Samoa's National Action Plan on Antimicrobial Resistance 2023-2028

1. National Health Service

2. Ministry of Agriculture and Fisheries

3. Scientific Research Organization of Samoa

4. Samoa Family Health Association

5. Food and Agriculture Organization of the United Nations

6. World Health Organization

7. Oceania University of Medicine

8. Samoa General Practitioners Association

9. Private Pharmacy (Niu Pharmacy)

10. National University of Samoa We also thank the participants of various workshops conducted to develop this plan. Last but not least, special thanks to the World Health Organization for their continuous assistance both financially and technically which highly contributed to the finalization of this plan. 3 ACRONYMS AAW Antimicrobial Awareness Week AMR Antimicrobial Resistance AMS Antimicrobial Stewardship APS Animal Protection Society AST Antimicrobial Susceptibility Testing CDCC Communicable Disease Control Committee CME Continuous Medical Education DTC Drug and Therapeutic Committee EQA External Quality Assurance EUCAST European Committee on Antimicrobial Resistance Surveillance Network FAO Food and Agriculture Organisation of the United Nations GOS Government of Samoa ICC Infection Control Committee ICO Infection Control Officer IEC Information Education Communication ILP Institutional Linkage Programme IPC Infection Prevention and Control IQA Internal Quality Assurance LIMS Laboratory Information Management System MCIL Ministry of Commerce Industry and Labour MNRE Ministry of Natural Resources MOH Ministry of Health MRO Multidrug Resistant Organisms MRL Maximum Residue Limits MTIIH Malietoa Tanumafili II Hospital MWCSD Ministry of Women Community and Social Development NFVG National Farm Vaccination Guidelines NGO Non-Governmental Organization NKFS National Kidney Foundation of Samoa NUS National University of Samoa OUM Oceania University of Medicine PPE Personal Protective Equipment PPTC Pacific Pathology Training Centre QA Quality Assurance SFHA Samoa Family Health Association SOP Standard Operating Procedure SROS Scientific Research Organization of Samoa TOR Terms of Reference TTMH Tupua Tamasese Mea’ole Hospital UNDP United Nations Development Programme WHO World Health Organisation ESBL Extended-Spectrum β-Lactamase 4 TABLE OF CONTENT Contents MESSAGE FROM HON. MINISTER OF HEALTH ......................................................................................... 2 ACKNOWLEDGEMENTS ............................................................................................................................ 3 ACRONYMS .............................................................................................................................................. 4 TABLE OF CONTENT ................................................................................................................................. 5 Background .............................................................................................................................................. 7 Introduction: .................................................................................................................................... 7 Situational Analysis: ......................................................................................................................... 7 GOVERNANCE FRAMEWORK ................................................................................................................... 8 National Antimicrobial Resistance Committee 8 Terms of Reference: ......................................................................................................................... 8 National AMR Committee Members ............................................................................................... 8 Budget: ............................................................................................................................................. 9 NATIONAL ACTION PLAN STRATEGIC AGENDA ...................................................................................... 10 Objective 1: To develop, implement and increase awareness of the national action plan for AMR across all relevant sectors within Samoa ............................................................................................... 11 Goal 1.1: To develop evidence-based awareness campaign for general public, consumers, prescribers and all stakeholders on AMR 11 Goal 1.2: To strengthen education and awareness on antimicrobial resistance and responsible use of antimicrobials 11 Goal 1.3: Strengthen information sharing across all relevant sectors on AMR 12 Goal 1.4: Strengthen National AMR Committee as a mechanism to coordinate the AMR activities in Samoa. 