Antimicrobial Resistance Strategy 2017 – 2022

GOVERNMENT OF THE REPUBLIC OF MALAWI Antimicrobial Resistance Strategy 2017 - 2022 Antimicrobial Resistance Strategy 2017 - 2022 Towards a world free from fear of untreatable infections GOVERNMENT OF THE REPUBLIC OF MALAWI LIST OF TABLES....................................................................................................................I ACRONYMS AND ABBREVIATIONS...................................................................................II PREFACE.............................................................................................................................V ACKNOWLEDGEMENTS.....................................................................................................VI CHAPTER 1: INTRODUCTION............................................................................................13 1.1 Background 15 1.2 The Global Health Development Agenda 16 1.3 Development of the AMR Strategy and Alignment with the Health Sector Strategic Framework 18 1.4 Guiding Principles/Core Values 19 CHAPTER 2: PERSPECTIVES ON AMR (GLOBAL & MALAWI)...........................................21 2.1 Background 22 2.2 Global Interventions on AMR 22 2.3 Global framework on AMR NAP 23 2.4 Malawi AMR Goal 23 CHAPTER 3: AMR STRATEGIC DIRECTION/AGENDA FOR MALAWI................................25 3.1 Health Sector Vision 27 3.2 Health Sector Mission 27 3.3 Broad Outcomes of the AMR Strategy 27 3.4 Detailed Objectives and Strategies 28 CHAPTER 4: FINANCING..................................................................................................35 CHAPTER 5: MONITORING AND EVALUATION..............................................................39 5.1 Sources of Data for Monitoring and Evaluation 39 5.2 Monitoring and Evaluation framework and process 40 TABLE OF CONTENTS 1.3.2 Alignment of the AMR strategy to Government of Malawi Strategic Framework 18 1.3.3 Development Process of the AMR strategy 19 3.4.1 Education and Awareness 28 3.4.2 Surveillance and Research 29 3.4.3 Infection, Prevention and Control 30 3.4.4 Optimal Use 30 3.4.5 Investment and Sustainability 31 CHAPTER 6: IMPLEMENTATION.........................................................................................43 6.1 Governance, Management and Partnership Structures in AMR 43 6.2 Management Structure for Stewardship 43 6.3 Operationalization of the AMR Strategy 45 Annex 1: Summary of Costs estimates (Malawi Kwacha) 46 Annex 2: Education & Awareness (Outcomes, Objectives, Strategies and Outputs) 52 Annex 3: Surveillance & Research (Outcomes, Objectives, Strategies and Outputs) 59 Annex 4: Infection, Prevention & Control (Outcomes, Objectives, Strategies & Outputs) 64 Annex 5: Optimal Use (Outcomes, Objectives, Strategies and Outputs) 71 Annex 6: Investment & Sustainability (Outcomes, Objectives, Strategies and Outputs) 75 Annex 7: Annual Work Plan (2017/18) 79 LIST OF TABLES Table 1: Demographic Population in Malawi (2017) 15 Table 2: SWOT Analysis Results 24 Table 3: Key AMR Targets 27 Table 4: Roles and Responsibilities 44 IANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 ACRONYMS AND ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome AMR Antimicrobial Resistance ACSM Advocacy, Communication, and Social Mobilization CHSU Community Health Sciences Unit CSOs Civil Society Organizations DEA Department of Environmental Affairs DISTMS Department of Information Systems and Technology Management Services EQA External Quality Assurance FAO Food and Agriculture Organization GAP Global Action Plan GDP Gross Domestic Product GLASS Global Antimicrobial Resistance Surveillance System GOM Government of Malawi HIV Human Immunodeficiency Virus HMIS Health Management Information System HSSP Health Sector Strategic Plan IDSR Integrated Disease Surveillance and Response IEC Information, Education and Communication IHR International Health Regulation IHP International Health Partnership KCH Kamuzu Central Hospital MDAs Ministries, Departments and Agencies MDGs Millennium Development Goals MDR Multidrug resistant MIE Malawi Institute of Education MoA Ministry of Agriculture MoAIWD Ministry of Agriculture, Irrigation, Water and Development MoEST Ministry of Education, Science & Technology MoH Ministry of Health MOU Memorandum of understanding MP Member of Parliament NAP National Action Plan NCDs Non-communicable Diseases NICD National Institute for Communicable Diseases NORAD Norwegian Agency for Cooperation Development PHC Primary Healthcare PMPB Pharmacy, Medicines and Poisons Board PPE Personal protective equipment QECH Queen Elizabeth Central Hospital SDGs Sustainable Development Goals TA Traditional Authority TB Tuberculosis TOR Terms of Reference WG Working group WHA World Health Assembly WHO World Health Organization UHC Universal Health Coverage UN United Nations VDC Village Development Committee XDR Extensively drug resistant ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022II Malawi has made remarkable progress in strengthening the health system and improving the health status of its people in the past years. However, the country continues to face challenges such as a high burden of infectious diseases including malaria, Tuberculosis (TB) and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), increased mortality and morbidity, increased burden of Non-communicable Diseases (NCDs) and shortage of medicines. Antimicrobial resistance (AMR) is a growing public health threat, and if we cannot work together to find solutions, we could enter a post-antibiotic era where gains in modern medicine would be reversed. Antimicrobial resistance threatens successful treatment of infections. The Ministry of Health (MoH) realizes that reducing the emergence of AMR is key to sustaining the gains as well as achieving the goals and objectives stipulated in the Health Sector Strategic Plan (HSSP), health related Sustainable Development Goals (SDGs), and other health sector strategic plans. The MoH in collaboration with other sectors developed this AMR policy to make AMR a nationally recognized health issue and bring together key stakeholders who can actively embrace AMR as a priority. Furthermore, the policy will help key stakeholders to understand the burden of AMR and to enlighten the common approach in the implementation of National Action Plan that comprehensively addresses the prevention and containment of AMR in the One Health Approach. This document compliments the guidance found in other policy making frameworks with emphasis on how to use evidence to inform policy and decision making processes. The successful implementation of this policy will require the multi-sectoral collaboration and dedication of the staff in the MoH, Ministry of Agriculture (MoA), Department of Environmental Affairs and the donor community. The Government of Malawi (GOM) will endeavor to channel resources to support antibiotics stewardship in all health programmes in the health sector. A special appeal is being made to all co-operating partners, both national and international, to support the continued support in the implementation of this policy. I wish to thank all those who have given their time, ideas and expertise during the development of the strategy. Finally, I would like to thank His Excellency the President, Professor Peter Mutharika for providing a