National Action Plan on Antimicrobial Resistance (AMR- NAP) 2023–2028

1.1. Background ............................................................................................................................ 10

1.2. Situational analysis .......................................................................................................... 13

1.2.1. Overview ........................................................................................................................ 13

1.2.2. Country Profile............................................................................................................... 13

1.2.3. AMR Situation in South Sudan: Strengths, Weaknesses, Opportunities and Threats (SWOT) Analysis ....................................................................................................................... 15

1.2.4. South Sudan AMR Stakeholders mapping and analysis ................................................ 19 2. STRATEGIC FRAMEWORKS FOR THE SOUTH SUDAN NATIONAL ACTION PLAN ......... 23

2.1. Vision ...................................................................................................................................... 23

2.2. Mission .............................................................................................................................. 23

2.3. Goal and AMR NAP Strategic Objectives ............................................................................ 23 2.3.1. . Goal ..................................................................................................................................... 23

2.3.2. AMR NAP Strategic Objectives ........................................................................................... 23

2.4. Guiding principles .................................................................................................................. 24 3. GOVERNANCE AND COORDINATION ................................................................................... 25 4. STRATEGIC PLAN ....................................................................................................................26 Strategic Objective 1: Improve awareness and understanding of antimicrobial resistance through effective communication, education, and training ................................................... 26 Strategic Objective 2: Strengthen the knowledge and evidence-based interventions through surveillance and research ............................................................................................................ 28 Strategic Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures............................................................................ 31 Strategic Objective 4: Optimize the use of antimicrobial medicines in humans, animals and the environment. ...................................................................................................................... 33 Strategic Objective 5: Develop the economic case for sustainable investment that takes account of the needs of allcountries and to increase investment in new medicines, diagnostic tools, vaccines and other interventions ................................................................. 35 - " 5. OPERATIONAL PLAN ................................................................................................................... 36 .. 6. COSTED OPERATIONAL PLAN .............................................................................................. 66 7. MONITORING AND EVALUATION PLAN ............................................................................... 68

7.1. Logic Model ...................................................................................................................... 69

7.2. Key performance indicators .................................................................................................. 70 8. REFERENCES...............................................................................................................................................74 9. ANNEX ............................................................................................................................................ 75 Annex I: Participants from Stakeholders Meeting, AMR NAP Development Workshops ...... 75

