National Action Plan on Antimicrobial Resistance 2017 – 2022

THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH COMMUNITY DEVELOPMENT GENDER ELDERLY AND CHILDREN THE NATIONAL ACTION PLAN ON ANTIMICROBIAL RESISTANCE 2017 - 2022 APRIL 2017 Ministry of Agriculture, Livestock and Fisheries i CONTENTS ACKNOWLEDGEMENTS ......................................................................................v FOREWORD ......................................................................................................vi EXECUTIVE SUMMARY ....................................................................................viii 1.0 INTRODUCTION ........................................................................................1 2.0 SITUATIONAL ANALYSIS ..........................................................................3 3.0 GOVERNANCE ...........................................................................................7 3.1 Antimicrobial Resistance Focal Point ...........................................................7 3.2 Establishment of National AMR Secretariat .................................................7 3.3 Establishment of Multi-sectoral Coordinating Committee ..............................7 Roles and Responsibilities of the National AMR Secretariat ...........................8 3.4 Establishment of Multi-Sectoral Technical Working Groups ...........................9 3.5 Revitalizing and Strengthening Medicines and Therapeutic Committee and .... Quality Improvement Teams .................................................................... 10 3.6 Guiding Principles ................................................................................... 10 4.0 STRATEGIC PLAN ....................................................................................12 4.1 Strategic Objective One........................................................................... 12 PRIORITY ACTION 1: AWARENESS-RAISING AND RISK .......................... COMMUNICATION ..................................................................................13 PRIORITY ACTION 2: EDUCATION .........................................................13 4.2 Strategic Objective Two ........................................................................... 14 PRIORITY AREA 3: SURVEILLANCE SYSTEM ..........................................15 PRIORITY ACTION 4: LABORATORY CAPACITY .....................................16 PRIORITY ACTION 5: RESEARCH AND DEVELOPMENT ..........................16 4.3 Strategic Objective Three ........................................................................ 17 PRIORITY ACTION 6: INFECTION PREVENTION AND CONTROL IN HEALTH CARE .........................................................................................18 PRIORITY ACTION 7: HEALTH WASTE MANAGEMENT SYSTEM .............19 4.4. Strategic Objective Four .......................................................................... 20 PRIORITY ACTION 8: REGULATORY FRAMEWORK FOR PRESERVATION OF ANTIMICROBIAL AGENTS ....................................................................21 ii PRIORITY ACTION 9: ANTIMICROBIAL STEWARDSHIP PROGRAMS .......22 4.5. Strategic Objective Five ........................................................................... 23 PRIORITY AREA 10: SUSTAINABILITY OF ANTIMICROBIAL RESISTANCE INTERVENTIONS .......................................................................................23 5.0 OPERATIONAL PLAN ...............................................................................24 6.0 MONITORING AND EVALUATION PLAN ..................................................55 7.0 ANNEX I: SWOT ANALYSIS .....................................................................62 8.0 ANNEX II: LIST OF CONTRIBUTORS.......................................................63 iii ABBREVIATION AND ACRONYMS ADDO Accredited Dispensing Drug Outlets AMR Antimicrobial Resistance BCC/IEC Behavior Change Communication/Information, Education and Communication BMC Bugando Medical Centre CDC Centre for Disease Control and Prevention CHMT Council Health Management Team CPD Continuous Professional Development DPs Development Partners EIDSR Integrated Disease Surveillance and Responses EQA External Quality Assessment FAO Food and Agriculture Organization of the United Nations GARP Global Antimicrobial Resistance Partnership GHSA Global Health Security Agenda GLASS Global Antimicrobial Resistance Surveillance System GOV Government HCAI Health Care Associated Infections HFs Health Facilities HCW Health Care Workers HIV Human Immunodeficiency Virus HMT Health Management Team IHR International Health Regulation IPC Infection Prevention and Control JEE Joint External Evaluation KAPB Knowledge Attitude Practice and Behavioral KCMC Kilimanjaro Christian Medical Centre MALF Ministry of Agriculture, Livestock and Fisheries MCC Multi-Sectoral Coordinating Committee MDR Multi Drug Resistance iv MoEVT Ministry of Education and Vocational Training MoHCDGEC Ministry of Health Community Development Gender Elderly and Children MSD Medical Stores Department MSH Management Science for Health NAP National Action Plan NEMLIT National Essential Medicines List for Tanzania NGO Non-Governmental Organization NHLQATC National Health Laboratory Quality Assurance and Training Centre PC Pharmacy Council PMO Prime Minister’s Office PORALG President’s Office Regional Administration and Local Government OIE World Organization for Animal Health QIT Quality Improvement Teams RHMT Regional Health Management Team STG Standard Treatment Guidelines TB Tuberculosis TFDA Tanzania Food and Drugs Authority TVLA Tanzania Veterinary Laboratory Agency WHO World Health Organization v ACKNOWLEDGEMENTS My sincere thanks go first and foremost to the World Health Organization for the technical and financial support during the development of this document. I would also like to thank the American Society of Microbiology for their support to the National Multi-sectoral Coordinating Committee (MCC) and Technical Working Group meetings. The FAO is also acknowledged for their technical contribution. The Ministry is grateful for the involvement and commitment of the Multi-sectoral Coordinating Committee and Technical Working Groups throughout this work under the Chairmanship of Prof. Muhammad Bakari Kambi, the Chief Medical Officer. Last but not least, my warmest thanks go to the Global Antibiotic Resistance Partnership (GARP), Tanzania Group for conducting situational analysis in 2015. This has been the backbone of our National Action Plan (NAP). DR. MPOKI M. ULISUBISYA PERMANENT SECRETARY (HEALTH) vi FOREWORD This National Action Plan addresses actions needed to be taken in order to combat antimicrobial resistance (AMR) in the country. It is obligatory to raise awareness of antimicrobial resistance and promote behavioral change through public communication programmes that targets human, animal and plant health. Inclusion of the use of antimicrobial agents and resistance in school curricula will further promote better understanding and awareness from an early age. Antimicrobial Resistance knowledge, surveillance and research will be strengthened through establishing a national surveillance system for antimicrobial resistance, establishing and building capacity for a national reference laboratory and designated laboratories for AMR surveillance, developing a national research agenda on AMR and establishing and supporting a coordinated mechanism that will ensure harmonized AMR guidelines, data management and sharing systems in human, animal and plant health settings. Better hygiene and infection prevention measures are essential to limit the development and spread of antimicrobial resistant infections including multi drug resistant pathogens. Infection Prevention and Control (IPC) programmes which incorporates in depth training of health personnel and education at the community level is essential in combating AMR in humans and animals. In line with IPC, personal hygiene should be continuously advocated throughout the food chain. Improvement of regulatory framework for preservation of antimicrobial agents and revisiting the policies, regulations, guidelines and directives on the use of microbial medicines in the country will be foster for development of antimicrobial stewardship to protect development of resistance of antimicrobial agents to human and animals. Effective National Action Plans will require political support from a broad range of government departments beyond Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC). Hence, AMR Agenda will be among Government political priorities. Besides that, the sustainability of NAP depends on the extent to which new attitudes and practices on antimicrobial use will be embedded in the whole society. This document vii which was developed under One Health Approach is intended to be used by public health, veterinary, agriculture and animal health workers and other stakeholders involved in managing antimicrobial products to ensure that they are used prudently in human, agriculture and veterinary sectors. UMMY MWALIMU (MP) MINISTER FOR HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN viii EXECUTIVE SUMMARY The plan is coherent to the WHO Global Action Plan on antimicrobial resistance with the following strategic objectives: improve awareness and understanding of antimicrobial resistance through effective communication, education and training; strengthen the knowledge and evidence base through surveillance and research; reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures; optimize the use of antimicrobial medicines in human and animal health; and develop the economic case for sustainable investment that takes account of the needs of all countries and to increase investment in new medicines, diagnostic tools, vaccines and other interventions. The situational analysis outlines the current AMR position in the country. The document summarizes the structure for the development and implementation of the NAP. It specifies the establishment of the National AMR Coordinating Committee, the Technical Working Groups, the Secretariat and the AMR Focal Point. It further describes the implementation structure at different levels. The Strategic Plan provides details of the priority actions, specific objectives, interventions and key activities to be performed for each strategic objective. Ten priority actions have been identified with several interventions. The deliberated initiatives includes the establishment of an evidence-based public communication Health Programme that targets human and animal health and the environment, including consideration of the food chain; advocacy campaign for AMR; establishment of knowledge management and sharing mechanisms at all levels; inclusion of AMR as a core component of professional education, training, certification and development. The AMR knowledge, surveillance and research will be strengthened through: establishing a national surveillance system for antimicrobial resistance; establishing and building capacity for a national reference laboratory and designated laboratories for AMR surveillance; developing a national research agenda on AMR; and establishing and supporting a coordinated mechanism that will ensure harmonized AMR guidelines, data management and sharing systems. In order to improve infection prevention and control in health care, there is a need to strengthen the national infection prevention and control programme in human and animal ix sectors at all levels. Another priority is increasing vaccination rates, which can reduce infection rates and dependency on antimicrobial agents, and ultimately reduce the spread of antimicrobial resistant pathogens. Further, strengthening laboratory and diagnostic infrastructural services to respond to AMR protocol is needed. Interventions to optimize the use of antimicrobial agents in human and animal health will include strengthening regulatory authority for controlling quality, distribution and use of antimicrobial agents; strengthening patient and health care provider compliance; reducing the prevalence of substandard medicines for both human and veterinary use and inappropriate or unregulated use of antimicrobial agents in agriculture; and strengthening stewardship for antimicrobial use in health facilities by providing evidence based prescribing and dispensing of standards of care. Stewardship will include monitoring and evaluating the use and consumption of antibiotics at all levels. The operational plan matrix gives details on how each activity will be conducted. It consists of sub activities, unit of measure, quantity, timelines, level of implementation, cost of implementation, source of funds and indicators. The monitoring and evaluation framework comprises indicators which will be measured in the process of implementation. The midterm review will be conducted after two years and the end of term evaluation will be conducted in 2022. 1 1.0 INTRODUCTION Antimicrobials play an essential role in combatting infectious diseases in both human and veterinary medicine. The introduction of penicillin in the 20th century led to a dramatic reduction in illnesses and deaths from infectious diseases. Conversely, the miracle cure provided by antimicrobials for common infections is being eroded by the emergence of antimicrobial resistance. Antimicrobial resistance (as defined by the WHO) is resistance of a microorganism to respond well to an antimicrobial medicine that was originally effective for treatment of infections caused by it. Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibiotics, antifungals, antivirals, and anti-parasitics. The standard treatments become ineffective and infections persist, increasing the risk of spread to others. Antimicrobial resistance is an emerging public health problem globally. Although there is limited data on antibiotic resistance in Tanzania, but even in the 1990s, resistance to antimicrobials in common use, such as ampicillin, tetracycline, Chloroquine, and trimethoprim-sulfamethoxazole, was significant. AMR has multiple implications such as prolonged and more expensive treatment as well as diminishing therapeutic choices among patient and healthcare providers. Others included increased mortality rates, long hospital stays, admission to the intensive unit and the spread of resistant microorganism to other patients. Also, it contributes to an increase in the cost of healthcare because of the need for more expensive second or third line antimicrobial agents. In addressing this, the Government has adopted the Agenda of the Sixty-eighth World Health Assembly of May 2015, which adopted the global action plan on antimicrobial resistance and urged Member States to develop National Action Plans for AMR using a “One Health Approach”. The National action plan will outline the key strategic objectives, interventions and activities to slow the development and spread of AMR and improve patient outcome. The objectives of the NAP are to: Improve awareness and understanding of antimicrobial resistance through effective communication, education and training; 2 Strengthen the knowledge and evidence base through surveillance and research; Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures; Optimize the use of antimicrobial medicines in human and animal health; Develop the economic case for sustainable investment that takes account of the needs of all countries and to increase investment in new medicines, diagnostic tools, vaccines and other interventions. The NAP provides a structure for a coordinated response and strengthening national stewardship among the numerous sectors and actors, including human, animal, agriculture, finance, environment, and well informed consumers. 3 2.0 SITUATIONAL ANALYSIS The report of the Global Health Security Agenda (GHSA) assessment using the International Health Regulations (IHR) Joint External Evaluation (JEE) tool conducted in 2016 concluded that antimicrobial resistance is a major problem in Tanzania and that there are high levels of inappropriate use of antimicrobials in the human and animal sectors. The report noted that although there are systems for monitoring antimalarial medicines, as well for HIV and TB resistance (8.5% new cases resistant to one drug, 1.1% MDR TB.), there is, however, no process for systematically collecting data on the prevalence of antibiotic resistance in common pathogens. The Global Antimicrobial Resistance Partnership (GARP) Tanzania Working Group conducted an AMR situational analysis in 2015 covering the situation and drivers of resistance in human and animal health. The report indicated that resistance of Streptococcus pneumoniae to Trimethoprim and Sulphamethoxazole in children under 5 increased from 25% in 2006 to 80% in 2012, leading to changes in the protocols for ARI treatment in children. Escherichia coli from urinary infections showed a 90% resistance to Ampicillin and 30-50% resistance to other common antibiotics. Extended-Spectrum Beta Lactamases (ESBL), which causes resistance to all beta lactam antibiotics, was found in 25-40% of E. coli (community and hospital) with more than 50% in children. Both the public and private sectors play an important role in veterinary health care. The veterinary health system in Tanzania is however currently not well regulated. Community level veterinary care is delivered through the public sector, while animal health care centers and clinics are provided by the private sector. Inadequate staff at the village level has led farmers to visit informal pharmacies and traditional medical practitioners to obtain antibiotics. Farmers may use antibiotics in animals to compensate for poor management due to lack of formal veterinary services and because of the prevalence of animal diseases. It is likely that farmers are unaware of potential negative effects of antibiotic overuse in animals. Antibiotics are commonly used to treat animals, just as they are in humans. In Tanzania, the animal diseases in which antibiotics are highly used are mastitis, tick borne diseases, fowl typhoid, colibacillosis, coccidiosis and other causes of diarrheal disease. The available studies show a number of multidrug resistant bacteria. One study isolated nine different 4 species of bacteria known to cause mastitis in lactating animals. Antibiotic susceptibility tests of the isolates to seven types of antibiotics indicated high resistance to penicillin G, chloramphenicol, streptomycin and oxytetracycline among Actinobacter pyogenes, Staphylococcus hyicus, Staphylococcus intermedius and Staphylococcus aureus from cattle with mastitis. Similar results were found in poultry where 11 isolates out of a total of 78 chickens that were found to have E. coli (65 percent), were resistant to amoxicillin clavulanate (82 percent), sulphamethoxazole (36 percent) and neomycin (54 percent). With regards to Health Care Associated Infection (HCAI) Prevention and Control, there is a clear plan and numerous guidelines for infection prevention and control which exist. At the same time, there are infection prevention and control committees in health facilities across the country although not always well resourced, active, or that effective. Waste management and hygiene in communities and health facilities need to be strengthened. Stronger compliance to antibiotic treatment regimes, quality assurance measures to prevent consumption of substandard medications, and restrictions of non-therapeutic uses of antibiotics within agriculture will provide a foundation for antimicrobial stewardship. The existence of legislation for regulation of quality, safety and efficacy of medicines including antimicrobial agents (Acts, Regulations and Guidelines) in the country is among the strengths; however challenges exist with regards to availability and rational use of medicines. The survey of medicines pricing and availability in Tanzania conducted in 2004 found that the median availability of medicines was 23.4%, 47.9% and 42.9% in the public, private and NGO sectors respectively. Another study which was conducted in Dar es Salaam, Kilimanjaro and Mbeya regions in 2014 indicated that 67.7% of patients were prescribed with antibiotics. Also, the study indicated that about 80% of all antibiotics are sold in the community drug outlets. The use of antibiotics in the community is indiscriminate and its restriction is very difficult. In addition to selling antibiotics without a prescription at a client’s request, drug sellers also promote inappropriate regimens. A cross-sectional study conducted in Accredited Drug Dispensing Outlets (ADDOs) and Duka la Dawa Baridi (DLDB) in Pwani and Morogoro regions used a simulated client method (“mystery shopper”) for data collection (Minzi and Manyilizu, 2013). The researchers found that 30 percent of DLDB and 35 percent of 5 ADDOs dispensed incomplete doses of antibiotics. Additionally, this study found that both ADDOs and DLDB dispensed fortified procaine penicillin powder (an injectable) as topical application for injuries. A study conducted in Kinondoni and Morogoro, involving 160 livestock keepers assessed awareness of human health threats from the use of antimicrobials in livestock and factors that promote selection pressure for resistance. For 30 percent of the livestock farmers it was the first time they have ever heard of the concept of antibiotic resistance. Fifty two percent were unaware of the type of disease that required use of antibiotics. Withdrawal period to be taken after an animal had been given antibiotic was unknown to 22 percent of farmers; 40 percent of them did not even knew that antibiotic use in animals may have an effect on humans. Raising awareness of antimicrobial resistance and promoting behavioural change through public communication programmes that target different audiences in human health, animal health and agricultural practice as well as consumers is critical to tackling antimicrobial resistance. In Tanzania, public awareness of antimicrobial resistance is still a challenge as currently these programmes are not in place. Patients’ knowledge of prescribed antimicrobials, including routes, dosages, frequency of administration, duration of use, and the importance of adhering to treatment even if they feel better, is limited. Patients usually demand for antibiotics even for diseases such as watery diarrhea and the common cold and self- medicate themselves with antimicrobials. However, there are institutions such as the Health Education Unit (HEU) in the Human health sector and the Farmers Educational Unit within the MALF which are mandated to educate the community on various topics related to human and animal health respectively. It is well known that including the use of antimicrobial agents and resistance in school curricula will promote a better understanding and awareness from an early age. Within undergraduate curricula in Human, Animal, Food Industry and Agriculture, AMR and related topics are included. However primary and secondary education curricula does not include AMR. In Tanzania, there is a functional public health laboratory network up to the dispensary level with a high quality national health laboratory quality assurance and training center (NHL QATC) at the apex and four zonal reference laboratories-Mbeya Zonal Referral Hospital 6 (MZRH), Bugando Medical Centre (BMC), Kilimanjaro Christian Medical Centre (KCMC) and Muhimbili National Hospital (MNH) Laboratories. The NHL-QATC is capable of conducting 7 of 10 priority testing areas: Bacteriology, virology, serology, parasitology, biochemistry, hematology and molecular, including sequencing, and is internationally accredited to the ISO 15189 standard for laboratory competency and quality. All other 4 zonal laboratories are also internationally accredited to the ISO 15189 (KCMC, Muhimbili, Bugando and Mbeya). There is also an EQA system in place coordinated by NHLQATC for priority diseases. In spite of such successes, there is no national AMR surveillance system for human, animals, agriculture and environment as well as partial and unreliable data on morbidity, mortality and other health outcomes in relation to AMR. Similarly, there is no investment for sustainability in new medicines, diagnostic tools, vaccines and other interventions and there is lack of national research agenda on AMR. The situational analysis has been summarized in a SWOT analysis as indicated in annex 1. 7 3.0 GOVERNANCE 3.1 Antimicrobial Resistance Focal Point The development and implementation of AMR Action Plan adopted the One Health Approach, and was coordinated by MOHCDGEC. The Pharmaceutical Services Unit (PSU) is the focal point. This will work in collaboration with the AMR secretariat. 3.2 The National AMR Secretariat The National AMR Secretariat shall includes AMR focal point within the MALF & MoHCDGEC and any other members nominated by MCC Chairperson. Roles and Responsibilities of the National AMR Secretariat (i) Preparation and circulation of documents (e.g. background papers, reports and advisory notes to MCC); (ii) Storage and archiving of MCC meeting proceedings; (iii) Build sustained partnerships and work nationally and internationally on containment of AMR; (iv) Identify stakeholders and facilitate formation of a multi- sectoral and multidisciplinary MCC; (v) Lead and coordinate the development of a national action plan for containment of AMR; (vi) Facilitate and oversee implementation, M&E of the plan through the MCC; (vii) Ensure regular data collection and information sharing by instituting effective communication and coordination among all stakeholders, members of MCC and their constituencies, sectors and disciplines; (viii) Coordinate national activities for establishment of AMR surveillance system; (ix) Report on the prevalence of and trends in AMR to the global AMR Surveillance system (GLASS). 3.3 Multi-sectoral Coordinating Committee A National Multi-Sectoral Coordinating Committee on AMR is the central National steering body and shall oversee and coordinate all AMR related activities in all sectors. The AMR Action plan operations shall be managed and implemented through the MCC under the chairmanship of the Chief Medical Officer and co-chaired by the WHO Representative to Tanzania. Members of the MCC include representatives from different sectors and disciplines specifically from the sectors responsible for human, animal, plant, environment health as well as livestock and food production. 8 Membership to the National Multi-Sectoral Coordinating Committee shall include National Medicines and Therapeutic Committee, Global Antimicrobial Resistance Partnership, Director of Veterinary Services, Director of Crop Development (Plant Health Services), Director of Aquaculture, Tanzania Livestock Keepers Association, Tanzania Horticultural Association, Regulatory Authorities (Pharmacy Council, Veterinary Council of Tanzania, TVLA, TFDA, Tanzania Pesticides Research Institute), One Health Coordination unit, Pharmaceutical Manufacturers and wholesalers. Other members from the Ministry of Health, Community Development, Gender, Elderly and Children include the following: Epidemiology; Health Services Inspectorate and Quality assurance Sections; Departments of Curative Services and Policy and Planning; and the National Health Laboratory and Quality Training Centre (NHLQTC). Membership also comprises Development Partners and International Organizations’ including the World Health Organization (WHO), Food and Agriculture Organization (FAO), Centre for Disease Control and Prevention (CDC), Management of Science for Health (MSH) and World Organization for Animal Health (OIE). It also includes medical and agriculture universities. Roles and Responsibilities of the MCC (i) The MCC is expected to lead facilitation, and when appropriate, coordination of a national response to the threat of AMR; (ii) Oversee the development of National AMR Plan of Action (NAP) and endorse it; (iii) To coordinate formulation of national programmes and/or projects on AMR; (iv) To oversee and evaluate the implementation of AMR activities in the country; (v) Provide a structure for information-sharing to mutually reinforce activities among sectors; (vi) Facilitate and when appropriate and agreed, coordinate efforts to contain and reduce the threat of AMR at national, zonal, regional, district and community levels; (vii) To forge linkages and collaboration with internal and external agencies and organizations for enhancement of AMR national agenda; (viii) To strengthen and promote national networking in the health systems and disease specific programmes in order to ensure effective and efficient use of resources and sharing of information; (ix) To promote sharing of expertise and resources for inter-sectoral AMR surveillance and research; (x) To convene or organize scientific seminars and serve as national scientific platform for AMR. 9 3.4 Multi-Sectoral Technical Working Groups The National MCC has four Technical Working Groups (TWGs) which are based on the five global strategic objectives that have been identified to achieve the Nation Action Plan for AMR main objectives. These TWGs are mandated with specific tasks including providing technical input, conducting situational analyses and in collaboration with MCC development of National AMR Action Plan. The four established technical working groups are: (i) Technical working group for Awareness, effective communication and Education (ii) Technical working group for AMR Knowledge, Surveillance, Research and sustainable investments (iii) Technical working group for sanitation, hygiene and infection prevention and control (iv) Technical Working Groups for Antimicrobial use stewardship Membership to TWGs Membership of a TWGs comprise relevant technical specialties. These include experts from infectious diseases, microbiology, infection prevention and control, social health, rational use of medicines, crop and drug regulation, surveillance, environmental health and health promotion. Each TWGs comprises of chairperson and about ten other members. Roles and Responsibilities of TWGs The MCC has established Terms of References (TORs) for each TWG stipulating specific scope, roles and responsibilities. The TWGs which are national groups interact with country representatives of the required sectors, as determined by their scope of work and report regularly to the MCC. Activities include but not limited to: (i) Collaborate with MCC Formulation of NAP (ii) Operationalize National AMR Action plan under their respective strategic objectives. (iii) Prepare annual work plan as per National AMR Action Plan (iv) Report to MCC on the progress to the implementation of the respective strategic objective. (v) Proposal writing (vi) Provide updates on ongoing activities and provide technical advice to the MCC or National AMR Focal Point. 