conducive working environment in which this policy has been formulated and will be implemented. Hon. Atupele Muluzi, MP MINISTER OF HEALTH FOREWORD ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022IV The discovery of penicillin in 1928 heralded a revolution in the treatment of infections. But even at that time, Alexander Fleming warned about driving selection of resistance through inappropriate use. Since 1987, no new class of antibiotics has been discovered. The alarming trend in the rise of antibiotic resistance to existing antibiotics and the slow-down in the development of new antibiotics will lead to catastrophic consequences of not being able to treat common infections effectively. Conditions which were previously managed by first line antibiotics are becoming harder to treat resulting in severe illness and prolonged treatment. The Malawi AMR Strategy document has been developed as a framework for managing AMR, limiting further increase in resistance, and improvement of patient outcome. In this policy, priority is given to resistance of other bacterial infections other than TB, as structures to address resistance in TB as well as in HIV, already exist in the Ministry of Health. Dr. Dan Namarika SECRETARY FOR HEALTH PREFACE VANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 The MoH is grateful to all key stakeholders that participated in the process of developing this strategy. The MoH is particularly grateful to Wathando Mughandira, Chief Economist, Directorate of Planning & Policy Development for his overall technical guidance in the development of this strategy; Mrs. Watipaso Kasambara, Coordinator of AMR activities in Malawi; the AMR Core team; the drafting team comprising of Collins Mitambo, Gift Nangwale and Gerald Tegha. The MoH wishes to thank Dr. Mirfin Mpundu, Head, Action against Antibiotic Resistance (ReAct), Africa & Executive Director, Ecumenical Network (EPN) and Dr. Collins Jaguga, Programme Officer, (ReAct) Africa for their editorial work and overseeing printing of this document. Much appreciation to ReAct Africa for their generous financial support to print this document. Finally, the MoH would like to sincerely appreciate the United Kingdom (UK) Department of Health through Fleming fund for their overall financial support. ACKNOWLEDGEMENTS ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022VI CHAPTER 1: INTRODUCTION 13ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 CHAPTER 1: INTRODUCTION 1.1 Background Malawi is a small, narrow and landlocked country with a surface area of 118,484 km of which 94,276 km is landlocked. Administratively, the country is divided into three regions, namely northern, central and southern regions. The country has 28 districts, which are further divided into traditional authorities (TA) ruled by chiefs. The TAs are sub-divided into villages, which form the smallest administrative units. There is a Village Development Committee (VDC), which is responsible for development activities. Politically, each district is divided into constituencies that are represented by Members of Parliament (MPs) in the National Assembly for purposes of legislations. Demographically, the country has an estimated population of 16.83 million people in 20161 with an average annual growth rate of 2.7%, giving an estimated population of 20.35 million people by 2022, with a sex ratio of 96 males per 100 females. An estimated 84% of the population lives in rural areas as compared to 16% in urban centres. Malawi is predicted to experience an average annual urban population growth rate of 4.2% from 2013 to 20302, which will result in an increase in urbanization. More than half of Malawi’s population is under the age of 15 years and with 19% of the total population being under-five. Those aged 65 years and above represent 3% of the total population in 2017 and should continue to increase as expectation of life improves, which stands at 55.7 and 58.8 years in 2013 for males and females respectively. Table 1: Demographic population in malawi (2017) Source: NatioNal StatiStical office Malawi 15ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 Economically, the country’s Gross Domestic Product (GDP) per capita in 2015 was estimated at US$381.403 . The real GDP growth for Malawi was reported as 5% in 2013, higher than the reported rate for Sub-Saharan Africa. This contributed to a reduction in the proportion of Malawians living below the poverty line from 52% in 2004 to 39% in 2009, which however is now estimated at 50.7% in 2016. However, poverty remains deep-rooted in rural areas. Population Number Percentage Children aged 0-59 months (under five years) 3,094,693 17% Population that is under 15 years of age 7,790,744 42% Population of adolescents (10-19 years of age) 3,954,332 21% Women of reproductive age (15-49 years) 3,871,569 21% Total population 18,711,338 100% 1 National Statistical Office in 2016 Population Projections 2 Unicef 2015 3Audit Report – Global Fund Grants for Malawi – October 2016 ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202216 In spite of having made significant progress in improving gender disparities, there are still hindrances to achieving gender parity. Examples include the impact on women of social and economic inequality. Up to 90% of all rural women work in agriculture, largely on production of food for domestic consumption. In addition, women are responsible for caretaking within their families, meaning women on average work longer hours compared to men and their work seldom generates an income. Many small entrepreneurial activities have been initiated targeting women and girls but they often find it hard to engage with these because of their heavy domestic and agricultural workload. Health is essential in every country’s development. Investments in health and healthcare are therefore central to the achievements of a country’s improvements. The relationship between health, wellbeing, economic growth, sound environment interventions and global partnerships is widely understood. Health is a basic human right. It is thus increasingly becoming evident that everybody should have unhindered access to healthcare. Consequently, attention has been drawn to certain categories of the population such as pregnant mothers, the elderly, children and people with disabilities among others. To this effect, the country has developed a national strategic framework aimed at promoting a human rights approach to service delivery. The health sector has also taken steps in mainstreaming human rights and gender at various levels through building capacity for service delivery in programming and implementation. The sector also works in partnership with Civil Society Organizations (CSOs) in promoting the rights for individuals and communities. 