National Action Plan on Prevention and Containment of Antimicrobial Resistance 2023-2027

1. Establish and sustain governance and co-ordination structures for tackling AMR in a “One Health Approach”

2. Increase public knowledge and understanding of AMR and use of antimicrobials, particularly in those involved in healthcare, nursing care, food, and livestock production and aquaculture.

3. Enhance surveillance and monitoring in order to understand the state of AMR patterns and trends and use of antimicrobials

4. Enhance proper infection prevention and control (IPC)

5. Promote antimicrobial stewardship (AMS) in order to reduce antimicrobial-resistant organisms; and

6. Accelerate research on the mechanism of AMR emergence and transmission, and its impact on the economy, and promote research and development for new preventive, diagnostic, and therapeutic technologies in order to ensure the continued availability of effective preventive, diagnostic, and therapeutic treatments for antimicrobial-resistant infections. 1 2023 - 2027 During implementation of the 2017–2022 National Action Plan for AMR, the following achievements and challenges were realised: Achievements

1. Development and implementation of the National Policy and Action Plan on the Prevention and Containment of Antimicrobial Resistance in November 2017.

2. Inauguration of the National Antimicrobial Stewardship Inter Agency Committee (NASIC).

3. Establishment of County Antimicrobial Stewardship Inter Agency Committee (CASICs) in 14 out of 47 counties

4. Development and implementation of the two strategies: National AMR Surveillance Strategy 2018-2022 and Communication Strategy 2018.

5. Development of MOALD Guidelines for Prudent Use of Antimicrobials in Animals, October 2018.

6. Development and implementation of the National Antimicrobial Stewardship Guidelines for Health Care Settings, March 2020.

7. Implementation of a Kenya National IPC Policy for Health Care Services 2021, Kenya National IPC Strategic Plan for Health Care Services 2021-2025-, , Kenya National IPC Guideline for Health Care Services 2010, and Basic Training Course for Infection Prevention and Control (IPC) available in the MOH e-learning academy.

8. Development of the National Monitoring and Evaluation (M&E) Framework and reporting system through the KHIS for AMR, Infection Prevention and Control and Patient Safety.

9. Early implementation of the National AMR Surveillance Strategy 2018-2022 with expansion from initial two pilot sites in 2018 to 23 by 2022.

10. Establishment of AMR One Health Surveillance System reporting platform and dashboard to visualise AMR trends across the country https://onehealth.nphl.go.ke/.

11. Annual commemoration of the World Antimicrobial Awareness Week since 2013.

12. Conclusion of a scoping report on the investment incentives for local production of essential antibiotics in Kenya in light of mitigating AMR.

13. Continuous mobilisation of technical and financial resources to support implementation of the AMR Policy through development partners. Challenges Various challenges were encountered during implementation of the previous NAP-AMR and these were largely responsible for missed targets on some of the strategic interventions and activities. They include the following:

1. Limited funding from both domestic and development partners

2. Inadequate knowledge on AMR across all sectors

3. Challenging environment for multisectoral collaboration

4. Weak infrastructure to support implementation across relevant sectors

5. Inadequate investment in communication, data management capacity, and monitoring and evaluation efforts

6. Inadequate political commitment across all levels

7. Limited laboratory capacity impacting surveillance and data collection

8. Underutilisation of established microbiology services 2 National Action Plan on Prevention & Containment of Antimicrobial Resistance OPERATIONAL FRAMEWORK In its aim of promoting countermeasures on AMR, this NAP is structured around strategic objectives in the following six areas: (1) Governance and Coordination Mechanisms in a One Health Approach (2) Public Awareness and Education, (3) Surveillance and Monitoring, (4) Infection Prevention and Control, (5) Appropriate Use of Antimicrobials, and (6) Research and Development. The NAP is organised around these objectives to facilitate collaborative action by the Kenyan Government, in partnership with development partners, individuals, and organisations aiming to strengthen healthcare, public health, veterinary medicine, agriculture, food safety, and research and manufacturing. Strategic interventions to achieve these objectives and specific actions to implement the strategies are presented for each objective as set out in Table 1. Table 1. Six Strategic Areas and Objectives for Countermeasures on AMR Strategic Areas Strategic Objective To establish and sustain governance and coordination structures for tackling Governance and Coordination AMR in a One Health approach To improve public awareness and understanding, and promote education Public Awareness and Education and training of professionals To continuously monitor antimicrobial resistance, use and disposal of Surveillance and Monitoring antimicrobials, and appropriately understand the trends and spread of antimicrobial resistance To prevent the spread of antimicrobial-resistant organisms by implementing Infection Prevention and Control appropriate infection prevention and control measures To promote appropriate use of antimicrobials in the fields of healthcare, Appropriate Use of Antimicrobials livestock production, agriculture, and aquaculture To promote research on antimicrobial resistance and foster research and Research and Development development to secure the means to prevent, diagnose and treat the antimicrobial-resistant infections The strategies to achieve the above objectives are described in subsequent sections with their purposes, background, specific actions, related ministries, agencies, and institutions for the actions, and indices to evaluate the actions. 3 2023 - 2027 IMPLEMENTATION FRAMEWORK GOVERNMENT COMMITMENT The Kenyan government will lead and consolidate the efforts by individual programmes or institutions through the development of policies, strategies, and legal frameworks towards combating AMR. These efforts will encompass the different government departments and the private, intergovernmental, and non-governmental sectors. A commitment from all these stakeholders will allow for the simultaneous achievement of set targets and for more resources to be generated. The government will collaborate with the civil societies to raise awareness and disseminate information about AMR to the general public. NATIONAL GOVERNMENT COORDINATION MECHANISMS The Ministries responsible for Health, Agriculture, Livestock, Fisheries, Environment, Education, Trade, National Treasury, and Cooperatives will continue being part of the multi-sectoral AMR Secretariat hosted at the Ministry responsible for Health to coordinate the AMR agenda. These ministries will implement the National Action Plan on Prevention and Containment of AMR 2023-2027 and associated policy and strategies in a “One-Health” approach. Institutions that will play a leading role in the implementation of the National Policy for AMR include the National and county governments, and departments and agencies from the relevant sectors. National Antimicrobial Stewardship Interagency Committee The AMR governance mechanism comprises the NASIC Steering Committee (NASIC-SC) and a NASIC Technical Committee (NASIC-TC). NASIC Steering Committee The NASIC-SC comprises the Principal Secretaries of relevant ministries and two representatives of the Council of Governors. The NASIC-SC is responsible for policy direction, resource mobilisation, budget, and work plan approvals. The membership of the NASIC-SC is as follows:

1. Co-Chairs: MOH and Ministry of Agriculture and Livestock Development (MOALD).

2. Members: Ministry of Mining, Blue Economy and Maritime Affairs (MIBEMA), Ministry of Environment, Climate Change and Forestry (MoECCF), Ministry of Education, Ministry of Investments, Trade and Industry, and the Ministry of National Treasury and Economic Planning.