Annex II: Elaborated Summary of Cost of Activities and Lead Agency/ Implementer (2023 - 2028) ............................................................................................................................................. 76 S L 11 C..c1 ' t ;::[ ICA [ - 1. INTR ODUCTION 1.1. Background Antimicrobial Resistance (AMR) is one of the top 10 global health threats. It is a phenomenon that occurs naturally when microbes. i.e., bacteria, fungi, parasites, and viruses, that cause infection, evolve to become resistant to medicines that are meant to kill them. As antimicrobials become Less effective, infections. even the most common e.g., pneumonia, are becoming harder or impossible to treat; this has major implications including, increa sed treatment costs, prolonged hospital stays, and complications in the management of diseases. While a natural phenomenon, human practices such as the misuse and indiscriminate use of antimicrobials across the human and animal health. crop production and contamination of the environment, has further exacerbated the emergence and spread of AMR [1] . Globally, recent evidence shows that bacterial AMR was alarmingly responsible for 1.27 million deaths and was associated with 4.95 million deaths in 2019 [2]. This surpasses the number of people who died from HIV/AIDS a nd malaria globally that year . Moreover, the cumulative cost of AMR is projected to be $120 trillion by 2050, if no action is taken [3]. Despite this, the challenge of indiscriminate use of antimicrobials co-exists with insufficient access to quality and effective antimicrobials, especially in Low- and middle-income countries. AMR threatens the attainment of some of the key global health and development milestones including Universal Health Coverage (UHC). Sustainable Development Goals (SDGs). The 68th World Health A ssembly, adopted the Global Action Plan on AMR as a blueprint for guiding AMR response in a One Health approach. Under the coordination of the Quadripartite agencies i.e.. the World Health Organization (WHO) , Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (WOAH, formerly OIE) and the United Nations Environment Program (UNEP) [4]. The interlinkages between human. animal and environmental health create the pathways for resistant pathogens and genes to spread across these interfaces. Hence, a whole of society, integrated "One Health" approach is reinforced to a ddress A MR. (.) '5> Q) ..... c..a.. Ci5 To strengthen the knowledge and evidence base through surveillance and research; 0::: 2 <( "' r:: 0·...... To reduce the incidence of infection through effective sanitation, hygiene and infection r:: (.) prevention measures; ca Cl> o.. E r:: 0 0 ...... To optimize the use of antimicrobial medicines in human and animal health; and ca .0 0 (.!) Fig 1. G loba l Acti on Pla n Strateg ic Objectives. Ad a pted from (WH O, 2015) Limited data exists on the burden of AMR in South Sudan. Available evidence cites the multi-drug resistant and rifampicin - resistant TB (MOR/RR TB) cases [5]. Other studies have also found high Levels of inappropriate antibiotics use in hospitals despite the existence of Local guidelines, absence of prescription Laws, weak regulatory enforcements, and weak capacities for Infection Prevention and Control (IPC) and Water Hygiene and Sanitation (WASH) [6]. The Republic of South Sudan is a signatory to the International Health Regulation (IHR) 2005 . In 2017, a Jo int External Evaluation (JEE) of the implementation of the International Health Regulation (2005) for public health events of international concern, including AMR , highlighted "no capacity" for the country to address AMR [7]. The South Sudan then developed its National Action Plan for Health Security (NAPHS) , which also includes interventions to address AMR, following recommendations from the JEE. The NAPHS also paved the way towards informing the NAP - AMR formulation. So _1 ch Sur ..J I N l L\ction Pl 1 1c , obul R ) ) 1 Jll 1 1Jt J11c Table 1. AMR indicators in the 2017 JEE of I HR core capacities mission report So th Sudan sc res I P.1.1 Legislatio n, laws, regulations, administrat ive requirements, policies or other National government instruments in place a re sufficient for im plementation of I HR (2005) legislation, policy and financing P.1 .2 The State can demonstrate that it has adjusted a nd aligned its domestic legislation , policies and admi nistrat ive arrangements to eable com pliance with I HR (2005) IHR coordination, P.2.1 A functional mechanism is established for the coordi nation a nd i nteljration of relevant communication and mtors in the implementation of I HR advocacy -'- -t · -- ,;,...,,......-.;. f P.3.1 Antimicrobial resistance detection 1 Antimicrobial resistance I - P.3.2 Surveillance of infections ca used by antimicrobial-resistant pathogens 1 f P.3.3 Health ca re -associated infection (HCAI) preventio nd cn rol prog rammes !I. l P.3.4 Antimicrobial stewardshi p activities 1 South Sudan developed its National Action Plan on AMR ( 2023 - 2028) to provide a roadmap for comprehensive multisectoral approaches and specific guidance to strengthen, and complement existing, AMR prevention and containment efforts. The process for NAP development commenced with a comprehensive situational analysis that was validated by the AMR Stakeholders. The strategic, operational, and monitoring and evaluation plans were then developed through a consultative multisectoral workshop and deliberations to describe and prioritize interventions, and activities, across five strategic objectives. The prioritized operational plan was also costed using the WHO Costing and Budgeting Tool for AMR NAPs. Technical guidelines such as the WHO Implementation Handbook for A MR NAPs and the Tripartite Manual for Developing NAPs were also consulted throughout. The South Sudan NAP - AMR considers existing plans, strategies and national programs being implemented in areas which AMR is cross-cutting . It is grounded on One Health and shall serve as a guiding framework for implementation and monitoring of the activities that willbe undertaken collectively to slow down and curb the emergence and spread of AMR in South Sudan. ;i \I . 1.2. Situationa l ana lysis 1.2.1. Overview A situational analysis was conducted to provide context on governance structures, capacities, and existing interventions for addressing AMR, to ensure that the NAP development process is in Line with the country's context, strengths, gaps and resources . A desk review of available peer-reviewed articles , grey Literature, and assessment reports such as the Tracking AMR Country Self-Assessment Survey (TrACSS) was conducted to inform human health situational analysis. For the Livestock and wildlife sector , key informant interviews and review of available Literature were also conducted . A Strengths, Weaknesses , Opportunities, and Threats (SWOT) matrix for AMR in human health, animal, plant, and environmental sectors was developed and validated by AMR Secretariat during the NAP development workshop. The situational analysis can be found here. 1.2.2. Country Profile South Sudan is the youngest country 1n Africa. 1 It is bordered by Central Africa Republic, Democratic Republic of Congo, Ethiopia, Kenya, Sudan, and Uganda. The population of South Sudan was estimated at 12 million, with a 1.3% annual growth rate and overall Life expectancy at birth at 55 years .2 The country also has one of the Largest Livestock populations in Africa, at over 36 million which includes cattle, goats, and sheep. It is estimated that 80% of the South Sudanese population make a Living from Livestock rearing. Livestock accounts for 65% of the agricultural Gross Domestic Product in the country, and the per capita Livestock ownership is one of the highest in Africa.3 Data on wildlife numbers for South Sudan is Limited. However, South Sudan is home to thousands of prized wildlife including endangered pangolins, African elephants , Nubian giraffe, buffalo, white-ea red kob, mongalla gazelle, Lion, African wild dog, and several indigenous species. Civil war outbreaks and insecurity, and natural disasters have affected health systems and overall progress in development efforts . - :iel'n.it;onAJbou t) l .. ilo( C -:Wdin!J l n _ CM1ptt'-hm!11¥tl"t ..1)11"f'nwnt,l00lo 01:.oiu. l"d bound.u>J KENYA Fig 2. Map of South Sudan and its states4 1 The World Bank in South Sudan 2 So uth Sudan Wo r ld Bank Country Profile 3 FAO South Sudan National Livestock Conference Flier 4 S o uth Sudan Map ! SL ' .. l ' 1 , '"'' cr obi dl R 51St. '"' '"' ,'1 Communicable diseases remain a major public health problem and are the leading causes of morbidity and mortality in South Sudan. Malaria, diarrhea, and pneumonia constitute about 77% of the tota l Outpatient department (OPO) diagnoses for children under five. Other causes of morbidity and morta lity include maternal deaths; severe acute malnutrition; TB/HIV. Moreover, in South Sudan, the WHO estimates that Non-Communicable Diseases (NCDs) accounted for 27% of all deaths in the country in 2016. The maternal mortality ratio is estimated to be 1150 deaths per 100,000 live births, child mortality rate at 99 per 1.000 live births, and infant mortality rate at 65 per 1,000 live births.5 Despite livestock representing the main source of livelihood and national GOP, livestock diseases such as anthrax, blackleg, Rift Va ley Fever (RFV) are concerning causes of mortality a nd morbidity, threatening food insecurity and socioeconomic conditions . The 2017-18 Rift Valley fever outbreak resulted in 2000 cattle, 5 human deaths6. The Government of South Sudan recognizes the linkages between public health and veterinary services in protecting a nimal health, ensuring food safety and eliminating disea se causing pathogens responsible for emerging a nd re-emerging infectious diseases and is implementing its strategic plan in collaboration with partners. 7 The country is also institutionalizing mechanisms including the IHR (2005) to safeguard the health and security of its people and as part of cooperation for national and global agenda. Hence, the implementation of the South Sudan NAP - AMR strategic interventions and activities further aligns with these national, regional and global priorities. 5 W HO Cou ntry Cooperation Strategy at Glance - South Sudan 6 FAO - Response to Increased Livesto ck Disease Outbrea ks in South Sudan 7 MARF Policy Framewor k and Strategic Plans 2012- 2016 I I ... 1.2.3. AMR Situation in South Sudan: Strengths, Weaknesses, Opportunities and . Threats (SWOT) Analysis Table 2: Analysis of the strengths , weaknesses , opportunities and threats on AMR Strengths Weaknesses Governance Governance • Existence of One Health Multisectoral • No government budget al ocation to support Management Committee AMR activities implementation in the different • Existing cross-cutting guidelines and strategies Line ministries across sectors such as the National Action Plan • No AMR policy for Health Security (NAPHS 2022-24), the • No AMR act National Environmental Policy 2015 - 2025, • Weak coordination and stakeholder engagement policy on AMR activities • Health sector strategic plan 2023-2028 Awareness and education • Essential medicines List 2018 • Dissemination and implementation of policies is • Standard treatment guidelines 2019 Lacking • Wildlife Conservation and protected areas bill • Lack of awareness on AMR among the general 2023 population. • Wildlife policy 2023 • Inadequate awareness among target Awareness and education stakeholders such as human healthcare workers , • Demonstrated capacity for training and Livestock, and value chain actors professional education on AMR in human health. • Limited capacity on the training and professional • Existing MLF extension messages and education on AMR in human health, the campaigns on several topics in relation to the veterinary , wildlife, agriculture (plant) , food Livestock disease in social media and news production, food safety and the environment Surveillance, evidence, and labs. sectors. • Availability of designated AMR National Public • Lack of evidence available on AMR and Lack Health Laboratory knowledge, attitude, and practices (KAP) studies • Enrolment in WHO GLASS for AMC Surveillance, evidence, and labs. • Demonstrated capacity for the detection of rifampicin resistance in the National TB program. • Lack of standardized and integrated One Health • Existence of Central Veterinary Diagnostic AMR surveillance capacity and utilization of Laboratory evidence generated for decision-making across • Surveillance systems for detection and reporting sectors of zoonotic diseases through IDSR and AEDIS • Inadequate Laboratory infrastructure and • Comprehensive guidelines and reporting forms capacities for microbiology, antibiotic for zoonotic disease outbreaks susceptibility testing, and antimicrobial residue • Ful y established monitoring, reporting and testing verification office for greenhouse gasses in place. • No satellite Veterinary Laboratories at • Existence of CODEX and relevant focal points for subnational Levels AMR and Veterinary products • No Legal frameworks for surveillance of • Passive AMR assessment conducted annually. Geneticaly Modified Organisms (GMOs) , including Lack of equipment for testing, and Sou ' SL• ' l - I nfection prevention and control mechanisms to monitor GMOs at border entry points • Infection Prevention and Control Strategy (2022- • No AMR Unit within the Central Veterinary 26) Diagnostic Laboratory (CVDL) and inadequate • Strong government commitment towards human resources improving coverage and ensuring access to • Limited capacity for the Bacteriology and vaccines . External Quality Assurance program (EQAP) Opti mi zed use of a nti microbials o Inadequate resources and infrastructure both at national and sub-national Level to support an " Demonstrated capacity on the availability of effective Laboratory system for one health regulations on prescription and sale of pandemic preparedness, prevention, and antimicrobials, for human use as reported in the response. Tracking Country Self-Assessment Survey. I nf ection prevention and control • Limited capacity for infection prevention and control i.e., Limited funding, no unified IPC training curriculum. • Lack of good manufacturing and improper hygiene practices to reduce the development and transmission of AMR in food processing. • Low vaccination coverage in human and animal health • Absence of healthcare associated infections (HAis) surveillance sites • Weak biosafety and biosecurity capacity • Inadequate waste treatment facilities (both Liquid and Solid) • Lack of good manufacturing and hygiene practices to reduce the development and transmission of AMR in food processing Opti mi zed use of a nti microbials • No Legislation, regulation and Legal frameworks on the sale and use of antimicrobials in for human and animal health (terrestrial and aquatic), as wellas environmental regulations and protection standards • Inadequate routine data colection for antimicrobial use or antimicrobial consumption in human and animal health, terrestrial, aquatic and agriculture. • Lack of Antimicrobial Stewardship program policy and plans for optimizing antimicrobial use in healthcare and veterinary settings, as wellas use of antimicrobial pesticide such as bactericides and fungicides use in plant production • Lack of monitoring antimicrobial use and consumption , and water quality testing for antimicrobial compounds • Inadequate representation of animal health, agriculture sectors in Drug and Food Control Agency • Fragmented supply chain systems for drugs, pesticide, pharmaceuticals Building an economic case for AMR • Limited research on AMR across sectors • Lack of research on the economic impact of AMR Opportunities Threats • Commitment of international partners including • Emerging and re-emerging public health threats WHO, FAO, OIE, Africa CDC, Green Climate • Availability of antimicrobials over the counter and Fund under the Global Environmental Facility for prophylactic use (GEF 8.) • Inadequate human and financial resources for • Opportunity for formalization and AMR activities • Low predictability of foreign funds operationalization of AMR governance structure • Borderless transmission of resistant pathogens • Pandemic fund under the Joint External • Unstable economic growth. Examination proposal is ongoing. • Donor fatigue • Existence of CODEX with focal points from different sectors. • Political instability and inter-communal conflicts • Strong commitment from the government , and • Inadequate number