1.2 The Global Health Development Agenda There is global recognition on the key role health plays in achieving International Development Goals. Some of the key global commitments that impact on health include: • Implementation of the International Health Regulation (IHR) – to guide the country on key actions needed to assure adherence to international regulations; • Ouagadougou declaration on Primary Health Care and Health Systems – a reiteration of and rededication to the principles of the primary healthcare (PHC) approach to improve the health of the people, within the context of an overall health system strengthening approach; • International Health Partnership (IHP+) on Aid Effectiveness; • The United Nations (UN) Millennium Development Goals (MDGs 4, 5 and 6 were directly on health and MDGs 1, 2, 3, 7 and 8 were health related) and the Post MDG 2015 agenda – a focus of global efforts in improving health impacts through implementing the Universal Health Coverage (UHC) agenda in health. The UN launched the Sustainable Development Goals (SDGs) which builds upon the MDGs. 17 SDGs were agreed and of these, SDG 3: “Ensure healthy lives and promote well-being for all ages” is directly Malawi is predominantly an agricultural country. Agriculture accounts for 35% of the GDP and more than 80% of export earnings (primarily from tobacco sales) and it supports more than 80% of the population. Government plans to transit from an agricultural economy to an industrial, service driven economy. Development aid has played a key role in stabilizing and improving the economy over the past 30 years. In addition, diaspora remittances increasingly contribute to the country’s economy. The country has made significant improvements in social services, such as health, housing, education, water, sanitation and others. Most social services, health inclusive, are provided free at point of use, to reduce financial barriers to their utilization. Government introduced free primary education in 1991 and enrolment increased from 1.9 million to about 3 million. Although enrolment increased, government data reveals that only 30% of the children who start in standard 1 actually reach standard 8 in primary school. Literacy rate is estimated at 62% and it is higher among men (69%) than women (59%). However, there are still many barriers to uptake of social services, mainly on the demand side (decision-making inability, especially, for women, household financial status with women having to rely on their spouses and lack of transport among others). 17ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 related to health. Other SDGs related to health are: Goal 1: End poverty in all its forms everywhere; Goal 2: End hunger, achieve food security and improve nutrition and promote sustainable agriculture; Goal 4: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all; Goal 5: Achieve gender equality and empower all women and girls; and Goal 6: Ensure availability and sustainable management of water and sanitation for all. SDG 3, which is directly related to health, has the following targets: Target 1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births. Target 2: By 2030, end preventable deaths of newborns and under five children. Target 3: By 2030, end the epidemics of AIDS, TB, malaria and Neglected Tropical Diseases, and combat hepatitis, water-borne diseases and other communicable diseases. Target 4: By 2030, reduce by one third premature mortality from NCDs through prevention and treatment, and promote mental health and wellbeing. Target 5: Strengthen prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol. Target 6: By 2020, halve deaths and injuries from road traffic accidents. Target 7: By 2030, achieve universal access to sexual and reproductive health care services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes. Target 8: Achieve universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all. Target 9: By 2030, substantially reduce the number of deaths and illness from hazardous chemicals and air, water and soil pollution and contamination. ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202218 The Government of Malawi (GoM) is a signatory to all these global health development agenda and is committed to fully participating in their implementation. As such, implementation of these international commitments is well integrated into the strategic focus of the health sector with regular monitoring and reporting on progress carried out. Malawi is expected to incorporate the SDGs into its national planning frameworks and ensure their full implementation. 1.3 Development of the AMR Strategy and Alignment with the Health Sector Strategic Framework 1.3.1 Alignment of the AMR strategy to Government of Malawi Strategic Framework As part of the national planning process, the GoM developed the Vision 2020 as its long-term strategy and the Malawi Growth and Development Strategy II (2012-2016) (and is in the process of developing the MGDS III 2017-2021) as the country’s medium term strategies to guide national development. The national strategies are aligned to and incorporate the international commitments and obligations. The national strategies provide guidance and priorities for the different sectors of government. In both the long-term and medium-term national strategies, the GoM prioritizes the health sector. The MDGs II has a significant health focus, with nearly all its nine priority areas directly or indirectly impacting on population health. In order to effectively implement national strategies and global health development agenda and contribute to national development, the health sector has been developing and implementing National Health Sector Strategic Plans (HSSPs) that are aligned to both national strategies and the Global health development agenda/commitments. The Health Sector Strategic Plan I was implemented from 2011 to 2016. In order to ensure continuity and integration of national priorities and international commitments into the strategic focus of the health sector, the health sector developed a successor strategic plan, the Health Sector Strategic Plan II (2017-2022) that articulates the priorities for health sector development in Malawi for the next five years. The AMR strategy has been drawn from the HSSP II where AMR has been strategically integrated as a critical area of intervention within the next five (5) years (2017-2022). The HSSP II recognizes the unprecedented fundamental challenges around anti-biotic drug resistance in Malawi which has significantly contributed to high mortality rates. The AMR strategy therefore unpacks the broad strategy on AMR as highlighted in the HSSP II. 1.3.2 Alignment of the AMR strategy to the Global Strategy on AMR At the sixty-eighth World Health Assembly (WHA) 2015, the WHA endorsed a Global Action Plan (GAP) to tackle antimicrobial resistance, including antibiotic resistance, the most urgent drug resistance trend. Particular emphasis is placed on an agreed upon strategic objectives to deal with AMR namely; (i) Education and Awareness; (ii) Surveillance and Research; (iii) Infection Prevention and Care; (iv) Optimal Use; and (v) Investment and Sustainability. The health sector in Malawi, as explained above, is signatory to numerous international global protocols on health and thus this strategy has closely been aligned to the global agenda on AMR outlined concisely above. The thought process behind the development of this strategy extensively considered the dynamism of the health sector in Malawi and in the process factoring in various contextual issues relevant to Malawi pertaining to AMR. This strategy is therefore a true representation of the critical issues that will have to be addressed in Malawi that are primarily underpinned in the World Health Organization’s (WHO) GAP on AMR. 1.3.3 Development Process of the AMR strategy Development of this strategy was guided by the advice of the MoH, taking the lead, and all key health stakeholders, adopting a multi-stakeholder consultation approach at different country level forums. The process was extensively rigorous and inclusive which will ensure that this strategy is widely embraced in Malawi. 