3. The Committee may co-opt any department, bureau, office, agency, or instruments of the government, and request the county governments and private sector for assistance as the circumstances may require. Terms of Reference for the Steering Committee • Policy direction • Approval of budgets • Approval of work plans • Resource mobilisation NASIC Technical Committee (NASIC-TC) The NASIC-TC comprises the Technical Directors of relevant ministries. The NASIC-TC is responsible for technical oversight, overseeing the implementation of the National Policy for AMR. It shall also ensure close coordination with other relevant stakeholders. 4 National Action Plan on Prevention & Containment of Antimicrobial Resistance Terms of Reference for the Technical Committee • Formulate, monitor, and evaluate implementation of the national action plan. • Collaborate and coordinate with government agencies, private and non-state actors. • Mobilise human and financial resources to support the plan through regular budget allocations and mainstreaming of activities within core programmatic areas. • Promulgate guidelines, make recommendations on rules and regulations, as well as possible penalties and sanctions for violations in accordance with existing laws, as may be necessary, related, or consistent with the purpose, intent, and objective of this NAP. • Submit to the steering committee regular status reports, budgets, and policy proposals on the implementation of the NAP. • Establish thematic area advisory groups and technical working groups to facilitate effective implementation of the NAP. • Provide technical inputs for the technical areas and objectives, and to introduce corrective technical actions • Perform other functions and activities as may be assigned by the NASIC-SC. The NASIC will meet at least biannually. The responsible Principal Secretaries will select a chairperson based on his or her expertise in leadership. There will be rotation of the chair every two years between MOH and MOALD. NASIC will have a mechanism (with appropriate records) to ensure that its members have no conflicts of interests and that the work of the committee in the interests of public health is transparent. The NASIC shall review its composition annually to ensure representation of all relevant sectors and stakeholders. National AMR Focal Persons The national AMR focal persons shall be appointed from the key ministries to enhance leadership, coordination, and collaboration for AMR NAP implementation. Within the key ministries, the AMR focal points from relevant departments will be nominated by the AMR focal person in the ministry for appointment by the technical directors. This will apply in the different agencies according to the structure of their organisations. The AMR focal persons constitute the membership of the NASIC Secretariat. The AMR Focal points constitutes the technical working groups (TWGs). NASIC Secretariat The NASIC will be supported by an appropriately resourced secretariat based at the MOH, responsible for the logistics of meetings; minute-taking; preparation and circulation of documents (e.g. background papers, reports, and advisory notes to ministers); and storage and archiving. The head of the Secretariat will be the national AMR focal person from the ministry at the time chairing the NASIC-TC. Roles and Responsibilities of the NASIC Secretariat • Link the two levels of the AMR co-ordination mechanism at the national and county levels. • Coordinate policy implementation at the national and county governments • Ensure continuous international, national, and county stakeholder engagement. • Develop and present the national AMR position in meetings, conferences, stakeholder meetings and other relevant national and international forums. • Ensure monitoring and evaluation of the National Action Plan on Prevention and Containment of AMR. • Engage technical advisors and support the functions of TWGs. Composition of the Secretariat The NASIC Secretariat is composed of the AMR focal persons representing the relevant sectors, notably human health, animal health, plant health, aquaculture, environment sectors, education, trade, and finance. The Secretariat can co- opt members as an when necessary. Representatives should have sufficient authority from their institutions to make decisions pertaining to policy implementation. 5 2023 - 2027 AMR Technical Working Groups The NASIC-TC is operationalised by six TWGs, in accordance with the defined strategic objectives of the AMR NAP. The TWGs are mandated with specific tasks to provide technical input and implementation recommendations. In addition, the TWGs will collaborate on review of AMR NAP, and monitoring and evaluation of each strategic objective of the NAP. The TWGs are accountable to the NASIC-TC. Membership to TWGs The membership of the TWG includes AMR focal points and experts from each NAP strategic objective across the One Health sectors and relevant stakeholders. The six TWGs shall include: • TWG for AMR Governance • TWG for Awareness and Education • TWG for AMR Surveillance, Monitoring and Laboratory Strengthening • TWG for Infection Prevention and Control • TWG for Antimicrobial use/ consumption (AMU/AMC) • TWG for AMR Research and Development Roles and Responsibilities of TWG Each TWG will have specific terms of reference stipulating specific scope, roles, and responsibilities. The TWGs interact with the representatives of the required sectors, as determined by their scope of work, and report regularly to the NASIC- TC. General responsibilities shall include to: • Develop work plans aligned to the specific objective areas • Cooperate with NASIC-TC in the formulation/review of NAP and respective operational plans • Coordinate implementation of prioritised activities outlined in the NAP per strategic objective • Ensure monitoring and evaluation of activities • Report to NASIC-TC on the progress of implementation of the respective strategic objectives. • Provide technical update, recommendations, and advice to the NASIC-TC and AMR focal persons COUNTY GOVERNMENT COORDINATION MECHANISMS At the county government, the lead departments (Health, Agriculture, Environment) will establish a CASIC. The CASIC will comprise county Chief Officers and county Directors of Technical Departments (Health, Agriculture, Livestock, Fisheries, Trade, Finance Environment, Education), representatives of regulatory bodies, professional associations, institutions of higher learning, faith-based organisations, and experts. The CASIC will be responsible for approving budgets and work plans, resource mobilisation and implementation of the NAP at the county level. Terms of Reference for the CASIC • Monitor and evaluate the implementation of the national action plan at the county level for the prevention and containment of AMR. • Mobilise human and financial resources to support the plan through regular budget allocations, mainstreaming of activities within core programmatic areas. • Enforce guidelines, rules, and regulations in accordance with existing laws, as may be necessary, related, incidental, or consistent with the purpose, intent, and objective of this National Action Plan. • Submit to the NASIC Secretariat regular status reports, budgets, policy proposals on the implementation of the national plan. • Collaborate and coordinate with the county and national government and non-state actors. 