National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 2018

Agreed on 30.03.2018 Minister of Agriculture of the Republic of Tajikistan I. Sattori Agreed on 04.04.2018 Chairman of the Committee on Food Security under Government of the Republic of Tajikistan F. Kamolzoda Approved on 01.05.2018 Minister of Health and Social Protection of Population of the Republic of Tajikistan N. Olimzoda National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan Dushanbe May 2018 Contents Abbreviations .............................................................................................. 3 Foreword ..................................................................................................... 4 An abstract of the main aspects of the document ......................................5 Background ................................................................................................. 6 Introduction ................................................................................................ 6 Situational analyses and assessment ..........................................................6 Country response ........................................................................................ 8 Strategic Guidelines ....................................................................................8 Strategic plan, operational plan and, M&E plan .........................................9 Strategic plan .............................................................................................. 9 Operational plan (linked to the strategic plan) .........................................15 References ................................................................................................. 32 National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 3 Abbreviations AMC Antimicrobial Medicines Consumption AMR Antimicrobial Resistance CAESAR Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR) network CFS Committee on Food Security under the Republic of Tajikistan CoEP Committee for Environmental Protection FAO Food and Agriculture Organization EUCAST European Committee of Antimicrobial Susceptibility Testing MoA Ministry of Agriculture MoHSPP Ministry of Health and Social Protection of Population MoES Ministry of Education and Science MoINT Ministry of Industry and New Technology MoEWR Ministry of Energy and Water Resources NCVD National Centre for Veterinary Diagnostics (OIE) World Organisation for Animal Health PHC Primary Health Care SHSSPPS State for Health Surveillance and Social Protection of Population Service Tajikstandard Agency of Standartization, Metrology, Certification and Trade Inspection WASH Water Sanitation and Hygiene WHO World Health Organization National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 4 Foreword The present National action plan on antimicrobial resistance (AMR) with component of antimicrobial consumption (AMC) covering both human and agriculture sectors was developed based on the World Health Organization's (WHO) Global plan on AMR dated 2015. With the purpose to develop this plan, in May 2016 an intersectoral and interagency working group was established under coordination of the State Sanitary and Epidemiological Surveillance Service (SSESS), the Ministry of Health and Social Protection of Population (MoHSPP) of the Republic of Tajikistan. With technical as sistance from the WHO a number of seminars, consultation meetings and workshops were conducted to identify country's priority areas and required actions for AMR con tainment and AMC and control. Following reforms targeted MoHSPP and Ministry of Agriculture (MoA) the Govern ment has created a National Food Security Committee under the President of the Republic of Tajikistan responsible for food security and safety including AMR and AMR from food and agriculture perspective with abolished former States for Veterinary Phytosanitary Surveillance and Plant Protection Services in the country since 2018. At the same time three MoHSPP States on Sanitary epidemiology, pharmaceutical, and medical surveillance services are abolished and a single State Surveillance Service for Health and Social Protection of Population (SSSHSP) has been established, which is the directly responsible institution for AMC and AMR human-related issues in the Republic of Tajikistan. Special gratitude goes to WHO staff and experts, all specialists from the MoHSPP, MoA and other ministries involved in the plan development pro cess, as well as partners in particular FAO and OIE in this area. National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 5 An abstract of the main aspects of the document Antimicrobial resistance is a major global threat to public health. If the challenge is not met, common infections will again become threats in everyday life, and the ad vancement of health care, both in human and animal health, will be severely set back. At the World Health Assembly in May 2015, a Global Action Plan was adopted by all WHO Member States, which also agreed to bring forward their own National Action Plans on AMR. The concept of “One Health” emphasises that no sector of society can solve this problem by itself – the solutions have to be sought in close collaboration between human health, animal health and agriculture, and also other sectors. In Tajik istan, this work has been on-going since 2015, with the nomination by the Minister of Health and Social Protection of the Population of a National Focal Point to coordinate the process, and to lead the work of an Intersectoral Coordinating Group on AMR. The Group has, after analysis of the situation of Tajikistan, and considering inter national experiences, worked on a National Action Plan. The Plan has four strategic objectives, all covering both human health aspects as well as animal health and agriculture: 1) To raise awareness and improve education on AMR; 2) To improve surveillance of the resistance situation in Tajikistan, and of the stron gest driving force, antimicrobial medicines use; 3) To improve Infection Prevention and Control through adequate measures for wa ter supply, sanitation and hygiene; 4) To achieve a more rational use of antimicromial medicines. To bring the Plan one step closer to realization, the overarching strategic objectives are broken down into some detail, pointing out who is to carry out what activities, and who is responsible for implementation, following up, and also broadly touching on what budget source should be covering costs, when such occur. Many of the more important activities are not in need of a price tag, such as regulatory changes and es tablishing routines for information exchange and flow. At the end, there is also a Monitoring and Evaluation part to facilitate following up of the implementation of the Plan. National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 6 Introduction The European strategic action plan on antibiotic resistance was adopted by Member States of the WHO European Region in September 2011. In line with this, WHO EURO commenced work to support the member states in their efforts to contain antibiotic resistance. In May 2015, the Sixty-eighth World Health Assembly adopted the Global action plan on antimicrobial resistance (AMR). The goal of the Global