1.4 Guiding Principles/Core Values The guiding principles demonstrate the government’s commitment towards attainment of equitable, accessible, affordable and sustainable high quality evidence-based health care. The following are the guiding principles for the AMR strategy: 1.4.1 National ownership and leadership: In the interest of national development and self-reliance, all partners in the health sector shall respect national ownership and Government leadership will remain central in guiding the implementation of the AMR strategy; 1.4.2 Human rights-based approach and equity: All the people of Malawi shall have the right to good health, and equitable access to AMR services without any form of discrimination, whether it be based on ethnicity, gender, age, disability, religion, political belief, geographical location, or economic and/or other social conditions; 1.4.3 Ethical considerations: The ethical requirement of confidentiality, safety and efficacy in both the provision of AMR services and AMR research shall be adhered to; 1.4.4 Efficiency and effectiveness: All stakeholders shall be expected to use available resources for AMR efficiently and effectively to maximize health gains. Opportunities shall be created to facilitate integration of AMR service delivery to leverage on efficiency and effectiveness in addressing health needs of the people of Malawi; 1.4.5 Transparency and accountability: Stakeholders shall discharge their respective mandates in a manner that is transparent and takes full responsibility for the decision they make; 1.4.6 Inter-sectoral and inter-ministerial collaboration: Collaboration shall be strengthened between Ministries, Departments and Agencies (MDAs), the private sector and Civil Society Organizations in the development and implementation of this strategy; 1.4.7 Community participation: Community participation shall be central in addressing health needs of the people of Malawi; 1.4.8 Evidence-based decision-making: All health interventions shall be based on proven and cost-effective national and international best practice; 1.4.9 Decentralization: AMR service provision and management shall be in line with the Local Government Act 1998, which entails devolving some health service delivery to Local Government structures. 1.4.10 Appropriate Technology: Health care providers shall use health care technologies that are safe, appropriate, relevant and cost-effective and beneficial to Malawi. 19ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 CHAPTER 2: PERSPECTIVES ON AMR (GLOBAL AND MALAWI) 21ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 CHAPTER 2: PERSPECTIVES ON AMR (GLOBAL AND MALAWI) 2.1 Background Escalating antimicrobial resistance is a growing global public health threat with extensive health, economic and social implications. Infections caused by resistant microorganisms result in longer duration of illness, higher mortality rates and increased cost with alternative treatments. Recent modeling by the independent review on AMR, projected that AMR will cause an additional 10 million deaths per year and a loss of up to US$100 trillion from global GDP by 2017 The review’s final report reinforces that AMR is a multifaceted and complex problem that cannot be tackled by one nation alone or one sector alone. Combating AMR will require sustained global action across a variety of sectors (Human, Agriculture, Veterinary and environmental) in order to understand, prevent and control resistance; to preserve existing treatments; and to develop and implement a variety of new solutions. Infectious diseases remain the leading cause of death in African countries and are responsible for the majority of years of life lost as well as the majority of deaths of children under 5 years old. 4 Infectious diseases featured prominently amongst the top 10 causes of death in Malawi in 2012 where HIV/AIDS, lower respiratory tract infections, malaria and diarrheal diseases accounted for 40,800; 13,000; 9, 500 and 6,900 deaths respectively. Of the total 100,000 recorded deaths in Malawi in 2012, 70,200 (70.1%) were attributable to infectious diseases.5 The high burden of communicable diseases, particularly the HIV/AIDS burden intimates extensive antimicrobial use and subsequent resistance but the burden, nature, extent and sequelae of AMR) in Malawi are yet to be quantified. AMR is a direct consequence of the selection pressure from both legitimate and indiscriminate antibiotic use in human, animal and environmental health, requiring a One Health approach for its containment. Infections caused by resistant microorganisms result in treatment failure in humans and animals, increase the risk of spread to communities and herds ,result in longer duration of illness, higher mortality rates, and increased costs of alternative treatment.6 Malawi is a signatory to the United Nations Political Declaration on AMR and the World Health Assembly Resolution (WHA 68.7) that urges member states to have in place National Action Plans (NAPs). Malawi is thus amongst the UN member states that endorsed the Global Action Plan (GAP) which was developed by a tripartite collaboration of the WHO, Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE) which integrated the One Health Approach as a blueprint for developing its NAP. 2.2 Global Interventions on AMR Over the years WHO has engineered specific activities in combating AMR: 1959 - WHO scientific group on antibiotics research recommends studies on resistance (The Work of WHO, 1959, Official Records of WHO no. 98) 1981 - WHO Scientific Working Group on Antimicrobial Resistance report includes guidelines for the appropriate use of antibiotics) (WHO/BVI/PHA/ANT/82.1) 2001 - WHO Global Strategy for containment of antimicrobial resistance (WHO/CDS/CSR/DRS/2001.2) 2011 - World Health Day “Antimicrobial resistance: no action today, no cure tomorrow” policy package 2012 - The evolving threat of antimicrobial resistance Options for action 2015 - Adoption by WHA of Global Action Plan for AMR 2016 - AMR resolution at the UN General Assembly 4http://apps.who.int/iris/bitstream/10665/112738/1/9789240692671 eng.pdf 5http://www.who.int/gho/countries/mwi.pdf?ua=1 6http://www.sciencedirect.com/science/article/pii/S1473309913703189 ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202222 ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 23 The WHO has developed materials, tools and templates to facilitate NAPs development by member states, which has been drawn from the Global GAP. The NAP manual7 and associated template8 provides a stepwise process for NAP development. The five strategic objectives of the GAP are as follows: 1. Improve awareness and understanding of AMR through effective communication, education and training. 2. Strengthen the knowledge and evidence base through surveillance and research. 3. Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures. 4. Optimize the use of antimicrobial medicines in human and animal health. 