hy si ol og ic s tu di es T em po ra l a nd s pa tia l a na ly si s of b ac te ria l in di ca to rs a nd it s A M R p ro fil e in ag ric ul tu re /a qu ac ul tu re A M R d et er m in an ts a nd v iru le nc e fa ct or s m in in g in b ac te ria l i nd ic at or s in ag ric ul tu re /a qu ac ul tu re a nd f is he rie s th ro ug h us e of w ho le g en om e se qu en ci ng U se o f ge no m ic te ch no lo gi es a nd d at ab as es to tr ac k A nt im ic ro bi al re si st an ce in th e W ha t a re th e re si st an ce ra te s of p at ho ge ns o f im po rt an ce in h ea lth y an im al s an d di se as ed an im al s? W ha t i s th e m on th ly /q ua rt er ly tr en d of ba ct er ia l i nd ic at or a nd it s A M R p ro fi le th ro ug ho ut th e pr od uc tio n cy cl e? In d iff er en t pr od uc tio n se tt in g? F ar m to s la ug ht er ho us e to m ar ke t? In a y ea r? A88 | P a g e P hi lip pi ne s (a nd g lo ba lly ) C ha ra ct er iz in g A M R in liv es to ck /p ou ltr y/ aq ua cu ltu re p at ho ge ns to w ar ds im pr ov ed A nt im ic ro bi al S te w ar ds hi p in a gr ic ul tu re /a qu ac ul tu re p ro du ct io n in th e co un tr y M et ag en om ic b as ed a pp ro ac h (u se o f 16 s rR N A ) fo r s ur ve y of A nt im ic ro bi al re si st an ce in liv es to ck /a qu ac ul tu re a nd it s en vi ro nm en t In flu en ce o f ba ct er ia l p op ul at io n in th e de ve lo pm en t a nd d is se m in at io n of A M R ( us e of s ho gu n m et ag en om ic s) W hi ch b ac te ria l s pe ci es is in flu en ci ng th e de ve lo pm en t a nd d is se m in at io n of A M R ? A si de f ro m b et a la ct am as e ge ne s, w ha t o th er eq ua lly im po rt an t A M R d et er m in an ts (p la sm id s, c ol is tin re si st an ce e tc ., m et al re si st an ce , S P Is , e tc .) a re p re se nt in b ac te ria l in di ca to rs in th e P hi lip pi ne s? A t w ha t r at e? W hi ch s am pl e? It s co rr el at io n an d pr es en ce in bo th h um an , a ni m al , a nd th ei r e nv iro nm en t? Fo od s af et y Su rv ei lla nc e of b ac te ria l i nd ic at or s (c om po ne nt 1 ), A M R p ro fi le , a nd v iru le nc e fa ct or s to w ar ds f oo d sa fe ty T ra ck in g of b ac te ria l i nd ic at or s an d its A M R pr of ile /c ha ra ct er is tic s th ro ug ho ut pr od uc tio n/ fo od c ha in (f ar m to m ar ke t t o ta bl e) Es ta bl is hm en t o f ba se lin e da ta o n A M U a nd A M re si du e in a gr ic ul tu re f ar m s an d fo od pr od uc ts in th e m ar ke t W ha t b ac te ria l s pe ci es is c om m on ly is ol at ed in th e fo od c ha in ? W ha t a re th ei r A M R p ro fil es an d vi ru le nc e fa ct or s? A t w ha t s ta ge /s te p of th e pr od uc tio n ch ai n ha s th e hi gh es t r at e of b ac te ria l i nd ic at or s? H as th e A M R p ro fil es c ha ng ed th ro ug ho ut th e pr od uc tio n? H ow a re w e go in g to s tr en gt he n th e fo od sa fe ty p ro gr am in th e P hi lip pi ne s? A re th e st ak eh ol de rs (p ro du ce rs a nd A89 | P a g e R ev ie w o f le gi sl at io ns /r eg ul at io ns re la te d to Fo od s af et y in th e P hi lip pi ne s: s tr en gt h an d po ss ib le lo op ho le s K A P o n Fo od s af et y am on g pr od uc er s an d co ns um er s C om pa ris on o f A M U a nd A M R p ro fi le s of ba ct er ia is ol at ed f ro m d iff er en t p ro du ct