of new antimicrobials in the partners such as the FAQ to improve Livestock research and development pipeline vaccination coverage . • Suboptimal biosecurity at borders and entry points • NGOs and private sector can be engaged in the awareness campaign on AMR • South Sudan engagement in regional and international AMR workshops and meetings. • Agr iculture and Livestock extension policy - KEY INTERVENTIONS o Develop AMR NAP with prioritized, costed, and have an operational plan with monitoring in place, for successful implementation. • Build Leadership capacity to ensure the effective functioning of AMR multisectoral coordination structures . • Organize AMR multisectoral coordination mechanism with dedicated Leadership , clear terms of reference , technical working groups, and adequate funding . • The NAP development should emphasize the importance of conducting routine studies on professionals i.e., healthca re workers, Livestock and value chain actors, and the general public's knowledge, attitudes , beliefs, and perceptions of AMR. • There is a need to increase public awareness campaigns on the consequences of AMR using different communication platforms and technologies including World AMR awareness Week (WAAW) . • Systematically incorporating AMR into training curricula (both pre-service and in- service) of healthcare workers, veterinarians and veterinary paraprofessionals. • Capacity building for staff working in Laboratories. surveillance, AMS, and I PC across human health and animal health facilities. • Improved water, sanitation, and hygiene (WASH) in healthcare facilities, veterinary centers, slaughterhouses, and in the community . • Strengthening vaccination campaigns and herd health programs. • Strengthen microbiological La boratories with the capacity for diagnostic stewardship, culture and susceptibility testing, and antimicrobial residue testing . • An effort should be made to implement a One Health surveillance system . • Establishing a robust national monitoring system for antimicrobial use/consumption . • Strengthen the supply chain management system to assure the availability of quality antimicrobials. • Developlegislation on prescription and sale of antimicrobials. • Implement Antimicrobial Stewardship program in health facilities to promote prudent use of antimicrobials. • Knowledge, attitude, and perception studies should be conducted to assess the drivers of inappropriate antimicrobial use among the general public, healthcare workers . • Conduct research on the burden and risk of AMR and antimicrobial use in order to identify barriers and drivers for prudent AMU practices. • Strengthen collaboration with international academics, universities, research institutes, and experts for knowledge sharing, capacity building, research, and other initiatives. - 1.2.4. South Sudan AMR Stakeholders mapping and analysis ., ... Table 3: Stakeholders mapping and analysis for AMR prevention and containment SECTOR STAKEHOLDERS AREA OF LEVEL OF LEVEL OF ENGAGEMENT ENGAGEMENT INFLUENCE MINISTRY OF CABINET One Health Partners All AMR NAP High High AFAIRS Objectives HUMAN HEALTH • Office of the Vice President (Service Cluster) High High • Ministry of Cabinet Affairs • Ministry of Health • State MOH • Doctors Union AllAMR NAP • Nurses and Midwifery Association Objectives • Laboratory Specialists Union • Drugs and Food Control Authority • Ministry of Interior • National Bureau of Standards LIVESTOCK AND • Ministry of Livestock and Fisheries High High FISHERIES · Marial Lou livestock training center · Pastoralists union · Herders · All AMR NAP Butchers' union Objectives · Private sector (pharmacist) · SMARFT (state ministries of animal resources, Fisheries and tourism) . SSVA (South Sudan Veterinary Association) AGRICULTURE • Ministry Of Agriculture and Food Security AllAMR NAP High High • Farmers Union Objectives - WILDLIFE • • Agricultural Inputs Providers Ministry of Wildlife Conservation and Tourism ALL AMR NAP · South Sudan Wildlife Society Objectives ENVIRONMENT • Ministry of Environment and Forestry High High • State Ministry of Agriculture, Environment, and forestry AllAMR NAP • City/municipal council (Sanitation and Environment Objectives Department) • County/ Payams Environmental Departments UN AGENCIES I • WHO (World Health Organization) AllAMR NAP High High DEVELOPMENT • FAO (Food and Agricultural Organization) Objectives PARTNERS • WOAH (World Organization for Animal Health) • UNICEF (United Nations Children's Fund) • AFRICA-CDC • GEF • UNDP • US-CDC • USAID • UNEP • MSF Family • WORLD BANK • GLOBAL FUND • IOM . - • • • • ICRC ASLM ICAP AMREF Health Afr ica Low High ' .. • CORDAID • FIND • AAA • MALARIA CONSORTIUM • Maltese international • Tearfund • VSF family • WORLD VISION • CARE INTERNATIONAL • SSRC • DRC • AAH 0 African Parks 0 Flora and Fauna international (FFI) 0 Nature conservation organization (SSNCO) 0 South Sudan wildlife conservation organization (SWCO) 0 Zoological society of London • HEALTH POOLED FUND (HPF) Low Low RESEARCH • Ministry of Higher Education, ALL AMR NAP High High INSTITUTES I • Public Health Institute Objectives ACADEMIA ENFORCEMENT AND • Juba City Council Optimal use of AMs High High REGULATORY • Drug And Food Control Authority (DFCA) AGENCIES • South Sudan General Medical Council • National Bureau of Standards - • • Ministry of Interior Ministry of Justice and Constitutional Affairs Low High • National Security • Ministry of Defense and Veteran Affairs R EGIONAL ECONOMIC • EAST AFRICAN COMMUNITY (EAC) ALL AMR NAP Low High COMMUNITIES Objectives • IGAD Low High CIVIL SOCIETY • Religious Leaders A wareness Medium High • Community Based Organizations • National BaseNet organization • NNGOs MEDIA • Ministry of Information, communication, Technology Awareness High High and Postal Services • Media Houses, such as, not Limited to: • SSBC (TV & Radio) • EBC • Miraya Radio • Advance Youth Radio • Classic FM (Radio one) • Bakhita Radio • Eye Radio • Capital Fm • Newspaper outlets MINISTRY OF FINANCE • Ministry of Finance and Planning Sustainability/ Low High AND PLANNING • National Revenue Authority Investment • State ministry of Finance • State revenue Authority MINISTRY OF Water • Ministry of Water Resources and Irrigation High High Resource and 0 South Sudan water corporation IRRIGATION .- 2. STRATEGIC FRAMEWOR KS FOR THE SOUTH SUDAN NATIONAL ACTION PLAN 2.1. Vision To ensure effective protection of human, animal, plant, and environment from the consequences of antimicrobial resistance in South Sudan. 2.2. Mission To reduce and control the emergence and spread of resistant microorganisms while ensuring the availability of safe, effective , and quality-assured antimicrobials and their prudent/rational use and disposal through a One Health approach. 2.3. Goal and AMR NAP Strategic Objectives 2.3.1. Goal To ensure continuity of successful prevention and treatment of infectious diseases with safe, effective, and quality assured antimicrobial medicines. 2.3.2. . AMR NAP Strategic Objectives The South Sudan AMR NAP outlines five strategic objectives, with corresponding interventions and activities , which will be implemented in Line with the GAP-AMR. Strategic Strategic ·. Strategic .·Strategic Strateg ic Objective 1 Objective 2 Objective 3 . Objective 4 . Objective 5 • • Improve Strengthen the Reduce the Optimize the use Develop the awareness and knowledge and incidence of of antimicrobial economic case for understanding of evidence base infection through medicines in sustainable antimicrobial through effective human, health investment that resistance surveillance and sanitation, and animal health takes account of th rough effective research hygiene and the needs of all communication, infection countries and to education and prevention increase training measures. investment in new medicines, diagnostic tools, vaccines and other interventions Fig 3. Strategic Objectives for South Sudan AMR National Action Plan 2023 - 2028 2.4. Guiding principles The South Sudan AMR NAP shall reflect five guiding principles which serve as the foundation under which the GAP AMR strategic objectives a re enunciated , a nd, subsequently, national action pla ns will be based on: Whole of society engagement, including a One Health Approach · Prevention:fir's1:' " ' " ' 1 · ,:·:, · • · :' ":· . \:" _- . · · · • '. '.: :'. . ' • .. ' , - ... \-: " ' • ' ' • :l"'I ·' ' • ,. •• ";'" . . ' 'fl " ... 1. ,' ' .< ' ,, \ ; • ; - . . ' ..... - I.. 0 "C1'' 0. "(3 \\ II c 0 I.. a. en Sustainability c "C B I Fig 4. Guiding Principles for the implementation of the AMR NAP 3. GOVER NANCE AND COOR DINATION Established and functional national multisectoral coordination mechanisms are pivotal for effective and sustainable implementation of the NAP-AMR. South Sudan has an approved One Health governance structure with terms of reference, under which seven (7) pillars are established, including AMR. It is chaired by the Office of Cabinet Affairs Minister. To ensure integrated and coordinated action , the proposed AMR governance is hence elaborated from this existing structure. The National AMR Multisectoral Committee shallprovide oversight and advice on all strategic objectives of the AMR NAP implementation. A national AMR Secretariat was established to coordinate and steer the NAP development process; Led by the National AMR Focal Person, the committee shall ensure continued multisectoral collaboration and coordination. Six technical working groups shall be established to operationalize implementation, provide technical input, monitoring and reporting of their specified technical areas. The AMR Secretariat shall therein, coordinate, synthesize reports and Liaise between the TWG and Nationa lAMR Multisectoral Committee. OFFICE OF CABINET AFFA IRS MINISTER (Chair, One Health Steering Committee) One Health Secretariat (Technical Leads fron Relevant Ministries) ... : i One Health Steering Committee 2 (Advocacy, Resource Mobilization and Policy t1 Ministries:Health, Livestoch & Fisheries, Environment & Forestry and all relevant Ministries \lll c ·;:; ' . .. - . ,. . . ... ·-· . . Ill · · One Healt h :T!!chnica lCommitt ee " :: ;'· ·:·\ · . . : '.: . ·'. x LU (All Directorates (DG) among Ministries ), IHR, Veter ina ry Services . ,'· ", . , • t' •, >• I '. ,' , i I' • • f .• ' >-! - c PILL.AR 5: PILLAR 7: Risk PILLAR 1: PILL.AR 2: PILL.AR 3 PILL.AR 4 Communication, Communication Surveillance Research/ PILL.AR 6: Laboratory Preparedness & Coordination and Community &Reporting Workforce AMR TWG Systems TWG Response TWG and Partnership Engagement TWG Development TWG TWG TWG t PILLAR 6: AMR TWG ·- ·- ·- ·- ·-I 0:: :a NationalAMR MultisectoralSteering Committee ... ...:i Q I AMR Secretariat t 2 t1 "C TWG .TWG Awareness, TWG Infection . TWG AMR QI ,'TWG Regulations TWG Resource Ill 0 ;!surveillance and Education and .' Prevention Control c. '.'. and Enforcement ' · Mobilization . Stewardship Research Training & WASH ... 0 Q. Fig 5. South Sudan AMR Governance Structure '- t • c:,. ' 1 10 11l -t:op 1 111 , . T' ubl R,,,si ,tu11ce L'l23 J '3 - 4. STRATEGIC PLAN Strategic Objective 1: I mprove awareness and understanding of antimicrobial resistance through effective communication, education, and training. The main objective of this intervention is to improve awareness of AMR across targeted key stakeholders and actors in the human health, animal health, plant, and environmental health so as to promote behavior change. While AMR is recognized as a public health issue in South Sudan, there are Limited AMR awareness campaigns in the country and hence, a need for nation-wide, government supported awareness raising activities with targeted messaging for stakeholders. Addressing AMR calls for stakeholders in South Sudan to understand the burden and threat posed by A MR, as well as each stakeholder ' s role in appropriate antimicrobial use to minimize the risk posed by AMR. While the Ministry of Livestock and Fisheries in collaboration with partners mounted several extension messages and campaigns, on topics to livestock disease and wellbeing of Livestock, through national broadcasting corporation, FM radio stations and posters etc., none of the messages had specifically addressed AMU or strict compliance with antimicrobials withdrawal periods, rational antimicrobial use, and antimicrobial residues in food. Due to the complex nature of AMR and interlinkages between sectors, communication messages ought to be context-specific and targeted to the respective audiences. This can be achieved through evidence-based public communication, awareness raising campaigns, social engagement, among others. Moreover, as outlined in the GAP-AMR, making AMR a core component of training, continuous professional development, and certification is also essential for ensuring proper awareness among professionals across the sectors. The following priority interventions and activities are proposed: - Strategic interventions 1.1 Improve awareness and understanding of 1.1.1 Conduct baseline survey to assess knowledge, attitudes and behavioral practice about AMU and AMR in the various groups of the general AMR among professionals and community in human health, animal health, agriculture, and the population. environment to guide training and education. 1.1.2 Develop and disseminate a comprehensive evidence-based national communication strategy for AMR. 1.1.3 Develop and disseminate IEC materials in the Local context and Language for diverse stakeholders in human, animal, and environmental health sectors . 1.1.4 Conduct regular antimicrobial resistance awareness campaigns including World Antimicrobial Awareness Week (WAAW) 1.2 Strengthen education and training on 1.2.1 Advocate the incorporation of antimicrobial resistance courses in undergraduate and graduate antimicrobial resistance of human, animal, curriculum for relevant stakeholders . plant, and environmental health 1.2.2 Incorporate AMR and related topics in undergraduate and graduate curriculum of human, animal, professionals. and environment professionals. 1.2.3 Conduct in-service training programs on AMR for human, animal, environmental professionals 1.3 Enhance engagement of media, civil 1.3.1 Provide trainings on antimicrobial resistance for media professionals for the dissemination of AMR society organizations, youth groups and key messages to the public. opinion Leaders on antimicrobial resistance 1.3.2 Conduct advocacy workshops on antimicrobial resistance for civil society organizations, youth prevention and control groups and opinion Leaders 1.4 Strengthen antimicrobial resistance 1.4.1 Conduct advocacy workshops on antimicrobial resistance for policy makers across the human, advocacy and communication with animal, and environmental sector policymakers .. Strategic Objective 2: Strengthen the knowledge and evidence-based interventions through surveillance and research. Surveillance of AMR , antimicrobial use, antimicrobial residues is essential in generating the needed evidence based, data and knowledge that will be translated into policy, practice and decision making to combat AMR. This objective aims to develop and strengthen capacities for standardized surveillance and monitoring of emergence, patterns, spread of resistance, prevalence of AMs in the environment/ecosystems as well as providing early warnings across humans, animals, plants and the environment. Several efforts have been implemented in South Sudan, including Integrated Disease Surveillance and Response {IDSR) strategy and existing Laboratory structures in the main reference Laboratory i.e., the National Public Health Laboratory, teaching hospitals, state hospitals, county, primary healthcare centers. There is also one functional Central Veterinary Diagnostic Laboratory in the capital city Juba. However, capacities for generating data through surveillance systems, conducting microbiology and antimicrobial susceptibility testing are limited. Laboratory-based AMR surveillance and diagnostics , with quality assurance and uninterrupted supply of consumables is also critical for generating quality data . The following priority interventions and activities are proposed: - Strategic Objective 2: Strengthen the knowledge and evidence base through surveillance and research. . ' Strategic interventions Activities 2.1 Strengthen Laboratories capacity to 2.1.1 Assess the capacity of existing Laboratories with respect to AMR. detect and report antimicrobial 2.1.2 Develop a national guideline and SOP for AMR surveillance system resistance at allsectors. 