6 National Action Plan on Prevention & Containment of Antimicrobial Resistance NATIONAL AND COUNTY GOVERNMENT COORDINATION MECHANISMS The Role of Intergovernmental Relations The Intergovernmental Relations (Amendment) Act 2021 establishes several Intergovernmental structures, which serve to facilitate greater intergovernmental cooperation and consultation under the devolved government model. The national government and county governments will use these structures to facilitate implementation of the NAP. See Figure 1. Figure 1. Structure for Coordination Mechanism NATIONAL ANTIMICROBIAL STEWARDSHIP INTER AGENCY COMMITTEE MOALD MOH MOECCF MIBEMA NASIC-SC NASIC-TC INTERGOVERNMENTAL NASIC SECRETARIAT RELATIONS NATIONAL TECHNICAL WORKING COUNTY ANTIMICROBIAL GROUPS STEWARDSHIP INTER AGENCY COMMITTEE CASIC SECRETARIAT COUNTY TECHNICAL WORKING GROUPS Reporting Collaborating Supporting PARTNERSHIPS AND IMPLEMENTATION The implementation of this National Action Plan will be guided by key institutional coordination and legal framework operating at different levels of the governance system in the country. This will require the sustained, coordinated, and complementary efforts of individuals and groups locally and globally, including public and private sector partners, healthcare providers, healthcare leaders, veterinarians, agriculture industry leaders, manufacturers, policymakers, and patients. 7 2023 - 2027 Table 2. Strategic Interventions to Operationalise the National Action Plan Sector Involved Responsible Time frame Entity Environmental Human Health Animal Health Plant Health Fisheries & Activity Deliverables Health Aquaculture Food Strategic Intervention: Strengthen governance and coordination mechanisms in a One health approach Develop a costed annual work Funded NASIC Secretariat X X X X X X 2023 NASIC plan for the NASIC Secretariat Annual work Plan Secretariat Increase dedicated Human Staffing plan X X X X X X 2023 NASIC resource for the NASIC Increased human resources Secretariat Secretariat for the NASIC Secretariat Establish M&E Unit within the M&E Unit Established X X 2024 NASIC NASIC Secretariat Establish an Information Information and X X 2024 NASIC Communication and communication technology Technology Unit within the unit established NASIC Secretariat Establish CASICs in all Functional CASICs (CASIC X X X X X X 2023-2027 NASIC, county counties members with official departments appointment letters responsible for and conducting regular sectors involved meetings) Develop CASIC workplans Launched CASIC workplans X X X X X X 2023-2027 CASICs Mobilise resources to support Funded CASIC workplan/ X X X X X X 2023-2027 CASICS, NASIC implementation of CASIC Activities workplans Review the M&E Framework M&E Framework Reviewed X X X X X X 2023 NASIC, NASIC for the AMR National Action Secretariat Plan Partners Review AMR Reviewed Communication X X X X X X 2023-2024 NASIC Communication Strategy Strategy Secretariat Partners Strategic Intervention: Mobilize Resources and Promote Internal and External Networking Develop and submit project Secure funding from X X X X X X NASIC proposals for funding proposals submitted Secretariat Partners Advocate and lobby for direct Direct budgetary support X X X X X X NASIC funding from government from government Secretariat Partners 8 National Action Plan on Prevention & Containment of Antimicrobial Resistance STRATEGIC OBJECTIVES STRATEGIC OBJECTIVE 1: TO STRENGTHEN GOVERNANCE AND COORDINATION MECHANISMS Measure of Outcome: Number of functional AMR One Health coordination structures at national and county levels of government. The country has established good foundations for addressing AMR. There is need to scale up and sustain efforts to make a sustainable impact. Progress will be actively monitored through an M&E framework. The Multi-Sectoral Coordinating Committee is responsible for coordinating, facilitating, and overseeing the implementation of all AMR activities in the country. Previous AMR containment measures were often siloed focusing mainly on human and animal health sectors. However, this approach is no longer considered adequate due to potential implications of widespread antimicrobial use, not just in human health and animal health, but also in crop and aquatic sectors, as well as environmental contamination through antimicrobial residual discharge. Focusing containment effects primarily in the two sectors limited the potential for comprehensive and sustained improvements across the country. There is now general acceptance that the inherent complexities of AMR containment require a coordinated multisectoral effort grounded in the One Health approach. Counties are at different levels of establishing a One Health platform and political commitment to AMR containment. This may be due to unique challenges facing them but attributed to governance and coordination mechanisms. There is need to focus on strengthening leadership, policy, governance, and enabling environment; building capacity; and supporting monitoring and feedback and self-learning through a dedicated thematic area. There is also a need to further strengthen coordination and reporting of county-level AMR governance structures and activities with national- level governance structures and activities and draw linkages to other relevant committees e.g. the IPC committees at the national and county level. Activity Deliverables Sector Involved Time frame Responsible Entity Environmental Human Health Animal Health Plant Health Fisheries & Health Aquaculture Food STRATEGIC OBJECTIVE 1: TO STRENGTHEN GOVERNANCE AND COORDINATION MECHANISMS Strategic Intervention: 1.1 Establish and Strengthen Governance and Coordination Mechanism at National and County Levels 1.1.1 Review of relevant Updated strategies X X X X X X 2023-2027 NASIC Secretariat policies and strategies related to AMR 1.1.2 Review National NASIC membership X X X X X X 2023 NASIC Secretariat Antimicrobial Stewardship and structure reviewed Interagency Committee membership and structure to incorporate all the relevant sector 1.1.3: Capacity development Capacity of the NASIC X X X X X X 2023-2027 NASIC Secretariat (technical, operational, Secretariat enhanced and financial) of the NASIC Secretariat for effective coordination and implementation of the NAP 9 2023 - 2027 Activity Deliverables Sector Involved Time frame Responsible Entity Environmental Human Health Animal Health Plant Health Fisheries & Health Aquaculture Food 1.1.4: Support establishment CASIC established in X X X X X X 2023-2025 NASIC Secretariat of CASICs in all counties all the counties CASIC Secretariat 1.1.5: Support development CASIC work plans X X X X X X 2023-2025 NASIC Secretariat of CASIC work plans on CASIC Secretariat AMR Strategic Intervention: 1.2 Strengthen and Sustain Collaborations in AMR 1.2.1 Conduct mapping of Mapped stakeholders X X X X X X 2023-2024 NASIC Secretariat stakeholders involved in CASIC Secretariat implementation of AMR National Action Plan 1.2.2: Formalise partnership Signed memorandums X X X X X X 2023-2027 MOH/MOALD/MoECCF/ and