action plan is to ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way and accessible to all who need them. The World Health Assembly also urged all Member States to develop and have in place by 2017 a national action plan on AMR that is aligned with the objectives of the Global action plan. A main aspect of the Global action plan is the ”One Health” approach, emphasizing the need for all relevant sectors to come together in a mul tisectoral approach on all levels, including a strong collaboration of WHO with FAO and OIE. Situational analyses and assessment There is presently a paucity of data on the AMR situation in Tajikistan, on the human side as well as from the veterinary/agricultural sector. It is necessary to improve the surveillance of AMR in health care, as a shared responsi bility to assess the global situation, as well as the protection of the population right on a proper treatment by providing a proper basis for the updated reports of treatment of infectious diseases. Also in this regard, data from the veterinary sector and agricul ture are important for inclusion in the national surveillance system. High-quality data are necessary for the optimal direction of countermeasures against the AMR problem and for evaluating the effect of such measures. To do this, it is also important to im prove the equipment of laboratories and train specialists. It is very important to maintain a national system of AMR and AMC surveillances in the veterinary environmental and agriculture sectors, and in food production chain, as they interact with the health sector and can have a significant impact on the situation in it and vice versa. Background National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 7 I innfection prevention and control plays an important role in water supply, water san itation and hygiene (WASH), especially in hospitals, to reduce the spread of resistant bacteria and can help reduce the number of infections and reduce the need for anti biotics. IPC and adequate WASH are also needed in outpatient settings and Primary Health Care (PHC) settings, and the prevention of infections among certain population groups, such as nursing care facilities and day care centers, can reduce the need for antimicrobial treatment. It is also important to reduce the emission of untreated sewage from municipal sew erage, hospitals, antimicrobial production waste and animal manures, and improve environmental surveillance. Since the number of animals in the world is much larger than humans, irresponsible and non-rational use of antibiotics in the production of agricultural food products negatively affect the bacteriological flora of the environment. Responsible and ratio nal use of antibiotics in farm animals is necessary to minimize the potential harm to human health, in particular, the formation of resistance to antibiotics, while ensuring the safe and effective use of antibiotics in veterinary sector. Apparently, this corresponds to a generally high level of antibiotic use, according to a survey conducted by the WHO / European Antimicrobial Supervision Project (EASP) published in the Lancet Infectious Diseases Magazine in 2013. By results of this survey, Tajikistan ranks third in the general use of antibiotics by people in comparative list of twelve European countries and Kosovo. It is necessary to improve the monitoring of data system on antimicrobial mediciens consumption and drug procurement policy, which are used both in the sectors of health, veterinary and agricultural at the national, regional and local levels. Thus, the input and analysis of data in this context is important for the national control system. In-patient treatment guidelines are available for at least the most serious infectious diseases. They will need to be updated regularly, also taking into account the devel opment of resistance to drugs. A great importance is the availability of appropriate guidelines for the use of antimicrobial medicines in actively using clinics that do not specialize in infectious diseases, including every common indication for the use of an timicrobial medicines. At the national level, it is necessary to use international recommendations on the rational use of antibiotics, adapted to the specific conditions of each country. Profes sional communities of veterinary workers should develop recommendations for the rational use of antibiotics in agricultural animals of various species, including indica tions for the use of antibiotics of the first, second and reserve lines in the treatment of various bacterial infections. National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 8 Strategic Guidelines Tajikistan responded to the challenge of AMR by appointing a national AMR coordina tor since 2015 by order of the Minister of Health and Social Protection to coordinate national work and contact WHO on this topic. In 2016, an intersectoral working group was established, whose task was to draw up a national action plan for Tajikistan to tackle growing AMR problems in Republic of Tajikistan. The national intersectoral coordination group or the formal way of responding to the AMR problem provides the concept of "One Health" and monitors the implementa tion of strategic measures. Country response National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 9 Strategic plan, operational plan and, M&E plan Global action plan strategic objective 1: Improve awareness and understanding of antimicrobial resis tance through effective communication, education and training. Awareness-raising and risk communication Objective 1 Increase national awareness of AMR Strategic interventions Activities 1.1. Establish a public communications pro gramme targeting audiences in human health practice. Milestone: Significant change in awareness levels by mid-2020. 1.1.1. Estimate awareness and knowledge through behavioural studies in different social and professional groups. 1.1.2. Develop and implement campaigns on the AMR directed to health care workers and empowering communities, nurses to de mand improved water, sanitation and hygiene (WASH) services in health facilities and hand hygiene by caregivers. 1.2. Establish a public communications pro gramme targeting the public; synchronized with (after) 1.1. Milestone: Significant change in awareness levels by end of 2022. 1.2.1. Estimate awareness and knowledge through behavioural studies in different social and occupational groups. 1.2.2. Develop and implement campaigns di rected to the public. Education Objective 2 Improve knowledge of antimicrobial resistance, responsible use of antimicrobials, and re lated topics Strategic interventions Activities 2.1. Include AMR and related topics as a core component of professional education, train ing, certification and development. 2.1.1. Include antimicrobial resistance, re sponsible use of antimicrobials, and related topics in undergraduate curricula for human health professionals, animal health profes sionals and food industry and agriculture pro fessionals. 2.1.2. Include antimicrobial resistance, re sponsible use of antimicrobials, and related topics in postgraduate curricula for human health professionals, animal health profes sionals and food industry and agriculture professionals, and specialists in the field of education. 