2.1.3 Capacitate Laboratory professionals on detection and reporting of AMR 2.1.4 Establish antimicrobial resistance active surveil ance system in human and animal sector 2.1.5 Procure modern and automated diagnostic equipment and supplies required for AMR detection 2.2 Strengthen quality management 2.2.1 Establish Quality Management System (QMS) for AMR surveillance in the different sectors . systems to provide consistent 2.2.2 Develop standards operating procedures (SOPs) for Laboratory surveillance of AMR in humans diagnostic standards by allLaboratories. and animals, food, agriculture, and environment consistent and harmonized with international standards . 2.2.3 Establish an internal and external quality assurance system for AMR surveillance. 2.3 Establish integrated antimicrobial 2.3.1 1 Develop national guidelines and plan for an integrated surveillance systems on AMR resistance surveilance system that 2.3.2 Establish a harmonized database and information sharing system on AMR in human, animal, al ows data sharing from human, water , plant, and environmental health. environment, animal and agricultural sectors. 2.3.3 Establish a joint reporting mechanism on AMR in human, animal, agriculture, and the environmental sectors 2.3.4 Enrollin GLASS AMR and strengthen regular reporting 2.4 Support Surveillance for Antimicrobial 2.4.1 Strengthen Laboratory capacity to carryout antimicrobial residue testing for food and feed Drug Residues in Food and Environment products. - 2.4.2 Establish surveillance and research of antimicrobial residues, effluent and waste in the environment, agriculture, food and feed sectors 2.5 Strengthen research capacity on AMR in 2.5.1 1 Develop an integrated and prioritized research agenda for AMR across allsectors. human, animal, agriculture, and 2.5.2 Capacitate professionals on basic and operational research in antimicrobial use and resistance . environmental health. 2.5.3 Conduct research AMR/AMU across the sectors to understand the drivers for AMR/AMU and use for policy formulation. 2.5.4 Establish platform (conference or symposium) for regular information sharing on antimicrobial resistance research. - Strategic Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and infection . ... ., prevention measures. Infection prevention and control goes hand in hand with adequate water supply, hygiene practices, and sanitation to limit the spread of infections at human health and animal health facility, and community levels. South Sudan has an existing IPC strategy, Standard Operating Procedures and guidelines as part of the efforts to strengthen national IPC programs. There is stilla need to ensure that the IPC programs and guidelines for minimum standards are disseminated, implemented, adhered to, and monitored at national and facility levels. This AMR NAP also cites interventions and activities for waste management systems, personal hygiene, and biosecurity. The Ministry of Health alongside the Ministry of Livestock are imploring vaccination as an infection prevention measure that reduces the risk of AMR spreading and developing from the reduced use of antimicrobial s in humans and animals. Moreover, the Environment sector is implementing phytosanitary measures to prevent infections in plant These efforts ought to be scaled up, especially in vulnerable communities. Scaling up of water, sanitation, and hygiene (WASH) measures in healthcare and animal facilities and routine immunization efforts is also critical. The following priority interventions and activities are proposed: 3.1Strengthen infection prevention and Control (IPC) 3.1.1 Conduct advocacy and sensitization on national IPC policy and Strategic Plan for program in health care settings . relevant stakeholders. 3.1.2 Strengthen the availability of IPC related equipment, PPE, supplies, utilities (water supply) and guidelines. 3.1.3 Develop, and disseminate IPC training manuals, SOPs and IEC materials to healthcare professionals. 3.1.4 Conduct sensitization campaigns to promote personal and phytosanitary hygiene. ... 3.2 Prevent and monitor health care-associated infections 3.2.1 Conduct health care-associated infections survey at the health facilities at human and veterinary health facilities 3.2.2 Implement health care-associated infection prevention measures 3.3 Accelerate Vaccination Campaigns to enhance 3.3.1 Conduct Vaccination Campaign for various health threats prevention and control of diseases and infections in 3.3.2 Capacitate Professionals on prevention and control of diseases in human and animal human and animal health 3.4 Strengthen waste management systems in the health, 3.4.1 Develop a comprehensive guideline of waste management system across the sectors. agriculture, and environment sectors and communities. 3.4.2 Conduct regular health promotion activities to advocate personal hygiene and environmental sanitation. 3.4.3 Promote and enforce hazardous waste management in health facilities. 3.5 5 Strengthen water, sanitation, and hygiene 3.5.1 Support and enforce human and animal health facilities to provide functional (WASH) services handwashing and bathing facility for staff and patients. 3.5.2 Support facilities to prepare and dispense alcohol-based hand sanitizer 3.6 Strengthen good husbandry practices and bio-security 3.6.1 Conduct assessment of knowledge, attitudes, behavior, and practices on good interventions in animal husbandry, plant, and fishery husbandry practice. sectors. 3.6.2 Develop guidelines on good bio-security measures in animal husbandry, plant, and fishery sectors. 3.6.3 Train human and animal health workers on the biosecurity guidelines. 3.6.4 Develop bio-risk guidelines for animal feed processing and poultry, dairy and beef production, food handlers and traders. - Strategic Objective 4: Opti m i ze the use of a nti m icrobi a l agents i n hu ma ns, a n i m a ls, a nd pla nt hea lth. Among the drivers of AMR is the misuse and indiscriminate use of antimicrobials across sectors, nonetheless Limited access to . ' essential antimicrobials, especialy in Low- and middle-income countries with high burden of infectious diseases, is a conundrum . Policies and strategies that ensure equitable and sustainable access to essential health products, including essential medicines and related health technologies, is a critical contribution to the promotion of access to health in general and the efforts towards Universal Health Coverage (UHC). Rational use of antimicrobials, with optimal prescribing and consumer practices cannot be understated for preserving effectiveness of antimicrobials. South Sudan has several initiatives such as the Pharmaceutical Policy, revised national Standard Treatment Guidelines and Essential Medicines List (EML) , and the Drug and Food Control Authority etc., to promote optimized drug use. However, there is a gap in enforcement of Legislation to ensure prudent use. A national policy or plan on antimicrobial stewardship should be developed and implemented through AMS interventions across all Levels. This AMR NAP also highlights enforcement of regulations in the distribution and sale of antimicrobials for humans, animals and plants as a priority intervention for anchoring AMS activities in South Sudan. Lastly, streamlined reporting and use of data on antimicrobial use and consumption is key to inform practitioners and decision makers across human health, animal health and plant & ecosystem health sectors. The following priority interventions and activities are proposed: Strategic Objective 4: Optimize the use of antimicrobial agents i n h uma n, animal, and pla nt health. Strategic i nterventions Activities 4.1 Establish antimicrobial stewardship program for selected facilities 4.1.1 Develop and disseminate antimicrobial stewardship policy. 4.1.2 Institutionalize antimicrobial stewardship in healthcare facilities. 4.1.3 Provide training on antimicrobial stewardship program. 4.1.4 Conduct point prevalence survey on antibiotic use in Hospitals. 4.2 Ensure optimal prescribing, dispensing and use of antimicrobials 4.2.1 Facilitate continued education and training to promote responsible prescribing in human and dispensing practices. 4.2.2 Review and disseminate STGs/EML based on antimicrobial resistance data and incorporate AWaRe classification of antibiotics. .. 4.2.3 Develop Antimicrobial prescribing and dispensing manuals. 4.2.4 Strengthen supervision of prescribing and dispensing outlets. 4.3 Strengthen antimicrobial use and consumption surveillance in 4.3.1 Conduct antimicrobial use and consumption surveillance at the national Level human, animal and plants and contribute data at global Level. 4.4 Prudent Use of Antimicrobial s in Agriculture and Veterinary 4. 4.1 Develop and disseminate prescription guidelines, veterinary standard Medicine treatment guidelines and formulary for improving appropriate use of antimicrobials in agriculture and veter inary medicine. 4.4.2 Restrict use of antimicrobials as growth promoters or as feed additives. 4.4.3 3 Develop antimicrobial stewardship guidelines for animal health facilities. 4.4.4 Implement antimicrobial stewardship in selected animal health facilities. 4.5 5 Develop and enforce Legislation on prescriptions for 4.5.1 Conduct a situational analysis of the existing regulations/Legisl ations and their combating AMR in human, animal and plant enforcement on antimicrobial use. 4.5.2 Develop Legislation/regulation on prescription and sale of antimicrobials for human, animal and plant use. 4.5.3 3 Conduct supervision of pharmacies and ensure adherence to good pharmacy practices . 4.6 Ensure an effective supply chain management of quality essential 4.6.1 Advocate inclusion of priority antimicrobials and Laboratory supplies in the antimicrobials and Laboratory supplies Long-term procurement agreement with government/non-government suppliers. - Strategic Objective 5: Develop the economic case for sustainable investment that takes account of the needs of allcountries and to increase investment in new medicines, diagnostic tools, vaccines and other interventions. .. Strategic Objective 5: Develop the economic case for sustainable investment that takes account of the national needs and increase investment in new medicines, diagnostic tools, vaccines and other interventions. Strategic interventions Activities 5.1 Strengthen the governance and 5.1.1 Establish and strengthen multisectoral AMR Technical Working Group (AMR-TWG) and Sub- multisectoral coordination for sustainable Technical Working Groups at national Level. implementation of AMR NAP. 5.1.2 Establish and strengthen AMR secretariat at the national Level (human resources, materials, finances, structures, etc.) 5.1.3 Establish focal points for human, animal, plant, water, sanitation, hygiene, waste and wastewater management at different Levels. 5.1.4 Organize annual joint review meetings on the implementation of the AMR NAP operational plan 5.2 Ensure availability of sustainable resources 5.2.1 Develop resource mobilization strategies to support AMR interventions. to support AMR interventions 5.2.2 Identify and engage Local and international funding agencies to support AMR interventions. 5.3 Determine the economic impact of AMR in 5.3.1 Conduct economic evaluation to determine expenditures for treatment of infectious disease in the South Sudan country. 5.4 Promote public-private partnerships on 5.4.1 Develop public-private partnership framework on antimicrobial resistance . antimicrobial resistance prevention and 5.4.2 Conduct regular advocacy platforms to engage the private sector on antimicrobial resistance. containment 5.5 Promote Innovation in the Search for 5.5.1 Support academia and other researchers in product development including application of traditional Alternative Treatments and Drug and indigenous knowledge. Development 5.5.2 Advocate for Multi-sectoral colaboration for research on alternative medicines in various aspects of antimicrobial use and resistance in humans, animals, and plants. - 5. OPER ATIONAL PLAN Strategic Objective 1: Improve awareness and understanding of antimicrobial resistance through effective communication, education, and training. Strategic inte rvention 1.1: Improve awaren ess an d understan_ding of AMR in the var ious groups of the ge neral population Sub-activity Unit Quantity Indicator Responsible Timelines in years lmpleme Cost entity ntation YRl YR2 YR3 YR4 YRS level Activity 1.1.1: Conduct baseline survey to assess knowledge, attitudes and behavioral practice about AMU and AMR among professionals and community in human health, animal health, agriculture, and the environment to guide training and education. -· - -· - 1.1.1.1 Conduct AMR and Survey 2 Reports and MoH/MoLF/Mo X x National antimicrobial use KAP survey publications EF/MWC&T/M among the general public. oA&FS, Academia, AMR secretariate (coordination) 1.1.1.2 Conduct a meeting to Workshop 2 Workshop MoH/MoLF/Mo X x National disseminate KAP study findings minutes and EF/MWC&T/M proceedings oA&FS, Academia, AMR secretariate (coordination) Activity - evelop and disseminate a coprehensive evidence-b sed i:ition l_ communication strategy for AM_R 1.1.2.1 Develop a communication Strategy 1 Availability of MoH/MoLF/Mo X National strategy for AMR. document National EF/MWC&T/M - Communication Strategy for AMR oA&FS, MITB&PS/ MW&IR - AMR -secretariat ·. 1.1.2.1 Conduct a workshop to Workshop 1 Workshop MoH/MoLF/Mo x National disseminate the communication minutes and EF/MWC&T/M and strategy proceedings oA&FS, AMR subnatio secretariat nal Activity 1.1.3 Develop and disseminate IEC materials in the Local context and Language for diverse stakeholders in human, animal, and environmental health sectors -- - 1.1.3.1 Adopt/develop IEC Flyers 45,000 Number of MoH/MoLF/Mo x National materials to the South Sudan Posters 4000 promotional EF/MWC&T/M and context and Language Brochures 30,000 materials oA&FS subnatio developed by type /MITB&PS- nal AMR secretariat 1.1.3.2 Disseminate IEC materials Dissemina 4 Number of MoH/MoLF/Mo x x National for AMR stakeholders including tion dissemination EF/MWC&T/M and the community events events oA&FS/MITB& subnatio PS AMR nal secretariat Activity 1.1.4 Conduct regular antimicrobial resistance awareness campaigns including World Antimicrobial Awareness Week (WAAW) - - 1.1.4.1 Conduct continuous Awarenes 5 Number of events MoH/MoLF/Mo X X X X X National awareness raising campaigns in s raising conducted EF/MWC&T/M and the general public on AMR and events oA&FS/MITB& subnatio AMU. PS AMR nal secretariat 1.1.4.1 Commemorate the World Commem 5 Number of MoH/MoLF/MoE x x x x x National antimicrobial awareness week oration commemoration F/MWC&T/MoA and (WAAW) event events &FS/MITB&PS subnatio AMR secretariat nal - Strategic inte rvention 1.2: Strengthen educ atio n and tra ining on antimicrobial resistance of human, animal, plant, and environmental health profes sionals • -- Activity 1.2.1 Advocate the incorporation of antimicrobial resistance courses in undergraduate and graduate curriculum for relevant stakeholders 1.2.1.1 Advocate for the Advocacy 2 Number of MoH/MoLF/Mo X X National integration of AMR and related workshop meetings EF/MWC&T/M & topics in formal and informal conducted oA&FS/MITB& Sub education at allLevels PS, MoHE, national AMR secretariat Activity 1.2.2 lncorp_orate AMR and related topics in undergraduate and grduate curriulum of human, animal, a d environment professionals 1.2.2.1 Review and update Curriculu 4 Revised MoH/MoLF/Mo X X National curricula to include AMR in all m curriculum EF/MWC&T/M Sub curricula for Human, Animal, Plant document oA&FS/MITB& national and environmental in PS, MoHE, undergraduate and graduate /Partners AMR courses secretariat 1.2.2.2 Train focal persons and Training 4 Number of MoH/MoLF/Mo x x National relevant educational partners at trainings provided EF/MWC&T/M & different Levels and sectors of the oA&FS/M ITB& Sub education system. PS, MoHE, national /Partners AMR secretariat 1.2.2.3 Develop and disseminate Teaching 1 Number of One Health, x x National teaching materials material Teaching material Public health and institute and subnatio universities - nal AMR secretariat - Activity 1.2.3 Conduct in-service training programs on AMR fo_r:_ human, animal, environmental professionals 1.2.3.1 Engage professional Advocacy 2 Number of MoH/MoLF/Mo X National . .. registration bodies for inclusion of workshop Professional EF/MWC&T/M AMR as part of Continuous bodies engaged oA&FS/MITB& professional Education (CPE) PS, MoHE, /Partners AMR secretariat 1.2.3.2 Develop AMR training Training 1 Approved training MoH/MoLF/Mo x National manual for CPE manual manual EF/MWC&T/M oA&FS/MITB& PS, MoHE, /Partners AMR secretariat 1.2.3.3 Conduct training and Training 4 Number of MoH/MoLF/Mo x x National disseminate materials for human, trainings EF/MWC&T/M and animal, environment professionals. conducted oA&FS/MITB& Subnatio PS, MoHE, nal /Partners AMR secretariat Intervention 1.3 Enhance engagement of media, civilsociety organizations, youth groups and opinion leaders on antimicrobial resistance prevention and control Activity 1.3.1 Provide trainings on antimicrobial resistance for media professionals for the dissem ination of AMR key messages to the public 1.3.1.1 Provide trainings on Training 5 Number of media MoH/MoLF/Mo x x x x x National antimicrobial resistance for media training EF/MWC&T/M &Sub professionals (print and electronic) oA&FS/MITB& national for PS, MoHE, effective reporting mechanism /Partners AMR secretariat - 1. 