io n sy st em s/ m an ag em en t C om pa ris on o f A M U a nd v et er in ar y dr ug re si du es in f oo d pr od uc ts f ro m d iff er en t pr od uc tio n sy st em s/ m an ag em en t co ns um er s) a w ar e of “ Fo od s af et y” ? O r t he rig ht q ue st io n w ou ld b e, d o w e ca re a bo ut fo od s af et y? T o pu sh th e ag en da o n fo od s af et y an d A M R , w e ne ed e vi de nc ed /d at a to c om e up w ith ev id en ce b as ed g ui de lin es C om m un ity / fa rm k no w le dg e, p er ce pt io ns a nd pr ac tic es / be ha vi ou r B as el in e st ud ie s on u se o f an tim ic ro bi al s an d fe ed s in a ni m al f oo d pr od uc tio n A ss oc ia tio n be tw ee n A nt im ic ro bi al u se a nd A nt im ic ro bi al re si st an ce in ag ric ul tu re /a qu ac ul tu re p ro du ct io n A nt im ic ro bi al re si st an ce p at hw ay s in a ni m al s; re vi ew p ra ct ic es a nd d ev el op m en t o f in te rv en tio ns to re du ce A M R in th e co un tr y K A P o n A M U /A M R in a gr ic ul tu re /a qu ac ul tu re pr od uc tio n (w he th er b ac ky ar d/ se m i co m m er ci al /l ar ge /l ar ge s ca le f ar m s) W ha t i s th e ex te nt o f re gu la tio n of m ed ic at ed fe ed s at th e lo ca l l ev el ? H ow m uc h do f ar m s us e m ed ic at ed f ee ds ? W ha t a re th e kn ow le dg e, a tt itu de s, a nd pr ac tic es o f fa rm er s, v et er in ar ia ns , a nd co ns um er g ro up s in th e P hi lip pi ne s re ga rd in g an tim ic ro bi al re si st an ce in a ni m al h ea lth ? W ha t a re th e K A P re ga rd in g an tim ic ro bi al re si st an ce in a ni m al h ea lth o f fa rm er s in ba ck ya rd f ar m s? A90 | P a g e A ss es sm en t o f co m pe te nc y an d lit er ac y le ve ls of v et er in ar ia ns re ga rd in g A M R in a ni m al he al th b ef or e an d af te r e xp os ur e to th e iA M R es po ns ib le c am pa ig n/ G A H P / G A qP ro ad sh ow s W ha t a re th e co m pe te nc y an d lit er ac y le ve ls of v et er in ar ia ns re ga rd in g A M R in a ni m al he al th b ef or e an d af te r e xp os ur e to th e iA M R es po ns ib le c am pa ig n/ G A H P / G A qP ro ad sh ow s? D is tr ib ut io n of a nt im ic ro bi al s, p re sc rip tio n pr ac tic es , m ar ke tin g K A P o n A M U /A M R f or v et d ru g m an uf ac tu re rs , se lle rs , e tc . ( in cl ud in g P ha rm ac ie s) R ev ie w o f re gu la to ry f ra m ew or k fo r h um an an im al a nt im ic ro bi al s W ha t a re th e bo tt le ne ck s to re gi st ra tio n of ph ar m ac eu tic al p ro du ct s an d ac tiv e ph ar m ac eu tic al in gr ed ie nt s in a ni m al h ea lth ? Su pp ly c ha in a nd p ro cu re m en t s tu di es K A P o n A M U /A M R f or v et d ru g m an uf ac tu re rs , se lle rs , e tc . ( in cl ud in g P ha rm ac ie s) R ev ie w o f re gu la to ry f ra m ew or k fo r h um an an im al a nt im ic ro bi al s W he re a re a nt ib io tic s ac tu al ly u se d in th e an im al / ag ric ul tu re s up pl y ch ai n fo r f ee ds a nd m ed ic in es ? P ric in g, d ru g av ai la bi lit y su rv ey s K A P o n A M U /A M R f or v et d ru g m an uf ac tu re rs , se lle rs , e tc . R ev ie w o f re gu la to ry f ra m ew or k fo r h um an an im al a nt im ic ro bi al s P ha rm ac ie s St ud ie s on u se o f an tim ic ro bi al s N at io na l A nt ib io tic G ui de lin es f or