10 3.5 Medicines and Therapeutic Committee and Quality Improvement Teams Medicines and Therapeutic Committees (MTC) in each health facility have the mandate to ensure the rational use of medicines including antimicrobial stewardship. The functions of MTC as stipulated in the Medicines and Therapeutic Guidelines include: (i) Monitoring of prescribing practices to adhere to the Standard Treatment Guidelines; (ii) Monitoring antimicrobial prescribing, dispensing and use against treatment guidelines to prevent antimicrobial resistance; (iii) Facilitate operational research to investigate rational use of antimicrobial; (iv) Monitor ethical promotions of medicines and medical supplies by medicines promoters (v) To provide on-going staff education and information on the use of antimicrobial and therapy (vi) Ensure availability of up-to-date important reference material for medicines information including the Standard Treatment Guidelines and Essential Medicines List (STG/NEMLIT) (vii) Advising management teams and all staff on antimicrobial related matters; The Quality Improvement Teams (QIT) lead in the infection prevention and control activities in reducing spread of hospital infections. 3.6 Guiding Principles These guiding principles as articulated in the 68th WHA, describe the role of all stakeholders to follow a common approach that requires integrated and well-coordinated efforts at the national, institutional, and individual levels. Such actions are linked to regional and global efforts. The principles are as follows: (i) Whole-of-society engagement including a One Health Approach. Antimicrobial resistance affects everybody, regardless of where they live, their health, economic circumstances, lifestyle or behaviour. It affects not only human health, but also other sectors such as animal health, agriculture, food security, water and sanitation and economic development. Therefore, everybody – in all sectors and disciplines – should be engaged in the implementation of the NAP and in particular in efforts to preserve the effectiveness of antimicrobial medicines by all means including conservation and 11 stewardship programmes. (ii) Prevention first Every infection prevented is one that needs no treatment. Prevention of infection can be cost effective and implemented in all settings and sectors, even where resources are limited. Good sanitation, hygiene and other infection prevention measures that can slow the development and restrict the spread of difficult-to-treat antibiotic-resistant infections are a “best buy”. (iii) Access The aim to preserve the ability to treat serious infections requires both equitable access to and appropriate use of, existing and new antimicrobial medicines. Effective implementation of NAP to address antimicrobial resistance depends also on access, inter alia, to health facilities, health care professionals, veterinarians, preventive technologies, diagnostic tools including those which are at “point of care”, and to knowledge, education and information. (iv) Sustainability The implementation of the NAP requires long-term investment in all the strategies in the plan. E.g. surveillance, operational research, laboratories, human and animal health systems, competent regulatory capacities, and professional education and training, in both the human and animal health sectors. Political commitment and international collaboration are needed to promote the technical and financial investment necessary for effective development and implementation of national action plans. (v) Incremental targets for implementation That NAP offers an opportunity for the country to determine the priority actions that it needs to take in order to attain each of the five strategic objectives and to implement the actions in a stepwise manner that meets both local needs and global priorities. 12 4.0 STRATEGIC PLAN The five strategic objectives are to be operationalized in order to achieve the desired results of this plan. In each strategic objective, the priority actions, specific objectives, interventions and key activities have been identified. STRATEGIC OBJECTIVES: 1. Create Awareness and Understanding of Antimicrobial Resistance through Effective Information, Education and Communication 2. Strengthen the Knowledge and Evidence Based through Surveillance and Research 3. Reduce the Incidence of Infection through Effective Sanitation, Hygiene and Infection Prevention Measures 4. Optimize the Use of Antimicrobial Agents in Human and Animal Health 5. Develop the Economic Case for Sustainable Investment that Takes Account of the Needs of all Countries and to Increase Investment in New Medicines, Diagnostic Tools, Vaccines and other Interventions 4.1 STRATEGIC OBJECTIVE ONE Create Awareness and Understanding of Antimicrobial Resistance through Effective Information, Education and Communication Steps need to be taken immediately in order to raise awareness of antimicrobial resistance and promote behavioral change, through public communication programmes that target different audiences in human, animal and plant health. Inclusion of the use of antimicrobial agents and resistance in school curricula will promote better understanding and awareness from an early age. Making antimicrobial resistance as core component of professional education, training, certification, continuing education and development in the health, veterinary sectors and agricultural practice, will help to ensure proper understanding and awareness among professionals. The national awareness and knowledge of AMR will be improved through establishment of an evidence-based public communication health Programme that targets human, animal, 13 plant including food chain; advocate for AMR and conduct campaign; establishment of knowledge management and sharing mechanism at all levels; include AMR as a core component of professional education, training, certification and development; as well as AMR as a component of Continuing Professional development (CPD). The priority action in this strategic objective are as follows: • Awareness-raising and risk communication • Education PRIORITY ACTION 1: AWARENESS-RAISING AND RISK COMMUNICATION Objective 1: Increase national awareness on AMR Interventions Activities 1.1. Establish an evidence-based public communications on AMR targeting human, animal and plant including food chain. 1.1.1 Conduct knowledge, Attitude, Practice and behavioural (KAPB) studies on AMR in different social and professional groups. 1.1.2 Develop and disseminate a communication strategy for AMR 1.2. Advocate for AMR and Conduct campaigns 1.2.1. Conduct Antibiotic awareness week 1.2.2. Conduct Training of Trainers (TOTs) at National, Regional and Council level on AMR 1.2.3. Conduct sensitization meetings at National, Regional, Council levels on AMR 1.2.4. Conduct multimedia awareness campaigns 1.3 Establish AMR knowledge Management and sharing mechanism at all levels 1.3.1 Develop knowledge sharing mechanism at all levels (data base, website, meetings, symposium, conferences) PRIORITY ACTION 2: EDUCATION Objective 2: Improve knowledge of AMR Interventions Activities 2.1 Include AMR as a core component of professional education, training, certification and development 2.1.1. Review, update and disseminate the existing education curricula in human, animal, plant health, food chain and environment 2.2. Include AMR as a core component of Continuing Professional development (CPD) 2.2.1. Review, update and disseminate the existing CPD guidelines for human, animal, plant, food chain and environment health 14 4.2 STRATEGIC OBJECTIVE TWO Strengthen the Knowledge and Evidence Based through Surveillance and Research Surveillance of antimicrobial resistance is critical for providing data on the extent and trends of the AMR problem. In Tanzania there is no AMR surveillance in the context of one health approach which in turn limits national efforts to tackle AMR. Through the NAP, the national surveillance system for AMR will be established. Laboratory-based surveillance is required for national action in the monitoring of AMR and its spread. For reliable microbiological and antimicrobial susceptibility testing, it is imperative to equip laboratories with equipment, reagents and human resource. Furthermore, a coordinated mechanism for AMR reporting will be established in order to share information in one health approach. Surveillance of antimicrobial consumption is an important undertake in combating AMR. It is critical to monitor antimicrobial consumptions in the country. The World Health Organization (WHO) methodology will be used to determine antimicrobial agent’s consumption surveillance in human, animals, plants and environment. Other initiatives will include establishing and building capacity for a national reference laboratory and designated laboratories for AMR surveillance, developing a multisector national research agenda on AMR and establishing and supporting a coordinated mechanism that will ensure harmonized AMR guidelines, data management and information sharing systems. The interventions under surveillance and research include the following priority actions: • Surveillance system • Laboratory capacity • Research and development 15 PRIORITY ACTION 3: SURVEILLANCE SYSTEM Objective 3 : Establish a national surveillance system for antimicrobial resistance Strategic interventions Activities 3.1 Develop a national AMR surveillance protocol 3.1.1 Review existing infectious disease surveillance systems 3.1.2 Develop standard operating procedures (SOPs) for AMR surveillance 3.2. Develop AMR surveillance reporting system 3.2.1 Develop a multisector AMR surveillance reporting and information sharing system in human, animals, plants and environment health 3.3 Establish antimicrobial agents consumption surveillance in human, animals, plants and environment 3.3.1 Conduct a baseline survey on selected antimicrobial consumption 3.3.2 Conduct antimicrobial consumption surveillance down the supply chain towards consumers 3.4 Establish antimicrobial residual testing program 3.4.1 Identify key antimicrobial agents for residual testing surveillance 3.4.2 Identify and support laboratories for testing antimicrobial residuals 3.4.3 Build human and infrastructural capacity in the identified laboratories for antimicrobial residual testing 16 PRIORITY ACTION 4: LABORATORY CAPACITY Objective 4 Build laboratory capacity to produce high-quality microbiological data for patient management and support surveillance activities in both human and animal sectors. Strategic interventions Activities 4.1. Designate laboratories for AMR surveillance 4.1.1. Assess the existing laboratories’ capacity and appoint one laboratory to be a national reference laboratory and appoint laboratories to carry out AMR surveillance in human, animal, plant and environmental health 4.2. Capacity building for designated laboratories for AMR surveillance 4.2.1 Conduct training, mentorship and supportive supervision for personnel on diagnostics and antimicrobial susceptibility testing 4.3 Strengthen supply chain system to support laboratory AMR surveillance 4.3.1 Develop the master list for the materials/ reagents/items required for AMR surveillance and supply mechanism to ensure constant availability 4.4 Strengthen quality assurance system for AMR surveillance 4.4.1 Identify and support QA scheme to be used basing on WHO/OIE guidelines/ISO Standards PRIORITY ACTION 5: RESEARCH AND DEVELOPMENT Objective 5 Establish a national multi sectoral research agenda on AMR Strategic interventions Activities 5.1. Develop a national multi sectoral research agenda on AMR 5.1.1. Engage relevant stakeholders to identify current gaps in knowledge and potential research areas 5.1.2. Develop national research guidelines on AMR 5.1.3. Undertake research related to AMR 5.2. Establish a mechanism for sharing AMR research findings 5.2.1. Organize multisector national AMR scientific symposiums 5.2.2 Establish a national AMR data repository 5.2.3 Establish a national biobank/bio-repository center 17 4.3 STRATEGIC OBJECTIVE THREE Reduce the Incidence of Infection through Effective Sanitation, Hygiene and Infection Prevention Measures Better hygiene and infection prevention measures are essential to limit the development and spread of antimicrobial resistant infection and multi drug resistant pathogens. Drug resistant does not only occur in health care setting but also at the household level. Infection Prevention and