collaborations with of understanding NEMA/Kenya Fisheries stakeholders Service (KeFS)/MIBEMA Professional bodies NASIC Secretariat CASIC Secretariat Implementing and development partners 1.2.3: Develop a framework Collaboration X X X X X X 2023-2027 MOH/MOALD/MoECCF/ for cross-sectoral framework developed NEMA/ KeFS/MIBEMA collaborations NASIC Secretariat CASIC Secretariat Partners Strategic Intervention: 1.3 Monitor Implementation of the National Action Plan 1.3.1 Develop the M&E M&E framework X X X X X X 2023 NASIC Secretariat framework for AMR CASIC Secretariat National Action Plan 1.3.2: Establish an M&E system X X X X X X 2023 NASIC Secretariat M&E system for NAP CASIC Secretariat implementation 10 National Action Plan on Prevention & Containment of Antimicrobial Resistance STRATEGIC OBJECTIVE 2: TO IMPROVE AWARENESS & UNDERSTANDING OF AMR THROUGH EFFECTIVE COMMUNICATION, EDUCATION & TRAINING Measure of Outcome: Proportion of stakeholders who are aware of AMR and AMU. AMR is a real public health crisis affecting the entire population that is exposed to antimicrobial resistant microorganisms (through human-human transmission, food, or other transmission routes). Promotion of nation-wide measures against AMR in human health and agriculture requires public awareness and understanding of AMR and antimicrobial use. The current level of public awareness is limited, and AMR is not a core component of professional education, training, or certification in both human and agricultural courses. Awareness campaigns are on-going through professional associations and stakeholder for a, in limited areas but these need to be scaled up countrywide. Therefore, there is need for increased awareness for the general public and professionals to ensure appropriate use of antimicrobials. However, it is important to develop AMR communication messages tailor made to suit different audiences and develop mechanisms to measure their effectiveness. There is need for creating awareness in relevant ministries to ensure concerted efforts in combating AMR. These efforts will also be replicated at county level. Combating AMR calls for commitment of national and county governments through resource mobilisation and ensuring comprehensive sensitisation at grassroots level. Antimicrobials for human and animal use can be accessed without prescription. With this regard, there is need to educate the farmers, animal keepers and the general public to enforce behaviour change. Reducing the emergence and spread of AMR requires AMS and IPC among professionals. Behaviour change based on increased knowledge and understanding of AMR is critical in addition to the strengthening regulations in this sector. Many farmers do not practice infection prevention measures in animals and crops and may resort to unnecessary use of antimicrobials; hence the need to emphasise adoption of good agricultural practices during sensitisation campaigns. Agriculture input manufacturers should be sensitised to eliminate unnecessary use of antimicrobials during processing especially of animal feeds. Activity Deliverable Sector Involved Time frame Responsible Entity Environmental Human Health Animal Health Plant Health Fisheries & Health Aquaculture Food STRATEGIC OBJECTIVE 2: TO IMPROVE AWARENESS & UNDERSTANDING OF AMR THROUGH EFFECTIVE COMMUNICATION, EDUCATION & TRAINING Strategic Intervention 2.1: Enhance Public Awareness, Knowledge, and Understanding of AMR 2.1.1: Develop, review, and Information, X X X X X X 2023-2027 NASIC Secretariat disseminate information, education, and CASIC Secretariat education, and communication communication materials and sensitisation materials Partners packages 2.1.2: Undertake studies to Knowledge attitudes X X X X X X 2024-2027 NASIC Secretariat assess the level of awareness and practices report CASIC Secretariat and intervention strategies on AMR among the public Partners 2.1.3: Review the AMR communication X X X X X X 2023 NASIC Secretariat communication strategy for strategy reviewed CASIC Secretariat AMR Partners 2.1.4. Conduct AMR awareness AMR awareness X X X X X X 2023–2027 NASIC Secretariat campaigns at national, county, events conducted and CASIC Secretariat and international levels reports developed Partners 11 2023 - 2027 Activity Deliverable Sector Involved Time frame Responsible Entity Environmental Human Health Animal Health Plant Health Fisheries & Health Aquaculture Food 2.1.5: Conduct periodic AMU AMU/AMR messaging X X X X X X 2023-2027 NASIC Secretariat and AMR messaging and dissemination report CASIC Secretariat dissemination on existing and emerging issues to targeted Partners groups 2.1.6: Develop and disseminate Periodic policy briefs X X X X X X 2023-2027 NASIC Secretariat periodic policy briefs for policy CASIC Secretariat makers across all sectors on AMR Partners 2.1.7: Create awareness on Dissemination X X X X X X 2023-2027 NASIC Secretariat environmental dimensions of materials on CASIC Secretariat AMR environmental dimensions of AMR Partners 2.1.8: Disseminate evidence- Dissemination reports X X X X X X 2023-2027 NASIC Secretariat based AMR findings to CASIC Secretariat leadership, professionals, and general public Partners Strategic Intervention 2.2: Promote Education and Training on AMR and IPC 2.2.1 Conduct training and Trained professionals X X X X X X 2023-2027 MOH/MOALD/ sensitisation of professionals on AMR and IPC MoECCF/NEMA/KeFS/ and extension workers on AMR MIBEMA, professional bodies NASIC Secretariat CASIC Secretariat Partners 2.2.2: Review and disseminate Reviewed AMR X X X X X X 2023-2027 MOH/MOALD/ AMR training modules modules MoECCF/NEMA/KeFS/ to include environmental MIBEMA, professional dimensions, aquaculture, and bodies crop health NASIC Secretariat CASIC Secretariat Partners 2.2.3: Incorporate AMR and AMR modules X X X X X X 2023–2027 MOH/MOALD/ IPC training modules as part incorporated MoECCF/NEMA/KeFS/ of continuous professional into continuous MIBEMA, professional development professional bodies development NASIC Secretariat CASIC Secretariat Partners 2.2.4: Incorporate AMR as AMR included as X X X X X X 2023-2027 MOH/MOALD/ component of in-service and component of in- MoECCF/NEMA/KeFS/ pre-service training curriculum service and pre- MIBEMA, professional for professionals service training bodies curriculum for NASIC Secretariat professionals Strategic Intervention 2.3: Build Capacity of Media Personnel on AMR 2.3.1: Coordinate media Media trainings X X X X X X 2023–2027 NASIC Secretariat personnel trainings on AMR/ reports CASIC Secretariat AMU and identify champions Media champions Partners identified 2.3.2: Engage media to cover AMR events report X X X X X X 2023–2027 NASIC Secretariat AMR events and occurrences Media Clips CASIC Secretariat Partners 12 National Action Plan on Prevention & Containment of Antimicrobial Resistance STRATEGIC OBJECTIVE 3: TO STRENGTHEN THE KNOWLEDGE & EVIDENCE BASE THROUGH SURVEILLANCE AND RESEARCH Measure of outcome Availability of information on incidence, prevalence, and resistance trends across pathogens required for the understanding of the AMR development and spread and timely national and local actions to improve treatments and curb the development of AMR. Establishing surveillance systems