A ni m al H ea lth W ha t a re th e m os t c om m on ly u se d an tim ic ro bi al s in th e ag ric ul tu re a nd aq ua cu ltu re in du st rie s? A91 | P a g e D ev el op m en t o f gu id el in es f or th e re gu la tio n of a nt im ic ro bi al s in d rin ki ng w at er T o tr ac k po lic y en fo rc em en t o n ra tio na l u se o f an tim ic ro bi al s in m ar ke ts , f ar m s an d co m m un iti es Ec on om ic s tu di es , c os ts o f A M R re si st an ce , ec on om ic p ro je ct io ns A ss es sm en t o f A nt im ic ro bi al u se (v ol um e, av ai la bi lit y, e tc .) d ur in g di se as e ou tb re ak s T em po ra l a na ly si s in th e an tim ic ro bi al u se an d at tit ud e of f ar m er s H ow f ar m er s re ac t d ur in g di se as e ou tb re ak s? H ow if th e A M U tr en d af fe ct ed b y di se as e ou tb re ak s? O r d ur in g no rm al s itu at io ns (n o di se as e ou tb re ak s) ? St ud ie s fr om e nv iro nm en ta l s am pl es / is ol at es C or re la tio n an d pr es en ce o f A M R de te rm in an ts in b ac te ria l i so la te d fr om hu m an , a ni m al , a nd th ei r e nv iro nm en t? En vi ro nm en ta l d is se m in at io n of p at ho ge ni c ba ct er ia (E . c ol i, Sa lm on el la , C am py lo ba ct er ) an d th ei r A M R p ro fil es a ft er m an ur e ap pl ic at io n fr om f ar m s (s w in e, p ou ltr y, ru m in an ts ) A ss es si ng th e im pa ct o f m an ur e ap pl ic at io n in ag ric ul tu ra l l an ds o n th e tr an sm is si on o f A M R in th e en vi ro nm en t A M R p ro fil e an d vi ru le nc e fa ct or s of b ac te ria H ow b ad is e nv iro nm en ta l c on ta m in at io n? W he re ? W ha t i s th e m ec ha ni sm o f tr an sf er fr om h um an s to a ni m al s to e nv iro nm en t? H ow a re th e pr ac tic es in a gr ic ul tu re a ff ec ts th e de ve lo pm en t a nd d is se m in at io n of A M R ? Ex am pl e, m an ur e ap pl ic at io n in f ar m s? W ha t a re th e bi g ro le s of G A H P , G aq P , a nd D EN R in th e re du ct io n of A M R d ev el op m en t an d di ss em in at io n in th e ag ric ul tu re s ys te m ? A92 | P a g e (X ) is ol at ed f ro m d iff er en t e nv iro nm en ts ex po se d to d iff er en t a nt hr op og en ic a ct iv iti es R ol e of s tr ay /w ild a ni m al s in th e di ss em in at io n of b ac te ria l i nd ic at or s an d A M R de te rm in an ts in d iff er en t e nv iro nm en t s et tin gs R ev ie w a nd c om pl ia nc e of e nv iro nm en ta l re la te d re gu la tio ns , p ro gr am s, a nd p ra ct ic es in th e fa rm : t ow ar ds A M R re du ct io n an d co nt ro l R & D a nd in no va tio n on a nt im ic ro bi al s D ia gn os tic / de te ct io n te ch no lo gi es D ev el op m en t a nd a pp lic at io n of s m ar t, lo w co st p at ho ge n de te ct io n pl at fo rm s (w he th er D N A o r s er ol og ic al b as ed a ss ay s) C ap ab ili ty a ss es sm en t o f D A N at io na l R ef er en ce L ab or at or ie s (B A I, N M IS , B FA R , N D A , P C C ), R eg io na l A ni m al D is ea se D ia gn os tic L ab or at or ie s, a nd p ar tn er in st itu tio n in th e co nd uc t o f A M R re la te d pr og ra m s/ su rv ei lla nc e/ re se ar ch B ef or e w e fu rt he r m ov e to c on du ct o f an t R & D an d in no va tio n ac tiv iti es /s tu di es , h av e w e as se ss ed th e ca pa bi lit y of o ur la