12 Objective 2: Strengthening AMR Surveillance and Research ................................................................ 13 Goal 2.1: To strengthen laboratory capacity for AMR surveillance and research 13 Goal 2.2: Review and finalize the microbiology SOPs that include AST across all relevant stakeholders 13 Goal 2.3: Ensure weekly internal quality assurance program and PPTC External Quality Assurance program are worthwhile. 14 Goal 2.4: Standardize national definition of MROs 14 Goal 2.5: Encourage communication across AMR surveillance system human, animal and environment sectors. 14 Objective 3: Strengthen infection prevention and control .................................................................... 15 Goal 3.1: Improve hygiene and sanitation practices in the community and healthcare settings 15 Goal 3.2: Strengthen infection prevention and control programs in healthcare-settings 15 Goal 3.3: Improve Healthcare Waste Management 16 5 Goal 3.4: Ensure availability and appropriate use of consumables and Personal Protective Equipment (PPE) 16 Goal 3.5: Promote Vaccination programs in commercial farms (Good Farm Practices – GFP) 16 Objective 4: Optimize use of antimicrobials .......................................................................................... 17 Goal 4.1: Promote the rational use of antimicrobials in human health through the implementation of the National Medicines Policy 2022 in relation to AMR containment. 17 Goal 4.2: Strengthen the capacity of healthcare professional to educate consumers on rational use of antimicrobials 17 Goal 4.3: Promote the rational use of antimicrobials for animal health 18 Goal 4.4: Strengthen procurement and supply of quality antimicrobials 18 Goal 4.5: Develop antimicrobial stewardship programs in hospitals 18 IMPLEMENTATION ................................................................................................................................. 20 Costing and M&E Framework 20 Monitoring and Evaluation 20 6 Background Introduction: Antimicrobial resistance (AMR) is one of the biggest challenges facing global public health today, with incidence of resistance in each bacterial species varying greatly between and within countries. It is becoming increasingly difficult, and in some cases, impossible to treat infections caused by antibiotic-resistant bacteria. The levels of antibiotic resistance and the overall impact in Pacific people are unknown, and only a handful of published reports regarding emergence and prevalence of antimicrobial resistance are available. Situational Analysis: The full burden of antimicrobial resistance in Samoa is under-appreciated. A country situational analysis on AMR conducted in February 2016 together with updated laboratory data and research findings all highlight the increasing incidence of multidrug resistant organisms in Samoa. Laboratory data show considerable decreases in susceptibility in all clinically significant pathogens identified to the most commonly prescribed classes of antimicrobials. Susceptibility to ciprofloxacin, gentamicin, and to third generation cephalosporin decreased in all major pathogens tested. Furthermore, the popular superbug Methicillin Resistant Staphylococcus aureus (MRSA) continues to be isolated from all wards within the Tupua Tamasese Mea’ole Hospital and also from patients in the community. Monitoring the antimicrobial susceptibility of these pathogens is the best way to inform empiric treatment regimens and to target infection prevention and control practises. Considering that the health system in Samoa is already overwhelmed with the burden of non-communicable diseases, political support at the national level is essential to address the issues preventing the effective identification, reporting and monitoring of antimicrobial resistance in Samoa. There is little known about the levels of AMR in livestock and the environment, but it may be a contributing factor to the overall levels of AMR in Samoa. The Global Action Plan on Antimicrobial Resistance endorsed at the World Health Assembly in May 2015 urges all Member States to develop National Action Plans on AMR by May