2.2. Include lessons to increase knowledge on antimicrobial resistance, responsible use of antimicrobials, as a component of general education. 2.2.1. Include antimicrobial resistance, re sponsible use of antimicrobials, in the curric ula for school children. Strategic plan National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 10 2.3. Include capacity building to increase knowledge on antimicrobial resistance, re sponsible use of antimicrobials, as a compo nent of public health and healthy life style promotion topic. 2.3.1. Include antimicrobial resistance, re sponsible use of antimicrobials, and related topics to Republican Centre for Healthy Life Style, relevant human, veterinary and agri cultural institutions to increase population awareness and promoting rational and prop er use of antibiotics in human and agriculture sectors. Global action plan strategic objective 2: Strengthen the knowledge and evidence base through surveil lance and research. Surveillance Objective 3 Set up a national surveillance system for antimicrobial resistance Strategic interventions Activities 3.1. Improve a national coordination struc ture for surveillance of AMR. Milestone: National coordinating group with appropriate mandate and terms of reference and designated focal point is strengthened by the end of 2018. 3.1.1. Write and approve terms of reference for a national coordinating group for AMR surveillance with the mandate to oversee the AMR surveillance programme in the human health and environment protection sectors, including collecting, aggregating and sharing data. 3.1.2. Ensure the existence of connections to laboratory system and data from veterinary, agriculture, environment (waste, water treat ment and disposal), and food safety, as well as, pharmaceutical production and procure ment. 3.2. Include AMR data from the food-borne pathogens side into the national AMR surveil lance structure. 3.2.1. Stregnthen a regular surveillance system of resistance in food-borne and wa ter-borne pathogens, in particular Salmonella and Campylobacter. 3.3. Active participation in WHO CAESAR net working. 3.3.1. Capacity building to enable national AMR surveillance(data management, analy sis, implementation of surveillance method ology using the CAESAR as a starting point). 3.3.2. Share data with CAESAR network. Objective 4 Set up a national surveillance system/monitoring centre for antibiotic consumption Strategic interventions Activities 4.1. Strengthen a national structure for ob taining an overview of the use of antibiotics within the country. 4.1.1. Write and approve terms of reference for a national coordinating group for antibi otic consumption surveillance, including col lecting, aggregating and sharing data. 4.1.2. Clarify the existence of and connec tions to relevant institutions and data from veterinary, agriculture, food safety and envi ronment protection sectors. National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 11 4.2. Investigate and monitor antibiotic use in larger hospitals and inform the pharmaceutical surveillance department of the State service for pharmaceutical activity surveillance (SSPAS). 4.2.1. Perform recurring Point Prevalence Studies on in-patients, as the patients may re ceive antibiotics from various sources. Laboratory capacity Objective 5 Improve laboratory capacity to produce high-quality microbiological data for patient man agement and support surveillance activities in both human and animal health and agricul ture sectors Strategic interventions Activities 5.1. Designate a national reference laborato ry for AMR surveillance. Milestone: National reference laboratory designated as responsible institution for es tablishment of AMR surveillance system by end of 2018. 5.1.1. Write and approve terms of reference for a national reference laboratory with ex pertise in methods for confirming and char acterizing specific pathogens and organizing quality assurance schemes. 5.1.2. Access to quality consumables for lab oratory diagnostics. 5.1.3. National accreditation system for labo ratory practices. 5.2. Improve the quality of bacteriology and AST 5.2.1. Implement standardized protocols for assessing AMR. 5.2.2. Strengthen laboratory infrastructure 5.2.3. Set up external and internal quality as surance systems. 5.2.4. Organize regular meetings with repre sentatives of laboratories to discuss method ology and standards. 5.3. Improve and increase the flow and test ings of diagnostic microbiological samples taken in human health care, environment and agriculture sectors. 5.3.1. Assess the limiting factors 5.3.2. Participate in CAESAR and POP (Proof of Principle) Study. Research and development Objective 6 Identify operational research priorities for responsible use of antimicrobial agents and bet ter practice in infection prevention in human and animal health Strategic interventions Activities 6.1. Prepare a national operational research agenda. Milestone: A national research institutions from health and agriculture developed the national operational research agenda by end of 2020. 6.1.1. Participation of RCFM in pharmaceu tical-epidemiological surveys of type Point Prevalence Studies (PPS) of prescription pat terns of antibiotics, with appropriate meth odology for health and agriculture sectors (RCFM, ЦГНКВП) (possibly ESAC methodolo gy for Primary Health Care). 6.1.2. Engage in pharmaco-epidemiological surveys, of type Point Prevalence Studies (PPS) in hospitals and in animal husbandry sector, with e.g. AMC standardized methodology. 6.1.3. Engage relevant experts to identify current gaps in knowledge and potential re search topics. National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 12 Global action plan strategic objective 3: Reduce the incidence of infection through effective sanitation, hygiene and prevention measures. Infection prevention and control (IPC) through improvement of infection control, water supply, sanitation and hygiene measures in health care and other facilities Objective 7 Improve a national infection prevention and control programme Strategic interventions Activities 7.1. Strengthen the proper development and use of infection prevention and control pol icies and strategies, water supply, sanitation and hygiene in health care facilities. 7.1.1. Improve the national infection preven tion and control coordinating unit with author ity delegated by a relevant administrative or political jurisdiction and an identified budget. 7.2. Ensure there are AMR/IPC, water supply, sanitation and hygiene programmes in each hospital settings. 7.2.1. Review the regulatory basis for IPC on AMR and improvement of water supply, san itation and hygiene in health care institutions (operation and maintenance) implementation. 7.2.2. When regulation is there, use nation ally developed training curriculum for adop tion to hospitals. 7.2.3. Integrate AMR/WASH/IPC as an inte gral part of improving the quality of health services. 7.3. Ensure there are AMR/IPC, water supply, sanitation and hygiene programmes in long term care facilities. 