bs ? N ot o nl y th ei r i nf ra o r p re se nc e of e qu ip m en t ne ce ss ar y to c on du ct R & D , b ut e sp ec ia lly th ei r te ch ni ca l k no w le dg e on A M R (a nd re la te d to pi cs ). A lte rn at iv es to a nt im ic ro bi al s P ro bi ot ic s as a lte rn at iv e to A M in a gr ic ul tu re liv es to ck p ro du ct io n W ha t a re a lte rn at iv es to a nt im ic ro bi al s as gr ow th p ro m ot er s? A93 | P a g e H um an H ea lt h R es ea rc h A re a T op ic s R es ea rc h qu es ti on s La bo ra to ry s tu di es M ic ro bi ol og y st ud ie s G en et ic , m ol ec ul ar , p hy si ol og ic s tu di es Fe as ib ili ty s tu dy a nd c os tin g fo r s tr en gt he ni ng of re fe re nc e la bo ra to rie s in L uz on , V is ay as an d M in da na o A M R in ve st m en t p la n fo r t he h ea lth s ec to r (in cl ud in g su rv ei lla nc e, H R , l ab or at or ie s, en vi ro nm en ta l m on ito rin g, M & E sy st em ) Sk ill m ix a ss es sm en t f or la bo ra to ry a nd su rv ei lla nc e fo r A M R G en om ic s tu di es f or s ur ve ill an ce A pp lic at io ns o f w ho le g en om e se qu en ci ng st ud ie s in c lin ic al m an ag em en t o f A M R M on ito rin g an d su rv ei lla nc e of A M R R ev ie w o f m on ito rin g an d su rv ei lla nc e sy st em s in o rd er to k no w w ha t i nf or m at io n is av ai la bl e an d ho w to in te gr at e or c om bi ne di ff er en t t yp es o f in fo rm at io n fo r m on ito rin g of p ro ce ss es , o ut pu ts a nd o ut co m es R ev ie w o f M & E an d su rv ei lla nc e sy st em s in ot he r c ou nt rie s an d ho w th es e ca n be a pp lie d to th e P hi lip pi ne s P ro to co l f or re sp on se to A M R o ut br ea ks in A94 | P a g e ho sp ita ls C om m un ity / fa rm k no w le dg e, p er ce pt io ns a nd pr ac tic es / be ha vi ou r W ha t a re th e ga ps in u nd er st an di ng o f Fi lip in os o n th e us e an tim ic ro bi al s? D is tr ib ut io n of a nt im ic ro bi al s, p re sc rip tio n pr ac tic es , m ar ke tin g C on du ct re pr es en ta tiv e dr ug a va ila bi lit y su rv ey s Su pp ly c ha in a nd p ro cu re m en t s tu di es C on du ct re pr es en ta tiv e su pp ly c ha in s tu di es (f ro m f or ec as tin g to d is tr ib ut io n) W ha t a re th e in st itu tio na l p ro ce ss es th at s er ve as b ot tle ne ck s to re gi st ra tio n of ph ar m ac eu tic al p ro du ct s? P ric in g, d ru g av ai la bi lit y su rv ey s C on du ct re pr es en ta tiv e su rv ey o f pr ic in g of es se nt ia l a nt im ic ro bi al s St ud ie s on u se o f an tim ic ro bi al s U pd at e th e N at io na l A nt ib io tic G ui de lin es D ev el op m en t o f IP C in p ub lic h ea lth a nd pr im ar y ca re p ro gr am s, f ra m ew or k an d tr ai ni ng m an ua l C om pl ia nc e of h ea lth f ac ili tie s on H A I re du ct io n an d IP C in te rv en tio ns W ha t a re th e ef fe ct s of th e im pl em en ta tio n of “n o pr es cr ip tio n no d is pe ns in g” p ol ic y on ac ce ss to a nt im ic ro bi al s? W ha t a re th e ef fe ct s of th e im pl em en ta tio n of “n o pr es cr ip tio n no d is pe ns in g” p ol ic y on th e he al th s ee ki ng b eh av io r o f Fi lip in os ? H ow d o Fi lip in os c irc um ve nt th e “n o pr es cr ip tio n no d is pe ns in g” p ol ic y? W ha t i s re la tio ns hi p be tw ee n an tim