Cook Islands Antimicrobial Resistance National Action Plan (2017-2020)

1.2. Strengthen public education on causes and prevention of antimicrobial resistance

1.3. Raise awareness of the need for antimicrobial stewardship amongst stakeholders in the National Plan 2. Strengthen surveillance of antimicrobial resistance and use

2.1. Establish a national surveillance system for antimicrobial resistance

2.2. Strengthen antimicrobial resistance surveillance in animal and environmental sectors

2.3. Strengthen monitoring of antimicrobial prescribing 3. Optimise the use of antimicrobials in all sectors

3.1. Strengthen antimicrobial stewardship in Cook Islands hospitals

3.2. Strengthen evidence-based procurement of antimicrobials for the health sector 4. Strengthen infection prevention and control

4.1. Strengthen the national infection prevention and control programme for human health

4.2. Strengthen infection prevention and control in the agriculture, private and environment sector including Pa Enua 9 Operational Plan Source of Sub-activity Date Implementer Cost Indicator funding 1. Raise awareness of antimicrobial resistance

1.1. Develop an evidence based awareness campaign

1.1.1 Establish the governance structure 2017 MOH, MOA, MMR, Nil - A body or committee is formed or for the implementation of the National MOE, private identified to drive the Action Plan ensuring representation from sector, NES implementation of the NAP, TOR Pa Enua finalized and meetings set

1.1.2 Incorporate National Antibiotic Jan 2017, Community Health Nil - AAW is incorporated into the Awareness Week into the Health 2018 Services HPU Annual Calendar Promotion Annual Calendar

1.1.3 Develop targeted messaging for 2017 AMR Working $5,000 WHO/ Potential Terminology agreed and used AAW with agreed terminology for Group Donor Funding consistently across awareness consistency in awareness messages and Media Committee materials ensure it is both in English and Maori

1.2 Strengthen public education on causes and prevention of antimicrobial resistance

1.2.1 Conduct a perception survey during 2017 and MOH $10,000 WHO/ Potential Baseline awareness data Te Maeva Nui annual event 2019 NGO’s & Youth per Donor Funding available Groups survey

1.2.2 Conduct ongoing awareness raising Nov MOA, MOH MOE, $2,000 WHO/ Potential Number of activities held activities through existing mechanisms 2017-2020 MMR , NGOs, Donor Funding annually and events (annual health conference, Private, GPs and church events, community outreach, outer Pharmacy island sports events, audio/video conference outreach to outer islands 10 throughout the year, monthly IC newsletter, hospital grand rounds, field visits, lagoon day, annual career day at the college, pharmacy resources/activities & other existing trainings)

1.2.3 Disseminate existing GP pamphlets 2017 onwards MOH, MOA $600 p.a. WHO/MOH Number of health-care to outer islands on using antibiotics professionals handing out responsibly to go with Pharmacy orders. pamphlets

1.2.4 Include antimicrobial resistance July 2017 MOH, MOE, MOA $500 p.a. MOE School health programme awareness into the health programme in onwards revised schools and in collaboration with MOE include in curriculum

1.3 Raise awareness of the need for antimicrobial stewardship amongst stakeholders in the National Plan

1.3.1 Hold an annual national meeting on November AMR working group $4,000 Potential Donor Meeting report is available antimicrobial resistance during Antibiotic 2017 and p.a. Funding Awareness Week to share information on 2018 AMR data and implementation of the national action plan.

1.3.2 Integrate antimicrobial resistance 2017, 2018 MOH Nil - Topic incorporated awareness and education as a topic into the health professional mentoring programme with the outer islands through video/audio conferencing

1.3.3 Strengthen and maintain knowledge 2017, 2018 MOH, MOA, Private $500 p.a. MOH/FAO/ Revision of continuing education of antimicrobial resistance and responsible Sector potential Donor programmes use of antibiotics through continuing Funds education programmes for all health Number of health professionals professionals, the animal and private completing the programme sector 11

1.3.4 Review and update as appropriate 2017 MOH Nil - Review completed the antimicrobial resistance component in health professional education programme

1.3.5 Hold a workshop for the animal MOA/FAO/Donor sector and animal owners on the 2017 MOA Workshop held Funds appropriate use of antibiotics

1.3.6 Develop and incorporate Nil Messaging developed and antimicrobial resistance messaging into 2017, 2018 MOH, MOA, NGO - implemented scheduled field visits

1.3.7 Conduct a perception survey on Nil antimicrobial resistance and use of 2017, 2018 MOA - Baseline awareness data antibiotics of livestock keepers Source of Sub-activity Date Implementer Cost Indicator funding 2. Strengthen surveillance of antimicrobial resistance and use

2.1 Establish a national surveillance system for antimicrobial resistance

2.1.1. Establish an AMR Surveillance January 2017 MOH, MMR, MOA Nil - TOR of AMR Surveillance Committee and develop TOR in the first Committee finalized meeting.