7.3.1. When regulation is there, use nation al curriculum for adoption to long term care facilities. Objective 8 Maintain a high vaccination coverage in the national vaccination program Strategic interventions Activities 8.1. Pronounce support from the AMR NAP/ NCG for continued vaccination efforts also from the AMR point of view 8.1.1. Improve vaccinations against commu nicable diseases Objective 9 Introduce infection prevention and control programmes in veterinary settings and animal husbandry Strategic interventions Activities 9.1. The need to use antibiotics in farm live stock must be reduced by improving animal health with biological safety measures. In clude issues of water supply, sanitation, hy giene and infection prevention and control as core (mandatory) content in training and education of veterinary professionals. Milestone: 9.1.1. Include ecological sanitation hygiene and infection prevention and control in un dergraduate curricula for animal health pro fessionals. 9.1.2. Offer courses to postgraduates/active personnel 9.1.3. Improve the prevention measures for zoonotic infections, particularly brucellosis Hygiene and sanitation at community level Objective 10 Limit the development and spread of AMR outside health settings by infection prevention and control. Strategic interventions Activities 10.1. Promote personal hygiene and safe sanitation by social mobilization and be havioural change support activities. Milestone: 10.1.1. Estimate adequate knowledge of personal hygiene and sanitation in different social groups as a basis for the social mobili zation campaigns. 10.1.2. Form and launch campaigns. National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 13 10.2. Promote prevention of infections in PHC and improving water supply, sanitation and hygiene in preschool facilities. 10.2.1. Teach personnel to teach children to improve habits on hand washing and to pro mote the safety of water supply, sanitation and hygiene in PHC and preschool facilities. Global action plan strategic objective 4: Optimize the use of antimicrobial medicines in human and animal health. Regulated access to high-quality antimicrobial medicines Objective 11 Ensure uninterrupted access to high-quality antimicrobial medicines Strategic interventions Activities 11.1. Strengthen the pharmaceutical supply chain, including the procurement, supply and management system for antibiotics for hu man use. 11.1.1. Update current medicines legislation and regulations. 11.1.2. Cancel the state taxes and duties on production and sales of medicines 11.2 Strengthen the pharmaceutical supply chain, including the procurement, supply and management system for antibiotics for veter inary and agricultural use. 11.2.1. Review and when applicable update current veterinary medicines legislations and regulations to international standards. Antimicrobial stewardship Objective 12 Improve and measure appropriate use of antimicrobial agents in health care Strategic interventions Activities 12.1. Create formal antimicrobial steward ship programmes in health care facilities. Milestone: Antimicrobial stewardship pro grammes established in 50% of acute care fa cilities by Aug 2018? 12.1.1. Write generic terms of reference for antimicrobial stewardship multidisciplinary committees and teams. 12.1.2. Ensure the establishment of such com mittees in each larger hospital including sur rounding Primary Health Care participation. 12.1.3. Provide antimicrobial stewardship training to healthcare staff. 12.2. Improve rational use of antibiotics through modernized National Standard Treat ment Guidelines (STGs). 12.2.1. Renew the existing system of data base. 12.2.2. Produce Standard Treatment Guide lines for common infections/common causes of antibiotic use. Objective 13 Ensure public access to adequate, quality controlled information on antibiotics and their use Strategic interventions Activities 13.1. Build up a system for neutral informa tion. 13.1.1. Build a system for market-indepen dent information on antibiotics /and treat ment of common infections/to the public. 13.1.2. Build a system for market-indepen dent information on antibiotics and treat ment of common infections to doctors/phar macists. 13.2. Improve public control over the infor mation flow from pharmaceutical industry on antibiotics. 13.2.1. Review present situation, legislation, and improve control. 13.2.2. Train specialists on collection and monitoring of data on adverse effects. National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 14 Objective 14 Ensure prudent use of antimicrobial agents in terrestrial and aquatic animals and agricul ture Strategic interventions Activities 14.1. Improve the national policies on use of antimicrobial agents in terrestrial and aquatic animals and agriculture. Milestone: Policy in place December 2018. 14.1.1. Establish policies on the use of criti cally important antibiotics. 14.1.2. Review the legal framework for use and prescription of antibiotics in animals for food production (with particular emphasis on poultry and aquaculture) and in agriculture. 14.1.3. Reform the legal framework in a di rection that eliminates or reduces the non-hu man use of critically important antibiotics and improve performance and oversight 14.1.4. Prohibit or reduce substantially the amount of antibiotics used for growth pro motion. 14.2. Ensure accumulation of data on antibi otic use for non-human purposes at a nation al level (see also SO 2). 14.2.1. Ensure data is collected on antibiotic use in animal husbandry. 14.2.2. Ensure data is collected on antibiotic use in other sections of agriculture. 14.2.3. Ensure data is collected on antibiotic use in aquaculture. National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 15 Su b ac ti vi ty U ni t Ti m el in e Re sp on si bl e en ti ty Co st e sti m at e (c ur re nc y) So ur ce o f fu nd in g In di ca to r Co m m en ts Su b ac ti vi ty 1 .1 .1 .1 A ss es s aw ar en es s an d kn ow l ed ge le ve l t hr ou gh s ur ve y of fa m ily d oc to rs a t t he P H C le ve l A w ar en es s su rv ey M ar ch 20 19 M ar ch 20 20 RC FM M oH SP P Ba se lin e aw ar en es s Po st in te rv en tio n aw ar e ne ss Su b ac ti vi ty 1 .1 .1 .2 A ss es s aw ar en es s an d kn ow l ed ge le ve l t hr ou gh s ur ve y of ho sp it al d oc to rs A w ar en es s su rv ey 20 18 – 20 22 M oH SP P/ Re gi on al h ea lth au th or iti es M oH SP P Ba se lin e aw ar en es s Po st in te rv en tio n aw ar e ne ss Su b ac ti vi ty 1 .1 .1 .3 Pe rf or m in fo rm ati on c am pa ig ns o n A M R fo r fa m ily do ct or s at th e PH C le ve l Ca m pa ig n 20 18 – 20 22 RC FM M oH SP P Ca m pa ig n pe rf or m ed +P os t in te rv en tio n a w ar en es s Su b ac ti vi ty 1 .1 .1 .4 Pe rf or m in fo rm ati on c am pa ig ns o n A M R fo r ho sp it al do ct or s Ca m pa ig n 20 18 – 20 22 M oH SP P/ Re gi on al h ea lth au th or iti es M oH SP P Ca m pa ig n pe rf or m ed +P os t in te rv en tio n aw ar en es s Su b ac ti vi ty 1 .1 .1 .5 Pe rf or m in fo rm ati on c am pa ig ns o n A M R fo r PH C nu rs es /n on d oc to r pe rs on ne l. Ca m pa ig n 20 18 – 20 22 RC FM M oH SP P Ca m pa ig n pe rf or m ed Su b ac ti vi ty 1 .1 .1 .6 Pe rf or m in fo rm ati on c am pa ig ns o n A M R fo r ho sp it al nu rs es /n on d oc to r pe rs on ne l Ca m pa ig n 20 18 – 20 22 M oH SP P/ Re gi on al h ea lth au th or iti es M oH SP P Ca m pa ig n pe rf or m ed O pe ra ti on al p la n (li nk ed t o th e st