ic ro bi al us e an d de m og ra ph ic c ha ra ct er is tic s? A95 | P a g e Im pl em en ta tio n st ud ie s an d re vi ew s A M S an d IP C b es t p ra ct ic es a nd im pl em en ta tio n re vi ew D ev el op s ys te m to m on ito r ho sp ita l a cq ui re d in fe ct io n an d ef fe ct iv en es s of in te rv en tio ns , th ei r l in k w ith A M R W ha t a re th e ou tc om es a nd im pa ct s? A re th es e co st e ff ec tiv e? Ec on om ic s tu di es , c os ts o f A M R re si st an ce , ec on om ic p ro je ct io ns P hi lH ea lth b en ef it pa ck ag es f or A M R a nd H A I Ex pa ns io n of e co no m ic s tu di es C os t ef fe ct iv en es s an al ys is o f su rv ei lla nc e, IP C a nd A M R in te rv en tio ns e sp ec ia lly in h ea lth ca re C os t ef fe ct iv en es s st ud ie s of in no va tiv e pr og ra m s in A M R a nd A M S (I s it w or th th e in ve st m en t? ) St ud ie s fr om e nv iro nm en ta l s am pl es / is ol at es A ss es sm en t o f En vi ro nm en t l ab s R & D a nd in no va tio n on a nt im ic ro bi al s W ha t i nc en tiv es f ro m th e go ve rn m en t a re ne ed ed to e nt ic e th e pr iv at e se ct or to in cr ea se in ve st m en ts in a nt im ic ro bi al re se ar ch a nd de ve lo pm en t ( R & D )? W ha t a re th e in st itu tio na l p ro ce ss es th at s er ve as b ot tle ne ck s to re gi st ra tio n of ph ar m ac eu tic al p ro du ct s? A96 | P a g e A lte rn at iv es to a nt im ic ro bi al s P ot en tia l o f he rb al m ed ic in es a s al te rn at iv e to an tim ic ro bi al s D ia gn os tic / de te ct io n te ch no lo gi es In no va tiv e an d ne w te ch no lo gi es En vi ro nm en t a nd O th er S tu di es 1. A ss es sm en t o f en vi ro nm en t l ab or at or ie s to d et ec t A M R 2. A M R d et ec tio n in w at er , w as te a nd e nv iro nm en t A nn ex I. M ap pi ng o f R eg ul at io n an d C on tr ol s fo r t he A nt im ic ro bi al M ar ke t i n A ni m al s an d H um an s T hi s A nn ex is p re pa re d to p ro vi de a n ov er al l p er sp ec tiv e of e xi st in g po lic ie s an d po te nt ia l p ol ic y ga ps o n A M R a nd re la te d ar ea s. G EN ER A L A R EA S A re a A ge nc ie s in C ha rg e P ol ic ie s Fo od S af et y La w s D O H , F D A a nd D A R A 9 71 1 or F D A A ct o f 20 09 R A 1 06 11 o r F oo d Sa fe ty A ct o f 20 13 “ A n A ct to St re ng th en th e Fo od S af et y R eg ul at or y Sy st em in th e A97 | P a g e C ou nt ry to P ro te ct C on su m er H ea lth a nd F ac ili ta te M ar ke t A cc es s of L oc al F oo ds a nd F oo d P ro du ct s, a nd f or o th er P ur po se s. A ni m al H ea lth L aw s D A Fa rm in g an d A ni m al P ro du ct io n Le gi sl at io n D A P es tic id e Le gi sl at io n an d S oi l Q ua lit y D EN R W as te M an ag em en t a nd D is po sa l L aw D O H , D EN R , D A P D 8 56 o r t he C od e on S an ita tio n of th e P hi lip pi ne s (C ha pt er X V III , s ec tio n 81 8 3) W at er L aw D EN R A qu ac ul tu re L aw D A A N IM A LS En tr y an d M an uf ac tu rin g of A nt im ic ro bi al s A ge nc ie s in C ha rg e of R eg ul at in g M ed ic in es / A nt im ic ro bi al s P ol ic ie s A ge nc ie s in C ha rg e of R eg ul at in g Fe ed s P ol ic ie s Li ce ns in g of Im po rt er Li ce ns e to O pe ra te (L T O ) or au th or iz at io n of d ru g pr od uc t fr om F D A n ec es sa