Control (IPC) with proper training of health personnel and education in the community level is needed to combat AMR. To facilitate infection prevention and control in health care, there is a need to strengthen the national infection prevention and control Programme at all levels. These efforts should go along with the efforts to strengthen National Linkages and Partnership to respond to antimicrobial resistance. The use of vaccines can reduce the infection rates and dependency on antimicrobial agents as well as the risk that antimicrobial resistant pathogens will develop and spread through food chain. To facilitate Laboratory and Diagnostic infrastructure support, strengthening of laboratory and diagnostic infrastructural services to respond to AMR protocol would be a prerequisite; which should involve capacity building on laboratory and diagnostic services for antimicrobial agents and timely detection of outbreaks caused by resistant pathogens. On aspect of training and professional development; Promotion of AMR based Competency practices in human and animal health through Professional Development is also a relevant and key strategic intervention. This would be achieved through such measures as establishment of certifiable structured training programmes on hygiene and Infection Prevention and Control (IPC) through accredited competency based curricula and guidelines on AMR conducted in teaching institutions and at the working environment. Overall best IPC practices will lead to better health outcome improvements in human and animal health, while overall treatment costs will be reduced. To address these challenges, two priority actions have been identified: 18 • Infection prevention and control in health care • Health Waste Management System PRIORITY ACTION 6: INFECTION PREVENTION AND CONTROL IN HEALTH CARE Objective 6: Strengthen the national infection prevention and control Programmes Strategic interventions Activities 6.1. Promote of IPC programmes in all human health care settings 6.1.1. Conduct scheduled supportive supervision to all health facilities by quality assurance teams (Ministry level, RHMT, CHMT) 6.1.2. Conduct advocacy and sensitization meeting 6.1.3. Facilitate availability of IPC related equip ment, supplies and guidelines 6.2. Establish and design IPC pro grammes in animal and plant health services 6.2.1. Promote good agricultural/animal husband ry practices 6.3. Strengthen vaccination Pro gramme in human and ani mal health 6.3.1. Review existing regulations to accommo date the need for a mandatory vaccination Programme in animal health 6.3.2. Establish a functioning vaccination program for human and animal health 6.4 Strengthening National Link ages and Partnership for IPC 6.4.1 Engage the communities on implementa tion of personal hygiene and environmental sanitation 6.4.2 Enforce the use of International Health Reg ulations (IHR) through Integrated Disease Surveillance and Response (IDSR) and exist ing bi-laws on prevention of outbreaks 6.4.3 Promote Food Chain Hygiene 19 PRIORITY ACTION 7: HEALTH WASTE MANAGEMENT SYSTEM Objective: Strengthen Health Waste Management at all levels Strategic interventions Activities 7.1. Develop and strengthen health waste management sys tems in health sector and animal sector 7.1.1 Promote personal hygiene and environmental sanitation in congregate settings 7.1.2 Promote zoo sanitary and phytosanitary inspectorate services in waste management 7.1.3 Procure waste management equipment 7.1.4 Orient Animal Health workers on hygiene and safety standards and waste management 7.1.5 Establish national and subnational moni toring system in the field of waste man agement 20 4.4. STRATEGIC OBJECTIVE FOUR Optimize the Use of Antimicrobial Agents in Human, Animal and Plant Health Antimicrobial resistance is closely linked to antimicrobial use, and it is estimated that 50% or more of hospital antimicrobial use is inappropriate. The irrational use of antimicrobial agents has been well identified in humans and now the problem has spread to animals whereby non-compliance to withdraw period concept causes drug resistance. Development of drug resistance to humans is increasing due to irrational use of antimicrobials in animals through food of animal origin such as meat, milk and eggs. In order to address this problem, there is a need for developing antimicrobial stewardship programs. Antimicrobial stewardship includes not only limiting inappropriate use but also optimizing antimicrobial selection, dosing, route, and duration of therapy to maximize clinical cure or prevention of infection, while limiting the unintended consequences. It is essential to strengthening stewardship for antimicrobial use in health facilities by providing evidence based prescribing and dispensing of standards of care. The stewardship will also monitor and evaluate the use and consumption of antibiotic at all levels. Also, priority areas to optimize antimicrobial use include the improvement of regulatory framework for preservation of antimicrobial agents and revisiting the policies, regulations, guidelines and directives on the use of antimicrobial in the country. Other interventions will include strengthening regulatory system in controlling quality, distribution and use of antimicrobial agents including inappropriate or unregulated use of antimicrobial agents in agriculture. In optimizing prudent use of antimicrobials the following priority actions has been identified: • Regulatory Framework for Preservation of Antimicrobial Agents • Antimicrobial Stewardship Programs 21 PRIORITY ACTION 8: REGULATORY FRAMEWORK FOR PRESERVATION OF ANTIMICROBIAL AGENTS Objective 8: To ensure appropriate use of antimicrobial agents Strategic interventions Activities 8.1 Develop and review policies, laws and guidelines on the use of antimicrobial agents in animals, agriculture and fish eries 8.1.1 Develop policy guidelines for handling and preservation of antimicrobial agents 8.1.2 Develop/review National Medicines , pesticides and national livestock Policy to address AMR 8.1.3 Develop /strengthen regulations on use and control of prescriptions 8.1.4 Develop and review STG and NEMLIT in veterinary practice, livestock production, agriculture and fisheries 8.1.5 Review STG/NEMLIT for human medicine including antimicrobial 8.2 Monitor proper use of preserved antimi crobial agents 8.2.1 Conduct regular inspection on pharmaceutical and agro chemical outlets 8.2.2 Conduct supportive supervision in slaughter houses and abattoirs to check compliance of withdraw peri ods and slaughter suitability 8.2.3 Conduct refresher trainings on professional ethics and enforcements on the use of antimicrobial agents 8.2.4 Establish a virtual networking platform on the use of preserved antimicrobials agents 22 PRIORITY ACTION 9: ANTIMICROBIAL STEWARDSHIP PROGRAMS Objective 8: To ensure appropriate use of antimicrobial agents Strategic interventions Activities 9.1 Establish antimicrobial steward ship programmes 9.1.1 Develop hospital formulary and other AMR policies 9.1.2 Develop a system on use of stand ard prescriptions 9.1.3 Audit antimicrobial prescribing 9.1.4 Prepare and share the report on health facility antimicrobial use & susceptibility test results to health care workers. 9.1.5 Educate prescribers, pharmacist, nurses and lab personnel about good antimicrobial prescribing practices and antimicrobial resist ance 9.2 Monitor antimicrobial steward ship programmes 9.2.1 Establish and operationalize medicines and therapeutic Com mittees and other related commit tees. 9.2.2 Provide capacity building to Medi cines and Therapeutic Commit tees and other related commit tees on antimicrobial stewardship programmes 9.2.3 Conduct supportive supervision to monitor antimicrobial steward ship programmes 23 4.5. STRATEGIC OBJECTIVE FIVE Develop the Economic Case for Sustainable Investment that Takes Account of the Needs of all Countries and to Increase Investment in New Medicines, Diagnostic Tools, Vaccines and other Interventions Targeted and interdisciplinary research efforts are needed to fill gaps that still exist in understanding of prevalence of antimicrobial resistance, patterns and its epidemiological impact on human and animal pathogens and diseases. A better understanding of the issue of antimicrobial resistance will create the foundations for ensuring that targeted and efficient measures can also be taken in the future. New medicines, diagnostic tools and vaccines are needed to combat emerging and spreading antimicrobial resistant pathogens. In order to achieve this, studies will be carried out to determine the economical case for further investment in research for new drug discoveries, development and piloting of new diagnostic tools, vaccines and alternative interventions. To prepare for the economic case for sustainable investment on antimicrobial resistance intervention, investment required will be identified, priorities on scientific research on AMR will be set and international collaboration will be fostered to support investigation and testing of new innovative technologies in the respective areas. PRIORITY AREA 10: SUSTAINABILITY OF ANTIMICROBIAL RESISTANCE INTERVENTIONS Objective 10: To prepare the economic case for sustainable investment in new medicines, diagnostic tools, vaccines and other interventions Interventions Activities 10.1 Identify the investment required for the implementation of the national action plan for AMR using one health approach 10.1.1. Engage the public, private sectors and development partners on the investment requirements for implementation of the AMR National Action Plan 10.1.2 Support piloting and dissemination of innovative ideas on investment for new medicines, diagnostic tools, vaccines and other interventions 10.1.3 Establish linkages with relevant stakeholders in implementing AMR National action plan 24 5.0 OPERATIONAL PLAN The operational plan matrix consists of sub activities, unit measure, quantity, time when a certain sub activity will be accomplished, level of implementation, cost of implementation, source of fund and indicators. PRIORITY ACTION 1: AWARENESS-RAISING AND RISK COMMUNICATION Intervention 1.1: Establish an evidence-based public communication on AMR targeting human, animal plant including food chain Activity 1.1.1: Conduct knowledge, Attitude, Practice and behavioral (KAPB) studies on AMR in different social and professional groups. S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / L e v e l o f im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st (U S D ) S o u rc e o f fu n d in g In d ic a to r Conduct a survey Survey 2 August 2017 Nation-wide MoHCDGEC/ MALF 10,000 Govt/ Partners KAPB surveys conducted and data shared Data entry and analysis Person 2 December 2018 Nation-wide MoHCDGEC/ MALF 1,000 Govt/ Partners Conduct a meeting to disseminate information Meeting 3 December 2018 Nation-wide MoHCDGEC/ MALF 5,000 Govt/ Partners Activity 1.1.2 Develop and disseminate a communication strategy for AMR S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st (U S D ) S o u rc e o f fu n d in g In d ic a to r Develop AMR com munication strategy workshop 3 August 2018 Nation-wide MoHCDGEC 4000 Govt/ Partners AMR com munication strategy developed and shared Print com munication strategy Copies 200 December 2018 Nation-wide MoHCDGEC 10,000 Mo HCDGEC Govt/ Partners 25 Intervention 1.2: Advocate for AMR and Conduct campaigns Activity 1.2.1: Conduct Antibiotic Awareness week S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Develop and dis seminate AMR IEC/ BCC mate rials Copies TV Broad cast Radio spots 500 5 5 2017 0nwards National wide MoHCDGEC/ MALF/POR ALG/PMO 20,000 Govt/Part ners Conduct AMR cam paigns Cam paign 5 2017 0nwards National wide MoHCDGEC/ MALF/POR ALG/PMO 5000 Govt/Part ners Activity 1.2.2: : Conduct Training of Trainers (TOTs) at National, Regional and Council level on AMR Training of 30 TOTs trainees at National level on AMR ToTs Ses sions 1 August 2017 National wide MoHCDGEC/ MALF 10,000 Govt/ Partners Training of 78 TOTs trainees at Regional level on AMR ToTs Ses sions 2 August 2017 26 Re gions MoHCDGEC/ MALF 35,000 Govt/ Partners Training of 558 trainees at Council level on AMR Train ees Ses sions 20 September November 2017 186 Councils MoHCDGEC/ MALF 200,000 Govt/ Partners Activity 1.2.3: Conduct advocacy meetings at National, Regional, Council and Community levels on AMR S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Conduct sensitiza tion meet ings for social and profession al groups. Sen sitiza tion meet ings 4 September 2017 National level Mo HCDGEC/ MALF/POR ALG 60,000 Gov/Part ners Number of AMR Sen sitization meetings conducted 26 Conduct sensitiza tion meet ings at Regional level Sen sitiza tion meet ings 26 October December 2017 Region al level Mo HCDGEC/ MALF/POR ALG 150,000 Gov/Part ners Sensi tization meetings at Council level Sen sitiza tion meet ings 186 January March 2018 Council level Mo HCDGEC/ MALF/POR ALG 465,000 Gov/Part ners Sensi tization meetings at Commu nity level Sen sitiza tion meet ings 16,000 wards April 2018 June 2020 Com munity level Mo HCDGEC/ MALF/POR ALG 300,000 Gov/Part ners Activity 1.2. 