ra te gi c pl an ) National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 16 Su b ac ti vi ty 1 .1 .1 .7 Im pr ov e aw ar en es s an d kn ow le dg e le ve l t hr ou gh ca m pa ig n ta rg eti ng fa rm er s Ca m pa ig n 20 18 – 20 22 M oA M oA Ca m pa ig n pe rf or m ed Su b ac ti vi ty 1 .2 .1 .1 A ss es s aw ar en es s an d kn ow l ed ge le ve l t hr ou gh s ur ve y of ge ne ra l p op ul ati on A w ar en es s su rv ey 20 18 – 20 22 N CH L (H ea lth L ife S ty le ) M oH SP P Ba se lin e aw ar en es s Po st in te rv en tio n aw ar e ne ss Su b ac ti vi ty 1 .2 .1 .2 Im pr ov e aw ar en es s an d kn ow le dg e le ve l t hr ou gh ca m pa ig n ta rg et in g en er al po pu la ti on Ca m pa ig n 20 18 – 20 22 N CH L (H ea lth L ife S ty le ) M oH SP P Ca m pa ig n pe rf or m ed +P os t in te rv en tio n aw ar en es s Su b ac ti vi ty 2 .1 .1 .1 Re vi se u nd er gr ad ua te c ur ri c ul um fo r m ed ic al d oc to rs to in co rp or at e A M R an d re la te d is su es Re vi se d cu rr ic ul um 20 20 M oH SP P/ TS M U M oH SP P Re vi se d cu rr ic ul um in tr o du ce d Su b ac ti vi ty 2 .1 .1 .2 Re vi se u nd er gr ad ua te c ur ri c ul um fo r ve te ri na ry d oc to rs to in co rp or at e A M R an d re la te d is su es Re vi se d cu rr ic ul um 20 21 M oA M oA Re vi se d cu rr ic ul um in tr o du ce d Su b ac ti vi ty 2 .1 .1 .3 Re vi se u nd er gr ad ua te c ur ri c ul um fo r fo od in du st ry a nd ag ri cu lt ur e pr of es si on al s to in co rp or at e A M R an d re la te d is su es Re vi se d cu rr ic ul um 20 22 M oA M oA Re vi se d cu rr ic ul um in tr o du ce d Su b ac ti vi ty U ni t Ti m el in e Re sp on si bl e en ti ty Co st e sti m at e (c ur re nc y) So ur ce o f fu nd in g In di ca to r Co m m en ts National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 17 Su b ac ti vi ty 2 .1 .2 .1 In te gr at e A M R an d re la te d to pi cs in th e /p os tg ra du at e/ cu rr ic ul a of fa m ily m ed ic in e tr ai ni ng Re vi se d cu rr ic ul um 20 19 RC FM M oH SP P Re vi se d cu rr ic ul um in tr o du ce d Su b ac ti vi ty 2 .1 .2 .2 In te gr at e A M R an d re la te d to pi cs in th e /p os tg ra du at e/ cu rr ic ul a of h os pi ta l s pe ci al is ts tr ai ni ng Re vi se d cu rr ic ul um 20 20 M oH SP P + TS M U M oH SP P Re vi se d cu rr ic ul um in tr o du ce d Su b ac ti vi ty 2 .1 .2 .3 In te gr at e A M R an d re la te d to pi cs in th e cu rr ic ul a of fa m i ly m ed ic in e re tr ai ni ng Re vi se d cu rr ic ul um 20 21 RC FM M oH SP P Re vi se d cu rr ic ul um in tr o du ce d Su b ac ti vi ty 2 .1 .2 .4 In te gr at e A M R an d re la te to pi cs in th e cu rr ic ul a of th e pr of es si on al d ev el op m en t co ur se s fo r fa m ily d oc to rs Re vi se d cu rr ic ul um 20 19 RC FM M oH SP P Re vi se d cu rr ic ul um in tr o du ce d Su b ac ti vi ty 2 .1 .2 .5 Re vi se p os tg ra du at e cu rr ic u lu m fo r ve te ri na ry d oc to rs to in co rp or at e A M R an d re la te d is su es , p ro m oti ng ra tio na l u se (p re ve nti ng e xc es si ve a nd in ap pr op ri at e us e) , p ro hi bi tin g th e us e as g ro w th p ro m ot or s an d us e of n ar ro w s pe ct ru m an tib io tic s w he n po ss ib le Re vi se d cu rr ic ul um 20 21 M oA M oA Re vi se d cu rr ic ul um in tr o du ce d National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 18 Su b ac ti vi ty 2 .1 .2 .6 Re vi se p os tg ra du at e cu rr ic ul um fo r fo od in du st ry a nd ag ri cu lt ur e pr of es si on al s to in co rp or at e A M R an d re la te d is su es , p ro m oti ng ra tio na l u se pr oh ib iti ng th e us e as g ro w th pr om ot or s (p re ve nti ng e xc es si ve a nd in ap pr op ri at e us e) , an d us e of n ar ro w s pe ct ru m an tib io tic s w he n po ss ib le Re vi se d cu rr ic ul um 20 22 M oA M oA Re vi se d cu rr ic ul um in tr o du ce d Su b ac ti vi ty 2 .1 .2 .7 Re vi se p os tg ra du at e cu rr ic u lu m fo r sp ec ia lis ts in t he fi el d of e du ca ti on to in co rp or at e A M R an d re la te d is su es . Re vi se d cu rr ic ul um 20 22 M in is tr y of E du ca tio n an d Sc ie nc e (M oE S) M oE S Re vi se d cu rr ic ul um in tr o du ce d Su b ac ti vi ty 2 .2 .1 .1 D ev el op s ui ta bl e A M R ed u ca tio n m at er ia ls fo r sc ho ol ch ild r e n Re vi se d cu rr ic ul um 20 20 M in is tr y of E du ca tio n an d Sc ie nc e (M oE S) M oE S Re vi se d cu rr ic ul um d e ve lo pe d Su b ac ti vi ty 2 .2 .1 .2 N ew A M R ed uc ati on m a te ri al s in s ch oo l c hi ld re n’ s cu rr ic ul um in tr od uc ed Re vi se d cu rr ic ul um in tr od uc ed 20 21 M in is tr y of E du ca tio n an d Sc ie nc e (M oE S) M oE S Re vi se d cu rr ic ul um im pl em en te d Su b ac ti vi ty 3 .1 .1 .1 Pr ep ar e te rm s of re fe re nc e f o r A M R su rv ei lla nc e N ati on al c o or di na t in g ce nt re te rm s of re fe re nc e Ja nu ar y 20 19 N CG o n A M R; M oH SP P; M in is tr y of A gr ic ul tu re M in is tr y of he al th , M in is tr y of A gr ic ul tu re N ati on al c oo rd in ati ng gr ou p te rm s of re fe re nc e re ad y fo r ap pr ov al Su b ac ti vi ty U ni t Ti m el in e Re sp on si bl e en ti ty Co st e sti m at e (c ur re nc y) So ur ce o f fu nd in g In di ca to r Co m m en ts National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 19 Su b ac ti vi ty 3 .1 .2 .1 En su re th e ex is te nc e of a nd co nn ec tio ns to la bo ra to ry st ru ct ur e an d da ta fr om ve te ri na ry , a gr ic ul tu re , f oo d sa fe ty s id e D at a flo w fr om v et er in ar y an d A gr ic ul tu re si de Ju ne 2 01 9 N CG o n A M R; M oH SP P; M in is tr y of A gr ic ul tu re M in is tr y of he al th , M in is tr y of A gr ic ul tu re A gr ee m en ts in p la ce , da ta fl ow s ta rt ed Su b ac ti vi ty 3 .2 .1 Es ta bl is h a re gu la r su rv ei l la nc e sy st em o f r es is ta nc e in fo od b or ne p at ho ge ns , i n pa rti cu la r Sa lm on el la Su rv ei l la nc e sy st em fo r A M R in fo od b or ne pa th og en s 20 20 M oH SP P + M oA M oH SP P + M oA Re po rti ng a nd d at a ex ch an ge o n A M R in fo od bo rn e pa th og en s to A M R su rv ei lla nc e ce nt re Su b ac ti vi ty 4 .1 .1 .1 W ri te te rm s of re fe re nc e fo r a na tio na l c oo rd in ati ng g ro up fo r an tib io tic c on su m pti on su rv ei lla nc e, in cl ud in g co lle ct in g, a gg re ga tin g an d sh ar in g da ta , f ro m h um an a nd v et / ag ri cu ltu re s id e D ra ft te rm s of re fe r en ce M id 2 01 9 N CG /M oH SP P D ra ft in p la ce Su b ac ti vi ty 4 .1 .1 .2 A pp ro va l o f t er m s of re fe r en ce fo r a na tio na l c oo rd i na tin g gr ou p fo r an tib io tic co ns um pti on s ur ve ill an ce , in cl ud in g co lle cti ng , a gg re ga tin g an d sh ar in g da ta , f ro m hu m an a nd v et /a gr ic ul tu re si de . T he d at a sh ou ld b e in c om pa ra bl e fo rm at s, in ac co rd an ce w ith in te rn ati on al st an da rd s (W H O E U RO ) A pp ro va l o f To R O ct 2 01 9 M oH SP P; M in is tr y of A gr ic ul tu re A pp ro ve d To R. National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 20 Su b ac ti vi ty 4 .1 .1 .3 In ve sti ga te a nd m on ito r sp ec ifi c a lly th e am ou nt o f an tim ic ro bi al s us ed in a ni m al s fo r fo od p ro du cti on a nd in a qu ac ul tu re Ye ar ly d at a 20 20 N ati on al C oo rd in ati on G ro up (N SG ), M oA , Co