5. Develop the economic case for sustainable investment that takes account of the needs of all countries and increase investment in new medicines diagnostic tools, vaccines and other interventions.9 2.4 Malawi AMR Goal To ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them. A thorough situational analysis on the burden, nature and extent of AMR in the human, animal and environmental health sectors is critical to the development of a relevant, evidence-based NAP. 2.4.1 Situational Analysis on AMR in Malawi Malawi has completed a comprehensive situational analysis on AMR as part of the project entitled “Antibiotic Stewardship and Conservancy in Africa” which is funded as part of the Norwegian Programme for Capacity Development in Higher Education and Research for Development (NORHED) by the Norwegian Agency for Cooperation Development (NORAD). The project has an overarching aim of human capital and research development in a global health priority - the optimal management of infections in the context of antimicrobial stewardship and conservancy. It is a 3-phased project which encompasses a situational analysis and infrastructure development in phase 1, curriculum development and student recruitment into the online coursework masters programme on antibiotic stewardship in phase 2 and human capital development in research and teaching in phase 3. The situational analysis was conceptualized as a situational and gap analysis of antimicrobial use and resistance to be undertaken by way of discrete research projects, systematic and literature reviews and canvassing expert opinion on aspects including but not limited to the health and economic context of the country, antimicrobial supply chain and management, surveillance of antimicrobial use and resistance in human health, animal health, agriculture and the environment, and, evidence-based best practice interventions and strategies. Expert opinion was sourced using the NAP checklist which was adapted into a situational analysis tool. 2.3 Global framework on AMR NAP 4http://apps.who.int/iris/bitstream/10665/112738/1/9789240692671 eng.pdf 5http://www.who.int/gho/countries/mwi.pdf?ua=1 6http://www.sciencedirect.com/science/article/pii/S1473309913703189 7http://apps.who.int/iris/bitstream/10665/204470/1/9789241549530 eng.pdf?ua=1 8http://www.who.int/antimicrobial-resistance/national-action-plans/supporting-documents-tools/en/ 9http://www.wpro.who.int/entity/drug resistance/resources/global action plan eng.pdf Strengths Weaknesses • Multi-sectoral network built on trust and willingness to co-operate. • Prescription and dispensing of medicines (including antibiotics) are regulated by the Pharmacy, Medicines and Poisons Board (PMPB) as are pesticides by the Pesticides Control Board. • Inadequate human resource and infrastructural capacity. • Lack of coordination of existing AMR-related initiatives and activities. • Lack of public awareness campaigns on AMR. Opportunities Threats • ‘One health’ concept note and roadmap endorsed by relevant Ministries. • Malawi endorsed the WHA Resolution 68.7 that required it to develop a NAP on AMR by May 2017. • Mechanisms exist to raise public awareness on AMR via City Councils, City Assemblies, the PMPB and the Malawi Bureau of Standards and should be coordinated by the Ministry of information. • The Medical Council, PMPB and the Veterinary Council can make AMR and antimicrobial stewardship mandatory in health professional curricula. • Absence of a formally mandated committee/ mechanism and dedicated budget to address AMR holistically, substantively, consultatively and collaboratively. • Practices and adherence to antibiotic therapy in public, community and private sectors. • Illegal selling of antibiotics. Table 2: SWOT analysis results ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202224 CHAPTER 3: AMR STRATEGIC DIRECTION/AGENDA FOR MALAWI 25ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 27 CHAPTER 3: AMR STRATEGIC DIRECTION/AGENDA FOR MALAWI 3.1 Health Sector Vision The vision of the health sector is to achieve a state of health for all the people of Malawi that would enable them to lead a quality and productive life. 3.2 Health Sector Mission The mission of the health sector is to provide strategic leadership by the MoH for the delivery of a comprehensive range of quality, equitable and efficient health services to all people in Malawi by creating an enabling environment for health promoting activities. 3.3 Broad Outcomes of the AMR Strategy 1.1.1 Improved awareness and understanding of antimicrobial resistance through effective communication, education and training; 1.1.2 Improved knowledge and evidence of AMR through research and surveillance; 1.1.3 Reduced incidence of infection through effective sanitation, hygiene and prevention measures; 1.1.4 Ensure sustainable investment through research and development; and 1.1.5 Optimal use of antimicrobials medicines in human & animal health and agriculture. Table 3: Key AMR targets No. Outcomes Baseline 2016 Target 2022 1 Improved awareness and understanding of antimicrobial resistance through effective communication, education and training 0% 90% 2 Improved knowledge and evidence of AMR through research and surveillance 5% 70% 3 Reduced incidence of infection through effective sanitation, hygiene and prevention measures 5% 90% 4 Ensure sustainable investment through research and development 5% 60% 5 Optimal use of antimicrobials medicines in agriculture, human and animal health 5% 100% ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202228 3.4 Detailed Objectives and Strategies The Malawi AMR strategy objectives define the health sector focus on AMR as prescribed by the Global Action Plan for AMR. To achieve the set objectives, the AMR strategy has clearly defined strategies for each of the objectives that will be implemented over five years (2017-2022). Detailed outputs and corresponding indicators for each of the strategies have been presented in the annexes below. 3.4.1 Education and awareness Raising awareness on AMR and promoting behavioral change through public communication programmes that target different audiences in human health, animal health and agricultural practice as well as consumers is critical to tackling this issue. Including the use of antimicrobial agents and resistance in school curricula will also promote a better understanding and awareness from an early age. Making AMR a core component of professional education, training, certification, continuing education and development in the health and veterinary sectors and agricultural practice will help to ensure proper understanding and awareness among professionals. Thus the objectives and strategies under this area have ensured that all critical issues on education and awareness on AMR have been well articulated and that targets are realistic and attainable by 2030. Objective 1: To increase national awareness on antimicrobial resistance. Strategies 1) Establish an evidence-based awareness programme targeting audiences in general public, policy makers and health care providers, veterinarians and other animal health providers, environmental practitioners and farmers; 2) Educate and engage with media, pharmaceutical industries, CSOs, NGOs, politicians, community leaders and other relevant stakeholders on AMR; 3) Conduct an assessment on socio behavioural drivers and determinants of AMR; 4) Establish a formal multi-sectoral and multi-disciplinary Advocacy, Communication, and Social Mobilization (ACSM) Working group; 5) Plan, launch and implement a series of media and public communication events every 2 months, each focused separately on objectives 1 to 5 of the global action plan/national action plan (GAP/NAP); and 6) Develop a mechanism and digital platform that links social behavioural practices to the Global Antimicrobial Resistance Surveillance System (GLASS) AMR surveillance network. Objective 2: Impart knowledge on AMR and related topics for human and animal health, agriculture and environmental professionals through pre-service training. Strategies 1) Lobby with training institutions, regulatory bodies and other relevant stakeholders on AMR pre-service training; and 2) Strengthen and consolidate AMR and related topics as a core component of professional education, training, certification and development for human and animal health and environmental professionals. Objective 3: To Improve knowledge of AMR and related topics for human and animal health, agriculture & environmental professionals through in-service training. Strategies 1) Plan and implement in-service trainings. 