3. 1.2 Distribute communication materials and tools to media Print materials 2000 Number of materials and MoH/MoLF/Mo EF/MWC&T/M x x National & outlets. and tools tools printed and oA&FS/MITB& Sub distributed PS, MoHE, national /Partners AMR secretariat Activity 1.3.2 Conduct advocacy workshops on antimicrobial resistance for civil society organizations, youth groups and opinion Leaders 1.3. 2. l Conduct advocacy Advocacy 3 Number of MoH/MoLF/Mo X X X National workshops on antimicrobial Workshop advocacy EF/MWC&T/M &Sub resistance workshops oA&FS/MITB& national for civil society groups including PS, MoHE, opinion Leaders and youth groups /Partners AMR secretariat 1. 3.2.2 Distribute communication Printed 10000 Number of MoH/MoLF/Mo x x National materials and tools to CSO, youth materials materials and EF/MWC&T/M &Sub groups, and opinion Leaders &Tools tools distributed oA&FS/MITB& national PS, MoHE, /Partners AMR secretariat Intervention 1.4 Strengthen antimicrobial resistance advocacy and communication with policymakers Activity 1.4.1 Conduct advocacy workshops on antimicrobial resistance for policy makers across the human, animal, and environmental sector - - 1.4.1.1 Organize advocacy Advocacy 3 Number of MoH/MoLF/Mo X X X National workshops for relevant South Workshop advocacy EF/MWC&T/M & Sub Sudan Legislative house workshops oA&FS/MITB& national committees on AMR PS, MoHE, /Partners AMR secretariat 1.4.1.2 Regularly develop and Policy Number of policy AMR TWG x x x National communicate a policy briefing on brief briefs AMR & Sub AMR findings in South Sudan disseminated secretariat national - a ,. I Strategic Objective 2: Strengthen the knowledge and evidence base through surveillance and research Strategic intervention 2.1: Strengthen laboratories capacity to detect and report antimicrobial resistance at all sectors. Sub-activity Unit Quantity Indicator Responsible Timelines in years lmpleme Cost entity YRl YR2 YR3 YR4 YRS ntation level Activity 2.1.1 Assess the capacity of existing Laboratories with respect to AMR. - - - 2.1.1.1 Identify a technical expert TWG 1 TWG with ONE HEALTH x National from various sectors for the defined TOR SC/AMR TWG assessment. AMR Secretariat 2.1.1.2 Conduct comprehensive Assess men 1 Assessment ONE HEALTH x National assessment of the existing various t report with SC/AMR TWG and Sub- Laboratories in all relevant sectors recommendation AMR national Secretariat 2.1.1.3 Communicate assessment Workshop 1 Workshop ONE HEALTH x National findings with allrelevant sectors. proceedings SC/AMR TWG and Sub- AMR national Secretariat Activity 2.1.2 Develop a national guideline for AMR surveillance system 2.1.2.l Organize stakeholders Workshop 1 Availability of ONE HEALTH x National meeting to develop National AMR National AMR SC/AMR TWG surveillance guideline surveillance AMR guideline Secretariat 2.1.2.2 Conduct stakeholders' Workshop 1 Validated AMR ONE HEALTH x National meeting to validate the revised surveillance SC/AMR TWG National AMR surveillance guideline AMR guideline Secretariat - 2.1.2.3 Disseminate the final revised National AMR surveillance Workshop 3 Number of dissemination ONE HEALTH SC/AMR TWG x National and Sub- guideline events AMR national Secretariat Activity 2.1.3 Capacitate Laboratory professionals on detection and reporting of AMR 2.1.3.1 Develop training manual on Training x National 1per Availability of ONE HEALTH AMR detection and reporting in Manual sector approved SC/AMR TWG human and animal (human training manual AMR and Secretariat animal) 2.1.3.2 Train professionals Number of ONE HEALTH x x x x National on Trained 30 professionals SC/AMR TWG and Sub- sample colection, pack aging, profession trained national shipping, and sampling techniques al for AMR active surveillance sites in both human and animal Activity 2.1.4 Establish antimicrobial resistance active surveillance system in human and animal sector - - 2. 1.4.1Identify selected AMR 6 Number of ONE HEALTH x National Laboratories for AMR surveillance . surveillanc human/2Laboratories SC/AMR TWG & Sub- e Labs animal selected for national AMR surveillance 2.1.4.2 Establish active AMR Surveillanc 6 human Number of AMR ONE HEALTH x x x x National surveillance system e sites sector/2 surveillance SC/AMR TWG & Sub- animal sites national Activity 2.1.5 Procure modern and automated diagnostic equipment and supplies required for AMR detection - - - - - - 2.1.5.1. Infrastructural Laboratorie 5 Renovated ONE HEALTH X x x x National improvement of the s Laboratories SC/AMR TWG & Sub- identified/existing Laboratories to national meet AMR implementation standards - 2.1.5.2 Procure sample collection materials for AMR surveillance site Surveilanc e sites 5 Diagnostic supplies MOH/MLF/Mo A x x x x National & Sub- , ' procured I national 2.1.5.3 Procure diagnostic Surveillanc 5 Diagnostic MOH/MLF/Mo x x National equipment for antimicrobial e sites equipment A determination procured 2.1.5.4 Service Contract to cover Contract/ 5 Service contract One health x x x x National preventative maintenance, training MoU signed &Sub and repair/replace damaged national equipment Strategic intervention 2.2: Strengthen quality management systems to provide consistent diagnostic standards by alllaboratories . Activity 2.2.1 Establish Quality Management System (QMS) for AMR surveilance in the different sectors. 2.2.1.1Train laboratory staff on Trained 30 Number of staff MOH/MLF/Mo x x x x Alllevel QMS and documentation in the Staffs trained A context of One Health ONE HEALTH &PARTNERS 2.2.1.2 Develop quality Guideline 1 Guidelines MOH/MLF/Mo x National management system guideline in developed/adopt A/MOE & Sub- alllaboratories ed national 2.2.1.3 Print and disseminate the Printed 50 Quality manual ONE x National Quality manual quality developed HEALTH/PART manual NERS Activity 2.2.2 Develop standards operating procedures (SOPs) for Laboratory surveillance of AMR in humans and animals, food, agriculture, and environment consistent and harmonized with international standards . 2.2.2.1Identify priority organisms, List 1 List of prioritized AMR x National samples and testing panels that organisms TWG/ONE meet international standards HEALTH SC &PARTNERS - 2.2.2.2 Develop and print SOPs for Laboratory AMR surveillance SOP 1 SOP developed AMR TWG ONE HEALTH x National SC&PARTNER s 2.2.2.3 Conduct dissemination Training 10 # Professionals AMR TWG X x National training to Laboratory professionals trained in new ONE HEALTH & Sub- on the new SOP SOP SC&PARTNER national s 2.2.2.4 Advocate the use of Advocacy 1 Workshop MoH/MoLF/Mo x National approved (WHO, FAO, WOAH) workshop proceedings EF/MoA&FS & Sub- standards operating procedures national (SOPs) for optimal AMR detection Activity 2.2.3 Establish an internal and external quality assurance system for AMR surveillance . 2.2.3 .1Establish routine internal Routine Daily Number of IQA MoH/MoLF/ x x x x National quality assessment (IQA) for AMR assessmen undertaken MoA&FS & Sub- surveillance. t national 2.2.3.1 Introduce a routine external EQAS 2 Number of EQA MoH/MoLF/ x x National quality assessment scheme undertaken MoA&FS & Sub- (EQAS) for allsurveillance national Laboratories. Intervent ion 2.3: Establish integrated ant imicrob ia lresistance surveillance system that allows data sharin g fr om human, water, environment, animal and agric ultura lsectors. ·· ·· .. Activity 2.3.1 Develop national guidelines and plan for an integrated surveillance systems on AMR 2.3.1.1 Develop an integrated Plan 1 Approved AMR TWG x National AMR surveillance plan Integrated AMR surveillance plan 2.3 . 1.2 Print and distribute the Surveillanc 100 Number of AMR TWG x National integrated AMR surveillance plan e plan copies printed and disseminated - Activity 2.3.2 Establish a harmonized database and information sharing system on AMR in human, animal, plant, and environmental health -- -- -- --- 2.3.2.1Assess and update existing Survey - 1 Survey report - AMR TWG X National • .. databases of AMR in the various sectors. 2.3.2.2 Identify and designate a Focal point 1 Designated focal AMR TWG x National sector as a national focal point for point AMR data colection and repository on secretariat AMR. 2.3.2.3 Develop data management AMR data 1 Harmonized AMR TWG x National guideline for data collection, manageme AMR data analysis, and information nt management management. guideline guideline in place 2.2.2.4 Print and distribute data Printed 100 Number of AMR TWG x National management guideline guideline guidelines printed Activity 2.3.3 Establish a joint reporting mechanism on AMR in human, animal, agriculture, and the environmental sectors 2.3.3 .1Conduct a multispectral Meeting 3 Meeting MOH/MLF/Mo x x National technical meeting to establish proceedings A/MOE/One- effective reporting system on AMR health Activity 2.3.4 Enrollin GLASS AMR and strengthen regular reporting. -- - - 2.3.4.1 Strengthen participation of GLASS 1 Approved AMR TWG x I I I National South Sudan in Global Enrollment enrollment I Antimicrobial Resistance GLASS AMR 2.3.4.2 Regular reporting of AMR Report 1/year Number of AMR TWG x x x x x National data through GLASS AMR reports submitted - Intervention 2.4: Suppo rt Surveillance for Antimicrobial Drug Resid es in Food and Environment _Activity 4.!__ r_engthen laboratory capacity !9 arr:y_ out antimicrobial resi_9 e testing for food and feed products. 2.4.1.1 Capacitate laboratory with Procureme 6 Residue testing MoH/MoLF/Mo X x x National equipment for antimicrobial nt equipment EF residue testing. available 2.4.1.2 Capacitate laboratory with Procureme 1/year Residue testing MoH/MoLF/Mo x x x National reagents for antimicrobial residue nt reagent EF testing. available 2.4.1.3 Establish laboratory for Lab 1 Modification of MoH/MoLF/Mo x x National environmental sample testing lab space for EF testing Activity 2.4.2 _Establish surve ilance and research of antimicrobial residues, effluent and waste in the environment, agriculture, food and feed sectors 2.4.2 .1Establish national Surveillanc 1 System MoH/MoLF/Mo X X X National antimicrobial residue e system established EF and surveillance system for subnatio environment, nal plant and food safety 2.4.2.2 Conduct research and Research 5 Number of MoH/MoLF/Mo x x x National surveillance on Report research EF and antimicrobial residues in food, reports subnatio effluents produced nal and waste Intervention 2.5: Strengthen research capacity on AMR in human, arii.m .. al, agriculture, and environmental health. . ' ' Activity 2.5.1 Develop an integrated and prioritized research agenda for AMR across all sectors. 2.5.1.1 Organize a workshop to Workshop 1 AMR research AMR TWG x National identify current gaps in AMR priority research in identified sectors and institutions - 2.5.1.2 Validate the priority research topics and issues to be integrated in Research agenda 2.5.1.3 Sensitize stakeholders and Workshop Workshop 1 2 Validated research priorities Number of AMR TWG AMR TWG x x x National National ., donors to conduct and support sensitization AMR research across sectors events Activity 2.5.2 Capacitate professionals on basic and operationa research in antimicrobial use and resistance . 2.5.2.1 Organize research Training 1/year Number of AMR TWG X x x x National methodology training on AMR for trainings and professionals in human. animal. provided subnatio agriculture, and environmental nal sectors. Activity_1.:_5.3 Conduct research AMR/AMU across the sectors to understand the drivers fo_r: AMR/AMU and use for policy formulation 2.5.3.1 Develop continuous AMR Workshop 5 Number of AMR TWG X X X X X National related research proposals with proposals and one health approach in response to developed subnatio cals . nal 2.5.3.2 Advocate for academic Workshop 2 Number of AMR TWG x x National institutional research on AMR academic and research studies subnatio conducted on nal AMR Activity 2.5.4 Establish platform (conference or symposium) for regular information sharing n antimic:_robial resistan resea ch. 2.5.4.1 Organize AMR research Workshop 4 Number of AMR TWG X X X x National finding communication workshop dissemination and for AMR stakeholders platform subnatio nal - Strategic Objective 3: Reduce the incidence of infection through effective sanitation, hygiene, and infection prevention measures. Strategic intervention 3.1: Strengthen infection prevention and Control (IPC) program in hea th care settings. Sub-activity Unit Quanti Indicator Responsible Timelines inyears lmpleme Cost ty entity YR l YR2 YR3 YR4 YRS ntation level Activity 3.1.1 Conduct advocacy and sensitization on national IPC policy and Strategic Plan for relevant stakeholders -- - ---- - - - 3.1.1.1 Conduct orientation Workshop 3 Number of MOH/IPC X National workshop for facility and county advocacy TWG/AMR and IPC focal persons on IPC policy workshops TWG subnatio and Strategic Plan nal 3.1.1.2 Orientate allhealthcare Workshop 5 Number of MOH/IPC x National workers at each facility on the Advocacy TWG/AMR and national IPC policy and Strategic workshop TWG subnatio Plan nal % Facilities MOH/IPC x x x x National 3.1.1.3 Monitor implementation of Facilities implemented TWG/AMR and the National IPC policy and National IPC policy TWG subnatio Strategic Plan at health facilities and Strategic Plan nal Activity 3.1.? Strengthen the availability of IPC related equipment, PPE, s pplies, utilities (water supply) an:J 51uidelines 3 .1.2.1 Support provision of Facilities 20 % Facilities with ONE HEALTH X X x x National adequate and appropriately adequate water SC/IPC and maintained water, sanitation, and and sanitation TWG/AMR subnatio health care waste management TWG nal facilities 3.1.2 .2 Train professional on Training 4 Number of ONE HEALTH x x x National appropriate use of IPC equipment, trainings provided SC/IPC and supplies and utilities TWG/AMR subnatio TWG nal 1.lu I - Activity 3.1.3 Develop, and disseminate IPC training manuals, SOPs, and IEC materials to all health professionals 3.1.3.1 Develop IPC training Manual 1 Number of ONE HEALTH I x National manual and SOPs and SOPs manuals and SOPs SC/IPC developed and TWG/AMR I reviewed TWG - 3.1.3.2 Develop IPC Information, IEC 10000 Number of ONE HEALTH I I x National I Education and communication materials IEC materials SC/IPC (IEC) & behavioral change Developed TWG/AMR communication materials (BCC TWG materials) 3.1.3.3 Organize IPC Training of · Training 2 Number TOT ONE HEALTH x x National Trainers (TOT) training for training provided SC/IPC and professionals I TWG/AMR subnatio I TWG nal Activity 3.1.4 Conduct sensitization campaigns to promote personal and phytosanitary hygiene. - - 3.1.4.lOrganize community Awareness 2 Number awareness ONE HEALTH x x x x National handwashing awareness meeting meetings meetings with SC/IPC and with key stakeholders stakeholders TWG/AMR subnatio TWG nal 3.1.4.2 Celebrate global Schools 4 Number of schools ONE HEALTH x x x x National handwashing day in schools by celebrating global SC/IPC and holding special program handwashing day TWG/AMR subnatio TWG/PARTNER nal s 3.1.4.2 Conduct sensitization Campaign 10 Number of ONE HEALTH x x x x x National campaign to promote personal (2/Year campaigns SC/IPC and phytosanitary hygiene in the ) conducted TWG/AMR subnatio community TWG/PARTNER nal s - Strategic intervention 3.2 Prevent and monitor health care-associated infections at human and veterinary health facilities Activity 3.2.1Conduct health care-associated infections survey at the health facilities 3.2.1.1 Organize a meeting to Meeting 1 Validated tool for ONE HEALTH x National develop a survey tool to conduct the survey SC/IPC health care-associated infections TWG/AMR TWG/PARTNER s 3.2.1.2 Conduct an assessment on Assess men 1 Assessment report ONE HEALTH x National health care-associated infections in t SC/IPC and facilities TWG/AMR subnatio TWG/PARTNER nal s Activityi 3.2.2Jmplement health care-asso iated j!::!