m m itt ee o f F oo d Se cu ri ty (C FS ) D at a de liv er ed to N CG . Ye ar ly re po rt s. Su b ac ti vi ty 4 .2 .1 In ve sti ga te a nd m on ito r an ti bi oti c us e in la rg er h os pi ta ls Co m pa ra bl e da ta fo r 5– 10 la rg es t h os pi ta ls 20 19 TS M U , N CG , S ci en tifi c Re se ar ch in sti tu te fo r Pr ev en tiv e M ed ic in e M oH SP P M on ito ri ng re po rt Ye ar ly re pe at s Su b ac ti vi ty 5 .1 .1 .1 D ev el op te rm s of re fe re nc e fo r na tio na l r ef er en ce la bo ra to ry o n A M R (o ne d es ig na te d, or tw o or m or e w ith c le ar ly de fin ed d iv is io n of re sp on si bi liti es ) f or h um an h ea lth N ati on al re fe re nc e la bo ra to ry te rm s of re fe re nc e Ja nu ar y 20 20 N CG , S H SS PP S, M oH SP P; SS E S B ac te ri ol og y La bo ra to ry , N ati on al P ub lic H ea lth La bo ra to ry N ati on al re fe re nc e la bo ra to ry te rm s of re fe re nc e re ad y fo r ap pr ov al Su b ac ti vi ty 5 .1 .1 .2 A pp ro va l o f t er m s of re fe re nc e fo r n ati on al re fe re nc e la bo ra to ry o n A M R fo r h um an h ea lth A pp ro ve d te rm s of re fe re nc e M ay 2 02 1 M oH SP P Te rm s of re fe re nc e ap pr ov ed /M in is tr y of A gr ic ul tu re w el l in fo rm ed ab ou t pr oc es s/ Su b ac ti vi ty 5 .1 .1 .3 D ev el op te rm s o f r ef er en ce fo r na tio na l r ef er en ce la bo ra to ry o n AM R (o ne d es ig na te d, o r t w o or m or e w ith c le ar ly d efi ne d di vi sio n of re sp on sib ili tie s) fo r ve te rin ar y/ ag ric ul tu ra l s ec to r N ati on al re fe re nc e la bo ra to ry te rm s of re fe re nc e Ja nu ar y 20 19 M oA ; C en tr e fo r Ve te ri na ry D ia gn os tic s, C FS N ati on al re fe re nc e la bo ra to ry te rm s of re fe re nc e re ad y fo r ap pr ov al Su b ac ti vi ty U ni t Ti m el in e Re sp on si bl e en ti ty Co st e sti m at e (c ur re nc y) So ur ce o f fu nd in g In di ca to r Co m m en ts National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 21 Su b ac ti vi ty 5 .1 .1 .4 A pp ro va l o f t er m s of re fe r en ce fo r na tio na l r ef er en ce la bo ra to ry o n A M R fo r ve te ri na ry /a gr ic ul tu ra l s ec to r A pp ro ve d te rm s of re fe re nc e M ay 2 02 0 M oA , C FS Te rm s of re fe re nc e ap pr ov ed /M oH SP P w el l in fo rm ed ab ou t pr oc es s/ Su b ac ti vi ty 5 .1 .2 .1 D ev el op c oo pe ra tio n on m et ho do lo gy /s ta nd ar ds be tw ee n hu m an a nd v et /a gr i cu ltu re s id e la bs A gr ee m en t on s ta n da rd s M ay 2 01 9 M oH SP P, M oA , C FS In te ra ge nc y pl an in p la ce Su b ac ti vi ty 5 .2 .1 .1 A pp ly s ta nd ar di ze d, u p to da te p ro to co ls to a ss es s A M R co ns is te nt ly St an da rd iz ed , up da te d pr ot oc ol s in p la ce th ro ug ho ut co un tr y 20 20 N ati on al R ef er en ce L ab .; SH SS PP S; M oH SP P; M oA ; N a ti on al C en tr e fo r Ve te ri na ry D ia gn os tic s Pr ot oc ol s in p la ce Su b ac ti vi ty 5 .2 .1 .2 Im pr ov e/ up da te q ua lit y th ro ug h pa rti ci pa tio n in in te rn ati on al p ro gr am s, s uc h as CA ES A R, E U CA ST , a nd in cl ud in g “w et la b w or ks ho ps ” N um be r of ex ch an ge s or c ou rs es ta ke n pa rt in 20 18 – 20 20 N ati on al R ef er en ce L ab .; SH SS PP S; M oH SP P; M oA ; N ati on al C en tr e fo r Ve te ri na ry D ia gn os tic s In cr ea se o f i nt er na tio n al c on ta ct s; n um be r of pe rs on ne l p ar tic ip at ed in w et la b w or ks ho ps Su b ac ti vi ty 5 .2 .1 .3 A pp ly s ec to r sp ec ifi c A ST gu id el in e th r o ug ho ut th e co un tr y D ec is io n on A ST (a nti bi oti c se ns iti vi ty te st ) g ui de lin e 20 21 N ati on al R ef er en ce L ab .; SH SS PP S; M oH SP P; M oA ; N ati on al C en tr e fo r Ve te ri na ry D ia gn os tic s D ec is io n an d pr ot oc ol s in pl ac e National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 22 Su b ac ti vi ty 5 .2 .2 .1 St re ng th en la bo ra to ry in fr as tr uc tu re – in cr ea se d av ai la bi lit y of c om pu te rs , in te rn et a cc es s to e ns ur e LI S or W H O N ET is in tr od uc ed Co m pu te rs an d in te r ne t a cc es s in la bo ra to ri es 20 19 SH SS PP S; M oH SP P; M oA ; N a tio na l C en tr e fo r Ve te ri na ry D ia gn os tic s N um be r of la bs re po rti ng to n ati on al c en tr e vi a in te rn et Su b ac ti vi ty 5 .2 .2 .2 St re ng th en la bo ra to ry in fr a st ru ct ur e – de ci si on a nd im pl em en ta tio n of h ar m on iz ed pu r c ha si ng o f h ig h qu al ity co ns um ab le s (s uc h as m ed ia , re ag en ts , a nti m ic ro bi al d is cs ) H ar m o ni ze d eq ui pm en t 20 20 SH SS PP S; M oH SP P; M oA ; N a tio na l C en tr e fo r Ve te ri na ry D ia gn os tic s Su b ac ti vi ty 5 .2 .3 .1 Ex te rn al q ua lit y as su ra nc e sy st em , E Q A , i m pl em en te d on th e na tio na l l ev el Pa rti ci pa tio n in CA ES A R EQ A 20 19 – co nti nu in g SS ES B ac te ri ol og y La bo ra to ry , S H SS PP S, M oH SP P Pe rf or m an ce y ea rl y Su b ac ti vi ty 5 .2 .3 .2 In te rn al q ua lit y as su ra nc e sy s te m im pl em en te d fr om th e N ati on al R ef er en ce la bo ra to ry to th e ne tw or k of la bo ra to ri es ; d ev el op ed o n th e ba si s of in te rn al q ua lit y as se ss m en t (IQ A ) e xp er ie nc e N um be r of la bs p ar tic ip ati ng in ye ar ly E Q A 20 19 M oH SP P, N RL , S H SS PP S N um be r of la bs p ar tic i pa tin g in y ea rl y IQ A Su b ac ti vi ty 5 .2 .4 .1 M ee tin gs w ith re pr es en ta tiv es o f l ab or at or ie s to di sc us s m et ho do lo gy a nd st an da rd s N um be r of la bs p ar tic ip ati ng in y ea rl y m ee tin g 20 19 SH SS PP S; M oH SP P; M oA ; N ati on al C en tr e fo r Ve te ri na ry D ia gn os tic s N um be r of la bs re pr e se nt ed in y ea rl y m ee tin g Su b ac ti vi ty U ni t Ti m el in e Re sp on si bl e en ti ty Co st e sti m at e (c ur re nc y) So ur ce o f fu nd in g In di ca to r Co m m en ts National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 23 Su b ac ti vi ty 5 .3 .1 .1 A ss es s lim iti ng fa ct or s, e x pl an ati on s to lo w v ol um e of sa m pl es ta ke n by c lin ic ia ns , e g th ro ug h qu es tio nn ai re s an d ev al ua tio n of e xp er ts Re po rt o n lim iti ng fa ct or s 20 19 SH SS PP S; M oH SP P Re po rt Su b ac ti vi ty 5 .3 .2 .1 Pa rti ci pa te in C A ES A R, P O P (P ro of o f P ri nc ip le ) S tu dy to st ar t t ow ar ds im pl em en ta tio n of s am pl in g an d ro uti ne di ag no sti cs . Co nti nu ou s tr ai ni ng in p ar al le l c a ll fo r ad di tio na l i nv es tm en t to w ar ds s us ta in ab le im pl e m en ta tio n of P oP . St ud y an d PO P St ud y 20 19 – 20 20 SS ES B ac te ri ol og y La bo ra to ry , S H SS PP S, M oH SP P; C A ES A R/ W H O N um be r of h os pi ta ls / la bs p ar tic ip ati ng in P O P st ud y Su b ac ti vi ty 6 .1 .1 .1 Co nv en e re le va nt e xp er ts to id en tif y ga ps in k no w le dg e an d po te nti al re se ar ch to pi cs . Ex pe rt m ee tin g M ay 2 01 9 N CG ; T SM U ; M oH SP P D ra ft re se ar ch a ge nd a de ve lo pe d Su b ac ti vi ty 7 .1 .1 .1 Pr ep ar e te rm s of re fe re nc e fo r a na tio na l i nf ec tio n pr e ve nti on a nd c on tr ol c oo rd i na tin g un it. Te rm s of re fe re nc e fo r an in fe cti on pr ev en tio n an d co nt ro l un it M ay 2 01 9 N CG , S