2017. Samoa has made Antimicrobial Resistance a priority agenda for the Health Sector with the establishment of an AMR Committee as well as the development of National Antibiotic Guidelines. In 2015, Samoa celebrated the first Antibiotic Awareness Week with the slogan “Fa'aāoga with Love” involving many public figures from church communities and parliament. Awareness of AMR and the responsible use is increasing; however there is still a lot of work to be done. Samoa also re-affirmed its commitment to combating AMR through comprehensive nationwide awareness campaigns and the development of required documents to assist in advancing AMR agenda items, one of these documents is the National Action Plan on AMR. More recently, the Samoa Medical Association acknowledged and discussed the importance of AMR in their Annual Scientific Meeting with the theme “Combat Antimicrobial Resistance”. Addressing this global threat will require a multi-sectoral approach at the global, regional and national levels. The inclusion of all national stakeholders in the discussion and the finalisation of Samoa’s National Action Plan on AMR is very important. This plan builds upon 7 a 2016 draft, and it is hoped that the endorsement of this revised and updated document will provide the much-needed momentum for implementing many of the AMR-related activities that have been postponed due to the Measles outbreak in 2019 and the subsequent COVID-19 pandemic. Guided by Framework for accelerating action to fight antimicrobial resistance in the Western Pacific Region which is endorsed by the Member States in the Western Pacific Region in 2019, we are optimistic that the identification of committed stakeholders locally and international partners like the World Health Organization (WHO) and its Collaborating Centres such as the PPTC and the University of Melbourne, Doherty Institute (COMBAT-AMR project), will provide the appropriate support for the successful implementation of this plan. The National Action Plan on Antimicrobial Resistance 2023-2028 outlines important actions to increase awareness, strengthen surveillance, research and infection prevention and control, and optimize the use of antimicrobials to ensure that we continue to have effective treatment options for our future generations GOVERNANCE FRAMEWORK The implementation of the Samoa’s National Action Plan on Antimicrobial Resistance for 2023-2028 will be the responsibility of the stand-alone National AMR Committee with the key driver being the Ministry of Health. The National AMR committee will report directly to the Director General of Health; co-chairs will be the Deputy Director General of Public Health and the Deputy Director General of Hospital and Clinical Services. National Antimicrobial Resistance Committee Terms of Reference: The TOR of the AMR committee is recommended to include: o Purpose: Adapt a ONE health approach to ensure all relevant sectors and stakeholders are engaged and contributing to the implementation of activities as outlined in the National Action Plan on AMR. o Report to: Communicable Disease Control Committee o Report frequency: quarterly and Annual Report o Meet quarterly o Finalize and ensure the official launch of the Nation Action Plan o Monitoring and evaluation of outcomes o Review and update the National Operational Plan every 5 years National AMR Committee Members Members of the National Committee on antimicrobial resistance are recommended to include members from the following:  Ministry of Health (MOH) (chair to be rotated)  Ministry of Natural Resources and Environment (MNRE)  Ministry of Agriculture and Fisheries (MAF)  Ministry of Women Community and Social Development (MWCSD) 8  Ministry of Foreign Affairs and Trade (MFAT)  Ministry of Commerce Industry and Labour (MCIL)  Ministry of Education Sports and Culture (MESC)  Scientific Organization of Samoa (SROS)  National University of Samoa (NUS)  Oceania University of Medicine (OUM)  General Practitioners  Private Pharmacies  Animal Protection Society (APS)  Samoa Family Health Association (SFHA)  Samoa National Kidney Foundation (SNKF)  Samoa Medical Association (SMA)  Samoa Nurses Association (SNA)  World Health Organization (WHO)  Food and Agriculture Organization (FAO)  Samoa Fire and Emergency Services Authority (FESA) Budget: The management of the overall budget and implementation of the Samoa’s National AMR Action Plan will be the responsibility of the Ministry of Health, with assistance from the Ministry of Agriculture, Scientific Research Organisation of Samoa and the Ministry of Natural Resources and Environment. Access to external funding for the plan’s activities will be led and coordinated by the Ministry of Health. 