_fection prevention measures 3.2.2.1 Provide training for health Training 5 Number of ONE HEALTH x x x National professionals on health care- trainings SC/IPC and associated infection prevention TWG/AMR subnatio measures TWG/PARTNER nal s 3.2.2.2 Regular onsite support for Onsite 2/year Number of onsite ONE HEALTH x x x National facilities to implement HCAls support supports SC/IPC and prevention measures conducted TWG/AMR subnatio TWG/PARTNER nal s Strat eg ic intervention 3.3 Accelerate Vaccination Campai gns to enhance prevent ion and control of disea se s and infections in human and animalhealth Activity 3.3.1 Conduct Vaccination Campaign for various health threats 3.3.1.1 Organize a workshop to Workshop 2 Availability of ONE HEALTH x National review the existing vaccination reviewed programs SC/IPC TWG/AMR -programs in animal and human health TWG/PARTNER s 3.3.1.2 Organize sensitization Sensitizatio 4 Number of ONE HEALTH x x x x National meetings for relevant stakeholders n meetings sensitization SC/IPC and on the use of Preventive meetings TWG/AMR subnatio medication (Vaccines) . TWG/PARTNER nal I s 3.3.1.3 Conduct Vaccination Vaccinatio 4 Number of ONE HEALTH x x x x National Campaign for various health n campaigns SC/IPC and threats campaigns TWG/AMR subnatio conducted TWG/PARTNER nal s Activity 3.2.2 Capacitate Professionals on prevention and control of diseases in human and animal ---- 3.2.2.1Conduct training to Training 5 Number training ONE HEALTH x x x x National capacitate professionals on provided SC/IPC and prevention and control of diseases TWG/AMR subnatio in human and animal TWG/PARTNER nal s Strategic intervention 3.4 Strengthen waste management systems in the health, agriculture, and environment se ct ors and communities . ---· - - ------- - --- - ----- - ----- - ! Activity 3.4.1Develop a comprehensive guideline of waste management system across the sectors -- - - - 3.4.1.1 Develop a comprehensive Guideline 1 Comprehensive ONE HEALTH x National guideline for waste management waste SC/AMR management TWG/PARTNER guideline in place s 3.4.1.2 Print and distribute waste Guideline 1000 Number of waste ONE HEALTH x National management guideline management SC/AMR and guidelines TWG/PARTNER subnatio distributed s nal Activity 3.4.2 Conduct regular health promotion activities to advocate personal hygiene and environmental sanitation . - 3.4.2.1 Assess knowledge attitude and practice of hand and Assess men t 1 Availability of KAP findings with ONE HEALTH SC/AMR x National and phytosanitary hygiene and recommendations TWG/PARTNER subnatio environmental sanitation in S/ACADEMIA nal different social groups of the community as wellas in animal, plant and fishery and workers. 3.4.2.2 Develop promotional Promotion 10000 Number and type ONE HEALTH x National materials based on the KAP al of promotional SC/AMR findings materials materials TWG/PARTNER (Flyers developed s Brochures) 3.4.2.3 Conduct continuous Campaigns 1/year Number of ONE HEALTH x x x National campaigns on personal hygiene campaigns SC/AMR and and environmental sanitation for conducted TWG/PARTNER subnatio allsectors. s nal Activity 3.4.3 Promote and enforce hazardous waste management in health facilities - - - 3.4.3 . 1Promote and enforce Health 20 Percentage of HF ONE HEALTH x x x x National health facilities to have functional facilities with functional and SC/AMR and incinerator, refuse pits and solid proper TWG/PARTNER subnatio waste colection bins solid waste s nal management 3.4.3 .2 Promote and enforce Health 20 Percentage of HF ONE HEALTH x x x x National hazardous waste management in facilities with functional and SC/AMR and health facilities proper TWG/PARTNER subnatio hazardous waste s nal management 3.4.3.3 Conduct awareness Campaign 3 Number of ONE HEALTH x x x x National campaign for waste segregation campaigns SC/AMR and and disposal conducted TWG/PARTNER subnatio s nal - 3.4.3.4 Organize a workshop to develop a tool to monitor Workshop 2 Availability of finalized tool ONE HEALTH SC/AMR x x National and ,. ' .. emerging polutants TWG/PARTNER subnatio s nal Strategic intervention 3.5 Strengthen Water , Sanitation, and Hygiene (WASH) services Activity 3.5.1 Support and enforce human and animal health facilities to provide functional handwashing and bathing facility for staff and patients 3.5.1.1 Organize onsite support to Onsite 5 Percentage of HF ONE HEALTH x x x National enforce human and animal health support having functional SC/AMR and I facilities to provide functional bathing TWG/PARTNER subnatio handwashing and bathing facility I facility for staff and s nal for staff and patients patients Activity 3.5.2 Support facilities to prepare and dispense alcohol-based hand sanitizer I 3.5.2.1 Orient facility staff on how Orientation 1 Number of ONE HEALTH x National to prepare and dispense alcohol- meeting meetings SC/AMR and based hand sanitizers conducted TWG/PARTNER subnatio s nal 3.5.2.2 Support facilities to prepare Onsite 4 Number of onsite ONE HEALTH x x x National and dispense support supports SC/AMR and alcohol-based hand sanitizer TWG/PARTNER subnatio s nal Strategic interventions 3.6 Strengthen good husbandry practices and bio-security interventions in animal husbandry, plant, and fishery sectors. Activity 3.6.1_5 onduct assessment of knowledge, .attitudes, behavior, and practices on good husbandry practice 3.6.1.1 Assess KAP on good Survey 1 Number of KAP ONE HEALTH x National husbandry practice assessment SC/AMR and conducted TWG/PARTNER subnatio s nal - 3.6.1.2 Organize a workshop to disseminate KAP assessment Work shop 1 Validation workshop and ONE HEALTH SC/AMR x National and findings proceedings TWG/PARTNER subnatio s nal Activity 3.6.2 Develop guidelines on good bio-security measures in animal husbandry, plant health, crop production, and fishery sectors. 3.6.2.1 Review and develop/adapt Guideline 1 Validated ONE HEALTH X National guideline on good biosecurity guideline, SC/AMR and measures in animal husbandry, TWG/PARTNER subnatio plant, and fishery sectors . s nal 3.6.2.2 Organize a sensitization Sensitizatio 3 Number of ONE HEALTH x x National meeting for AMR stakeholders on n Sensitization SC/AMR and good biosecurity measure workshop workshops TWG/PARTNER subnatio guideline s nal Activity 3.6.3 Train human and animal health workers on the biosecurity guidelines 3.6.3. 1Conduct TOT training for TOT 3 Number of TOT ONE HEALTH x x x National plant, fishery, and animal training training provided SC/AMR and professionals on the guidelines. TWG/PARTNER subnatio s nal 3.6.3.2 Conduct regular monitoring Onsite 5 Monitoring reports ONE HEALTH x x x National of good animal husbandry and monitoring SC/AMR and biosecurity activities in animal TWG/PARTNER subnatio husbandry, plant, and fishery. s nal Activity 3.6.4 Develop bio-risk guidelines for animal feed processing and poultry, dairy and beef production, food handlers and traders 3.6.4.1 Conduct bio-risk Survey 1 Survey report ONE HEALTH X National assessment SC/AMR and TWG/PARTNER subnatio s nal 3.6.4.2 Develop bio-risk guideline Guideline 1 Guideline ONE HEALTH x National developed SC/AMR . - TWG/PARTNER s I ' 3.6.4.3 Organize a meeting to Meeting 3 Number of ONE HEALTH x x National disseminate bio-risk guideline for dissemination SC/AMR and relevant stakeholders meetings TWG/PARTNER subnatio s nal Strategic Objective 4: Optimize the use of antimicrobial agents in human, animal and plant health. Strategic intervention 4.1 Establish antimicrobial stewardshi p program for selected facilities Sub-activity Unit Quanti Indicator Responsible Timelines in years lmpleme Cost ty entity YR! YR2 YR3 YR4 YR S ntation level Activity 4.1.1 Develop and disseminate antimicrobial stewardship policy 4.1.1.1 Organize a stakeholder Working 1 Number of working MoH. ML&F, x National workshop to develop the Manual manuals developed MWC&T, ONE antimicrobial stewardship policy. HEALTH SC 4.1.1.2. Print and disseminate the Printed 300 Number of copies MoH. ML&F. x National stewardship policy for health copies printed MWC&T, ONE and facilities HEALTH SC subnatio nal Activity 4.1.2 Institutionalize antimicrobial stewardship in healthcare facilities 4.1.2.1Conduct ASP sensitization Sensitizatio 3 Number of ASP MoH, ML&F. x x x National workshop for health facility n meeting sensitization MWC&T. and managers at allLevels : meetings subnatio nal 4.1.2.2 Ensure antimicrobial Health 20 Number of facilities MoH, ML&F. x x x x National stewardship as one of health care facilities with functional MWC&T. and ASP - facility managements' quality improvement parameters subnatio nal Activity 4.1.3 Provide training on antimicrobial stewardship program 4.1.3.1 Develop integrated Manual 1 Approved training MoH/AMR TWG/ x National Antimicrobial Stewardship manual ONE HEALTH SC program training manual 4. 1.3.2 Organize TOT training for TOT 2 Number of ASP MoH/AMR TWG/ x x National selected antimicrobial stewardship training team trained ONE HEALTH SC and program team members subnatio nal 4.1.3.3 Provide ASP cascading Training 6 Number of MoH/AMR TWG x x x x National training for the Antimicrobial professional and Stewardship and the Drug and trained subnatio Therapeutic Committees and other nal professionals Activity 4.1.4 Conduct point prevalence survey on antibiotic use in Hospitals 4.1.4.1Organize a technical Meeting 1 Final survey tool MoH/AMR TWG x National meeting to adapt point prevalence survey tool 4.1.4.2 Conduct the point Survey 1 Survey findings MoH/AMR TWG x National prevalence survey and subnatio nal Strategic intervention 4.2 Ensure optimal prescribing, dispensing and use of antimicrobials in human Activity 4.2.1Facilitate continued education and training to promote responsible prescribing and dispensing practices. 4.2.1.1Conduct a needs Assessmen 1 Need assessments MoH/AMR X National assessment to inform AMR related t findings TWG/Partners CMEs trainings for relevant professionals - 4.2.1.2 Conduct regular CMEs and training for health professionals CMEs and trainings 3/year Number of CMEs and training MoH/AMR TWG/Partners x x x National and ". organized subnatio nal Activity 4.2.2 Review and disseminate STGs/EML based on antimicrobial resistance data and incorporate AWaRe classification of antibiotics - - - - - 4.2.2.1Review STG/EML based on STG 1 Updated STGs/EML MoH/Partners X X National the AMR data available. DFCA/NBS/ and Academia subnatio - - nal 4.2.2.2 Conduct stakeholders' Workshop 1 Validation MoH/Partners x X National validation meeting on the revised workshop DFCA/NBS/ and STG/EML proceedings Academia subnatio nal 4.2.2.3 Printing of the updated Number of 300 Number of copies MoH/Partners x x National STG/EML copies printed DFCA/NBS/ Academia 4.2.2.4 Dissemination of STG/EML Workshop 3 Number of copies MoH/AMR x x National disseminated TWG/Partners and subnatio nal 1 4.2.2.5 Provide orientation for Orientation 5 Number of MoH/AMR x x National health professionals on AWaRe workshop orientation TWG/Partners and categorization of antibiotics workshops subnatio nal Activity 4.2.3 Develop Antimicrobial prescribing and dispensing manuals 4.2.3.1Organize a workshop to Workshop 2 Draft prescribing MoH/Partners x National develop manual for antimicrobial and dispensing /DFCA &Sub prescribing and dispensing, manual national .. 4.2.3.2 Conduct stakeholders . Workshop 1 Validated manual MoH/Partners x National validation /DFCA &Sub meeting on the manual national 4.2.3 .3 Printing and dissemination Number of 500 Number of copies MoH/Partners x National of manuals copies printed /DFCA &Sub national 4. 2.3.4 Training of prescribers and Training 6 Number of MoH/Partner s x x x x National dispensers on the professionals /DFCA &Sub trained on the national manual Activity 4.2.4 Strengthen supervision of prescribing and dispensing outlets - - 4.2.4.1 Develop a tool for more Tool 1 Finalized tool MoH/DFCA/Partn x National efficient supervision and ers & Sub monitoring of healthcare facilities national and pharmacies/drug stores 4.2 .4.2 Train professional councils Training 5 Number of MoH/DFCA/Partn x National and Licensing organs on Licensing bodies ers & supervision and monitoring and professional Subnatio dispensing outlets councils trained nal Strategic inte rvention 4.3 Strengthen antimic robialuse and consumption surveillance in human, animal, and plants Activity 4.3.1Conduct antimicrobial use and consumption surveilance at the national Level and contribute data at global Level 4.3.1.1Conduct survey on Survey 1/year Number surveys MoH/MWC& T/ML x National antimicrobial consumption in F & Sub humans and animal population national 4.3. 1.2 Regular reporting of AMR Report 1/year Number of reports AMR TWG x x x x x National data through GLASS AMC submitted - .. '.j ' Strategic intervention 4.4 Prudent Use of Antimicrobial s in Agriculture and Veterinary Medicine Activity 4.4.1Develop and disseminate prescription guidelines, veterinary standard treatment guidelines and formulary for improving appropriate use of antimicrobials in agriculture and veterinary medicine - - - 4.4.1.1 Develop Prescribing ' 1 Availability of One health x National Prescribing/treatment guidelines in /treatment Prescribing/treatme SC/Academia animals and plants guideline nt guideline 4.4.1.2 Print and distribute the Copies of 500 Number of copies One health SC x x National guidelines the & Sub guideline National 4.4.1.3 Organize training for Training 5 Number of trained MAFS/MOH/MLF/ x x x National veterinary and agriculture professionals Academia & Sub professionals on National prescription/treatment guidelines Activity 4.4.2 Restrict use of antimicrobials as growth promoters or as feed additives r -- - - - 4.4.2.1 Conduct a risk assessment Assessmen 1 Assessment report j One -Health Multi-- - x - - National on the use of growth promoters t Sectoral Steering & Sub and use of antimicrobial agents as committee national feed additives - - 4.4.2.2 Develop regulation or Guidelines 1 Guideline One Health Multi- x National guidelines on the use of growth developed Sectoral Steering promoters and antimicrobial committee agents as feed additives. r 4.4.2.3 Print and distribute the Copies of 1000 Number of copies One Health Multi- x I x National regulation/guidelines on growth guidelines of guidelines Sectoral Steering promoters and feed additives . printed and committee disseminate 4.4.2.4 Sensitize farmers /animal Sensitizatio 10 Number of One Health Multi- x x x x National health professionals and feed n sensitization Sectoral Steering & Sub importers/producers on growth workshop workshop committee National I promoters. .. Activity 4.4.3 Develop antimicrobial stewardship guidelines for animal health facilities 4.4.3.1 Develop antimicrobial Guideline 1 Guideline MAFS/MOH/MLF/ x National stewardship guidelines for animal developed Academia/partner health s 4.4. 3.2 Print and disseminate Copies of 1000 Number of copies MAFS/MOH/MLF/ x National antimicrobial stewardship guidelines produced Academia/partner & Sub guidelines for animal health s National 4.4.3 .3 Train veterinary Training 5 Number of MAFS/MLF/Acade x x x National professionals on antimicrobial professionals mia/partners & Sub stewardship program in both trained National public and private sector. Activity 4.4.4 Implement antimicrobial stewardship in selected animal health facilities 4.4. 4.1 Conduct need assessment Assess men 1 Assessment MAFS/MLF/Ac ade x National on AMS program in veterinary t findings mia/pa rtners & Sub sector National 4.4.4.2 Implement AMS in selected Health 10 Number of HF MAFS/MLF/Acade x x x National public and private animal health facilities implementing mia/partners &Sub facilities antimicrobial National stewardship Strategic intervention 4.5 Develop and enforce legis lation on pr es criJ>tions for combating AMR in human, animal and plant .. : Activity 4.5.1 Conduct a situational analysis of the existing regulations/legislations and their enforcement on antimicrobial use 4.5.1.1 Review the existing Situational 1 SA with gaps and One Health SC x National regulation on prescription of analysis recommendations DFCA antimicrobial use/consumption . 4. 