4: Implement AMR multimedia awareness campaigns S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Develop, print and dissemina tion of IEC/BCC print materials on AMR (Posters, leaflets, T-Shirts) to the commu nity IEC/ BCC print materials 12 sets October 2017 June 2020 National wide MoHCDGEC/ MALF/ PORALG 300,000 Govt/ Partners Broadcast radio and TV Pro grammes Programme 12 October 2017 June 2020 National wide MoHCDGEC/ MALF/ PORALG 150,000 Govt/ Partners Disseminate AMR messages through social media Messages 12 sets October 2017 June 2020 National wide MoHCDGEC/ MALF/ PORALG 150,000 Govt/ Partners Intervention 1.3: Establish AMR knowledge Management and sharing mechanism at all levels Activity 1.3.1: Develop AMR knowledge sharing mechanism at all levels S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Orient AMR for Data base/ repository and Webpage devel opers Orientation sessions 1 Septem ber 2017 National level MoHCDGEC/ MALF/PMO 2,000 Govt/ Partners AMR in formation shared/ dissemi nated 27 Develop Web page on AMR Webpage 1 Septem ber 2017 National wide MoHCDGEC/ MALF/PMO 1,000 Govt/ Partners Develop Data base system on AMR knowledge sharing Database 1 Septem ber 2017 National wide MoHCDGEC/ MALF/PMO 5,000 Govt/ Partners / DPs Conduct sympo sium and confer ences on AMR Workshop 5 April 2017 Onwards National wide MoHCDGEC/ MALF/PMO/ PORALG/ DPs 25,000 Govt/ Partners PRIORITY ACTION 2: EDUCATION Intervention 2.1: Include AMR as a core component of professional education, training, certification and development Activity 2.1.1: Review, Update and disseminate the existing curricula to include AMR for human, Animal, Plant Health, food chain and environment S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Conduct a needs assessment to identify gaps on relevant (Human, Animal and plant) curricula Curricula 4 Jan 2018 National wide MoHCDGEC/ MALF/ Mo EVT 15,000 Govt/ Partners Revised curricula available for the tar geted pro fessional groups Disseminate needs assessment findings to cur ricula developing bodies Dissemi nation meetings 1 February 2018 National Level MoHCDGEC/ MALF/ Mo EVT 4,000 Govt/ Partners Review and Up date curricula to include AMR in all curricula for human, Animal, Plant Health, food chain and envi ronment Reviewed and Up dated Cur ricula 4 March April 2018 National Level MoHCDGEC/ MALF/ Mo EVT 20,000 Govt/ Partners Develop basic AMR training ma terial for Primary and Secondary school curricula for human, Ani mal, Plant Health, food chain and environment Developed Basic AMR training material 2 March 2018 National Level MoHCDGEC/ MALF/ Mo EVT 10,000 Govt/ Partners Training of 398 ToTs (26 REO,186 Primary and 186 Secondary DEOs on basic AMR ToTs Ses sions 12 April –May 2018 Nation wide MoHCDGEC/ MALF/ Mo EVT 120,000 Govt/ Partners 28 REO and DEO to orient Primary and Secondary school teachers on basic AMR training material school curricula for human, Ani mal, Plant Health, food chain and environment Orienta tion ses sions 2 May June 2018 Nation wide MoHCDGEC/ MALF/ Mo EVT 100,000 Govt/ Partners Intervention 2.2: Include AMR as a core component of Continuing Professional development (CPD) Activity 2.2.1: Review, Update and disseminate the existing CPD guideline for human, Animal, Plant Health, food chain and environment S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Conduct assess ment on the existing CPD con tents to identify gaps in relation to AMR Guideline 4 Jan 2018 National level MO HCDGEC, MALF Train ing Depart ments 12,000 Govt/ Partners Revised curricula available for the targeted education level Share needs as sessment findings to professional and other relevant Bodies/authorities Dissemi nation meetings 4 March 2018 National level Professional Bodies MoHCDGEC MALF 4,000 Govt/ Partners Develop generic AMR CPD training material focusing on one health ap proach Basic AMR training material 1 March 2018 National level MO HCDGEC, MALF Train ing Depart ments 5,000 Govt/ Partners Disseminate ge neric AMR –CPD training material focusing on one health approach to relevant profes sional bodies Dissemi nation meeting 1 April 2018 National level Professional bodies MoHCDGEC MALF 2,000 Govt/ Partners 29 PRIORITY AREA 3: SURVEILLANCE SYSTEM Intervention 3.1 : Develop a national AMR Surveillance Protocol Activity 3.1.1: Review existing infectious disease surveillance system S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Collect information on the pre-existing disease surveillance systems Surveil lance sys tem 1 Jul-17 National level Mo HCDGEC/ MALF 6,900.00 Govt/ Partners Informa tion on infec tious disease Set up stake holders meeting to review the proposed surveil lance draft Meeting 1 Aug-17 National level Mo HCDGEC/ MALF 23,850.00 Govt/ Partners Activity 3.1.2: Develop standard operating procedures (SOPs) for AMR surveillance S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Identify target micro organisms and anti microbial agents for AMR surveillance meeting 1 Nov 17 National level Mo HCDGEC/ MALF 0 AMR SOP in place and used Conduct Multi sectoral workshops to develop/harmonize SOPs for AMR sur veillance Workshop 1 Nov 17 National level Mo HCDGEC/ MALF 6,900.00 Govt/ Part ners Disseminate the AMR surveillance SOPs Workshop TBD Dec 17 Nation wide Mo HCDGEC/ MALF 5,000.00 Govt/ Part ners 30 Intervention 3.2 : Develop AMR surveillance reporting system Activity 3.2.1: Develop a multisector AMR surveillance reporting and information sharing system in human, animals, plants and environment S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Collect and com pile information on the pre-ex isting reporting system on AMR List of existing disease reporting system 1 Jul-17 National level Mo HCDGEC/ MALF 0 Govt/ Partners Functional AMR sur veillance reporting system Set up stake holders meet ing to review the collected information standardize the reporting system on AMR surveil lance Meeting 1 Nov-17 National level Mo HCDGEC/ MALF 23,850.00 Govt/ Partners Prepare a sched ule for reporting of AMR surveil lance data Calendar 1 Jul-17 National level Mo HCDGEC/ MALF/POR ALG 500 Govt/ Partners Intervention 3.3: Establish antimicrobial agents consumption surveillance in human, animals and agriculture Activity 3.3.1: Conduct a baseline survey on selected antimicrobial consumption S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Identify areas/sectors for baseline survey on selected antimi crobial consumption Districts 1 March, 2017 National Level Mo HCDGEC 0 Baseline data on anti micro bial con sumption available Customize the WHO methodology for sur veillance of antimi crobial consumption Meeting 1 Mar-17 Mar-17 Mo HCDGEC 0 Prepare the baseline survey tools Meeting 1 Mar-17 Mar-17 Mo HCDGEC 0 Conduct training for data collectors Work shop 1 Mar-17 National Level Mo HCDGEC 1,900 WHO 31 Conduct field visit and data collection Person 10 for 3 weeks Mar-17 MSD & TFDA Mo HCDGEC 12,500 WHO Data analysis and report writing Person 2 Mar-17 National Level Mo HCDGEC 2,200 WHO Stakeholders’ base line survey dissemi nation workshops Work shops 1 Mayr-17 National level Mo HCDGEC 6,100 WHO Activity 3.3.2: Conduct antimicrobial consumption surveillance down the supply chain towards consumers S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Conduct training for data collec tors Work shop 4 Dec-18 National wide Mo HCDGEC/ MALF 26,000 Gov/ Partners Antimicrobial consumption sur veillance system established and monitored at all levels of the sup ply chain Conduct field visit and data collection Person Quar terly Dec-18 National wide Mo HCDGEC/ MALF 70,500 Gov/ Partners Data analysis and report writ ing Person Quar terly Dec-18 N Nation al wide Mo HCDGEC/ MALF 5,200 Gov/ Partners Data dissemina tion Work shops Quar terly Dec-18 National wide Mo HCDGEC/ MALF 10,100 Gov/ Partners Monitoring AMC at all levels of the supply chain Annu ally Ongo ing National wide Mo HCDGEC/ MALF 15,700 Gov/ Partners Intervention 3.4: Establish antimicrobial residual testing program Activity 3.4.1: Identify key antimicrobial agents for residual testing surveillance S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Review and identify antimicrobial agents for residual testing surveillance in hu man, animals and agriculture Meeting 1 Jul-17 Dar es salaam Mo HCDGEC/ MALF/ PORALG 0 Gov/ Partners Availability of list of antimi crobial agents for residual testing 32 Activity 3.4.2: Identify and support laboratories for testing antimicrobial residuals S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Assess and identify existing laboratories with capacity to test antimicrobial residuals Visit TBD Aug-17 National wide Mo HCDGEC/ MALF/ PORALG 10,325.00 Govt/ Partners Availability of list of labora tories for re sidual testing Activity 3.4.3: Build human and infrastructural capacity in the identified laboratories for antimicrobial residual testing S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Prepare a train ing package for antimicrobial residual testing Training package 1 Sep-17 Morogoro Mo HCDGEC/ MALF/ PORALG 3250 Govt/ Partners Partners Number of per sonnel trained for antimicrobial residual testing Number and type of infrastructure provided Train of train ers (TOTs) for antimicrobial residual testing Training session 1 Oct-17 Appointed Labs Mo HCDGEC/ MALF/ PORALG 10,000 Govt/ Partners Roll out the training package to the personnel in the identified laboratories for antimicrobial residual testing Training 16 Nov-17 Appointed Labs Mo HCDGEC/ MALF/ PORALG 0 Provide men torship and supportive su pervision to the personnel in the identified labora tories for antimi crobial residual testing Sup portive supervi sions 1 Jan-18 Appointed Labs Mo HCDGEC/ MALF/ PORALG 1,590.00 Govt/ Partners and part ners Provide neces sary equipment to the laborato ries for antimi crobial residual testing Equip ment Sep-17 Appointed Labs Mo HCDGEC/ MALF/ PORALG 100,000 Govt/ Partners 33 PRIORITY ACTION 4: LABORATORY CAPACITY Intervention 4.1: Designate a national reference laboratory for AMR Surveillance Activity 4.1.1: Assess the existing laboratories’ capacity and appoint one laboratory to be a national reference laboratory and appoint laboratories to carry out AMR surveillance in human, animal, plant and environmental health S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Develop a com prehensive as sessment tool for evaluation of the existing laboratories’ capacity for AMR surveillance Assess ment tool 1 Aug-17 National level Mo HCDGEC/ MALF/ PORALG 6450 Govt/ Partners Lab for AMR Surveillance identified and functioning Assess and ap point one labo ratory to serve as a designated national refer ence laboratory Labora tories 16 Aug-17 National wide Mo HCDGEC/ MALF/ PORALG 12,000 Govt/ Partners Asses and ap point labora toires to carry out AMR sur veillance in humain, animal, plant and en vironnemental health Labora tories 100 Aug-17 National wide Mo HCDGEC/ MALF/ PORALG 40,000 Govt/ Partners Provide neces sary equipment for AMR surveil lance. Equip ment 1 Sep-17 Appointed Lab Mo HCDGEC/ MALF 100000 Govt/ Partners 34 Intervention 4.2: Capacity Building for Designated Laboratories for AMR Surveillance Activity 4. 2.1 : Conduct training, mentorship and supportive supervision for personnel on diagnostics and antimicrobial susceptibility testing S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Train personnel on AMR surveillance. Training 1 Sep-17 MO HCDGEC/ MALF/ PORALG 11300 Gov/ Partners Number of per sonnel with skills on diagnos tics and antimi crobial suscep tibility testing Provide mentor ship and supportive supervision to the personnel for AMR surveillance. Support ive 4 Jan-18 MO HCDGEC/ MALF/ PORALG 2800 Gov/ Partners Intervention 4.3: Establish supply chain system to support laboratory AMR surveillance Activity 4.3.1 Develop the master list for the materials/reagents/items required for AMR surveillance and supply mechanism to ensure constant availability S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Develop the master list for the materi als/reagents/items required for AMR surveillance Master list 1 Oct-16 National wide MO HCDGEC/ MALF/ PORALG 8250 Gov/ Partners Percent age of diagnos tics and reagents available for AMR surveil lance Conduct a meeting to assess and quantify materials required for AMR surveillance Meeting 1 Oct-16 National wide MO HCDGEC/ MALF/ PORALG 0 Gov/ Partners Carry out consulta tive meeting to de fine the supply chain mechanisms for AMR surveillance materials meeting 1 Nov-16 National wide MO HCDGEC/ MALF/ PORALG 5000 Gov/ Partners 35 Intervention 4.4: Strengthen quality assurance system for AMR surveillance Activity 4.4.1: Identify and support QA scheme based on the WHO/OIE guidelines/ISO standards S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Institute EQA AMR programs basing on the WHO/OIE guide lines and ISO stan dards to participating laboratories labora tory 16 Aug-17 National wide MO HCDGEC/ MALF/ PORALG 5,000.00 Gov/ Partners AMR sur veillance tests per formed as per WHO/ OIE/ISO stan dards Train laboratory per sonnel on AMR QA program Training session 1 Sep-17 National wide MO HCDGEC/ MALF/ PORALG 10,000.00 Gov/ Partners Support implemen tation of EQA AMR scheme for appointed laboratories Labora tory 16 Oct-17 National wide MO HCDGEC/ MALF/ PORALG 40,000.00 Gov/ Partners 36 PRIORITY ACTION 5: RESEARCH AND DEVELOPMENT Intervention 5.1: Develop a national multi sectoral research agenda on AMR Activity 5.1.1: Engage relevant stakeholders to identify current gaps in knowledge and potential research topics. S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Identify current gaps and develop a national research agenda on AMR Work shop 1 Feb-17 nationwide MO HCDGEC/ MALF/ PORALG 9000 Gov/ Partners Research gap on AMR identified and vali datedConduct stakeholders meeting to validate the national research agenda on AMR Meeting 1 Mar-17 National Level MO HCDGEC/ MALF/ PORALG 9000 Gov/ Partners Activity 5.1.2: Develop national research guidelines on AMR S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Conduct a workshop to develop AMR re search guidelines Work shop 1 Feb-17 National Level MO HCDGEC/ MALF/ PORALG 2000 Gov/ Partners National AMR research guideline in place Print AMR guidelines Copies 100 Mar-17 National Level MO HCDGEC/ MALF/ PORALG 3500 Gov/ Partners Activity 5.1.3: Undertake research related to AMR S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Develop AMR related research proposals with one health ap proach Proposals TBD Sep-17 National wide MO HCDGEC/ MALF/ PORALG 5000 Gov/ Partners Number of Re search con ducted Conduct research activities Research papers 1 Dec-18 National wide MO HCDGEC/ MALF/ PORALG 10000 Gov/ Partners 37 Intervention 5.2: Establish and support system for sharing AMR research findings Activity 5.2.1: Organize a multisector national AMR scientific Symposium S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Establish and sup port the organizing scientific conference committee on AMR Commit tee 1 Jan-18 Dar es salaam MO HCDGEC/ MALF/ PORALG 0 Gov/ Partners AMR Sympo sium/ confer ence con ducted Conduct AMR sci entific symposia or roundtable discus sions annually Confer ences 1 Dec-18 Dar es salaam MO HCDGEC/ MALF/ PORALG 17600 Gov/ Partners Activity 5.2.2: Establish a national AMR data repository S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Establish National AMR bulletin Bulletin 1 Dec-18 Dar es salaam MO HCDGEC/ MALF/ PORALG 5000 Gov/ Partners National AMR re pository estab lished Establish an electron ic system for AMR data repository Reposi tory 1 Jul-17 Dar es salaam MO HCDGEC/ MALF/ PORALG Gov/ Partners Activity 5.2. 