H SS PP S, M oH SP P; N ati on al In fe cti on C on tr ol So ci et y (if s uc h ex is ts ) In fe cti on p re ve nti on an d co nt ro l u ni t t er m s of re fe re nc e re ad y fo r ap pr ov al National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 24 Su b ac ti vi ty 7 .1 .2 .1 D ev el op a tr ai ni ng c ur ri cu lu m on IP C, c ov er in g th e fo llo w in g as pe ct s w ith a h os pi ta l pe rs pe cti ve : (i) s ur ve ill an ce o f h ea lth c ar e as so ci at ed in fe cti on s; (i i) st an da rd , c on ta ct , d ro pl et s, an d ae ro so l p re ca uti on s (ii i) m ea su ri ng c om pl ia nc e of IP C m ea su re s (ii ii) h an d hy gi en e (u si ng W H O g ui de lin es ) ( iv ) ad he re nc e to h yg ie ne a nd im pr ov ed w at er s up pl y an d sa ni ta tio n in h ea lth fa ci liti es as a b as is fo r eff ec tiv e IP C (u si ng W H O g ui de lin es ) IP C cu rr ic u lu m s ui te d fo r ho sp i ta ls M ay 2 01 9 D ep ar tm en t f or S an ita ry Ep id em io lo gy S ur ve ill an ce Se rv ic e Cu rr ic ul um d ev el op ed an d st ar tin g to b e im pl e m en te d Su b ac ti vi ty 7 .1 .2 .2 D ev el op a tr ai ni ng c ur ri cu lu m on IP C, c ov er in g th e fo llo w in g as pe ct s, w ith a P H C pe rs pe c tiv e: – su rv ei lla nc e of in fe cti on s as so ci a t ed w ith h ea lth ca re a t PH C le ve l; – pr ec au tio n m ea su re s: s ta n da rd , c on ta ct , d ro pl et a nd ae ro so l a t P H C le ve l; – ev al ua tio n of IP C, w at er su pp ly , h yg ie ne a nd s an ita tio n m ea su re s be in g fo llo w ed at P H C le ve l IP C cu rr ic u lu m s ui te d fo r PH C M ay 2 01 9 D ep ar tm en t f or S an ita ry Ep id em io lo gy S ur ve ill an ce Se rv ic e Cu rr ic ul um d ev el op ed an d st ar tin g to b e im pl e m en te d Su b ac ti vi ty U ni t Ti m el in e Re sp on si bl e en ti ty Co st e sti m at e (c ur re nc y) So ur ce o f fu nd in g In di ca to r Co m m en ts National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 25 Su b ac ti vi ty 7 .2 .1 .1 Re vi ew th e re gu la to ry b as is fo r im pl em en tin g IP C, w at er su pp ly , s an ita tio n an d hy gi en e pr og ra m m es in h os pi ta ls a nd L TC Fs M ay 2 01 9 M oH SP P Re vi ew fi ni sh ed Su b ac ti vi ty 7 .2 .2 .1 En su re e xi st en ce o f l oc al ly ad op te d IP C, w at er s up pl y, sa ni ta tio n an d hy gi en e pr o gr am m es in e ac h ho sp ita l, ba se d on n ati on al p ro gr am IP C pr o gr am m es in h os pi ta l D ec em be r 20 21 Re gi on al h ea lth a ut ho ri tie s; H os pi ta l a dm in is tr ati on s N um be r of h os pi ta ls w ith an d w ith ou t I PC , w at er su pp ly , s an ita tio n an d h y gi en e pr og ra m m es Su b ac ti vi ty 7 .3 .1 .1 En su re e xi st en ce o f l oc al ly ad op te d IP C pr og ra m m es in ea ch lo ng te rm c ar e fa ci lit y IP C pr o gr am m es in L CT F M ay 2 02 0 Re gi on al h ea lth a ut ho ri tie s; LC TF a dm in is tr ati on s N um be r of L CT F w ith a nd w ith ou t I PC p ro gr am m es Su b ac ti vi ty 9 .1 .1 .1 Re vi se u nd er gr ad ua te c ur ri cu lu m fo r ve te ri na ry p ro fe ss io na ls to in co rp or at e an tib io tic s st or ag e, u se a nd co ns um pti on , w at er s up pl y, sa ni ta tio n an d hy gi en e an d in fe cti on p re ve nti on a nd co nt ro l Re vi se d cu rr ic ul um M ay 2 01 9 M in is tr y of A gr ic ul tu re M in is tr y of A gr ic ul tu re Re vi se d cu rr ic ul um in tr od uc ed Su b ac ti vi ty 9 .1 .2 .1 D ev el op s ho rt c ou rs es fo r po st gr ad ua te s/ ac tiv e pe rs on ne l i nc or po ra tin g an tib io tic s st or ag e, u se a nd c on su m p tio n, w at er s up pl y, s an ita tio n an d hy gi en e an d in fe cti on pr ev en tio n an d co nt ro l Co ur se s de ve lo pe d M ay 2 01 9 M in is tr y of A gr ic ul tu re Co ur se s de ve lo pe d National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 26 Su b ac ti vi ty 9 .1 .2 .2 Im pl em en t s ho rt c ou rs es fo r po st gr ad ua te s/ ac tiv e pe rs on ne l Co ur se s gi ve n D ec em be r 20 19 M in is tr y of A gr ic ul tu re Co ur se s gi ve n in n r of re gi on s Su b ac ti vi ty 1 0. 1. 1. 1 Es tim at e kn ow le dg e of sc ho ol ch ild re n ab ou t p er so n al h yg ie ne . Kn ow le dg e su rv ey D ec em be r 20 19 Ce nt er fo r H ea lth y Li fe S ty le Ba se lin e da ta Po st in te rv en tio n da ta Su b ac ti vi ty 1 0. 1. 2. 1 Fo rm a nd la un ch c am pa ig n di re ct ed a t s ch oo lc hi ld re n Ca m pa ig n D ec 2 01 9 Ce nt er fo r H ea lth y Li fe S ty le Po st in te rv en tio n da ta sh o w in g im pr ov em en t Su b ac ti vi ty 1 0. 2. 1. 1 Te ac h pe rs on ne l t o te ac h im po rt an ce o f i m pr ov ed h an d w as hi ng h ab its (a ft er to ile t, be fo re fo od ) a m on g ch ild re n, w at er s up pl y, s an ita tio n an d dr aw in g fr om in te rn ati on al ex pe ri en ce Ca m pa ig n, Le ct ur es to pe rs on ne l in d ay c ar e ce nt er s D ec 2 01 9 Ce nt er fo r H ea lth y Li fe S ty le N um be r of d ay c ar e ce n te rs p er c ity re ac he d by ca m pa ig n Su b ac ti vi ty 1 1. 1. 1. 1 In th e on go in g re vi sio n of la w s an d re gu la tio ns d ea lin g w ith m ed ic al a nd v et er in ar y pr od uc ts an d pr ac tic es , e ns ur e sh ift in g of th e em ph as is of th e re gu la to ry ap pr oa ch fr om q ua lit y co nt ro l t o qu al ity a ss ur an ce a nd d efi ni ng th e le ga l p ro vi sio n re qu iri ng co m pl ia nc e w ith g oo d la bo ra to ry , c lin ic al , m an uf ac tu rin g, d is tr ib uti on a nd st or ag e pr ac tic es (G LP , G CP , G M P, G D P, G SP ) 20 19 – 20 22 D ep ar tm en t A ge nc y on Ph ar m ac eu tic al C on tr ol ; M oH SP P M oH SP P Re vi se d le gi sl ati on in pl ac e Su b ac ti vi ty U ni t Ti m el in e Re sp on si bl e en ti ty Co st e sti m at e (c ur re nc y) So ur ce o f fu nd in g In di ca to r Co m m en ts National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 27 Su b ac ti vi ty 1 2. 1. 1. 1 Pr ep ar e ge ne ri c te rm s of re f er en ce fo r m ul tid is ci pl in ar y an tim ic ro bi al s te w ar ds hi p co m m itt ee s. C on si de r in te r na tio na l e xp er ie nc e Te rm s of re fe re nc e M ay 2 01 9 M oH SP P; w ith N ati on al A ss oc ia tio n of P ha rm ac is ts (i f su ch e xi st s) , P ed ia tr ic S oc ie ty (if s uc h) , R CF M C on su m er s A ss oc ia tio n M oH SP P Te rm s of re fe re nc e re ad y fo r ap pr ov al Su b ac ti vi ty 1 2. 1. 1. 2 A pp ro va l o f g en er ic te rm s of re fe re nc e fo r m ul tid is ci pl in ar y an tim ic ro bi al s te w ar d sh ip c om m is si on s A pp ro va l A ug 2 01 9 M oH SP P … M oH SP P A pp ro ve d To R Su b ac ti vi ty 1 2. 1. 1. 3 Re ne w al o f m ul tid is ci pl in ar y an tim ic ro bi al s te w ar ds hi p co m m itt ee s an tim ic ro bi al st ew ar ds hi p co m m itt ee s Co m m is si on s Ja n 20 19 M oH SP P, re gi on al h ea lth au th or iti es N um be r of c om m is si on s es ta bl is he d of to ta l n r ho sp ita ls Su b ac ti vi ty 1 2. 2. 1. 1 D efi ne , f or e ac h an tib io t ic in te ns iv e ho sp ita l m ed ic al sp ec ia lty , h ow b es t t o m ak e ST G s cr ed ib le , b as ed o n m od er n ev id en ce in cl ud in g in te rn ati on al , a nd g en er al ly ac ce pt ed . F oc us o n co m m on in fe cti on s/ in di ca tio ns th at an sw er fo r la rg e qu an titi es o f an tib io tic c on su m pti on D efi ne d ST G s ys te m fo r co m m on in fe c tio ns O ct ob er 20 19 M oH SP P w ith m ed ic al a ss oc i ati on s D efi ne d ST G s ys te m fo r co m m on in fe cti on s Su b ac ti vi ty 1 2. 