9 NATIONAL ACTION PLAN STRATEGIC AGENDA The National AMR Committee works will be guided by the Vision, Goal and four Strategic Objectives of this plan. VISION “Samoa is well protected against the emerging threats of ongoing antimicrobial resistance” MISSION “To reduce and prevent development of resistance to available antimicrobials in Samoa” GOAL “To ensure for as long as possible, continuity of the ability to treat and prevent infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way and accessible to all who need them” STRATEGIC OBJECTIVES STRATEGIC STRATEGIC STRATEGIC STRATEGIC OBJECTIVE 1 OBJECTIVE 2 OBJECTIVE 3 OBJECTIVE 4 To develop and To strengthen To strengthen infection To optimize the use implement a costed Antimicrobial prevention and control of antimicrobials multi-sectoral Resistance surveillance national action plan and research and increase awareness on AMR across all sectors NATIONAL AMR ACTION PLAN VISION, MISSION, GOAL & KEY OBJECTIVES 10 OPERATIONAL PLAN ACTIVITY INDICATOR IMPLEMENTER TIMELINE Objective 1: To develop, implement and increase awareness of the national action plan for AMR across all relevant sectors within Samoa Goal 1.1: To develop evidence-based awareness campaign for general public, consumers, prescribers and all stakeholders on AMR Conduct Knowledge, attitude and  KAP survey conducted and completed perception/behavioural (KAP)  KAP survey report finalized, published surveys that is inclusive of and disseminated. consumers, prescribers and health  Perception survey report finalized, professionals at targeted mass published and disseminated to clinics, events or using targeted groups to private pharmacies and all health June ensure target messaging on IEC facilities. AMR Committee 2023/2024 materials  Ensure the design for the survey is fit for purpose, look at the questions asked in the survey  Use clinics, private pharmacies, health facilities Regular AMR multi-media  Increase in numbers of population campaigns, use the results and accessing AMR multi-media campaigns All AMR findings from the KAP surveys in Ongoing Stakeholders order to better inform messaging to the public Goal 1.2: To strengthen education and awareness on antimicrobial resistance and responsible use of antimicrobials Annual celebrations and  AAW activity plan developed and commemoration of the World implemented Antimicrobial awareness Week 18-  AAW IEC materials developed and 24 November disseminated  Ensure any awareness conducted  Incorporate the “Stewards for the is inclusive of animal and Future” theme to align with regional July – Nov AAW Focus Group environmental health strategy. 2023-25  Review slogan Fa’aāoga with Love  Look at taking the awareness sessions to the communities and consider the roles of NGOs, MWCSD Integrate AMR programs in Health  AMR issues are addressed during MOH Annually Career Day NUS/MESC health career day. Incorporation of AMR component  Mapping of AMR components into medical curriculum at NUS and conducted and implemented NUS/OUM 2022 OUM Incorporate AMR components into  AMR is included in continuing education continued health professional for all healthcare professionals, allied development programs for nurses, health professionals and veterinarians. pharmacists, dentists, medical MOH/ officers, medical laboratory Ongoing NKFS/MAF/MESC scientists / technicians, veterinarians, paravets and 11 ACTIVITY INDICATOR IMPLEMENTER TIMELINE paramedics. Integrate AMR awareness programs  Specific AMR plan and IEC materials for October into farmers’ capacity building Farmers are developed and translated. MAF/APS 2023/2024 programs Strengthen the role of the Sepsis  Sepsis bundle training carried out committee and provide support for MOH June 2024 the expansion of the sepsis bundle training Conduct training to improve  Increased Awareness on correct and appropriate antibiotic prescription in appropriate antibiotic dosage for animal animals consumption (Stop prescription of MOH/MAF/APS June 2024 antibiotics by human pharmacists and intended for dog/cat use) Include AMR into the agenda for  AMR issues are addressed at the MWCSD monthly sessions for Sui o community level. Nu’u and Sui Tama’ita’i o Nu’u  Consider the Aiga ma Nuu HPED MOH / Twice a year Manuia program through MWCSD MWCSD as a mechanism for promoting WASH in villages and families Integrate AMR awareness into  AMR awareness is integrated in Community Outreach Programs community health programs. conducted by Samoa Family Health Association (SFHA), Samoa Cancer At least once Society and other relevant NGOs. AMR Committee a year  Enable the partners by developing a basic awareness and communication tool for AMR they can use Goal 1.3: Strengthen information sharing across all relevant sectors on AMR Biennium AMR Symposium  Participation of all key partners in the AMR Committee 2023 Biennium AMR Symposium Sharing of AMR information through  AMR information are available and ministerial websites and social media accessible on key sector partner’s pages (MOH, MAF, OUM, NUS, and websites and social media pages SROS etc.) AMR Committee Ongoing As an example, creating an AMR link within the MOH website and restart AMR Facebook page Goal 1.4: Strengthen National AMR Committee as a mechanism to coordinate the AMR activities in Samoa. Revise the representation of the  AMR Committee ToRs are revised to national AMR committee to include reflect inclusion of committee members November AMR Committee members from all relevant from all relevant stakeholders. 