2) Develop a monitoring, evaluation plan and tools for the in-service training. ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 29 Objective 4: To impart knowledge on AMR and related topics through formal education system at primary and secondary school level. Strategies 1) Introduce and strengthen the concept of AMR and appropriate use of antimicrobials as part of school curriculum. 2) Lobby with Ministry of Education, Science & Technology (MoEST) and the Malawi Institute of Education (MIE) and relevant stakeholders on the inclusion or mainstreaming of AMR and related topics in the primary and secondary school curricula. 3.4.2 Surveillance and research To better understand and respond to AMR patterns and key drivers, information about antimicrobial resistance incidence, prevalence, and trends must be gathered. There are significant gaps in the information available on the development and global economic implications of antimicrobial resistance. Stronger networks of information sharing and a global strategic research agenda would improve global understanding of AMR. The Malawi Government, working with, research organizations professional bodies, non-governmental organizations, industry and the academia will pursue research on the causes and impacts of antimicrobial resistance. A global emphasis on surveillance and evidence based research will inform policies and the actions we will take to address the growing health security challenges of antimicrobial resistance. In addition, increased information about antimicrobial resistance will assist research and development of medical and agriculture alternatives to antimicrobials. Malawi’s AMR strategy has carefully devised strategies that will ensure that the existing data challenges/gaps on AMR in Malawi are addressed in the medium term. Objective 1: To strengthen the national AMR surveillance system. Strategies 1) Incorporate AMR into the existing surveillance system (take into account issues of one health concept when developing activities); 2) Establish a national coordinating centre for surveillance of AMR; 3) Strengthen the national epidemiological surveillance system on AMR in human health, animal health, agriculture and environment; 4) Establish mechanism for regular sharing of AMR data across human, animal health, agriculture and environmental sectors. Objective 2: To identify key stakeholders and resources in AMR research. Strategies 1) Create a multi-disciplinary AMR research platform. Objective 3: To develop and incorporate AMR research priorities into the National (Health) Research Agenda. Strategies 1) Develop an AMR research agenda; and 2) Incorporate AMR research priorities into the National (Health) Research Agenda. 30 ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 3.4.3 Infection prevention and control Stronger hygiene and infection prevention measures, including vaccination, can limit the spread of resistant microorganisms and reduce antimicrobial misuse and overuse. Infection prevention measures such as sanitation, hand washing, food and water safety, and vaccination can decrease the spread of microorganisms resistant to antimicrobial medicines. By preventing infectious diseases whose treatment would require antimicrobial medicines and viral infections which are frequently mistreated with antimicrobial medicines, the global community can better steward these essential medicines. Sustainable antimicrobial use extends beyond human well-being to animal production. Antibiotics are frequently used to stimulate growth and prevent infections in farms and slaughterhouses. Sustainable animal husbandry practices can reduce the risk of resistant bacteria spreading through the food chain to humans. Objective 1: To prevent and control infection at national level. Strategies 1) Establish systems and processes for Infection Prevention and Control (IPC); 2) Develop appropriate infrastructure for IPC implementation. 3) Re-introduce health promotion week. Objective 2: To prevent and control infection at community level. Strategies 1) Promote personal hygiene and sanitation through behaviour change activities in communities. 2) Promote safe disposal of antimicrobials. Objective 3: To prevent and control infection at health care and animal health settings. Strategies 1) Strengthen hand hygiene in health care and animal waste. 2) Ensure safety of health care and animal health workers. 3) Strengthen availability of IPC supplies in health care and animal health settings. Objective 4: To prevent and control infection in agriculture. Strategies 1) Promote good agricultural practices. 2) Ensure workers’ safety during use of chemicals. Objective 5: To reduce impacts of AMR on the environment. Strategies 1) Promote safe management of waste from health care, animal health, industry and agriculture. 3.4.4 Optimal Use To increase the longevity of antimicrobials, clinical, pharmacy, and veterinary practices must eliminate unnecessary dispensing. Evidence based prescribing through effective, rapid, low-cost diagnostic tools are needed to optimize use of antimicrobials for humans and animals. In addition to better prescribing practices, the Malawi community must adjust patients’ and the agricultural industry’s inappropriate and unregulated use of antimicrobial agents. Stronger compliance to antibiotic treatment regimes, quality assurance measures to prevent consumption of substandard medications, and restrictions of non-therapeutic uses of antibiotics within agriculture will provide ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 31 a foundation for antimicrobial stewardship. Regulations for antibiotic distribution, quality, and use could preserve the effectiveness of antibiotics as a public good. Objective 1: To ensure uninterrupted access to high-quality antimicrobial medicines Strategies 1) Strengthen national regulatory authorities for improved quality, safety and efficacy of antimicrobials. 2) Strengthen legislation to regulate prescription and dispensing of antimicrobials. 3) Develop and enforce an enabling regulatory framework and coordination for regulations on use of antimicrobials in human, animals and agriculture. 