2. 1. 2 Cr ea te th e ab ov e in fr as tr uc tu re D ec is io n En d 20 19 M oH SP P w ith m ed ic al a ss oc i ati on s In fr as tr uc tu re d ec id ed an d im pl em en te d National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 28 Su b ac ti vi ty 1 2. 2. 2. 1 Pr od uc e N ati on al S ta nd ar d T r ea tm en t G ui de lin es fo r th e m os t c om m on in di ca tio ns fo r an tib io tic u se in h os pi ta ls G ui de lin es 20 19 – co nti nu in g Re sp ec tiv e ST G G ro up /D ed i ca te d ST G re sp on si bl e en tit y; an d ag re ed w ith th e M oH SP N um be r of g ui de lin es pr od uc ed a nd im pl e m en te d Su b ac ti vi ty 1 2. 2. 2. 2 Pr od uc e N ati on al S ta nd ar d T r ea tm en t G ui de lin es fo r th e m os t c om m on in di ca tio ns fo r an tib io tic u se in P ri m ar y H ea lth C ar e/ Fa m ily M ed ic in e G ui de lin es 20 19 – co nti nu in g A d ed ic at ed S TG G ro up fo r co m m on in fe cti on s in P H C, w ith a dd ed re le va nt s pe ci al is ts (p ae di at ri cs , E N T, in fe cti ou s di se as es ..) ; R CF M ; In a gr ee m en t w ith th e St at e Se rv ic es fo r su rv ei lla nc e of ph ar m ac eu tic al a nd m ed ic al ac tiv ity N um be r of g ui de lin es pr od uc ed a nd im pl e m en te d G ui de lin es sh ou ld b e co nd en se d in to h an dy fo rm at , de liv er ed to e ac h PH C Ce n tr e et c. Su b ac ti vi ty 1 3. 1. 1. 1 Fo rm a n ati on al b oa rd o f e x pe rt s en tr us te d w ith w ri tin g in fo rm ati on o n th e va ri ou s an tib io tic s ub st an ce s, th ei r sp ec tr um a nd p ro pe r us e Bo ar d no m in at ed M ay 2 01 9 M oH SP P; S A PH C Bo ar d fo rm ed Su b ac ti vi ty 1 3. 1. 1. 2 Pu bl is h th is n eu tr al , i nd us tr y in de pe nd en t i nf or m ati on on a g ov er nm en ta l p ub lic w eb s ite W eb s ite w ith in fo Fe b 20 19 M oH SP P/ N om in at ed E xp er t Bo ar d W eb s ite w ith in fo o pe n Su b ac ti vi ty 1 3. 2. 1. 1 Re vi ew p re se nt s itu ati on o f an tib io tic m ar ke tin g, re vi ew le gi sl ati on a nd o th er re gu la tio ns Re vi ew pe rf or m ed M ay 2 01 9 M oH SP P W ri tt en re vi ew Su b ac ti vi ty U ni t Ti m el in e Re sp on si bl e en ti ty Co st e sti m at e (c ur re nc y) So ur ce o f fu nd in g In di ca to r Co m m en ts National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 29 Su b ac ti vi ty 1 3. 2. 1. 2 Re fo rm le gi sl ati on a nd re gu la tio ns to b ett er c on tr ol m ar ke tin g of a nti bi oti cs to p ub lic an d to h ea lth p ro fe ss io na ls , so th at n eu tr al in fo rm ati on be co m es th e la rg er p ar t Le gi sl ati on re fo rm s D ec em be r 20 19 M oH SP P R e fo rm ed le gi sl ati on a nd re gu la tio n Ph ar m ac ol og y de pa rt m en t ( fo r ad ve rs e eff ec ts m on it o ri ng ) e st ab lis he d. Su b ac ti vi ty 1 4. 1. 1. 1 M ak e a lis t o f c ri tic al ly im po rt an t a nti bi oti cs fo r hu m an us e ba se d on W H O li st . Li st o f cr iti ca lly im po rt an t an tib io tic s fo r hu m an us e Ju ne 2 01 9 M oH SP P; M oA , C FS M oH SP P Li st o f c ri tic al ly im po rt an t an tib io tic s re ad y fo r ap pr ov al Su b ac ti vi ty 1 4. 1. 2. 1 Re vi ew th e le ga l f ra m ew or k fo r us e an d pr es cr ip tio n of an tib io tic s in a ni m al s fo r fo od pr od uc tio n (w ith p ar tic ul ar em ph as is o n po ul tr y an d aq ua cu ltu re ) a nd in a gr ic ul tu re . Re vi ew Ju ne 2 01 9 M oA , C FS , M oH SP P M oH SP P, M oA , C FS Su b ac ti vi ty 1 4. 1. 3. 1 Re fo rm th e le ga l f ra m ew or k in a d ire cti on th at e lim in at es or re du ce s th e no n hu m an us e of c ri tic al ly im po rt an t an tib io tic s, p ar tic ul ar ly flu or oq ui no lo ne s an d ce ph al os po ri n’ s of 3 rd a nd 4 th ge ne ra tio ns Re fo rm D ec em be r 20 19 M oH SP P, M oA , C FS M oH SP P, M oA Re ne w ed le ga l f ra m e w or k In p la ce National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 30 Su b ac ti vi ty 1 4. 1. 3. 2 In tr od uc e pr e lic en se a ss es s m en t o f s af et y of a nti bi oti cs in te nd ed fo r u se in fa rm li ve st oc k, c on sid er in g th e po te nti al de ve lo pm en t o f r es ist an ce to dr ug s u se d in h um an h ea lth ca re La w o r re gu la tio n D ec em be r 20 19 M oA , C FS La w /r eg ul ati on in p la ce Su b ac ti vi ty 1 4. 1. 3. 3 En su re th at a ll an tib io tic u se fo r fa rm a ni m al s i s b y pr es cr ip tio n by a v et er in ar ia n on ly, a nd fo r tr ea tm en t p ur po se s La w o r re gu la tio n D ec em be r 20 19 M oA , C FS La w /r eg ul ati on in p la ce Su b ac ti vi ty 1 4. 1. 3. 4 En su re th at e co no m ic in ce n tiv es fo r ir ra tio na l u se a re el im in at ed La w o r re gu la tio n D ec em be r 20 19 M oA , C FS La w /r eg ul ati on in p la ce Su b ac ti vi ty 1 4. 1. 4. 1 Im m ed ia te m ea su re s to e lim in at e or s ub st an tia lly re du ce an tib io tic u se a s gr ow th sti m ul at or s Re vi ew a nd re fo rm o f le gi sl ati on an d re gu la tio ns 20 20 M oA , C FS M in is tr y of A gr ic ul tu re Re vi ew p er fo rm ed Su b ac ti vi ty 1 4. 1. 4. 2 A nti bi oti c us e as g ro w th s tim ul at or s ph as ed o ut U se o f an tib io tic s as g r o w th sti m ul at or s 20 21 M oA , C FS M in is tr y of A gr ic ul tu re Fo llo w u p pe rf or m ed Su b ac ti vi ty 1 4. 2. 1. 1 En su re d at a on a nti bi oti c us e in a ni m al h us ba nd ry is co lle ct ed , a nd a gg re ga te d to na tio na l l ev el /N CG D at a M ay 2 01 9 M oA ; S H SS PP S, N CG Re lia bl e da ta in p la ce w ith N CG Su b ac ti vi ty U ni t Ti m el in e Re sp on si bl e en ti ty Co st e sti m at e (c ur re nc y) So ur ce o f fu nd in g In di ca to r Co m m en ts National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 31 Su b ac tiv ity 1 4. 2. 1. 2. En su re d at a on a nti bi oti c us e in a gr ic ul tu re is c ol le ct ed , a nd ag gr eg at ed to n ati on al le ve l/ N CG Re vi ew M ay 2 01 9 M in is tr y of A gr ic ul tu re ; SH SS PP S, N CG Re lia bl e da ta in p la ce w ith N CG Su b ac ti vi ty 1 4. 2. 1. 3. En su re d at a on a nti bi oti c us e in a qu ac ul tu re is c ol le ct ed , an d ag gr eg at ed to n ati on al le ve l/ N CG Re vi ew M ay 2 01 9 M in is tr y of A gr ic ul tu re ; SH SS PP S, N CG Re lia bl e da ta in p la ce w ith N CG National Action Plan to Tackle Antimicrobial Resistance in the Republic of Tajikistan 32 1. European strategic action plan on antibiotic resistance; WHO EURO, 2011 2. Global action plan on AMR; WHO, 2015 3. Health Code, Tajikistan; Tajikistan Government, 2017 4. Epidemic ciprofloxacin-resistant Salmonella typhi in Tajikistan,Threlfall, EJMur doch, DA et al. The Lancet , Volume 351, Issue 9099, 339 5. Antibiotic use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe; Versporten, Ann et al. The Lancet Infec tious Diseases , Volume 14, Issue 5, 381–387 6. Sixth Ministerial Conference on Environment and Health, 13–15 June 2017, Ostra va, Czech Republic. ANNEX I TO THE DECLARATION OF THE MINISTERIAL CON FERENCE A COMPLEX OF POSSIBLE MEASURES TO PROMOTE THE OCEAN DECLA RATION References