to detect and report resistant pathogens as well as the consumption of antimicrobials plays a critical role in developing evidence-based policies and guidelines to control/ limit overuse of antimicrobials which is a major driver of AMR. In Kenya surveillance and research on AMR is dependent on local research institutions, training institutions, health facilities and international research partners. More detailed surveillance has historically been limited to enteric pathogens which cause diarrheal diseases and significant mortality and morbidity in children. This data is insufficient to facilitate implementation of robust interventions. While the country cannot wait for all the data to initiate actions, data collection can be undertaken alongside risk mitigation. Building the capacity of health professionals and laboratories that take part in the process of surveillance enable reliable and robust diagnostic testing and proper data to be reported. With proper information and sharing of surveillance studies across borders, targeted approaches and treatment strategies may be developed to limit the spread and emergence of pathogens with AMR. The extent and impact of AMR in the agricultural sector is not yet well defined. The judicious use of antimicrobials in food-producing animals is a critical step in lessening the AMR patterns seen in human medicine. This necessitates the establishment of an effective monitoring system to monitor trends in AMR from the point of slaughter to processing of animals, as well as the implementation of surveillance systems focusing on AMR mitigation strategies in animals. Activity Deliverables Sector Involved Time frame Responsible Entity Environmental Human Health Animal Health Plant Health Fisheries & Health Aquaculture Food STRATEGIC OBJECTIVE 3: TO STRENGTHEN THE KNOWLEDGE & EVIDENCE BASE THROUGH SURVEILLANCE AND RESEARCH Strategic Intervention 3.1: Strengthen the National AMR Surveillance System 3.1.1: Establish AMR Surveillance Functional X X X X 2023–2027 MOALD/MoECCF/NEMA/ sites in environment, crop, and surveillance sites KeFS/MIBEMA aquaculture sectors established NASIC and CASIC Secretariat Partners 3.1.2: Increase the number of AMR Surveillance X X 2023–2027 MOH/MOALD AMR Surveillance Sentinel Sites sentinel sites NASIC and CASIC Increased Secretariat Partners 3.1.3: Integrate information Integrated X X X X X X 2023–2027 MOH/MOALD/MoECCF/ management system for AMR information NEMA/KeFS/MIBEMA and AMU/AMC management NASIC and CASIC system established Secretariat Partners 3.1.4: Scale up the AMR AMR information X X X X X X 2023–2027 MOH/MOALD/MoECCF/ information management management NEMA/KeFS/MIBEMA system to include data from all system scaled up NASIC and CASIC sectors Secretariat Partners 13 2023 - 2027 Activity Deliverables Sector Involved Time frame Responsible Entity Environmental Human Health Animal Health Plant Health Fisheries & Health Aquaculture Food 3.1.5: Review the AMR AMR surveillance X X X X X X 2023-2024 MOH/MOALD/MoECCF/ Surveillance Strategy using a strategy reviewed NEMA/KeFS/MIBEMA One Health approach NASIC and CASIC Secretariat Partners 3.1.6: Publish annual AMR Annual AMR X X X X X X 2023-2027 MOH/MOALD/MoECCF/ surveillance report surveillance report NEMA/KeFS/MIBEMA published NASIC and CASIC Secretariat Partners 3.1.7: Conduct AMR data AMR data review X X X X X X MOH/MOALD/MoECCF/ analysis, data review meetings reports. NEMA/KeFS/MIBEMA and utilisation to optimise use NASIC and CASIC of data for decision making Secretariat Partners Strategic Intervention 3.2: Strengthen Laboratory Capacity for AMR Surveillance 3.2.1: Assess capacities of Laboratory X X X X X X 2023-2027 MOH/MOALD/MoECCF/ existing laboratories on assessment report NEMA/KeFS/MIBEMA AMR surveillance including NASIC and CASIC environment, food, crop, and Secretariat aquaculture Partners 3.2.2: Establish and maintain Laboratory quality X X X X X X 2023-2027 MOH/MOALD/MoECCF/ laboratory quality management management NEMA/KeFS/MIBEMA system in all the surveillance system established NASIC and CASIC sites Secretariat Partners 3.2.3: Standardise laboratory Standardised X X X X X X 2023-2025 MOH/MOALD/MoECCF/ testing methods and reporting laboratory NEMA/KeFS/MIBEMA tools for AMR surveillance methods and NASIC and CASIC reporting tools Secretariat Partners 3.2.4: Conduct training on AMR Training reports X X X X X X 2023-2027 MOH/MOALD/MoECCF/ testing methods across all NEMA/KeFS/MIBEMA sectors NASIC and CASIC Secretariat Partners 3.2.5: Develop a forecasting Forecasting and X X X X X X 2023-2027 MOH/MOALD/MoECCF/ and quantification tool for quantification tool NEMA/KeFS/MIBEMA microbiological laboratory NASIC and CASIC supplies (as a means of Secretariat understanding the need, to draw on economies of scale and Partners to reduce stock outs) 14 National Action Plan on Prevention & Containment of Antimicrobial Resistance STRATEGIC OBJECTIVE 4: TO REDUCE THE INCIDENCE OF INFECTION THROUGH EFFECTIVE SANITATION, HYGIENE, AND IPC MEASURES Measure of Outcome: extent of reduction in the prevalence of preventable infections, and in particular the incidence of drug resistant infections in health care settings. Better hygiene and infection prevention control are essential to limit the development and spread of antimicrobial-resistant infections and multidrug-resistant bacteria. To prevent transmission of AMR infections infection prevention and control, biosecurity, sanitation, hand washing, food and water safety and animal hygiene must be core components of infectious disease prevention. Vaccination, where appropriate as an infection prevention measure, should be encouraged. Prophylactic use of antibiotics in humans and animals, to prevent the acquisition and spread of diseases, and their use as a growth stimulant, promotes the development of AMR. Infection prevention and control including surveillance of health care associated-infections (HAIs) should be institutionalised and strengthened. Kenya currently has IPC policy, strategy, guidelines, and basic training course in place. This NAP supports the Implementation of the IPC Strategic Plan to reduce the incidence of infections and demand for antimicrobials and subsequently reduce AMR. Improving the level of husbandry, hygiene management and maintaining the health condition of livestock are extremely important elements of controlling the occurrence and selection of antimicrobial resistant organisms leading to the prevention of the occurrence of infectious diseases in animals, to secure safety production of animal products, as well as to reduce instances of using veterinary antibiotics. They are also highly important from the viewpoint of reducing production costs. During food processing and distribution processes, promote countermeasures to reduce contamination with Antimicrobial Resistant Organisms and other microorganisms as well as to prevent food poisoning from occurring by promoting HACCP (Hazard Analysis and Critical Control Point). In all fields of livestock, farm-raised aquatic animals and pets, appropriate vaccination is important to prevent infectious diseases, in addition to thorough hygienic management. Studies have indicated that antibiotics can contaminate the