2.1.2. Conduct regular training on 2017, 2018 Laboratory 15,000 WHO/ Potential Training undertaken antimicrobial susceptibility testing Donor Funding (EUCAST) for laboratory personnel

2.1.3. Strengthen the collection and 2017 Laboratory 5,000 WHO/ Potential Functioning LIMS analysis of laboratory data through the Donor Funding development of an electronic LIMS (WHONET training) 12

2.1.4. Conduct regular internal quality every 6 Laboratory Potential Donor Internal qualityassurance assurance audits months Funding undertaken

2.1.5. Sharing of AMR data during November MOH, MOA, MOE Nil - Annual AMR report following Antibiotic Awareness Week and at other and June AMR meeting regular times throughout the year 2017, 2018

2.2 Strengthen antimicrobial resistance surveillance in animal and environmental sectors

2.2.1 Continue with survey programmes in 2017, 2018 MOA SPC/ Potential Surveys conducted animal sectors, sending of samples Donor Funding overseas for confirmation and relaying of the AMR data to the surveillance committee once established

2.2.2 Conduct a point prevalence study on 2017,2018 MOA SPC/FAO/ Report on findings of study antimicrobial use in agriculture in Potential Donor Rarotonga Funding

2.3 Strengthen monitoring of antimicrobial prescribing

2.3.1 Undertake an antimicrobial 2017, 2018 MOH, MOA WHO/FAO/ Report on survey fundings prescribing pattern/consumption survey in Potential Donor the health & animal sector Funding Sub-activity Date Implementer Cost Source of funding Indicator 3. Optimise the use of antimicrobials in all sectors

3.1 Strengthen antimicrobial stewardship in Cook Islands’ hospitals

3.1.1 Re-evaluate the terms of reference 2017, 2018 Chair of DTC and Nil - TOR and membership of DTC membership of the Drugs & Therapeutics IPCC and IPCC re-evaluated and Infection Prevention and Control Committee and ensure incorporation of 13 antimicrobial stewardship as one of the key focus

3.1.2 Provide technical assistance for 2017,2018 MOH and MOA WHO/SPC/FAO/ - Technical assistance professional development in terms of Potential Donor identified workshops and trainings on the causes Funding - Training needs identified and management of AMR both in-country and overseas

3.1.3 Ensure adherence to the Cook ongoing DTC WHO/Potential - Clinical audits conducted Islands Antibiotic Guidelines, e.g. internal Donor Funding and results fed back to clinical audit and providing prescriber prescribers and dispensers feedback on antimicrobial use, at least twice per year (electronic and manual prescriptions)

3.2 Strengthen evidence-based procurement of antimicrobials for the health sector

3.2.1 Review the Cook Islands Essential 2018 DTC WHO/Potential - Iteration of the EML is Medicines List to ensure it reflects best Donor Funding printed and dissemination practice with regard to antimicrobial to relevant stakeholders choice for human health

3.2.2 Ensure the procurement of 2017,2018 MOH Pharmacy - Other than exceptional antimicrobials is based on the Cook circumstances, antimicrobials Islands Essential Medicines List purchased should only be those on the EML

3.2.3 Ensure medications procured 2017,2018 MOH Pharmacy, - WHO/Potential Audit or spot checks show no especially antimicrobials have no less DTC Donor Funding antibiotics had arrived into the than 2 years shelf life remaining when Cook Islands with less than two they arrive into the Cook Islands years shelf life

3.2.4 Conduct audits of expired antibiotics 2017, 2018 MOH Pharmacy – WHO/Potential Audit report available and every six months in Rarotonga and Pa Rarotonga Donor Funding actions to address the issues Enua Pa Enua – Officer raised in the audit in Charge 14 Source of Sub-activity Date Implementer Cost Indicator funding 4. Strengthen infection prevention and control

4.1 Strengthen the national infection prevention and control programme for human health

4.1.1 Conduct an assessment of IPC 2017 MOH IPCC $6,000 WHO/Potential Assessment carried out programmes at national and facility levels Donor Funding including IC guidelines

4.1.2 Activate the IPC Committee and 2017 MOH - Regular meeting reports and hold regular meetings actions on IPC issues are addressed

4.1.3 Strengthen the national and facility 2017, 2018 MOH IPCC $2,000 WHO/Potential Regular trainings conducted based IPC programmes through regular Donor Funding training including Pa Enua

4.1.4 Strengthen recording/supply 2017, 2018 MOH Pharmacy, - No or limited stock outs of PPE processes and maintain appropriate stock Quality and and IC supplies reported from the levels at all times of PPE and IC supplies Infection Control, hospital as well as Pa Enua including those for Pa Enua Pa Enua medical officer in charge/nurse practitioner, Hospital Manager

4.1.5 Pa Enua to ensure all medical waste 2017 MOH/ - No reports of incidents with is disposed of as appropriate including HHS and Pa Enua inappropriately disposed waste returning to Rarotonga for incineration if officer in charge applicable

4.1.6 Ensure ongoing maintenance of the 2017 Hospital Manager $5,000 WHO/Potential Maintenance plan for incinerators Rarotonga and Aitutaki hospital MOH Donor Funding are in place incinerators 15

4.1.7 Raise the awareness of infection 5 May MOH, MOE, MOA $5,000 WHO/Potential Number of events held where control practises in the community and (National Donor Funding infection control messaging and congregate settings Hand Hygiene practices were available. Day) Times of drought, heavy rains and during national events

4.2 Strengthen IPC in the agriculture, private and environment sector including Pa Enua

4.2.1 Conduct a situational analysis on 2017 MOH, MOA, MMR, $10,00 SPC/FAO/WHO/ Report from the situation analysis water and sanitation ICI (Te Mato Vai), 0 Potential Donor available and forward actions NES Funding identified

4.2.2 Share information between sectors 2017, 2018 MOH, MMR, MOA, $2,000 SPC/FAO/WHO/ - Trainings conducted on best practises of IPC including MOE Potential Donor - Regular meetings recorded biannual training on IPC Funding 16