ry D O H A O 2 01 4 00 34 B FA D (F D A ) B ur ea u FD A D A ? A98 | P a g e C irc ul ar 0 7 s. 2 00 4 B us in es s pe rm it LG U D T I LG U D T I P re R eg is tr at io n of Im po rt at io n FD A Im po rt at io n of A ct iv e P ha rm ac eu tic al In gr ed ie nt s/ Im po rt at io n of P re m ad e an tib io tic s C us to m s D T I C us to m s D T I M an uf ac tu rin g LT O o r a ut ho riz at io n of d ru g pr od uc t f ro m F D A n ec es sa ry D O H A O 2 01 4 00 34 D T I FD A D A ? R eg is tr at io n of p ro du ct ? D A ? FD A ? D A ? FD A ? D is tr ib ut io n an d M ar ke tin g of A nt im ic ro bi al s A ge nc ie s in C ha rg e of R eg ul at in g M ed ic in es / A nt im ic ro bi al s P ol ic ie s A ge nc ie s in C ha rg e of R eg ul at in g Fe ed s P ol ic ie s A99 | P a g e B us in es s pe rm it fo r di st rib ut io n D T I FD A D O H A O 2 01 4 00 34 D T I FD A P os t M ar ke tin g of A nt im ic ro bi al s A ge nc ie s in C ha rg e of R eg ul at in g M ed ic in es / A nt im ic ro bi al s P ol ic ie s A ge nc ie s in C ha rg e of R eg ul at in g Fe ed s P ol ic ie s B us in es s pe rm it fo r r et ai l st or es (a gr iv et s to re s) LG U LG U P re sc rip tio n P R C P R C U til iz at io n D A , P V M A FD A s ho ul d be in vo lv ed he re ? D A , P V M A H U M A N S En tr y an d M an uf ac tu rin g of A nt im ic ro bi al s A ge nc ie s in C ha rg e of R eg ul at in g M ed ic in es / A nt im ic ro bi al s P ol ic ie s A100 | P a g e Li ce ns in g of Im po rt er LT O o r a ut ho riz at io n of d ru g pr od uc t f ro m F D A n ec es sa ry D O H A O 2 01 4 00 34 o r “ R ul es a nd R eg ul at io ns o n th e Li ce ns in g of Es ta bl is hm en ts E ng ag ed in th e M an uf ac tu re , C on du ct o f C lin ic al T ria l, D is tr ib ut io n, Im po rt at io n, E xp or ta tio n, a nd R et ai lin g of D ru g P ro du ct s, an d Is su an ce o f O th er R el at ed A ut ho riz at io ns ” B us in es s pe rm it LG U D T I FD A (L T O ) D O H A O 2 01 4 00 34 o r “ R ul es a nd R eg ul at io ns o n th e Li ce ns in g of Es ta bl is hm en ts E ng ag ed in th e M an uf ac tu re , C on du ct o f C lin ic al T ria l, D is tr ib ut io n, Im po rt at io n, E xp or ta tio n, a nd R et ai lin g of D ru g P ro du ct s, an d Is su an ce o f O th er R el at ed A ut ho riz at io ns ” P re R eg is tr at io n of Im po rt at io n FD A D O H A O 2 01 4 00 34 o r “ R ul es a nd R eg ul at io ns o n th e Li ce ns in g of Es ta bl is hm en ts E ng ag ed in th e M an uf ac tu re , C on du ct o f C lin ic al T ria l, D is tr ib ut io n, Im po rt at io n, E xp or ta tio n, a nd R et ai lin g of D ru g P ro du ct s, an d Is su an ce o f O th er R el at ed A ut ho riz at io ns ” Im po rt at io n of A ct iv e P ha rm ac eu tic al In gr ed ie nt s/ Im po rt at io n of P re m ad e an tib io tic s FD A (C us to m s & D T I) D O H A O 2 01 4 00 34 o r “ R ul es a nd R eg ul at io ns o n th e Li ce ns in g of Es ta bl is hm en ts E ng ag ed in th e M an uf ac tu re , C on du ct o f C lin ic al T ria l, D is tr ib ut io n, Im po rt at io n, E xp or ta tio n, a nd R et ai lin g of D ru g P ro du ct s, an d Is su an ce o f O th er R el at ed A ut ho riz at io ns ” M an uf ac tu rin g D T I FD A D O H A O 2 01 4 00 34 o r “ R ul es a nd R eg ul at io ns o n th e Li ce ns in g of Es ta bl is