environment through three principal channels: animal waste, human waste and manufacturing waste containing active pharmaceutical ingredients. This can result in soil, crops and water sources contamination and facilitate the development of antimicrobial resistance amongst the pathogens with which they interact creating environmental reservoirs of antimicrobial resistant bacteria. This calls for adequate treatment of waste products released into the local environment, limiting the sale and use of by products that could contain antimicrobials like manure from animals treated with antimicrobials. Public awareness on proper disposal of antimicrobials and treatment of hospital waste will be beneficial in reducing the burden of antimicrobial resistant pathogens in the wastewater. Activity Deliverables Sector Involved Time frame Responsible Entity Environmental Human Health Animal Health Plant Health Fisheries & Health Aquaculture Food STRATEGIC OBJECTIVE 4: TO REDUCE THE INCIDENCE OF INFECTION THROUGH EFFECTIVE SANITATION, HYGIENE, AND IPC MEASURES Strategic Intervention 4.1: Strengthen Infection Prevention and Control Measures 4.1.1: Improve hand hygiene Improved hand X 2023-2027 MOH compliance in healthcare hygiene compliance NASIC and CASIC facilities rate Secretariat Partners 4.1.2: Coordinate continuous Improved health care x 2023-2027 MOH in-service IPC training for worker knowledge NASIC and CASIC healthcare workers level on IPC Secretariat Professional bodies Partners 15 2023 - 2027 Activity Deliverables Sector Involved Time frame Responsible Entity Environmental Human Health Animal Health Plant Health Fisheries & Health Aquaculture Food 4.1.3: Establish a national HAI HAI surveillance x 2023-2027 MOH surveillance system system established NASIC and CASIC Secretariat Partners 4.1.4: Incorporate IPC and AMS IPC and AMS x 2023-2027 MOH indicators into the National indicators NASIC and CASIC Health Insurance Fund incorporated into Secretariat accreditation checklist the National Health Insurance Fund Partners accreditation checklist 4.1.5: Disseminate and implement Farm biosecurity X X X X X 2023-2027 MOALD/MoECCF/ farm biosecurity guidelines guidelines NEMA/KeFS/ MIBEMA disseminated NASIC and CASIC Secretariat Partners 4.1.6: Advocate for vaccination Counties sensitised on X X 2023-2027 MOH, MOALD, MIBEMA, and immunisation to reduce vaccination NASIC and CASIC incidences of preventable Secretariat diseases Partners 4.1.7: Strengthen hygiene and Hygiene and food X X 2023-2027 MOALD/MoECCF/ food safety measures in food safety measures NEMA/KeFS/ MIBEMA value chains strengthened NASIC and CASIC Secretariat Partners 4.1.8: Strengthen good Strengthened X X X X 2023-2027 MOALD /KeFS/ MIBEMA agricultural practices along the agricultural practices NASIC and CASIC food value chain Secretariat Partners 4.1.9: Conduct continuous Strengthened Bio risk X X X X X X 2023-2027 MOH/MOALD/ biorisk management training for management MoECCF/NEMA/ KeFS/ professionals under One Health MIBEMA Strategic Intervention 4.2: Reduce and Minimise Environmental Contamination by Antimicrobials 4.2.1: Map key sources of High risk facilities X 2023-2027 MoECCF/NEMA contamination / high risk mapped NASIC and CASIC facilities that have an impact on Secretariat AMR in the environment. Partners 4.2.2: Develop and disseminate Guidelines, X X X X X X 2023-2027 MOH/MOALD/ guidelines, procedures and procedures and MoECCF/NEMA/ KeFS/ protocols on effluent and waste protocols on effluent MIBEMA disposal from different sectors and waste developed NASIC and CASIC and disseminated Secretariat Partners 4.2.3: Enhance compliance Effluent and waste X X X X 2023-2027 MoECCF/NEMA/ KeFS/ to proper effluent and waste management MOH management, treatment, and compliance enhanced NASIC and CASIC safe disposal Secretariat Partners 16 National Action Plan on Prevention & Containment of Antimicrobial Resistance STRATEGIC OBJECTIVE 5: TO OPTIMIZE THE USE OF ANTIMICROBIALS Measure of outcome: extent of reduction in national human consumption of antibiotics, the consumption of antibiotics used in food production and the use of medical and veterinary antimicrobial agents for applications other than human and animal health. Prudent AMU is vital to sustainable prevention and treatment of microbial diseases. Areas of focus in this strategic objective include development and implementation of guidelines, enhanced regulation, enhancing human resource capacity, ensuring access to essential antimicrobials as well as strengthening lab diagnostic capacity. Ensuring sustainable access to quality essential antimicrobials is, therefore, integral in successfully hampering the development of AMR. Consumption of substandard or counterfeit antimicrobials containing less than the specified amount of the active ingredient, or consuming suboptimal dosage due to lack of supply or limited accessibility to antimicrobials contributes to the emergence of AMR. Strengthening the regulatory measures, tools, and activities of the national drug regulatory agency in ensuring the safety, efficacy, and quality of medicines from market authorisation to post-marketing surveillance will help combat AMR. Efforts must also focus on sustaining an efficient supply chain system towards ensuring the availability or accessibility of quality medicines to all patients at all times with emphasis on appropriate use by both patients and prescribers. Additionally, Kenya has developed an essential medicines list incorporating AWaRe (Access, Watch, Reserve) categorisation of antibiotics as well development of National Guidelines on Antimicrobial Stewardship to ensure prudent use of antimicrobials. Antimicrobials are important in protecting the health and welfare of livestock and enhance the efficient production of safe food. On the other hand, their use always involves a risk of selecting antimicrobial resistant bacteria that might bring adverse effects to human medicine, veterinary medicine, and food safety. The local demand for animal food products such as milk, meat, fish, and eggs, is bound to increase. This increased demand for animal protein engenders complex intensive production systems that results to an increase in the use of antimicrobial agents. The WOAH, Codex Alimentarius Commission and other international organisations have formulated guidelines concerning the use of veterinary Antimicrobials. Appropriate use of veterinary antimicrobials will be ensured through various regulatory systems based on applicable laws. Activity Deliverables Sector Involved Time frame Responsible Entity Environmental Human Health Animal Health Plant Health Fisheries & Health Aquaculture Food STRATEGIC OBJECTIVE 5: TO OPTIMIZE THE USE OF ANTIMICROBIALS Strategic Intervention 5.1: Support Implementation of Strategies and Guidelines to Optimise the use of Antimicrobials 5.1.1: Conduct baseline Baseline data X X X X X 2024 MOH, MOALD, Pharmacy and assessment on AMU/AMC on AMU/AMU Poisons Board (PPB), Veterinary generated Medical Directorate (VMD), Pest Control Products Board (PCPB) NASIC and CASIC Secretariat Partners 5.1.2: Develop, review, Strategies and X X X X X 2023-2027 MOH, MOALD, PPB, VMD, PCPB and disseminate guidelines NASIC and CASIC Secretariat