3 Establish a national biobank/bio repository center S u b a ct iv it y U n it Q u a n ti ty D a te / T im e F ra m e Lo ca ti o n / Le v e l o f Im p le m e n ta ti o n R e sp o n si b le E n ti ty C o st ( U S D S o u rc e o f F u n d in g In d ic a to r Equip the national laboratory with equipment for bio bank/bio repository biobank/ bio re pository equip ment National Level MO HCDGEC/ MALF/ PORALG 5000 Gov/ Partners National biobank/ bio re pository center estab lished Source and train personnel on use of a web-based biore pository Trainings July-17 National Level MO HCDGEC/ MALF/ PORALG 10000 Gov/ Partners 38 PRIORITY ACTION 6: INFECTION PREVENTION AND CONTROL IN HEALTH CARE Intervention 6.1: Strengthen of IPC Programmes in all Human Health Care Settings Activity 6.1.1: Conduct scheduled supportive supervision and monitoring to health facilities by quality assurance teams (Ministry level, RHMT, CHMT) S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st ( C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Revise and avail tools (policies, guide lines and standard operating procedures 4 Quality Meet ing with Terms of Refer ence 4 July 2017 nation wide MO HCDGEC/ MALF/ PORALG 5,000 Gov/ Partners Number of HFs super vised Material design and printing of Guidelines handouts Policy , Guide line and SOP docu ment 20,000 July 2017 National level 100,000 Gov/ Partners To conduct biannual Monitoring and eval uation IPC practices in health facilities Monitor ing tools and re ports 2 National wide MO HCDGEC/ MALF/ PORALG 50,000 Gov/ Partners Activity 6.1.2: Conduct advocacy and sensitization on IPC S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st ( C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Develop Information, Education and Com munication (IEC) & behavioural change communication mate rials (BCC materials) IEC/BCC Materi als 100,000 May 2017 Dar es salaam MO HCDGEC/ MALF/ PORALG 100,000 Gov/ Partners IPC sen sitization sessions con ducted Sensitization, orienta tion & training stake holders at all levels Persons 600 July 2018 Country wide MO HCDGEC/ MALF/ PORALG 150,000… Gov/ Partners 39 Activity 6.1.3: Facilitate availability of IPC related equipment, supplies guidelines and improve infrastructure S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st ( C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Conduct needs as sessments for IPC related equipment and supplies Quanti fied items TBD May 2017 Country wide MCC ,TWG from, ministry of health & Agri culture, TBD Gov/ Partners IPC equip ment, supplies and guide lines available in health facilities Procure and distrib ute IPC materials IPC ma terials TBD May 2017 Country wide MCC ,TWG from, ministry of health & Agri culture, TBD Gov/ Partners Disseminate guide lines Guide line docu ments 20,000 July 2018 Country wide MCC, TWG from ministry of health & Agri culture, 100,000 Gov/ Partners Provide adequate and appropriately maintained water and sanitation as well as waste manage ment Stan dard health facility 14,000 National wide Ministry of health &PO RALG 50,000 Gov/ Partners 40 Intervention 6.2: Establishment and design of IPC programmes in animal health services Activity 6.2.1: Promote good agriculrural/animal husbandry S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st (C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r To develop tools policies, guidelines and standard operat ing procedures Work shop 4 July 2018 National Level MALF 5,000 Gov/ Partners IPC interven tions instituted across animal health care set ting Material design and printing of Guidelines handouts Copies 10,000 July 2018 National level MALF 50,000 Gov/ Partners Develop proposal for recruitment of skilled man power for submission to central and local Govern ment. Meeting 1 Dec 2018 National Level MALF 1000 Gov/ Partners Conduct supportive supervision visits Quarterly Ongo ing Nation wide MALF 25,000 Gov/ Partners Intervention 6.3. Strengthen vaccination Programme in human and animal health Activity 6.3.1 Review existing regulations to accommodate the need for a mandatory vaccination in animal health S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st (C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Review regulations Meetings 2 July 2018 National Level MALF 1000 Govt/ Partners Regula tions on manda tory vaccina tion on animal health approved Conduct stakeholders meeting to share the draft of regulations Work shop 1 Dec 2018 National Level MALF 5000 Govt/ Partners Approval and dis semination of the regulations Meetings 2 April 2019 National Level MALF 0 41 Activity 6.3.2 Establish a functioning vaccination program for human and animal health S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st ( C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Procurement of vac cines vaccines TBD July 2018 National Level MALF 26,000 GoT& DPs Func tional Vaccina tion pro gram for animal health in place Distribution of vac cines routes TBD July 2018 National Level MALF 5,000 GoT& DPs Provide capacity building Work shop 2 Dec 2018 National Level MALF 11,000 GoT& DPs Conduct inspection Visits Annu ally Ongo ing National Level MALF 12,000 GoT& DPs Intervention 6.4 Strengthening National Linkages and Partnership for IPC Activity 6.4.1: Engage the communities on implementation of personal Hygiene and environmental sanitation S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st ( C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Strengthen health committees at ward and village levels to implement Commu nity lead total sanita tion (CTLS) Meeting 8 July 2018 National level MO HCDGEC/ MALF/ PORALG 50,000 GoT& DPs Involve ment of the Commu nity on IPC en hanced Equip the Health committees with skills to conduct inspection on adher ence to sanitary measures. Meeting 8 July 2018 National level MO HCDGEC/ MALF/ PORALG 50,000 Govt/ Partners 42 Activity 6.4.2: Enforce the use of international health regulations (IHR) through integrated disease surveillance and response (IDSR) and existing laws on prevention of outbreaks S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st ( C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Orient stakeholders on IHR & IDSR Meeting 1 July 2018 National level MO HCDGEC/ MALF/ PORALG 50,000 Govt/ Partners IHR & IDSR regula tions and bi- laws enforced Discuss how to im plement regulations and laws Meeting 1 July 2018 National level MO HCDGEC/ MALF/ PORALG 50,000 Govt/ Partners Monitor implementa tion of regulations and laws visits Once in 2 years July 2018 National level MO HCDGEC/ MALF/ PORALG 12,000 Govt/ Partners Activity 6.4.3: Promote Food Chain Hygiene S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st ( C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Train inspectors and other law enforcers on Public Health Act 2009 and Codex al mentarius Sessions 2 July 2018 National level MO HCDGEC/ MALF/ PORALG 5,000 Govt/ Partners Food chain hygiene improved Sensitize the commu nities in food hygiene preparation. Meeting 4 July 2018 National level MO HCDGEC/ MALF/ PORALG 10,000 Govt/ Partners 43 PRIORITY ACTION 7: HEALTH WASTE MANAGEMENT SYSTEM INTERVENTION 7.1: Develop and strengthen waste management systems in health and animals sectors Activity 7.1.1: Promote personal hygiene and environmental sanitation in congregate settings S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st ( C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Review the existing infectious outbreak guidelines to accom modate concept of hygiene and sanita tion. Meeting 8 July 2018 National level MO HCDGEC/ MALF/ PORALG 50,000 Govt/ Partners Hygiene and sani tation incor porated on infec tious disease outbreak guide lines Activity 7.1.2: Promote zoo sanitary and phytosanitary inspectorate S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st ( C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Equip zoo sanitary and phytosanitary points with necessary facilities Sanitary facilities lump sum July 2018 National level MO HCDGEC/ MALF/ PORALG 20,000 Govt/ Partners Zoo sani tary and phytos anitary environ mental improved Conduct capacity building to respective inspectors Meeting 4 July 2018 National level MO HCDGEC/ MALF/ PORALG 10,000 Govt/ Partners 44 Activity 7.1.3: Procure waste management equipment S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st (C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Assess health fa cilities to determine needs Visits 1 July 2019 National level Mo HCDGEC/ PORALG 10,000 GOT &DPs Waste manage ment equip ment available Procure incinerators incinera tors 200 July 2018 National wide Mo HCDGEC/ PORALG 200,000 GOT &DPs Activity 7.1.4: Orient Animal and Health workers on hygiene and safety standards and waste management S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st ( C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Conduct need as sessment Visits 1 July 2018 National level MO HCDGEC/ MALF/ PORALG 10,000 Govt/ Partners HCW ori ented on hygiene and safe ty stan dards and waste manage ment Prepare training ma terials Meeting 1 Dec 2018 MO HCDGEC/ MALF/ PORALG 0 Govt/ Partners Conduct training Work shop 8 Feb 2019 National level MO HCDGEC/ MALF/ PORALG 45,000 Govt/ Partners Activity 7.1.5: Establish national and subnational monitoring system in the field of waste management S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st ( C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Conduct supportive supervision Visits Annually July 2018 National level MO HCDGEC/ MALF/ PORALG 50,000 Govt/ Partners Func tional system for moni toring waste manage ment Prepare report and share Reports Annu ally July 2018 National level MO HCDGEC/ MALF/ PORALG 50,000 Govt/ Partners 45 PRIORITY ACTION 8: REGULATORY FRAMEWORK FOR PRESERVATION OF ANTIMICROBIAL AGENTS Intervention 8.1 Develop and review policies, laws and guidelines on the use of antimicrobial agents in animals, agriculture and fisheries Activity 8.1.1. Development of guidelines for handling and preservation of antimicrobial agents. S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ c u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r To prepare draft of the guidelines Work shop 1 Sep tem ber 2017 Nation wide MO HCDGEC/ MALF/ PORALG 20,000 Govt/ Partners Guide lines for handling and preser vation of antimi crobial agents devel oped Conduct stakeholders validation meeting Meeting 1 No vem ber 2017 Nation wide MO HCDGEC/ MALF/ PORALG 17,000 Govt/ Partners Printing and distribu tion Number of cop ies 1 March 2018 National wide MO HCDGEC/ MALF/ PORALG 70,000 Govt/ Partners Activity 8.1.2 Develop/review National Medicines pesticides and national livestock to address AMR S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le E n ti ty C o st (C u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r To review draft of the policy Work shops 3 Sep tember 2017 Nation wide MO HCDGEC/ MALF/ PORALG 22,000 Govt/ Partners National medi cines, pesti cides and national livestock policies re viewed/ devel oped Conduct stakeholders meeting Meet ings 5 January 018 National wide MO HCDGEC/ MALF/ PORALG 10,000 Govt/ Partners Prepare cabinet paper Meeting 1 August 2018 National wide MO HCDGEC/ MALF/ PORALG 0 Govt/ Partners Approval of the policy Meeting 1 March 2018 Dar es Salaam MO HCDGEC/ MALF/ PORALG 0 Govt/ Partners 46 Activity 8.1.3: Develop/strengthen regulations on use and control of prescriptions S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le E n ti ty C o st ($ c u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Prepare draft regula tions under the Phar macy Act, Cap 311 and Animal disease Act, No.16 of 2003 Work shop 1 Sep tember 2017 National Level Mo HCDGEC 8,000 Govt/ Partners Regula tions on use and control of pre scrip tions in place Conduct stakeholders validation meetings Meeting 1 No vember 2017 National Level Mo HCDGEC 25,000 Govt/ Partners Printing and dissemi nation of regulations Meeting 1 March 2018 National wide Mo HCDGEC 70,000 Govt/ Partners Activity 8.1 4: Develop Standard Treatment Guidelines (STG) and NEMLIT in veterinary practice, livestock production, agriculture and fisheries S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ c u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r To prepare draft of the guidelines Work shop 1 Sep tember 2017 Nation wide MALF 15,000 Govt/ Partners STG/ NEMLIT in vet erinary practice, livestock produc tion, agricul ture and fisheries devel oped and distrib uted Conduct stakeholders validation meeting Meeting 1 No vember 2017 Nation wide MALF 17,000 Govt/ Partners Printing and distribu tion Number of cop ies 1 March 2018 National wide MALF 70,000 Govt/ Partners 47 Activity 8.1.5: Review STG/NEMLIT for the health sector S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ c u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Review the guidelines Work shop 1 Sep tember 2017 Nation wide Mo HCDGEC 5,000 Govt/ Partners STG/ NEMLIT for the health sector reviewed and dis tributed Conduct stakeholders validation meeting Meeting 1 No vember 2017 Nation wide Mo HCDGEC 10,000 Govt/ Partners Printing and distribu tion Number of cop ies 1 March 2018 National wide Mo HCDGEC 70,000 Govt/ Partners Intervention 8. 