2022 stakeholders AMR Committee quarterly meetings  Meeting minutes reflect quarterly AMR Committee Quarterly meetings AMR committee to report to CDCC  AMR-related issues conveyed to the AMR Committee Quarterly quarterly national level authority 12 ACTIVITY INDICATOR IMPLEMENTER TIMELINE Objective 2: Strengthening AMR Surveillance and Research Goal 2.1: To strengthen laboratory capacity for AMR surveillance and research Conduct staff training needs  Training needs of staff are assessed and assessment for Microbiology addressed for Microbiology staff MOH (Clinical Ongoing  Minimum staff of 6 staff in Microbiology Laboratory) staff and a post-grad in microbiology Develop capacity for MTII and TTMH  Improved laboratory capacity to MOH (Clinical laboratories in performing AMR- accurately identify and report multidrug Ongoing Laboratory) related tests and reporting of MROs. resistant organisms of interest Identify changes in trends of  Tally of MROs isolated each month circulating MROs reported to detect any major increases in frequency that may be indicative of MOH (Clinical Ongoing potential outbreaks Laboratory)  Provide feedback to clinicians about the trends of MROs in Samoa Advertise and fill in position for  Data officer position filled in MOH (Clinical November Laboratory Data officer Laboratory) 2023 Incorporate AMR Surveillance tasks  Data Officer to collate, analyse and MOH/AMR within the “Laboratory Data Officer” disseminate AMR data/reports including 2022 committee TORs data from MTII Training to improve capacity in  Hire TA to assist with training generating reports for AMR using  All relevant personnel able to generate WHO TA Ongoing Excel, Access, WHONET for all reports correctly and in a timely manner relevant personnel Provide training to remind health  More than 90% of forms completed, MOH/AMR professionals of the importance of i.e. include NHN and DOB committee, HOUs, Quarterly completing the minimum identifiers  Conduct audits to monitor compliance Laboratory for patients on laboratory forms. of form-filling behaviours Include in new recruits orientation  At least two audits per year conducted MOH/AMR Twice a year to monitor form-filling habits committee Provide training for doctors on  Doctors are made aware on proper SMA/MOH/DDG documenting deaths attributed to documentation of deaths attributed to Annually Clinical AMR. AMR Doctors must send samples to  At least 1 presentation conducted for laboratory for testing with correct doctors during CME on laboratory and accurate information on services every year. GPs/MOH Ongoing laboratory request forms.  Edit request forms to include tick box for “pre-antibiotic or “post antibiotic” sample Conduct research on causes of  AMR related deaths are documented in deaths attributed to AMR in Samoa hospital records as cause of death. MOH Clinical  AMR related mortality and morbidity Services/AMR are reported to CDCC and ICC on a Committee/MOH Ongoing monthly basis. Clinical  Changes in trends of priority pathogens Laboratory/QAIPC isolated from TTMH in patients with – diabetes, cancer, etc. Goal 2.2: Review and finalize the microbiology SOPs that include AST across all relevant stakeholders Revise and update Clinical laboratory  Updated SOPs used to guide testing and MOH Clinical Annually SOPs for AMR surveillance, including reporting of MROs isolated from Laboratory 13 ACTIVITY INDICATOR IMPLEMENTER TIMELINE performing AST, reporting of MROs humans in humans Revise and update SOPs for AMR  Updated SOPs used to guide testing and surveillance, including performing reporting of MROs isolated from MAF /SROS Annually AST, reporting of MROs in animals animals Build capacity for culture and  Improved capacity for performing AST sensitivity testing for suspected MRO and reporting of MROs isolated from MAF Ongoing infections in animals animals Goal 2.3: Ensure weekly internal quality assurance program and PPTC External Quality Assurance program are worthwhile. Conduct weekly IQA to ensure  Weekly IQA programmes conducted Microbiology Ongoing reliability of results reported and documented staff/QA Officer TTMH and MTIIH laboratories to  