strategies, guidelines, and disseminated. interventions to optimise Partners use of antimicrobials 5.1.3: Establish a national AMU and AMC x x x x x 2023-2027 MOH, MOALD, PPB, VMD, PCPB monitoring system for Monitoring NASIC and CASIC Secretariat AMU and AMC systems established Partners 17 2023 - 2027 Activity Deliverables Sector Involved Time frame Responsible Entity Environmental Human Health Animal Health Plant Health Fisheries & Health Aquaculture Food 5.1.4: Review, disseminate AMS guidelines X X 2023-2027 MOH, MOALD, PPB, VMD, PCPB and implement AMS developed and NASIC and CASIC Secretariat guidelines implemented Partners 5.1.5: Monitor compliance AMU compliance X X X 2023-2027 MOH, MOALD, PPB, VMD, PCPB to antimicrobial use data available NASIC and CASIC Secretariat guidelines and strategies Partners 5.1.6: Promote adoption of Point of care X X X 2023-2027 MOH, MOALD, PPB, VMD, PCPB point of care diagnostics diagnostics tools NASIC and CASIC Secretariat tools adopted Partners Strategic Intervention 5.2: Strengthen the Regulatory System of Antimicrobials 5.2.1: Conduct routine joint Post marketing X X X 2023-2027 MOH, MOALD, PPB, VMD, PCPB risk-based post marketing surveillance NASIC and CASIC Secretariat surveillance and quality reports surveys of antimicrobials Partners 5.2.2: Engage regulatory Market X X X 2023-2027 MOH, MOALD, PPB, VMD, PCPB bodies on market authorisation NASIC and CASIC Secretariat authorisation process of process updated antimicrobials Partners 5.2.3: Hold annual GDP inspection X X X 2023-2027 MOH, MOALD, PPB, VMD, PCPB engagements with report NASIC and CASIC Secretariat regulatory bodies, including on Good Partners Distribution Practice 5.2.4: Review laws and Laws and X X X 2023-2027 MOH, MOALD, PPB, VMD, PCPB regulations related to regulations NASIC and CASIC Secretariat AMU/AMC reviewed Partners 5.2.5: Periodic review of Updated list X X 2023-2027 MOH, MOALD, PPB, VMD, PCPB antimicrobials classified as of critical NASIC and CASIC Secretariat critical for use in human antimicrobials and animal health Partners Strategic Intervention 5.3: Strengthen Laboratory Capacity for Quality Control (QC) of Antimicrobials 5.3.1: Enhance laboratory Laboratory X X X 2023-2027 MOH, MOALD, PPB, VMD, PCPB capacity to assess the capacity for QC NASIC and CASIC Secretariat quality of antimicrobial enhanced agents Partners 18 National Action Plan on Prevention & Containment of Antimicrobial Resistance STRATEGIC OBJECTIVE 6: TO DEVELOP AN ECONOMIC CASE FOR SUSTAINABLE INVESTMENT THAT TAKES ACCOUNT OF THE NEEDS OF KENYA, AND INCREASE INVESTMENT IN NEW MEDICINES, DIAGNOSTIC TOOLS, VACCINES AND OTHER INTERVENTIONS Measure of Outcome: extent of increase in sustainable investment in capacity to counter antimicrobial resistance, including investment in developing of new medicines and diagnostics. Research is required on trends in resistance, practices and attitudes driving resistance in Kenya to inform appropriate interventions including the research agendas that were published by WHO in 2023. In addition to investment in the discovery and development of new antimicrobials, diagnostic tools, and vaccines, is required. Research and development of new antimicrobials though perceived as a less attractive business investment than that of medicines for chronic diseases, can provide opportunities for feeding the antimicrobial pipeline. Research and investment in diagnostic tools and improved vaccines can contribute to the overall reduction in AMU. The causes, effects and impacts of AMR in the animal sector entail a better and deeper knowledge of the phenomena’s complexity. Veterinary antimicrobial consumption needs be further assessed in order to determine the correlation of AMR in both animal and human health in the country. Moreover, toxicological studies need to be performed to establish the safety of veterinary drug residues in the human diet, as well in the human intestinal flora. Researchers are needed to enhance the development of effective strategies and alternatives to combat AMR in food-producing animals. To implement policies for combating AMR, it is important not only to accumulate existing scientific evidence and incorporate it into public health measures, but also to create new scientific evidence in Kenya and share it with society and the international community. Activity Deliverables Sector Involved Time frame Responsible Entity Environmental Human Health Animal Health Plant Health Fisheries & Health Aquaculture Food STRATEGIC OBJECTIVE 6: TO DEVELOP AN ECONOMIC CASE FOR SUSTAINABLE INVESTMENT THAT TAKES ACCOUNT OF THE NEEDS OF KENYA, AND INCREASE INVESTMENT IN NEW MEDICINES, DIAGNOSTIC TOOLS, VACCINES AND OTHER INTERVENTIONS Strategic Intervention 6.1: Promote Research on AMR 6.1.1: Consolidate Inventory X X X X X X 2023-2027 MOH/MOALD/MoECCF/ and inventory for research NEMA/KeFS/MIBEMA, ongoing and created research institution completed research NASIC and CASIC on AMR Secretariat Partners 6.1.2: Develop AMR Research X X X X X X 2023-2027 MOH/MOALD/MoECCF/ research agenda agenda NEMA/KeFS/MIBEMA, guided by the WHO develop research institution policy on global NASIC and CASIC research agenda for Secretariat AMR and research priorities Partners 6.1.3: Promote Increased X X X X X X 2023-2027 MOH/MOALD/MoECCF/ research on research on NEMA/KeFS/MIBEMA, alternative therapies alternative research institution therapies NASIC and CASIC Secretariat Partners 19 2023 - 2027 Activity Deliverables Sector Involved Time frame Responsible Entity Environmental Human Health Animal Health Plant Health Fisheries & Health Aquaculture Food 6.1.4: Prioritise Economic X X X X X X 2023-2027 MOH/MOALD/MoECCF/ research on impact of AMR NEMA/KeFS/MIBEMA, economic impact of established research institution AMR NASIC and CASIC Secretariat Partners 6.1.5: Promote Operational X X X X X X 2023-2027 MOH/MOALD/MoECCF/ operational research research NEMA/KeFS/MIBEMA, on programmes conducted research institution with impact on AMR NASIC and CASIC Secretariat Partners 6.1.6: Promote Research X X X X X X 2023-2027 MOH/MOALD/MoECCF/ research on the on the NEMA/KeFS/MIBEMA, environmental environmental research institution dimension of AMR dimension NASIC and CASIC of AMR Secretariat conducted Partners 20 National Action Plan on Prevention & Containment of Antimicrobial Resistance MONITORING AND EVALUATION Upon the official adoption of this National Action Plan, NASIC shall review the Monitoring & Evaluation Framework to include targets and indicators for the activities captured within the National Action Plan for AMR. An M&E framework for the AMR national action plan is critical in measuring the impact of proposed interventions. This framework will be developed for each activity bearing a monitoring indicator to be measured in the process of its implementation. The framework will incorporate both objective and outcome indicators. Responsible ministries/ departments/agencies will monitor and evaluate interventions identified in the NAP. 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 2027. In addition, annual operational plans and a Communication and Surveillance Strategy has been developed to support further implementation of the NAP. 21 2023 - 2027 LIST OF CONTRIBUTORS