2: Monitor proper use of preserved antimicrobial agents Activity 8.2.1 : Conduct regular inspection on pharmaceutical and agro chemical outlets S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ c u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Establish joint inspec tion teams People 1 June 2017 Nation wide MO HCDGEC/ MALF/ PORALG 0 M Gov/ Partners Number of in spections con ducted Develop inspec tion tools including checklist Tools and checklist 1 Au gust 2017 National wide Mo HCDGEC/ MALF 10000 M Gov/ Partners Conduct training to inspectors work shops 3 2017 2019 National wide Mo HCDGEC/ MALF 15000 Gov/ Partners Procure vehicles and motorcycles for in spection Num ber of vehicle/ motor cycles 5 – ve hicles and 180 - Mo torcycles 2017 – 2019 National wide Mo HCDGEC/ MALF 700,000 Gov/ Partners Conduct joint inspec tion Inspec tion 6 2017 2019 National wide Mo HCDGEC/ MALF 120,000 Gov/ Partners 48 Activity 8.2.2: Conduct supportive supervision in slaughter houses and abattoirs to check compliance of withdraw periods and slaughter suitability S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ c u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r To develop supervi sion checklist Check list 1 August 2017 Dar es Salaam MALF 2000 Govt/ Partners Number of sup portive supervi sion in slaughter houses and ab attoirs con ducted To conduct orienta tion to supervision team Work shop 1 Sep tember 2017 Regions MALF 8 000 Govt/ Partners To conduct regu lar supervisions to ensure compliance with slaughter suit ability and withdraw periods. Number of cop ies 1 March 2018 National wide MALF 70,000 Govt/ Partners Conduct awareness on slaughter proto cols to abattoirs Mentor ing ses sions 3 2017 2019 Zones MALF 15000 Govt/ Partners Activity 8.2.3: Conduct refresher trainings on professional ethics and enforcement on use of antimicrobial agents S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ c u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Conduct training needs assessments Session 1 Sep tember 2017 Nation wide Profes sional Council and boards 5,000 Govt/ Partners Num ber of profes sionals trained Develop training pro grams Session 3 2017 2019 National Level Profes sional Council and boards 10,000 Govt/ Partners Conduct training of trainers Work shop 3 2017 2019 National Level Profes sional boards and Council 12000 Govt/ Partners Conduct training to professionals Work shop 3 2017 219 Zones Profes sional boards and Council 12000 Govt/ Partners 49 Activity 8.2.4: Establish a virtual networking platform on the use of preserved antimicrobial agents S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n /L e ve l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ c u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Procure relevant virtual networking equipment. Set of equip ment 1 October 2017 Dar es Salaam Mo HCDEC/ MALF 20,000 Govt/ Partners Virtual network ing plat form on the use of pre served antimi crobial agents devel oped Establish a central database on use and resistance of antimi crobial agents Data base 1 January 2018 Nation wide Mo HCDEC 10000 Govt/ Partners Conduct training to designated officers on use of virtual equipment Training work shop 3 2017 2019 Nation wide Mo HCDEC 15000 Govt/ Partners Operationalize and monitor virtual plat form Report 4 De cember 2019 Nation wide Mo HCDEC 30000 Govt/ Partners PRIORITY ACTION 9: ANTIMICROBIAL STEWARDSHIP PROGRAMS Intervention 9.1: Establish antimicrobial stewardship programmes Activity 9.1. .Develop hospital formulary and other AMR policies S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ c u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Hospitals to develop formulary based on STG/NEMLIT Work shop 1 Sep tem ber 2018 Nation wide PORALG/ MO HCDGEC 22,000 Govt/ Partners Hospital formu lary and other AMR policies formu lated Hospital develop/ adopt AMR policies Work shop 1 No vem ber 2018 Nation wide PORALG/ MO HCDGEC 10,000 Govt/ Partners Monitor the use of hospital formulary and other AMR poli cies Visits 1 Ongo ing Nation wide PORALG/ MO HCDGEC 12,0000 Govt/ Partners 50 Activity 9.1.2 Develop a system on use of standard prescriptions S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ cu rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Design/review a standard prescription Work shop 1 August 2017 National level Mo HCDGEC/ MALF 10000 Govt/ Partners Standard prescrip tion available and used in health facilities Print and distribute prescriptions to all practitioners Pre scrip tions many October 2017 Nation wide MSD 0 Govt/ Partners Activity 9.1.3 Audit antimicrobial prescribing S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ c u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r MTC/Stewardship team to collect data on antimicrobial agent consumption Work shop 1 August 2018 National level Mo HCDGEC/ PORALG 10000 Govt/ Partners The use of anti microbial agents in HFs auditedAudit if the data complies to stipu lated standards Audit ongo ing ongoing National wide PORALG/ RHMT/ CHMT 0 Provide feedback to prescribers Feed back meeting ongo ing ongoing National wide PORALG/ RHMT/ CHMT 0 Activity 9.1.4 Prepare and share the report on health facility antimicrobial use & susceptibility test results to health care workers S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ cu rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Prepare a report on the trend of antimi crobial use in health facilities report annually August 2018 National level HFs 0 Govt/ Partners Reports on AMR shared to HCWs Prepare the report on AMR susceptibility test results Audit annu ally ongoing National wide HFs 0 Share the report to core workers Meety quar terly ongoing National wide HFs 0 Submit report to re sponsible authorities Feed back meeting annu ally ongoing National wide HFs 0 51 Activity 9.1.5: Educate prescribers, pharmacist, nurses and lab personnel about good antimicrobial prescribing practices and antimicrobial resistance S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ cu rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Prepare training ma terials Meeting 1 August 2018 National level Mo HCDGEC 500 Govt/ Partners Number of train ings on good antimi crobial prescrib ing practices and anti microbial resis tance con ducted Conduct training Work shops annu ally ongoing Nation wide Mo HCDGEC 32,000 Intervention 9.2 Monitor antimicrobial stewardship programmes 9.2.1 Establish and operationalize medicines and therapeutic Committees and other related committees S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ c u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Develop guidelines for veterinary thera peutic committees Work shop 3 Sep tem ber 2017 Dar es Salaam MALF 15000 Govt/ Partners Function al medi cines and ther apeutic commit teesFacilitate meetings of therapeutic com mittees Meetings Quarterly Febru ary 2018 All districts MALF 12000 Govt/ Partners Conduct regular supervision to thera peutics committees Visits Annually Oc tober 2018 All districts MALF 12000 Govt/ Partners Conduct joint inspec tion Inspec tion 6 2017 2019 National wide Mo HCDGEC/ MALF 120,000 Govt/ Partners 52 Activity 9.2.2: Provide capacity building on antimicrobial stewardship programmes for Medicines and Therapeutic Committees and other related committees S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ cu rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Prepare training ma terials Meeting 1 August 2018 National level Mo HCDGEC 200 Govt/ Partners Number of train ings on good antimi crobial prescrib ing practices and anti microbial resis tance con ducted Conduct training Work shops Quar terly ongoing Nation wide Mo HCDGEC 22,000 Activity 9.2.3: Conduct supportive supervision to monitor antimicrobial stewardship programmes S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ cu rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Develop supervision checklist Check list 1 August 2018 Dar es Salaam Mo HCDGEC/ MALF 2000 Govt/ Partners Number of sup portive supervi sion to monitor antimi crobial steward ship pro grammes con ducted Conduct regular su pervisions Visits Annu ally August 2018 on wards Regions Mo HCDGEC/ MALF 20000 Govt/ Partners 53 PRIORITY AREA 10: SUSTAINABILITY OF ANTIMICROBIAL RESISTANCE Intervention 10.1. Identify the investment required for the implementation of the national action plan for AMR using one health approach Activity: 10.1.1. Engage the public and private sectors (local and international) and development partners on the investment requirements for implementation of the NAP on AMR S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ c u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Assess investment requirements for implementation of the NAP on AMR Meeting/ Work shop 1 Oct-17 National level MO HCDGEC/ MALF 10200 Govt/ Partners Propor tion of targeted AMR stake holders engaged in NAP Integrates the NAP on AMR into the sectoral plans meeting 1 Oct-17 national level MO HCDGEC/ MALF 0 Engage local and international devel opment partners on implementation of the NAP AMR Meeting 1 Nov 17 national level MO HCDGEC/ MALF 5,250.00 Govt/ Partners Review and priorities areas for investment in new medicines, diagnostic tools, vac cines and other inter ventions work shop 1 Mar 18 National wide MO HCDGEC/ MALF 1,500.00 Govt/ Partners Activity: 10.1.2 Support piloting and dissemination of innovative ideas on investment for new medicines, diagnostic tools, vaccines and other interventions S u b a ct iv it y U n it Q u a n ti ty D a te / T im e fr a m e Lo ca ti o n / Le v e l o f o p e ra ti o n R e sp o n si b le e n ti ty C o st ($ c u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Support the imple mentation of the selected innovative ideas work shop 4 Jun-19 national wide MO HCDGEC/ MALF 250000 Govt/ Partners Innova tion for medi cines, di agnostic tools and vaccines sup ported Support dissemina tion of the appropri ate innovative ideas work shop 1 Dec-20 nationwide MO HCDGEC/ MALF 5000 Govt/ Partners 54 Activity 10.1.3 : Establish linkages with relevant stakeholders in implementing AMR National action plan S u b a ct iv it y U n it Q u a n ti ty D a te Lo ca ti o n R e sp o n si b le e n ti ty C o st (c u rr e n cy ) S o u rc e o f F u n d in g In d ic a to r Identify and Promote linkages with relevant partners on how to contain antimicrobial resistance Meet ings 4 July 2018 country wide MO HCDGEC/ MALF/ PORALG 5000 Govt/ Partners Coordi nation in imple menting NAP en hanced Sensitize and dis seminate knowledge on how to contain antimicrobial resis tance. Meet ings 4 July 2018 country wide MO HCDGEC/ MALF/ PORALG 5000 Govt/ Partners Conduct MCC meet ings Meet ings 20 Ongo ing National Level Mo HCDGEC/ MALF 20,000 Govt/ Partners Conduct AMR TWG Meet ings 20 Ongo ing National Level Mo HCDGEC/ MALF 50,000 Govt/ Partners 55 6.0 MONITORING AND EVALUATION PLAN Monitoring and Evaluation of AMR national action plan is critical in measuring the effects of interventions. Indicators will be used to determine whether the interventions are on its way to achieve the objective and goal of the AMR- NAP. Each activity bears a monitoring indicator to be measured in the process of its implementation. Monitoring and evaluation framework will incorporate both process and outcome indicators. Individual Ministries/ institutions/bodies will have the responsibility for monitoring and evaluating relevant identified NAP activities and feeding information, findings and recommendations into the overall M&E process. A mid-term review will be done after two years to monitor the implementation of the NAP. End of term evaluation will be conducted in 2021. P la n n in g e le m e n t (a ct iv it y li n k e d t o t h e st ra te g ic p la n ) In d ic a to r T yp e V a lu e (c a lc u la ti o n ) F re q u e n cy o f d a ta c o ll e ct io n D a ta s o u rc e M e th o d B a se li n e 1.1.1. Conduct knowl edge, Attitude, Practice (KAP) and behavioural determinants studies in different social and professional groups on AMR. KAPB survey conducted and data shared Process indicator No Once Baseline survey report, post intervention survey reports KAP survey No pre-ex isting data 1.1.2.Develop and Dis seminate a communica tion strategy for AMR AMR Communi cation strategy developed and shared Process indicator No Once Key informant at MoHCDGEC and MALF Key informant interview No pre-ex isting data 1.2.1 Conduct antibiotic awareness week Number of AMR campaigns con ducted Outcome indicator No Annually Media - No pre-ex isting data 1.2.2 Conduct training of trainers at national, regional and council levels on AMR Number of AMR trainings con ducted Outcome indicator Yes Annually Reports - No pre-ex isting data 1.2.3. Conduct sensitiza tion meetings at Nation al, Regional, Council and Community on AMR Number AMR of sensitization meetings con ducted Outcome indicator Yes Annually Reports AMR surveillance programme implémentation report No pre-ex isting data 1.2.4.Conduct multi media awareness cam paigns Number of AMR multime dia awareness campaigns con ducted Outcome indicator Yes Annually Key informant and report at MOHCDGEC&MALF Key informant interview and awareness campaign re ports No pre-ex isting data 1.3.1.Develop knowl edge sharing mecha nism at all levels (Data base, Website, Meet ings, conferences) AMR information shared/dissemi nated Process indicator No Annually Key informant and report at MOHCDGEC&MALF Key informant interview and Knowledge sharing mecha nism on AMR reports No pre-ex isting data 56 P la n n in g e le m e n t (a ct iv it y li n k e d t o t h e st ra te g ic p la n ) In d ic a to r T yp e V a lu e (c a lc u la ti o n ) F re q u e n cy o f d a ta c o ll e ct io n D a ta s o u rc e M e th o d B a se li n e 2.1.1.Review, Update and disseminate the existing education cur ricula in human, animal, Plant, food chain and environment health Revised curricula available for tar get professional groups Process indicator No Annually Key informant and report at MOHCDGEC&MALF Key informant interview and reports No pre-ex isting data 2.2.1. Review, update and disseminate the ex isting CPD guidelines for human, animal, plant, food chain and environ ment health Revised curricula available for the targeted educa tion level Process indicator No Annually Key informant and report at MOHCDGEC&MALF Key informant interview and reports No pre-ex isting data 3.1.1 Review existing infectious disease sur veillance system Information on infectious dis ease surveillance shared and vali dated Process indicator No Once Available document Verification No pre-ex isting data 3.1.2 Develop standard operating procedures (SOPs) for AMR surveil lance AMR SoPs in place and used Process indicator No Once Available SoPs Verification No pre-ex isting data 3.2.1 Develop multisec tor AMR surveillance reporting and informa tion sharing system in human, animals, agri culture and environment health Functional AMR surveillance re porting system Outcome indicator No Once Key informant at MCC Secretariat MCC report No pre-ex isting data 3.3.1 Conduct a baseline survey on selected anti microbial consumption Baseline data on antimicro bial consumption obtained Process indicator No Once Key informant at MCC Secretariat MCC report No pre-ex isting data 3.3.2 Conduct antimi crobial consumption surveillance down the supply chain towards consumers Data on antimi crobial consump tion available at all level of the supply chain Process indicator No Annually AMC Surveillance report Survey No pre-ex isting data 3.4.1 Identify key an timicrobial agents for residual testing surveil lance Availability of list of antimicrobial agents for re sidual testing Process indicator No Once Key informant at MCC Secretariat MCC