TTMH and MTIIH laboratories’ MOH Clinical Lab/ participate in External Quality participation in EQA programmes Quarterly PPTC Assurance programs documented Goal 2.4: Standardize national definition of MROs Develop AMR handbook outlining  AMR handbooks are developed, printed definitions for all AMR related and disseminated across relevant sector terminologies, including pathogens partners and stakeholders. AMR Committee of interest in both animal and  At least one presentation to the (clinical December humans. Book will also include doctors’ weekly CME meetings on lab/consultant 2023 reporting of notifiable MROs, and utilizing the book pathologist) relevant policies and Acts that guide the AMR committee Goal 2.5: Encourage communication across AMR surveillance system human, animal and environment sectors. Ensure reporting of MROs to the IPC  Standardize reporting forms for MROs QAIPC and to the MOH National  MROs reports are updated and Laboratory/Data Ongoing Surveillance team. disseminated on a weekly basis. Officer Establish integrated national AMR  AMR national surveillance data from All relevant surveillance system across human, relevant laboratories are integrated in Annually laboratories animal and environment sectors. one report on quarterly basis. Develop Annual AMR Surveillance  Annual AMR surveillance report are Ongoing, Report developed and disseminated across SROS, MNRE, MAF, every relevant stakeholders prior to annual MOH, FAO, WHO November AAW Establish a mechanism for AMR risk  Risk analysis and scoping study for most analysis and surveillance in livestock feasible mechanism for AMR and food. surveillance in animals and imported animal feed are conducted and reported to the AMR Committee on regular basis.  Risk analysis and scoping study for most MAF, MCIL, MOH Annually feasible mechanism for AMR surveillance in imported and locally produced risk foods such as meats, milk, eggs, and fish from aquaculture are conducted and reported to the AMR committee on regular basis. Monitor and identify all AMR-related  All related AMR projects and activities MOH/AMR Ongoing or linked projects (COMBAT-AMR, harmonized and working collectively committee/HRC- 14 ACTIVITY INDICATOR IMPLEMENTER TIMELINE Research projects, university MOH projects, etc.) to avoid duplication of outputs Objective 3: Strengthen infection prevention and control Goal 3.1: Improve hygiene and sanitation practices in the community and healthcare settings Reactivate the Komiti tumāmā  Regular monitoring of good sanitation concept in villages to assist with practises in all villages. MOH/MWSCD/NG ensuring good sanitation practises Ongoing Os (e.g. ADRA) and infection and prevention resources are well utilized. Increase awareness in improving  Proactive multi-media hand hygiene hygiene and sanitation practises education and awareness campaign are Annually MOH/MNRE/MESC during the annual national hand disseminated publicly during national (May 5) hygiene day commemoration hand hygiene day. Reactivate hand washing campaigns  More compliance with correct hand MESC/MOH/ADRA hygiene. Conduct cross sectional hygiene  % of the public who have knowledge compliance education programs in and aware of hand hygiene importance. hospitals, schools, for food handlers,  Food-handlers template for spot-checks All stakeholders Ongoing tattooists, slaughterhouses and hospitality workers, Review and ensure that the  Food regulation is reviewed and Regulation for the Food Act reflect adhered to. Maximum Residue Limits (MRL) in MOH/MCIL Every 3 years at-risk foods and establish penalties for violation. Strengthen public health laboratory  Ongoing water testing to identify MOH/SROS/SWA As required capacity to conduct water testing acceptable MRLs Conduct ongoing food testing-  Quality assurance and Improved food bacterial contamination of food and safety potential lack of adherence to MOH/SROS/SWA Ongoing antimicrobial withdrawal limits/MRLs Goal 3.2: Strengthen infection prevention and control programs in healthcare-settings Review MOH Infection Control  MOH Infection Control Manual is Manual (2022) reviewed and submitted to Clinical Governance Committee for endorsement. MOH/QAIPC Annually  MOH Infection Control Manual is published and disseminated across the relevant stakeholders/partners. IPC team proactive response to  IPC team is notified when an MRO is identification of MROs in hospital identified QAIPC/Clinical and Ongoing wards  Laboratory staff notifies ICO and clinical Lab Staff staff when an MRO is identified Conduct awareness session for all  No. of MOH staff made aware and MOH/QAIPC MOH staff on National Infection involved in the implementation of the Ongoing Control Manual. National Infection Control Manual Conduct infection control trainings  No. of hospital workers who participate MOH/QAIPC Ongoing for hospital workers. and understand Infection Control. 