1. Allan Azegele MoALD–DVS

2. Amos Oyoko MoH–DHSQAR

3. Anima Sirma MoALD–DVS

4. Bernard Wambulwa Kakamega County Government–CDH

5. Bridgit Muasa MoALD–DVS

6. Cynthia Odhiambo MSH–USAID MTaPS Program

7. Daisy Muriuki MIBEMA–KeFS

8. Damaris Mwololo MoALD–DVS

9. Daniel Kasangi MIBEMA–KeFS

10. Daniel Kosen MoALD–SDLD

11. David Ibiiri MoALD–DVS

12. Emmanuel Tanui MoH–DHSQAR

13. Eunice Omesa WHO

14. Evans Tenge M&E–FAO

15. Evelyne Wesangula ECSA–HC – Laboratory Program

16. Felister Kiberenge MoH–DHSQAR

17. Gavin Orangi Makueni County Government–CDH

18. Gunturu Revathi AKUH

19. Hillary Kagwa CDH/Kiambu County

20. Irene Alwala Trans Nzoia County–CDVS

21. Ishmael Mganda MoALD – PP&FSD

22. Jack Omolo Kilifi County Government–CDVS

23. Jane Lwoyero WOAH

24. Jedidah Kahura MoH–NPHL

25. Jennifer Njuhigu MoH–DHSQAR

26. John Kariuki MoALD–DVS

27. John Mumbo NEMA

28. Joseph Kamau MoH–DHSQAR

29. Joseph Mukoko MSH–USAID MTaPS Program

30. Joseph Mwangi Nyeri County Government–CDVS

31. Julian Nyamupachitu ReACT Africa

32. Karim Wanga PPB

33. Khaoma Barasa MoALD–DVS

34. Kigen Bartilol MoH/DHSRQA

35. Loice Ombajo UoN/KNH

36. Martin Matu ECSA–HC – Laboratory Program

37. Marybeth Maritim UoN/KNH

38. Mirfin Mpundu ReACT Africa

39. Nancy Mulwa MoALD–DVS

40. Naphtali Mwanziki MoALD- KVB

41. Ndinda Kusu MSH–USAID MTaPS Program

42. Nkatha Gitonga MSH–USAID MTaPS Program

43. Oscar Agoro Nyeri County Government–CDH 22 National Action Plan on Prevention & Containment of Antimicrobial Resistance

44. Philemon Kosgei MoALD–DVS

45. Robert Onsare KEMRI

46. Romona Ndanyi MoALD–DVS

47. Ruth Omani FAO – AMR FP

48. Samuel Kariuki KEMRI

49. Simon Kibias MoH/DHSQAR

50. Sophie Masika MoALD–DVS

51. Stephanie Kamau MIBEMA–KeFS

52. Susan Githii MoH–NPHL

53. Tracie Muraya ReACT Africa

54. Veronicah Kamau MoH–DHSQAR

55. Wilson Busienei NEMA

56. Zacharia Mwangi MoALD – PP&FSD

57. Zaietuni Mulaa Trans Nzoia County Government–CDH 23 2023 - 2027 BIBLIOGRAPHY Global Antibiotic Resistance Partnership-Kenya Working Group (2011): Situational Analysis; Antibiotic Use and Resistance in Kenya (http://www.cddep.org/sites/default/files/garp/sitan/img/ screen_shot_2015-12-15_at_12.06.41_pm.png) Global Framework for Development & Stewardship to Combat Antimicrobial Resistance. WHO. 2018 Global research agenda for antimicrobial resistance in human health. Policy brief. WHO. June 2023 GLASS manual for antimicrobial resistance surveillance in common bacteria causing human infection. WHO. 2023 Situation Analysis on Antibiotic Use and Resistance in Kenya (2016) Guidance to facilitate monitoring and evaluation for antimicrobial resistance national action plans. World Health Organization, Food and Agriculture Organization of the United Nations, United Nations Environment Programme and World Organisation for Animal Health, 2023 Guidelines for the prudent use of antimicrobials in animals Nairobi, Kenya: Government of Kenya, October 2018. Kenya National Action Plan on Antimicrobial Resistance: Review of Progress in The Human Health Sector. Geneva: World Health Organization; 2022 Ministry of Health, Kenya National Infection Prevention and Control Policy for Health Care Services. Third Edition. Nairobi, Kenya: Government of Kenya, May 2021 Murray, Christopher JL; Ikuta, Kevin Shunji; Sharara, Fablina; Swetschinski, Lucien; Aguilar, Gisela Robles; al., et (2022) Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet. Volume 399, Issue 10325, 629-655 National antimicrobial stewardship guidelines for health care settings in Kenya. 2020 National Policy for the Prevention and Containment of Antimicrobial Resistance, Nairobi, Kenya: Government of Kenya, May 2017. O’Neill, 2014, Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations (https://amr-review.org/Publications) World Health Organization 2015, Global Action Plan on Antimicrobial Resistance World Health Organization 2015, Global Antimicrobial Resistance Surveillance System: Manual for Early Implementation. World Health Organization 2015, Worldwide country situation analysis: response to antimicrobial resistance. (http://www. who.int/drugresistance/documents/situationanalysis/en/). WHO implementation Handbook for National Action Plans on Antimicrobial Resistance: Guidance for the Human Health Sector. 2022 24 National Action Plan on Prevention & Containment of Antimicrobial Resistance ANNEXES COSTING OF AMR NAP 2023-2027 ACTIVITIES AMR NAP IMPLEMENTATION COST (KES)

6. Research & Development, 83,828,558, (4%) 1. Strengthening Governance & Coordination, 292,556,710, (14%)

5. Optimized use of Antimicrobials, 218977,361, (11%)

2. Improving Awareness & Understanding, 566,139,368, (28%)

4. Reducing Incidence of Infections, 500,,980,023, (25%)

3. Surveillance & Monitoring of AMR/AMC/AMU, 372.470,598, (18%) Strengthening Governance & Coordination Improving Awareness & Understanding Surveillance & Monitoring of AMR/AMC/AMU Reducing Incidence of Infections Optimized use of Antimicrobials Research & Development 25 2023 - 2027 Strategic Objective 1: Strengthening Governance and Coordination Mechanisms Strategic Objective 2: Improving Awareness and Understanding of AMR through Effective Communication, Education & Training Strategic Objective 3: Strengthen the Knowledge & Evidence-Base Through Surveillance and Research 26 National Action Plan on Prevention & Containment of Antimicrobial Resistance Strategic Objective 4: Reduce the Incidence of Infection Through Effective Sanitation, Hygiene, and IPC Measures Strategic Objective 5: Optimise the Use of Antimicrobials Strategic Objective 6: Develop an Economic Case for Sustainable Investment 27 REPUBLIC OF KENYA