5.1.2 Conduct stakeholder Workshop 1 Validation One Health SC x National validation meeting of the workshop /DFCA situational analysis proceedings - Activity 4.5.2 Develop Legislation/regulation on prescription and sale of antimicrobials for human, animal and plant - - 4.5.2.1Develop --- Regulation 1 - - Regulation/Legislati MoH/One health X National 6I •'\ I Legislation/regulation on /Legislation on developed SC/Academia/ prescriptions and sale of document DFCA/NBS antimicrobial agents in human, animal and plant use 4.5.2.2 Conduct stakeholders Workshop 1 Popularization MoH/One health x x National meeting to popularize regulations workshop SC/Academia/ &subnati of prescriptions and sale of proceedings DFCA/NBS onal antimicrobials in human and animal health/sector Activity 4.5.3 Conduct supervision of pharmacies and ensure adherence to good pharmacy practices - - - -- - ---- 4.5.3.1 Conduct inspection of Inspection Quarter x x x x National Number of DFCA/MoH &subnati pharmacies and establish Ly pharmacies onal compliance of over-the-counter inspected medication 4.5.3.2 Enforce regulation Report Quarter Number of DFCA/MoH x x x x National and compliance to over-the- Ly pharmacies &Sub counter medication national Strategic intervention 4.6 Ensure an effective supply chain management of quality essential antimicrobials and laboratory supplies Activity 4.6.1 Advocate inclusion of priority antimicrobials and Laboratory supplies in the Long-term procurement agreement with government/non-government suppliers 4.6.1.1 Assess prioritization Assessmen 1 Assessment report DFCA/MoH/MA&F x National of essential antimicrobials and t S/AMR TWG Laboratory supplies in the government and non- government procurement List for human and animal health sectors .. 4.6.1.2 Advocate inclusion Long term Continu Antimicrobial and MoH/PARTNERS x x x National of priority antimicrobials and agreement ous Laboratory supplies Laboratory supplies in included in the government Long-term suppliers' Long- procurement agreements and/or term procurement non-government suppliers agreements Strategic Objective 5: Develop the economic case for sustaina ble investment that takes accou nt of the national needs and increase investment in new medicines, diagnostic tools, vacci nes, and other interventions. Strategic intervention 5.1Strengthen the governance and multisectoral coordination for su stainable i m plementatio n of AM R NAP. Sub-activity U nit Qua nti I nd icator Responsi ble Timeli nes i n yea rs lm pleme Cost ty entity YR l YR2 YR3 YR4 YRS ntation level Activity 5.1.1 Establish and strengthen national AMR multisectoral steering committee, national AMR secretariat, and TWGs 5.1.1.1 Define membership and TOR 1 Approved TOR AMR TWG X National approve TOR for the AMR multisectoral steering committee, national AMR secretariat 5.1.1.2 Define membership and TOR 1per Approved TOR AMR TWG x National approve TORs for AMR six- TWG Technical Working Groups 5.1.1.3 Organize AMR sensitization Workshop 2 Workshop AMR TWG x x National workshop for the TWGs proceedings 5.1.1.3 Organize regular quarterly Meeting 3/year Meeting report AMR TWG x x x x x National meeting for NAP implementation review - Activity 5.1.2 Establish and Strengthen AMR secretariat at the national Level (human resources, materials, finances , structures , etc.) -- 5.1.2.1 Establish an office for AMR 1 National AMR TWG X National .:I ' National AMR coordination dedicated AMR office Office established 5.1.2.2 Recruit competent and AMR staff 3 HR reports with AMR x x National experienced AMR Staff TWG/Partners personnel to facilitate AMR recruitment coordination Activity 5.1.3 Establish focal points for human. animal, plant. water, sanitation, hygiene, waste and wastewater management at different Levels. 5.1.3.1Nominate AMR Focal AMR focal 1per Appointment AMR TWG X National Persons across allthe sectors person sector Letters with and (human, animal, agriculture, and To Rs subnatio environment) nal Activity 5.1.4 Organize annual joint review meetings on the implementation of the AMR NAP operational plan 5.1.4.1Organize biannual Coordinati 2 Meeting AMR TWG x x x x x National AMR coordination meeting to on meeting proceedings and review AMR NAP implementation subnatio nal Strategic intervention 5.2 Ensure availability of sustainable resources to support AMR interventions Activity 5.2.1 Develop resource mobilization strategies to support AMR interventions - - 5.2.1.1 Organize a multisectoral Workshop 1 Availability of AMR TWG x National meeting to develop resource strategy mobilization strategy 5.2.1.2 Disseminate the strategy to Workshop 1 Dissemination AMR TWG x National relevant AMR stakeholders report and subnatio nal - Activity 5.2.2 Identify and engage Local and international funding agencies to support AMR interventions 5.2.2.1Map and identify allAMR Workshop 2 List of AMR AMR TWG X x National funding agencies in the country funding agencies & Sub- national 5.2.2 .2 Engage stakeholders to Workshop 2 List of AMR AMR TWG x x National document their areas of NAP-AMR activities with & Sub- implementation and their supports funding source national Strategic intervention 5.3 Determine the economic impact of AMR in South Sudan Activity: 5.3.1 Conduct economic evaluation to determine expenditures for treatment of infectious disease in the country 5.3.1.1 Organize a meeting to Workshop 2 Protocol in place AMR TWG X x National develop a protocol for the economic evaluation 5.3.1.2 Collect data across the Field work 2 Field work report AMR TWG x x National country to study the economic & Sub- impact of AMR in SSD national 5.3.1.3 Organize a workshop to Workshop 2 Economic AMR TWG x x National perform data analysis and report evaluation report writing Strategic intervention 5.4 Promote public-private partnerships on a".'timicrobial resistance prevention and containment Activity 5.4.1Develop public-private partnership framework on antimicrobial resistance 5.4.1.1 Engage all relevant AMR Workshop 1 PPP framework AMR TWG x National stakeholders to develop Public developed & sub- Private Partnership (PPP) national framework - .;:) ., ' 5.4.1.2 Disseminate the PPP Workshop 2 Dissemination AMR TWG x National framework for allrelevant report & sub- stakeholders national Activity 5.4.2 Conduct regular advocacy platforms to engage the private sector on antimicrobial resistance 5.4.2.1 Identify relevant AMR Workshop 1 List of relevant AMR TWG x National stakeholder from the private sector private stakeholders 5.4.2.2 Organize regular advocacy Workshop 5 Number of AMR TWG x National workshop workshops & sub- national Strategic intervention 5.5 Promote Innovation in the Search for Alternative Treatments and Drug Development Activity 5.5.1 Support academia and other researchers in product development including application of traditional and indigenous knowledge. - - - 5.5.1.1 Provide seed funding for Proposal 10 Number of AMR TWG X X National proposal development in product proposals funded development and indigenous knowledge on antimicrobial solutions 5.5.1.2 Establish and promote MOU 3 Number of MOU AMR TWG x x National regional and international signed signed colaboration for AMR R&D Activity 5.5.2 Advocate for Multi-sectoral collaboration for research on alternative medicines in var ious aspects of antimicrobial use and resistance in humans, animals, and plants 5.5.2.1 Sensitize relevant Workshop 2 Number of AMR TWG x x National stakeholders to mobilize resources sensitization & sub- required for research on alternative workshop national medicines 5.5.2.2 Carry out a country-wide Survey 1 Survey report AMR TWG x x National survey of indigenous knowledge & sub- on antimicrobial solutions national - 6. COSTED OPER ATIONAL PLAN The South Sudan AMR NAP was costed using the WHO Costing and Budgeting Tool for AMR NAPs. Prioritization of activities in the Operational Plan were conducted and costed all the 172 Sub activities across the five strategic objectives and, lead agencies and implementers. The total budget for the AMR NAP 5-year operational plan was USO 11,923,921; a detailed breakdown of the costed document to activity-Level costs for each strategic intervention is also found on Annex II and here. 1. LEAD AGENCY STRATEGIC OBJECTIVE MoE MOH MLF MWC&T Total Strategic Objective 1: Improve awareness and understanding of antimicrobial resistance through effective communication, 224,132 1,757,608 714,975 8,995 2,705,710 education, and training Strategic Objective 2: Strengthen the knowledge and evidence 274,455 3,486,468 598,278 153,381 4,512,581 base through surveillance and research Strategic Objective 3: Reduce the incidence of infection through 174,297 728,609 519,476 37,859 1,460,242 effective sanitation, hygiene, and infection prevention measures. Strategic Objective 4: Optimize the use of antimicrobial 16,380 804,909 541,204 1,362,493 medicines in human and animal health. Strategic Objective 5: Develop the economic case for sustainable investment that takes account of the national needs and increase 81,592 1,425,860 293,852 81,592 1,882,895 investment in new medicines, diagnostic tools, vacci nes, and other interventions. Total 770,855 8,203,454 2,667,785 281,826 11,923,921 - Tota l budget: USD 11,923,921, ·1 ''.. Distribution of Costs Across Lead Distribution of Costs Across Lead Agencies/Implementers Agencies/Implementers MWC&T 1281 ,826 MLF 2,667,785 MOH 8,203,454 MoE 770,855 •MoE •MOH •MLF • MWC&T - 7. MONITOR ING AND EVALUATION PLAN The goal of the AMR National Action Plan M&E plan is to establish a system that is robust, comprehensive, fully integrated, and well-coordinated to guide monitoring of the implementation of the AMR NAP and evaluate impact. It also provides a strategic Link with the relevant stakeholders to ensure that strategies are effective in responding to the antimicrobial resistance threats in South Sudan. Moreover, it enables problems to be detected early, thereby reducing the Likelihood of major cost overruns or time delays and related health outcomes. Monitoring should take place bi-annually and be Led by AMR TWG. Evaluation of the implementation of the NAP AMR should take place at halfway through the timeframe (last quarter of 2025) and at the end of Year 5 (mid - 2028). The indicator framework provides a List of indicators at output, outcome and Impact Level selected by the stakeholders to track progress towards implementation of Strategic Objectives, Strategic interventions, key activities, and underlying sub activities . cu E 0 :J 0 CJ) cu • ·t>- +i • <( • --' Q) "'tJ 0 2 u ·- C'l 0 ...J I - 7.2. Key performance indicators Baseline information and data is missing for the majority of indicators on the table below. Hence, it is proposed that each of the AMR Technical Working Groups willcollect baseline data and set targets for 2023-2028 A MR NAP implementation period. Increased A wareness and understanding Level on Outcome Survey report 2-3 years antimicrobial resistance among humans, animals, and environment health professionals Percentage of schools implementing curricula that Output Survey report 5 years includes AMR and related topics Number of advocacy workshops created on Output Institutional report Annualy antimicrobial resistance for policymakers Number of antimicrobial resistance trainings for Output AMR TWG report Annualy media professionals /Institutional report - Strategic Objective 2: Strengthen the knowledge and evidence base through surveillance and research. Number oflaboratories included in the national AMR surveillance system to detect and report Output NPHL report/AMR TWG report Annualy ·1 ..... -t I antimicrobial resistance in human sectors Number of laboratories included in the national AMR Output One Health Annualy surveil ance system to detect and report SC/AMR TWG antimicrobial resistance in the animal sector - Number of AMR data submitted to WHO-GLASS Output AMR TWG Annualy report/Surveillance I report Percentage of bloodstream infections due to Outcome Published 3-5 years methicillin-resistant staphylococcus aureus and surveillance extended spectrum beta-lactamase I reports E. coli among patients seeking care and blood I I sampled Number of humans, animal, and environment Labs Output Admin report Annual y with a standard quality management system Total number research studies on antimicrobial Output Published Annual y resistance Literatures - Strategic Objective 3: Reduce the incidence of infection through effe ctive s anitat ion, hygiene, and infection prevention measures. Proportion of health care facilities with quality water Outcome Survey report Annually supply and sanitation facilities Decreased rate of health care-associated infections Outcome Survey report 3- 5 years Percentage of HF with functional and proper Outcome Survey report Biannualy hazardous waste management system Availability of guideline on good biosecurity Output One Health Biannualy measures in animal husbandry, plant, and fishery SC/AMR TWG sectors. report Number of school campaigns conducted to promote Output One Health Annualy personal hygiene SC/AMR TWG report St rateg ic Objective 4: Optimize the u se of a ntimicrobi almedicines in human and animal health. .. ·} '• . '\ . •. ... : Number of human and animal health care facilities Output Facility report Annually implementing antimicrobial stewardship program Percentage of adherence to standard treatment Outcome Survey report Biannual y guidelines in health facilities Number of Antimicrobial consumption (AMC) data Output AMR TWG Annualy submitted to WHO-GLASS report/Surveillance report - ,_, 'J Percentage of a ntibiotic consu m ption from ACCESS Outcome Hea lth facility Bia n n ua lly grou p i n h u ma n report/Su rvey Ava i la bi lity of veteri na ry sta nda rd treatment Output One Hea lth 3-5 yea rs g uideli nes SC/AM R TWG report/i nstitutional report Avai la bi lity of Legislation/reg u lation on prescri ptions Output One Hea lth Bia n n ua lly a nd sale of a nti microbia l agents i n h u ma n a nd SC/AM R TWG a nima ls report Strategic Objective 5: Develop the economic case for sustainable investment that takes account of the national needs and increase investment in new medicines, diagnostic tools, vaccines, and other interventions. Fu nctiona l m u lti-sectora l AM R TWGs at nationa l Outcome AM R TWG An n ua lly Level for sustaina ble AM R NAP im plementation report/One Health SC report Ava ila bi lity of f u nds for the im plementation of the Output Responsi ble An n ua lly A M R N ationa l action pla n mi nistries Ava i la bi lity of nationa l d ata that estimates the Output Resea rch f i nd i ng 3-5 yea r economic i m pact of antimicrobial resista nce i n a ll releva nt sectors I ncreased h u ma n resou rce ca pacity i n R& D O utcome A M R TWG Bia n n ua l - 8. R EFER ENCES 1. World Health Organization. ( 2020) . Antibiotic resistance. World Health Orga nization. Retrieved April 30, 2023, from https://www .who .int/news- room/fact-sheets/detail/antib iotic-resistance 2. Antimicrobial Resistance Collaborators (2022) . Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis . Lancet (London, Eng land), 399(10325). 629-655.https://doi .org/10.1016/SO 140-6736( 21)02724 -0 3. J onas.Olga B.; Irwin, Alec; Berthe.Franck Cesar Jean; Le Ga ll.Francois G.; Marquez.Patricio V ..Drug-resistant infections : a threat to our economic future (Vol. 2) : final report (English). HNP/Agriculture Global Antimicrobial Resistance Initiative Wa shington. D.C. : World Bank Group. http://documents .wo rldbank .org/curated/en/32331 14933969937 58/final- repor 4. World Health Organization. (2015) . Global action plan on antimicrobial resistance. World Health Organization. https:ljapps.who .int/iris/handle/10665/ 193736 5. World Health Organization Annual Report (2021) , South Sudan 6. Otim ME, Demaya DK. AL Marzouqi A. Mukasa J. Are Antibiotics Prescribed to Inpatients According to Recommended Standard Guidelines in South Sudan? A R etrospective Cross-Sectional Study in Juba Teaching Hospital. J Multidiscip Healthc. 2021Oct 13; 14:2871-2879. doi: 10.2147/JMDH.53 21990 PMID: 34675535; PMCID: PMC8522334. 7. World Health Organization ( 2017) . Joint external evaluation of IHE core capacities of the mission report republic of South Sudan 15-20 October 2017. https://www.afro .who .int/publications/south - sudan- j oint-external-evaluation- report2018 8. South Sudan National Action Plan for Health Security - 2020 - 2024 9. UNEP ( 2023) : To reduce antimicrobia lresistance. world must cut down pollution. Image.https://wedocs.u nep.org/bitst rea m/ha ndLe/20 .500.118 2 2/383 7 3/a ntimicrob al R.pdf 10. Photo 2. CIDRAP (2022). Antimicrobial resistance far deadlier than thought, study finds. Image. Retrieved from: https://www .cidrap.umn .edu/antimicrobial- stewardship/antimicrobial - resistance-far-deadlier-thought-study -f inds 9. A N N EX