15 ACTIVITY INDICATOR IMPLEMENTER TIMELINE  Training for cleaners about cleaning up isolation rooms after MRO patient discharge Conduct infection control audits for  No. of health facilities audited for to monitor IPC practises in infection control and fully complied MOH/QAIPC Ongoing healthcare facilities with the National Infection Control Manual. Goal 3.3: Improve Healthcare Waste Management Conduct refresher trainings on waste  No. of refresher trainings provided on segregation and waste management waste segregation and waste protocols for MOH and MAF and APS management for MOH and MAF staff. staff for human and animal  Waste labelled and discarded MOH/MAF/MNRE/ healthcare waste components accordingly (sharp box sent to Annually APS respectively. incinerator)  % of refresher trainings participants who understand healthcare waste management. Develop healthcare waste  Healthcare waste management IEC management IEC materials to materials are developed and November MOH/MNRE illustrate waste management disseminated across the relevant 2024 protocols for public awareness. stakeholders. Establish a mechanism for safe  Best practices for safe disposal of MOH/MAF/MNRE/ disposal of expired antibiotics for antibiotics are adhered to. Pharmaceutical July 2024 hospital and private pharmacies and warehouse from Animal Health division Establish mechanism for disposal of  Expired reagents are discarded MOH/MAF/MNRE/ expired reagents appropriately. Pharmaceutical July 2024 warehouse Undertake assessment on infectious  Evidence-based assessment report is and hazardous waste disposal in developed and disseminated to inform MNRE/MAF/APS July 2024 veterinary sector. policy decisions Goal 3.4: Ensure availability and appropriate use of consumables and Personal Protective Equipment (PPE) Ensure continued access to alcohol  No more than 1 stock-out of alcohol hand-rub and revert to locally made hand rub reported a year. MOH/MAF Ongoing solutions during stock-outs. Ensure continued access to PPEs  No more than 1 stock-out of PPEs (face masks, disposable gloves, reported a year MOH Ongoing disposable gowns) Conduct an audit within the hospital  No of healthcare workers using PPEs ICO officer/MOH Quarterly on the appropriate use of PPEs appropriately and where required Goal 3.5: Promote Vaccination programs in commercial farms (Good Farm Practices – GFP) Promote vaccination programmes  National Farm Vaccination Guideline in commercial farms (NFVG) for cattle, pig, sheep and poultry species in commercial sector Promote vaccination in is developed. MAF Ongoing companion animals to decrease  No of companion animals vaccinated preventable diseases  No. of NFVGs disseminated  No. of commercial farms adopting/implementing NFVGs. 16 ACTIVITY INDICATOR IMPLEMENTER TIMELINE Objective 4: Optimize use of antimicrobials Goal 4.1: Promote the rational use of antimicrobials in human health through the implementation of the National Medicines Policy 2022 in relation to AMR containment. Ensure biennial updating and  Essential Medicines List is updated; soft Every two distribution of Essential Medicines and hard copies are disseminated MOH Pharmacy years List (EML) to relevant stakeholders across the relevant stakeholders. Regular update of stock levels  Essential Medicines List and out of stock including out of stock items and items are disseminated across the price list to relevant stakeholders. relevant stakeholders. MOH Pharmacy Ongoing  Updated price list is provided upon request. Ensure all doctors and pharmacists  No. of doctors and pharmacists both in both in public and private health public and private health sectors sectors have access to the updated accessing, utilizing, and adhering to the MOH/GPs National Antibiotic Guidelines. updated National Antibiotic Guidelines. Pharmacy/QAICPS TBC  Conduct audits to monitor use and adherence to the guidelines  Conduct customized training to address issues identify in the audits. Conduct regular training for the  Conduct training for the prescribers on prescribers (doctors and dentists) on the use of the antibiotic after updates. the use of antibiotic guidelines.  