report No pre-ex isting data 3.4.2 Identify and sup port laboratories for testing antimicrobial residuals Availability of list of laboratories for residual test ing Process indicator No Once Key informant at MCC Secretariat MCC report No pre-ex isting data 57 P la n n in g e le m e n t (a ct iv it y li n k e d t o t h e st ra te g ic p la n ) In d ic a to r T yp e V a lu e (c a lc u la ti o n ) F re q u e n cy o f d a ta c o ll e ct io n D a ta s o u rc e M e th o d B a se li n e 3.4.3 Build human and infrastructural capacity in the identified labora tories for antimicrobial residual testing Number person nel trained for antimicrobial residual testing Number and type of infra structure pro vided Outcome indicator Yes Once Key informant at MCC Secretariat MCC report No pre-ex isting data 4.1.1 Assess the existing laboratories’ capacity and appoint one labora tory to be a national reference laboratory and appoint laboratories to carry out AMR surveil lance in human, animal plant and environmental health Lab for AMR surveillance identified and functioning Outcome indicator No Once Key informant at MCC Secretariat MCC report No pre-ex isting data 4.2.1 Conduct training, mentorship and sup portive supervision for personnel on diagnostics and antimicrobial sus ceptibility testing Number of per sonnel with skills on diagnostics and antimicro bial susceptibility testing Outcome indicator Yes Periodically Key informant at MCC Secretariat MCC report No pre-ex isting data 4.3.1 Develop the mas ter list for the materials/ reagents/items required for AMR surveillance and supply mechanism to ensure constant avail ability Percentage of AMR surveillance diagnostics & reagents avail able Process indicator Yes Once Key informant at MCC Secretariat MCC report No pre-ex isting data 4.4.1 Identify and sup port the QA scheme to be used based on the WHO/OIE guidelines AMR surveillance tests performed as per WHO/ OIE/ISO stan dards Process indicator No Once Key informant at MCC Secretariat MCC report No pre-ex isting data 5.1.1 Engage relevant stakeholders to identify current gaps in knowl edge and potential re search topics. Research gap on AMR identified and validated Process indicator No Once Key informant at MCC Secretariat MCC report No pre-ex isting data 5.1.2 Develop national research guidelines on AMR National AMR research guide lines in place Outcome indicator No Once Key informant at MCC Secretariat MCC report No pre-ex isting data 5.1.3 Undertake re search related to AMR Number of AMR research con ducted Outcome indicator Yes Annually Publications/sym posium Reports No pre-ex isting data 58 P la n n in g e le m e n t (a ct iv it y li n k e d t o t h e st ra te g ic p la n ) In d ic a to r T yp e V a lu e (c a lc u la ti o n ) F re q u e n cy o f d a ta c o ll e ct io n D a ta s o u rc e M e th o d B a se li n e 5.2.1. Organize a mul tisector national AMR scientific symposium AMR Sympo sium/conference conducted Outcome indicator No Annually Key informant at MCC Secretariat MCC report No pre-ex isting data 5.2.2 Establish a nation al AMR repository National AMR repository es tablished and accessible Outcome indicator No Once Key informant at MCC Secretariat MCC report No pre-ex isting data 5.2.3 Establish a nation al biobank/bio repository center National bio bank/bio re pository center established and accessible Outcome indicator No Once Key informant at MCC Secretariat MCC report No pre-ex isting data 6.1.1 Conduct scheduled supportive supervision to all health facilities by quality assurance teams (Ministry level, RHMT, CHMT) Number of HFs supervised Process indicator Yes Annually Baseline survey report and post intervention survey reports supervision Baseline survey re port 6.1.2. Conduct advocacy and sensitization meet ing IPC sensitization sessions con ducted Process indicator No Biannually Baseline survey report and post intervention survey reports KAP survey Baseline survey re port 6.1.3 Facilitate avail ability of IPC related equipment, supplies and guidelines IPC equipment, supplies and guidelines avail able IPC infrastruc ture improved Outcome indicator No Annually HMIS reports Routine data collection re ports Existing HMIS re ports 6.2.1 Promote good agricultural and animal husbandry practices IPC interventions instituted across animal and plant sectors Outcome indicator No Annually Key informant at MALF and PO RALG Assessment Existing or ganogram 6.3.1. Review existing regulations to accom modate the need for a mandatory vaccination programme in animal health Regulations on mandatory vacci nation on place Outcome indicator No Annually Key informant at MALF Assessment Existing document of regulations 6.3.2. Establish a func tioning vaccination pro gramme for human and animal health Organized and functioning vaccination pro gramme Outcome indicator No Annually Key informant at MALF & PO RALG Assessment Existing or ganogram 6.4.1. Engage the com munities on implemen tation of personal hy giene and environmental sanitation Involvement of the Community on IPC enhanced Process indicator No Annually AMR reports Survey No pre-ex isting data 59 P la n n in g e le m e n t (a ct iv it y li n k e d t o t h e st ra te g ic p la n ) In d ic a to r T yp e V a lu e (c a lc u la ti o n ) F re q u e n cy o f d a ta c o ll e ct io n D a ta s o u rc e M e th o d B a se li n e 6.4.2. Enforce the use of International Health Regulation (IHR) through Integrated Dis ease Surveillance and Response (IDSR) and existing laws on preven tion of outbreaks IHR & IDSR reg ulations and bi laws enforced Process indicator No Annually AMR reports Assessment No pre-ex isting data 6.4.3. Promote Food Chain Hygiene Food chain hy giene improved Process indicator No Annually Supervision report Supervision Existing supervision reports 7.1.1. Promote personal hygiene and environ mental sanitation in congregate setting Hygiene and sanitation in corporated on infectious dis ease outbreak guidelines Process indicator No Once Supervision report Supervision Existing supervision reports 7.1.2. Promote zoo sani tary and phytosanitary inspectorate services in waste management Zoo sanitary and phytosanitary environmental improved Outcome indicator No Annually Supervision report Supervision Existing supervision reports 7.1.3. Procure waste management equipment Waste manage ment equipment available Outcome indicator No Annually Supervision report Supervision Existing supervision reports 7.1.4. Orient health workers on hygiene and safety standards and waste management HCWs oriented on hygiene and safety standards and waste man agement Process indicator No Annually Supervision report Supervision Existing supervision reports 7.1.5. Establish national and subnational moni toring system in the field of waste manage ment Functional sys tem for monitor ing waste man agement Process indicator No Annually Supervision report Supervision Existing supervision reports 8.1.1. Develop guide lines for handling and preservation of antimi crobial agents. Guidelines for handling and preservation of antimicrobial agents in place Outcome indicator No Once Available document Assessment No pre-ex isting data 8.1.2. Review National Medicines Policy pesti cides and national live stock policies to address AMR National medi cines policy pesticides and national live stock policies reviewed/devel oped Outcome indicator No Once Available document Assessment Existing document 8.1.3. Develop/ strengthen regulations on use and control of prescriptions Regulations on use and control of prescription in place Outcome indicator No Once Available document Assessment No pre-ex isting data 60 P la n n in g e le m e n t (a ct iv it y li n k e d t o t h e st ra te g ic p la n ) In d ic a to r T yp e V a lu e (c a lc u la ti o n ) F re q u e n cy o f d a ta c o ll e ct io n D a ta s o u rc e M e th o d B a se li n e 8.1.4. Develop and re view STG and NEMLIT in veterinary practice, livestock production, agriculture and fisheries STG/NEMLIT in veterinary prac tice, livestock production, agri culture and fish eries developed and distributed Process indicator No Once Available document Assessment No pre-ex isting data 8.1.5. Review STG/ NEMLIT for human medicines including anti microbials STG/NEMLIT for the health sector reviewed and distributed Process indicator No Once Available document Assessment Existing STG/NEM LIT 8.2.1. Conduct regular inspection on pharma ceutical and agro chemi cal outlets Number of inspections con ducted Process indicator No Annually Inspection report Inspection Existing inspection reports 8.2.2. Conduct sup portive supervision in slaughter houses and abattoirs to check com pliances of withdraw period and slaughter suitability Number of sup portive supervi sion in slaughter houses and abattoirs con ducted Process indicator No Annually Supervision report Supervision Existing supervision reports 8.2.3 Conduct refresher trainings on professional ethics and enforcements on the use of antimicro bial agents. Number of professionals trained Outcome indicator Yes Biannually Professional boards and Councils Assessment Existing reports 8.2.4. Establish a virtual networking platform on the use of preserved antimicrobial agents Virtual network ing platform on the use of preserved anti microbial agents developed Outcome indicator No Once Platform Assessments No pre-ex isting data 9.1.1 Develop hospital formulary and other AMR policies Hospital formu lary and other AMR policies formulate Outcome indicator No Biannual Available document Supervision Existing documents 9.1.2 Develop a system on use of standard pre scriptions prescription available and used in health facilities Process indicator No Annually Prescribing prac tices Assessment Pre- existing prescribing practices 9.1.3 Audit antimi crobial prescribing The use of anti microbial agents in HFs audited Process indicator No Annually Prescribing prac tices Assessment Pre- existing prescribing practices 9.1.4 Prepare and share the report on health facility antimicro bial use & susceptibility test results to health care workers. Reports on AMR shared to HCWs Process indicator No Annually HFs AMR reports Assessment No pre-ex isting data 61 P la n n in g e le m e n t (a ct iv it y li n k e d t o t h e st ra te g ic p la n ) In d ic a to r T yp e V a lu e (c a lc u la ti o n ) F re q u e n cy o f d a ta c o ll e ct io n D a ta s o u rc e M e th o d B a se li n e 9.1.5 Educate prescribers, pharmacist, nurses and lab person nel about good antimi crobial prescribing prac tices and antimicrobial resistance Number of trainings on good antimicro bial prescribing practices and antimicrobial resistance con ducted Outcome indicator Yes Annually HMIS reports Assessment No pre-ex isting data 9.2.1 Establish and operationalize medi cines and therapeutic Committees and other related committees. Functional medicines and therapeutic com mittees Outcome indicator No Annually MTC reports Assessment MTC reports 9.2.2 Train Medicines and Therapeutic Com mittees and other related committees on antimicrobial steward ship programmes Number of trainings on good antimicro bial prescribing practices and antimicrobial resistance con ducted Outcome indicator Yes Annually MTC reports Assessment MTC reports 9.2.3 Conduct support ive supervision to moni tor antimicrobial stew ardship programmes Number of sup portive supervi sion to monitor antimicrobial stewardship pro grammes con ducted Process indicator Yes Annually MTC reports Assessment MTC reports 10.1.1 Engage public, private and develop mental partners on the investment require ments for implementa tion of the AMR national action plan Proportion of targeted AMR stakeholders engaged in NAP Process indicator Yes Once Key informant at MCC Secretariat MCC report No pre-ex isting data 10.1.2 Support piloting of innovative ideas for in new medicines, diagnos tic tools, vaccines and other interventions Number of pilot studies con ducted Process indicator Yes Once Key informant at MCC Secretariat MCC report No pre-ex isting data 10.1.3 Establish linkages with relevant stakehold ers in implementing AMR national action plan Linkages estab lished Process indicator No Annually Key informant at MCC Secretariat MCC report No pre-ex isting data 62 7.0 ANNEX 1: SWOT ANALYSIS 63 8.0 ANNEX II: LIST OF CONTRIBUTORS Dr. Sero H. Luwongo Ministry of Agriculture, Life Stock and Fisheries (Member MCC & Chairperson, TWG) Prof. Said Aboud Muhimbili University of Health and Allied Sciences (Member MCC & Chairperson, TWG) Dr. John Rwegasha Muhimbili National Hospital (Member MCC & Chairperson, TWG) Mr. Adam Fimbo Tanzania Food and Drug Authority (Member MCC & Chairperson, TWG) Mr. Henry Irunde MoHCDGEC (Member MCC & TWG) Ms. Rose Shija World Health Organization (Member MCC & TWG) Dr. Niwael Mtui UN-Food and Agriculture Organization (Member MCC & TWG) Dr. Joseph Masambu Tanzania Veterinary Laboratory Agency (Member MCC & TWG) Dr. Mtebe Majigo Muhimbili University of Health and Allied Sciences (Member MCC & TWG) Mrs. Siana Mapunjo MoHCDGEC (AMR Coordinator; Secretariat MCC & Member TWG) Dr. Gibonce Kayuni Ministry of Agriculture, Life Stock and Fisheries (Secretariat MCC & Member, TWG) Prof. Robinson Mdegela Sokoine University of Agriculture (Member MCC) Prof. Stephen Mshana Catholic University of Health and Allied Sciences (Member MCC) Dr. Zakaria Makondo Ministry of Agriculture, Life Stock and Fisheries (Member, TWG) Mr. Nelson Faustin Pharmacy Council (Member, TWG) Dr. Hamza Mwamhehe Veterinary Council of Tanzania (Member, TWG) Mr. George Mlavwasi Muhimbili National Hospital (Member, TWG) Dr. Jeremia Seni Catholic University of Health and Allied Sciences (Member TWG) Mr. Longinus Tegulirwa Ministry of Agriculture, Life Stock and Fisheries (Member, TWG) Dr. Victor Muchunguzi National Health Laboratory Quality Assurance and Training Center (Member, TWG) Dr. Mariam Ongara MoHCDGEC (Member, TWG) Dr. Hamisi Nikuli Ministry of Agriculture, Life Stock and Fisheries (Member, TWG) Dr. Charles Masambu MoHCDGEC (Member, TWG) Dr Romuald Mbwasi St John’s University (Member, TWG) Mr. Dedan Jonas MoHCDGEC (Member, TWG) Dr. Japhet Simeo District Medical Officer – Ruangwa (Member, TWG) Mr. Edwin Mkwama MoHCDGEC (Member, TWG) Dr. Joel Manyahi Muhimbili National Hospital (Member, TWG) Dr. Yasinta Kisisiwe MoHCDGEC (Member, TWG) Dr. Rogath Kishimba MoHCDGEC (Member, TWG) Mrs. Lucy Nderimo Pharmaceutical wholesalers Association (Member, TWG) Dr. Ndekya Oriyo National Institute for Medical Research (Member, TWG)