Annex I: Participants from Stakeholders Meeting a nd AMR NAP Development Work shops I f S •d" lr, Ii I I • [ I I .i1ti1 11-.:r 01 [ l ,1 - I ' 3 - Annex II: Elaborated Summary of Cost of Activities and Lead Agency/ Implementer (2023 - 2028) STRATEGIC OBJECTIVE Strategic Objective 1: Improve awareness and understanding of antimicrobial 224,132 1,757,608 714,975 8,995 2,705,710 resistance through effective communication, education, and training Strategic Intervention 1.1: Improve awareness and understanding of AMR in the 7,688 1,031,276 206,373 8,995 1,254,332 various groups of the general population Activity 1.1.1: Conduct baseline survey to assess knowledge, attitudes and behavioral practice about AMU and AMR among 302,876 302,876 professionals and community in human health, animal health, agriculture, and the environment to guide training and education Activity 1.1.2: Develop and disseminate a comprehensive evidence-based national 45,783 45,783 communication strategy for AMR Activity 1.1.3: Develop and disseminate IEC materials in the local context and language for 366,343 366,343 diverse stakeholders in human, animal, and environmental health sectors Activity 1.1.4: Conduct regular antimicrobial resistance awareness campaigns including 7,688 316,274 206,373 8,995 539,329 World Antimicrobial Awareness Week (WAAW) Strategic Intervention 1.2: Strengthen education and training on antimicrobial 216,444 519,405 335,210 1,071,059 resistance of human, animal, plant, and environmental health professionals Activity 1.2.1: Advocate the incorporation of antimicrobial resistance courses in 62,827 12,833 75,660 undergraduate and graduate curriculum for relevant stakeholders Activity 1.2.2 : Incorporate AMR and related topics in undergraduate and graduate curriculum 204, 191 105,933 310,124 of human, animal, and environment professionals Activity 1.2.3: Conduct in-service training programs on AMR for human, animal, 216,444 252,386 216,444 685,275 environmental professionals Strategic Intervention 1.3: Enhance engagement of media, civil society organizations, youth groups and opinion 206,928 73,649 280,576 leaders on antimicrobial resistance prevention and control Activity 1.3.1: Provide trainings on antimicrobial resistance for media professionals for the 78,066 78,066 dissemination of AMR key messages to the public Activity 1.3.2: Conduct advocacy workshops on antimicrobial resistance for civil society 128,862 73,649 202,510 organizations, youth groups and opinion leaders •• .. Strategic Intervention 1.4: Strengthen antimicrobial resistance advocacy and 99,744 99,744 communication with policymakers Activity 1.4.1: Conduct advocacy workshops on antimicrobial resistance for policy makers across 99,744 99,744 the human, animal, and environmental sector Strategic Objective 2: Strengthen the knowledge and evidence base through 274,455 3,486,468 598,278 153,381 4,512,581 surveillance and research Strategic Intervention 2.1: Strengthen laboratories capacity to detect and report 2,967,574 498,676 153,381 3,619,631 antimicrobial resistance at all sectors Activity 2.1.1: Assess the capacity of existing 53,593 53,593 laboratories with respect to AMR. Activity 2.1.2: Develop a national guideline for 23,987 23 ,987 AMR surveillance system Activity 2.1.3: Capacitate laboratory 216 ,678 198,740 415,418 professionals on detection and reporting of AMR Activity 2.1.4: Establish antimicrobial resistance active surveillance system in human and animal 77,516 77,516 sector Activity 2.1.5: Procure modern and automated diagnostic equipment and supplies required for 2,595 ,801 299,937 153,381 3,049, 118 AMR detection Strategic Intervention 2.2: Strengthen quality management systems to provide consistent 352,667 352,667 diagnostic standards by all laboratories. Activity 2.2.1: Establish Quality Management System (QMS) for AMR surveillance in the 127,896 127,896 different sectors. Activity 2.2.2: Develop standards operating procedures (SOPs) for laboratory surveillance of AMR in humans and animals, food, agriculture , 121,062 121,062 and environment consistent and harmonized with international standards. Activity 2 .2.3: Establish an internal and external 103,709 103,709 quality assurance system for AMR surveillance . Strategic Intervention 2.3: Establish integrated antimicrobial resistance surveillance system that allows data sharing 71,420 71,420 from human, water, environment, animal and agricultural sectors. Activity 2.3.1: Develop national guidelines and plan for an integrated surveillance systems on 36,534 36,534 AMR Activity 2.3.2: Establish a harmonized database and information sharing system on AMR in 23,595 23,595 human, animal, plant, and environmental health Activity 2.3.3: Establish a joint reporting mechanism on AMR in human, animal, 11,291 11,291 agriculture, and the environmental sectors - Strategic Intervention 2.4: Support Surveillance for Antimicrobial Drug Residues in Food and Environment 191,582 46,530 238,113 ''J Activity 2.4.1 : Strengthen laboratory capacity to carryout antimicrobial residue testing for food 63,271 8,405 71,677 and feed products. Activity 2.4.2: Establish surveillance and research of antimicrobial residues, effluent and 128,311 38,125 166,436 waste in the environment , agriculture, food and feed sectors Strategic Intervention 2.5: Strengthen research capacity on AMR in human, animal, 82,872 94,807 53,071 230,751 agriculture, and environmental health. Activity 2.5.1: Develop an integrated and prioritized research agenda for AMR across all 58,240 58,240 sectors . Activity 2.5.2: Capacitate professionals on basic and operational research in antimicrobial use 53,071 53,071 and resistance. Activity 2.5.3: Conduct research AMR/AMU across the sectors to understand the drivers for 51,393 36,568 87,961 AMR/AMU and use for policy formulation Activity 2.5.4: Establish platform (conference or symposium) for regular information sharing on 31,479 31,479 antimicrobial resistance research. Strategic Objective 3: Reduce the incidence of infection through effective sanitation , 174,297 728,609 519,476 37,859 1,460,242 hygiene, and infection prevention measures. Strategic Intervention 3.1: Strengthen infection prevention and Control (IPC) 389,392 389,392 program in health care settings. Activity 3.1. 1: Conduct advocacy and sensitization on national IPC policy and 177,666 177,666 Strategic Plan for relevant stakeholders Activity 3.1.2: Strengthen the availability of IPC related equipment , PPE, supplies , utilities (water 27,559 27,559 supply) and guidelines Activ ity 3.1.3: Develop, and disseminate IPC training manuals, SOPs, and IEC materials to all 15,210 15,210 health professionals Activity 3.1.4: Conduct sensitization campaigns 168,957 168,957 to promote personal hygiene Strategic Intervention 3.2: Prevent and monitor health care-associated infections at 113,202 98,089 211,292 human and veterinary health facilities Act ivity 3.2.1: Conduct health care-associated 53,935 38,822 92,757 infections survey at the health facilities Activity 3.2.2: Implement health care-associated 59,267 59,267 118,535 infection prevention measures Strategic Intervention 3.3: Accelerate Vaccination Campaigns to enhance 122,760 115,356 238,116 prevention and control of diseases and infections in human and animal health .rm -. Activity 3.3.1: Conduct Vaccination Campaign 82,728 75,324 158,052 for various health threats Activity 3.3.2: Capacitate Professionals on prevention and control of diseases in human and 40,032 40,032 80,064 animal Strategic Intervention 3.4: Strengthen waste management systems in the health, 174,297 58,980 37,859 37,859 308,995 agriculture, and environment sectors and communities. Activity 3.4.1: Develop a comprehensive guideline of waste management system across 38,344 38,344 the sectors Activity 3.4.2 : Conduct regular health promotion activities to advocate personal hygiene and 65,418 19,855 23,230 23,230 131,732 environmental sanitation. Activity 3.4.3 : Promote and enforce hazardous 70,535 39, 126 14,629 14,629 138,918 waste management in health facilities Strategic Intervention 3.5: Strengthen Water, 44,275 11,196 55,471 Sanitation, and Hygiene (WASH) services Activity 3.5.1: Support and enforce human and animal health facilities to provide functional 11,196 11,196 22,392 handwashing and bathing facility for staff and patients Activity 3.5.2: Support facilities to prepare and 33,079 33,079 dispense alcohol-based hand sanitizer Strategic Intervention 3.6: Strengthen good husbandry practices and bio-security 256,976 256,976 interventions in animal husbandry, plant, and fishery sectors. Activity 3.6.1: Conduct assessment of knowledge, attitudes , behavior, and practices on 45 ,836 45 ,836 good husbandry practice Activity 3.6.2: Develop guidelines on good bio- security measures in animal husbandry, plant, 61,523 61,523 and fishery sectors. Activ ity 3.6.3: Train human and animal health 78,980 78,980 workers on the biosecurity guidelines Activity 3.6.4: Develop bio-risk guidelines for animal feed processing and poultry , dairy and 70,637 70,637 beef production, food handlers and traders Strategic Objective 4: Optimize the use of antimicrobial medicines in human and 16,380 804,909 541,204 1,362,493 animal health. Strategic Intervention 4.1: Establish AMR 366,412 366,412 stewardship program for selected facilities Activity 4.1.1: Develop and disseminate 43,016 43,016 antimicrobial stewardship policy Activity 4 .1.2: Institutionalize antimicrobial 117,546 117,546 stewardship in healthcare facilities Activity 4.1.3: Provide training on antimicrobial 101,480 101,480 stewardship program Activity 4.1.4: Conduct point prevalence survey 104,370 104,370 on antibiotic use in Hospitals L) I s J I.I 11 l Cttf , lg ·:..1.. - r - Strategic Intervention 4.2: Ensure optimal prescribing, dispensing and use of 239,396 239,396 antimicrobials in human Activity 4.2.1 : Facilitate continued education and training to promote responsible prescribing and 59,963 59,963 dispensing practices Activity 4.2.2: Review and disseminate STGs based on antimicrobial resistance data and 78,889 78,889 incorporate AWaRe classification of antibiotics Activity 4.2.3: Develop Antimicrobial prescribing 84,969 84,969 and dispensing manuals Activity 4 .2.4: Strengthen supervision of 15,575 15,575 prescribing and dispensing outlets Strategic Intervention 4.3: Strengthen antimicrobial use and consumption 26,055 26,055 52,111 surveillance in human and animal Activity 4.3.1: Conduct antimicrobial use and consumption surveillance at the national level 26,055 26,055 52,111 and contribute data at global level Strategic Intervention 4.4: Prudent Use of Antimicrobials in Agriculture and Veterinary 16,380 391,298 407,678 Medicine Activity 4.4.1: Develop and disseminate prescription guidelines, veterinary standard treatment guidelines and formulary for improving 16,380 133,850 150,230 appropriate use of antimicrobials in agriculture and veterinary medicine Activity 4.4.2: Restrict use of antimicrobials as 124,132 124,132 growth promoters or as feed additives Activity 4.4 .3: Develop antimicrobial stewardship 78,910 78,910 guidelines for animal health facilities Activity 4.4.4: Implement antimicrobial 54,406 54,406 stewardship in selected animal health facilities Strategic Intervention 4.5: Develop and enforce legislation on prescriptions for 141,422 113,077 254,499 combating AMR in human and animal Activity 4.5.1: Conduct a situational analysis of the existing regulations/legislations and their 16,612 9,208 25,820 enforcement on antimicrobial use Activity 4.5.3: Develop legislation/regulation on 37,321 16,380 53,701 prescription and sale of antimicrobials Activity 4.5.4: Conduct supervision of pharmacies and ensure adherence to good 87,489 87,489 174,979 pharmacy practices Strategic Intervention 4.6: Ensure an effective supply chain management of 31,624 10,773 42,397 quality essential antimicrobials and laboratory supplies Activity 4 .6.1: Advocate inclusion of priority antimicrobials and laboratory supplies in the 31,624 10,773 42,397 long-term procurement agreement with governmenUnon-government suppliers r ,.. , Strategic Objective 5: Develop the economic case for sustainable investment that takes account of the national needs and increase 81,592 1,425,860 293,852 81,592 1,882,895 investment in new medicines, diagnostic tools, vaccines, and other interventions. Strategic Intervention 5.2: Ensure availability of sustainable resources to support AMR 50,682 50,682 interventions Activity 5.2.1: Develop resource mobilization 26,008 26,008 strategies to support AMR interventions Activity 5.2.2: Identify and engage local and international funding agencies to support AMR 24,674 24,674 interventions Strategic Intervention 5.3: Determine the 398,612 398,612 economic impact of AMR in South Sudan Activity 5.3.1: Conduct economic evaluation to determine expenditures for treatment of 398,612 398,612 infectious disease in the country Strategic Intervention 5.4: Promote public- private partnerships on antimicrobial 141,219 141,219 resistance prevention and containment Activity 5.4.1: Develop public-private partnership framework on antimicrobial 39,482 39,482 resistance Activity 5.4.2: Conduct regular advocacy platforms to engage the private sector on 101,737 101,737 antimicrobial resistance Strategic Intervention 5.5: Promote Innovation in the Search for Alternative 476,414 476,414 Treatments and Drug Development Activity 5.5.1: Support academia and other 202,865 202,865 researchers in product development Activity 5.5.2: Advocate for Multi-sectoral collaboration for research on alternative medicines in various aspects of antimicrobial 273,549 273,549 use and resistance in humans, animals, plants and environment Strategic Intervention 5.1: Strengthen the governance and multisectoral coordination 81,592 500,151 152,633 81,592 815,967 for sustainable implementation of AMR NAP. Activity 5.1.2: Establish and Strengthen AMR secretariat at the national level (human 5,304 5,304 resources, materials, finances, structures, etc.) Activity 5.1.1: Establish and strengthen national AMR multisectoral committee, AMR secretariat, 81,592 423,805 81,592 81,592 668,580 and TWGs Activity 5.1.4 : Organize annual joint review meetings on the implementation of the AMR 71,042 71,042 142,084 NAP operational plan Total 770,855 8,203,454 2,667,785 281,826 11,923,921 l'Jlr ud II, i" I r ·[ /, - '')I I I f\ 1 ' l I I r .1 ,, : \ \