Incorporate into the induction program for interns  Annual Practicing Certificate to include MOH Annually completion of a standardised online training for antibiotic prescribing (approved by the Medical/Dental Council). Goal 4.2: Strengthen the capacity of healthcare professional to educate consumers on rational use of antimicrobials Recruit an additional pharmacist and  At least 1 pharmacist and 2 pharmacy pharmacy technicians and/or technicians and/or assistants are November assistants to strengthen capacity to recruited at MOH Pharmacy MOH 2024 educate consumers on AMR appropriate use. Develop a brochure with key  Antibiotic guidelines key messages are messages of antibiotic guidelines accessible by the public at all health and distributed amongst all health facilities. facilities.  Use of visual advertisements on the importance of AMR at waiting areas in the different sections of the hospital. November  TV monitors in different waiting areas MOH 2024 within the hospital to display key messages on a daily basis.  Important information regarding the use of antibiotics is added as an additional label to the antibiotic prescribed when it is dispensed. Develop bi-lingual (Samoan &  Messages on appropriate use of November English) self-care cards on the antibiotics are printed on Self-care MOH 2024 appropriate use of antibiotics. cards and distributed with each 17 ACTIVITY INDICATOR IMPLEMENTER TIMELINE antibiotic prescription. Goal 4.3: Promote the rational use of antimicrobials for animal health Conduct training on rational use of  At least 3 trainings conducted with antimicrobials in the animal sectors Farmer’s association, Vets, paravets and MAF and APS Annually targeting famers and animal health SROS staff. Improve awareness of rational use of  Appropriate use and correct dosages antibiotic in companion prescribed by qualified veterinary MAF and APS Annually animals/horses professionals Goal 4.4: Strengthen procurement and supply of quality antimicrobials Undergo discussions with Ministry of  Tendering process is consulted and Finance in terms of amending the updated to ensure procurement of tendering process of medicines to quality antimicrobials. consider procurement of antibiotics MOH/MOF July 2024 registered in countries with stringent registration systems and reputable registration authorities. Goal 4.5: Develop antimicrobial stewardship programs in hospitals Establish AMS programme under the  ICC meetings are conducted on monthly DTC linked to ICC; include as main basis agendas in committees.  DTC meetings are conducted on bi- monthly basis.  Roles of DTC & ICC committees in MOH Ongoing driving antibiotic stewardship programmes in hospitals are strengthened and linked through strong partnership. Revise a legal framework/policy to  Nurse Practitioner/Senior Nurse ensure inclusion of a legal provision Specialists are allowed to prescribe pre- for Nurse Practitioners/Senior Nurse defined list of antibiotics MOH June 2024 Specialists to prescribe a pre-defined list of antibiotics. Conduct education training on AMS  Quarterly trainings conducted. All health November components for multiple sectors stakeholders 2023 External auditing of AMS  At least one external auditing November programmes in hospitals. conducted on AMS programs in MOH / QA 2023 hospitals. Conduct regular prescription audits  At least 4 prescription audits conducted at pharmacies and dissemination of within a year. audit results to relevant health  Level of pharmacies compliance with MOH/QAIPC Quarterly professionals. the updated National Antibiotic Guideline. Review and update antibiogram  Antibiogram is updated and distributed Every three every year and distribute to relevant to doctors, nurses, pharmacists and AMR COMMITTEE years professionals. others. Review and update antibiotic  National Antibiotic Guideline is Every two MOH guideline every 2 years. updated, printed and disseminated to years 18 ACTIVITY INDICATOR IMPLEMENTER TIMELINE all prescribers Develop guidelines on the use of  Use of antibiotics in animals guideline is antibiotics in animals based on developed and in line with the internal international best practices. best practices.  Restricted prescribing of medications Every three MAF/APS for animal use to qualified veterinary years professionals  Line-list of banned drugs in food- producing animals (e.g. metronidazole) Continual auditing of antibiotic  At least two audits conducted per year MOH/Private/ scripts to ensure exclusive use of QAIPC and Six monthly prescriptions for dispensing of Pharmacies antibiotics. 19 IMPLEMENTATION Costing and M&E Framework The National AMR Committee will develop a Costing and M&E framework to assist in submitting for annual budgetary requirements linked to harmonize results-based M&E Framework. Monitoring and Evaluation This National AMR Action Plan for Samoa will be reviewed every two years or more frequently when required. 20