hm en ts E ng ag ed in th e M an uf ac tu re , C on du ct o f C lin ic al T ria l, D is tr ib ut io n, Im po rt at io n, E xp or ta tio n, a nd R et ai lin g of D ru g P ro du ct s, an d Is su an ce o f O th er R el at ed A ut ho riz at io ns ” R eg is tr at io n of P ro du ct FD A D O H A O 2 01 4 00 34 o r “ R ul es a nd R eg ul at io ns o n th e Li ce ns in g of Es ta bl is hm en ts E ng ag ed in th e M an uf ac tu re , C on du ct o f C lin ic al T ria l, D is tr ib ut io n, Im po rt at io n, E xp or ta tio n, a nd R et ai lin g of D ru g P ro du ct s, an d Is su an ce o f O th er R el at ed A ut ho riz at io ns ” A101 | P a g e In cl us io n in P N D F (f or go ve rn m en t p ro cu re m en t a nd P hi lH ea lth p ur ch as in g) D O H H ea lth R eg ul at io ns T ea m /P D (N C P A M )1 8 D O H A O 2 01 2 00 23 o r t he “ R ev is ed Im pl em en tin g G ui de lin es f or th e P hi lip pi ne N at io na l F or m ul ar y Sy st em (P N FS )” R ef er en ce p ric in g (f or go ve rn m en t p ro cu re m en t a nd P hi lH ea lth p ur ch as in g) D O H D is tr ib ut io n an d M ar ke tin g of A nt im ic ro bi al s A ge nc ie s in C ha rg e of R eg ul at in g M ed ic in es / A nt im ic ro bi al s P ol ic ie s B us in es s pe rm it fo r di st rib ut io n D T I FD A D O H A O 2 01 4 00 34 o r “ R ul es a nd R eg ul at io ns o n th e Li ce ns in g of Es ta bl is hm en ts E ng ag ed in th e M an uf ac tu re , C on du ct o f C lin ic al T ria l, D is tr ib ut io n, Im po rt at io n, E xp or ta tio n, a nd R et ai lin g of D ru g P ro du ct s, an d Is su an ce o f O th er R el at ed A ut ho riz at io ns ” P os t M ar ke tin g of A nt im ic ro bi al s A ge nc ie s in C ha rg e of R eg ul at in g M ed ic in es / A nt im ic ro bi al s P ol ic ie s B us in es s pe rm it fo r r et ai l LG U D O H A O 2 01 4 00 34 o r “ R ul es a nd R eg ul at io ns o n th e Li ce ns in g of 18 T he F or m ul ar y E xe cu tiv e C ou nc il (F E C ) re co m m en ds li st o f d ru gs to b e in cl ud ed in P N D F to U se c/ A se c in c ha rg e of N C P A M (P D ). A102 | P a g e st or es (h os pi ta l p ha rm ac y an d re ta il st or es ) FD A D O H Es ta bl is hm en ts E ng ag ed in th e M an uf ac tu re , C on du ct o f C lin ic al T ria l, D is tr ib ut io n, Im po rt at io n, E xp or ta tio n, a nd R et ai lin g of D ru g P ro du ct s, an d Is su an ce o f O th er R el at ed A ut ho riz at io ns ” P re sc rip tio n 19 P R C ( ?) P ro fe ss io na l o rg an iz at io ns H os pi ta ls th ro ug h cl in ic al ph ar m ac ol og is ts U til iz at io n D O H P D FD A 20 R A 1 09 18 o r P ha rm ac y A ct (A rt ic le IV , s ec tio n 30 ) 19 P ro fe ss io na l p ra ct ic e of p hy si ci an s ar e be yo nd th e ju ris di ct io n of F D A w hi le P R C d oe s no t a nd m ay n ot h av e th e ca pa ci ty to m on ito r ho w ph ys ic ia ns p re sc rib e. In te re st in gl y, th e A nt im ic ro bi al S te w ar ds hi p (A M S ) P ro gr am in H os pi ta ls is d es ig ne d in s uc h a w ay th at h os pi ta ls c an “s el f re gu la te ” in p at ie nt u se o f r es tr ic te d an tim ic ro bi al s. 20 F D A im pl em en ts th e "n o pr es cr ip tio n no d is pe ns in g po lic y" o f p re sc rip tio n dr ug s an d ph ar m ac is t on ly O T C m ed ic in es th ro ug h its fi el d m on ito rin g of fic e.