4) Promote good governance on antimicrobial use. 5) Strengthen supply chain systems. Objective 2: To improve appropriate use of antimicrobials in health systems. Strategies 1) Establish antimicrobial stewardship programmes in human and animal health systems. 2) Develop antibiotic policy to enforce rational use of antibiotics. 3.4.5 Investment and Sustainability Research and development of new antimicrobial medicines, diagnostic tools, and vaccines must be reinvigorated. The Malawi community must encourage sustainable investments in new medicines, diagnostic tools, vaccines, and alternative interventions. The majority of pharmaceutical companies are no longer researching a new antibiotic which is a global concern for human and animal health. Research and development is needed to produce new treatments that can be deployed against multi-drug resistant infections. To stimulate the development and production of affordable, equitable access to new medicines, diagnostic tools, vaccines, and alternatives, these medications may need to be de-linked from price and sales volume. Objective 1: To develop an economic case for investment that addresses the country’s AMR needs. Strategies 1) Develop an all-inclusive plan used for securing and lobbying funding for AMR implementation. Objective 2: To develop an effective mechanism for a sustainable AMR implementation. Strategies 1) Develop an all-inclusive effective plan for sustainable AMR implementation. 2) Strengthen organizational capacity for a sustainable AMR implementation. 3) Monitoring and evaluation. Objective 3: To identify operational research priorities for participation in international collaborative research to support the development of new medicines, diagnostic tools and vaccines. Strategies 1) Establish procedures for participation in international collaborative research to support the development of new medicine, diagnostic tool and vaccines. Objective 4: To identify operational research priorities for participation in international collaborative research to support the development of new medicines, diagnostic tools and vaccines. Strategies 1) Strengthen and streamline international collaboration on AMR. 2) Strengthen inter-sectoral coordination of AMR activities. Objective 5: Strengthen national collaboration to address AMR containment in disease control programs. Strategies 1) Strengthen drug resistance containment activities of disease control programs with AMR program. 32 ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 CHAPTER 4: FINANCING 33ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 35 CHAPTER 4: FINANCING This AMR strategy will primarily be financed through the MoH budget system. It is envisaged that since AMR is integrated into the HSSP II, resources will trickle down from the Ministry of Finance to the Ministry of Health through the existing structures. However, it is well documented that the resource envelope for the HSSP II is hugely limited and hence there will be need to mobilize additional financial resources from different sources. It is imperative that various financing options be critically explored to ensure that adequate resources will be available for the AMR strategy implementation. It is envisaged that the Health Sector Development Partners will also play a critical role in the financing of this strategy over the entire period of the strategy. To this effect, some financing options already under discussion include the Health Sector Joint Fund (HSJF) and also the Global Fund, from where some of the resources will potentially be drawn. NGOs and other partners involved in AMR activities will also complement the MoH in implementing the strategy. Detailed cost estimates for the various strategic interventions included in this strategy that will form the basis for funding are listed in Annex 1. CHAPTER 5: MONITORING AND EVALUATION 37ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 39 CHAPTER 5: MONITORING AND EVALUATION The health sector intends to strengthen the management and use of health information from all sources, to better guide decision-making. In order to effectively monitor the performance of the AMR strategy during the implementation period, the health system strengthening framework for monitoring and evaluation will be used. This framework will provide a single platform for monitoring and evaluation that is relevant to Malawi and even for the implementing partners. The performance of the AMR will be measured using an agreed set of indicators. 5.1 Sources of Data for Monitoring and Evaluation 5.1.1 Routine HMIS data and routine reports The main source of data for monitoring the effective implementation of the AMR strategy will be the routine HMIS. The HMIS data is available on monthly, quarterly and annual basis. The HMIS will need to be modified to capture the necessary indicators for antibiotics use and development of resistance. The private hospitals and other sectors will also need to provide the AMR report which will be integrated in the HMIS. The AMR secretariat will need to produce a report which will be shared with the different stakeholders. 5.1.2 National surveys and demographic health surveys The demographic health surveys which are conducted at specific intervals will be used to inform the implementation and progress of the AMR strategy in Malawi. This process will provide important information on impact indicators such as neonatal mortality rate, maternal mortality rate and prevalence of diseases. The AMR strategy will also be informed by several national surveys which will act as important sources of data. 5.1.3 Program reviews The AMR program will be reviewed annually to monitor progress being made in each financial year. These reviews will be done at districts, zonal and national levels in coordination with all the sectors supporting AMR. In addition there will be two main reviews, the mid-term and the final reviews. The mid-term review will evaluate the progress that has been made and identify some strategies that will enable the MoH to meet some of the indicators that have been missed. The review will also assist the MoH to accelerate some interventions that have missed their targets. The end of program review will be conducted to assess the extent and effectiveness on how the AMR strategy has been implemented and provide recommendations from the lessons learnt. 5.1.4 Antimicrobial stewardship Improving the use of antibiotics is an important patient safety and public health issue as well as a national priority. A growing body of evidence demonstrates that hospital-based programs dedicated to improving antibiotic use, commonly referred to as “Antibiotic Stewardship Programs” (ASPs), can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. These programs help clinicians improve the quality of patient care and improve patient safety through increased infection cure rates, reduced treatment failures, and increased frequency of correct prescribing for therapy and prophylaxis. They also significantly reduce hospital cost and antibiotic resistance. In recognition of the urgent need to improve antibiotic use in hospitals and the benefits of antibiotic stewardship programs, the report of the situation analysis conducted in 2016, recommended that all hospitals should implement Antibiotic Stewardship Programs. ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202240 Malawi has addressed Antimicrobial stewardship programs in strategy number 4; which talks about optimizing the use of antimicrobial medicines in both humans and animals; the strategy further stipulates in one of the key outputs that it will establish antimicrobial stewardship programs in all health facilities by instituting these core elements: • Leadership commitment: Dedicating necessary human, financial and information technology resources. • Accountability: Appointing a single leader responsible for program outcomes. Experience with successful programs show that a physician or a microbiologist leader is effective. • Medicines expertise: Appointing a single pharmacist leader responsible for working to improve antibiotic use. • Action: Implementing at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment (i.e. “antibiotic time out” after 48 hours) • Tracking: Monitoring antibiotic prescribing and resistance patterns. • Reporting: Regular reporting of information on antibiotic use and resistance to doctors, nurses and relevant staff. • Education: Educating clinicians about resistance and optimal prescribing. 5.2 Monitoring and Evaluation Framework and Process The Monitoring and Evaluation (M&E) framework, shown in annex 7 provides guidance on the focus and priorities it will have, as it improves on the generation and use of required knowledge for evidence based decision-making. CHAPTER 6: IMPLEMENTATION 41ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 43 CHAPTER 6: IMPLEMENTATION The implementation of the AMR Strategy will be the responsibility of all health sector stakeholders in Malawi. It will be implemented under the health sector partner alignment, coordination arrangement and the decentralization system. The systems and structures established by the Government of Malawi and those created under the partnership alignment, the coordination and the decentralization system will play their defined role and responsibilities during the implementation of the AMR strategy. The AMR National Coordinating Centre under the Department of Preventive Health Services in the Ministry of Health will play a central role of coordinating all AMR activities. It will provide its overall stewardship role of the sector and provision of policy and technical support to implementing partners. It will also have an important role of stimulating wider public debate and innovation. This chapter discusses the implementation arrangements for the AMR NAP, including roles and responsibilities of various stakeholders. 6.1 Governance, Management and Partnership Structures in AMR AMR activities need to be better coordinated in order to maximize the outputs the health sector provides to the people of Malawi. Improvement in coordination and management of the surveillance system will enable the country to have evidence based policy formulation in regulating antibiotic use in human and animal health. The Malawi MoH guidance on coordination and governance is provided through three oversight structures: • The management structure: This guides internal Ministry coordination, to guide implementation of defined interventions and activities at the different levels. • The governance structure: This looks at defining the guiding strategic direction and following up on the operation of interventions. It is largely defined through formal legislation, with members and functions formally gazetted by the government. • The partnership structure: This guides external coordination of service delivery by all stakeholders at the respective levels of care. All partners providing services at a given level of care engage with each other through this structure. The existing partnership instrument (the partnership alignment and coordination Memorandum of Understanding) will serve as the formal instrument to guide the functioning of the partnership in health. It is guided by interpretation of the principles of the 2005 Paris Declaration on Aid Effectiveness. 6.2 Management Structure for Stewardship The key oversight functions of the AMR activities will be managed by the Minister of Health through the AMR National Coordinating Centre, whose duties are defined by AMR Technical Working Group. As a government agency, the MoH, through the AMR National Coordinating Centre, will set the agenda for AMR surveillance in Malawi in collaboration with key stakeholders. The MoH has an organizational structure, with establishment for both technical and administrative staff. Each of the established position has specified job descriptions. Several partner institutions and civil society will complement the work of the Ministry in discharging its core functions on AMR through advocacy, surveillance, research and training as well as quality assurance. ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202244 Table 4: Roles and responsibilities Stakeholder Roles and responsibilities in AMR NAP Ministry of Health • Overall stewardship of the sector, and provision of policy, strategic guidance and technical support • Development of operational tools and monitoring progress of implementation of AMR strategy through the National Coordinating Centre • Provision of finances and resources for the planning and implementation of AMR activities • Training/Education of all health workers AMR National Coordinating Centre • Coordinate the planning and implementation of AMR activities in all sectors to ensure a systematic and comprehensive approach Ministry of Agriculture • Development and implementation of policies and plans relating to AMR activities in animal health • Collaborates with MoH to increase access to AMR data in animals Ministry of Education / Malawi Institute of Education • Training/Education of all health workers • Collaborates with MoH in curriculum development incorporating AMR Ministry of Natural Resources, Energy and Mining / Environmental Affairs Department • Coordinate environmental assessments in the implementation of AMR activities • Collaborates with MoH on the safe management of waste disposal to avoid contaminating the environment • Conduct environmental monitoring of activities to ensure compliance with national/International guidelines Ministry of Local Government • Mobilization of additional resources for AMR activities at local government level Ministry of Finance, Economic Planning and Development / National Statistical Office • Mobilizing financial resources for GoM and allocating the resources to government ministries and departments • Provide technical support on national surveillance and research Health Development Partners • Complement financing of the AMR NAP priorities with earmarked or un earmarked funds • Provision of demand driven technical assistance and inputs into implementation of the AMR priorities • Actively participate in joint sector monitoring and review Partner Institutions • Actively participate in collection of AMR data in Non-State institutions to contribute to the AMR National database • Participate in joint sector monitoring Central Medical Stores Trust • Procurement and distribution of antibiotics and related medical supplies ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 45 Table 4: Roles and responsibilities; cont’d 6.3 Operationalization of the AMR Strategy In order to operationalize the AMR strategy, Annual Work Plans (AWPs) from the output tables have been developed that articulate the activities to be implemented for each of the priority objectives, strategies, outputs and broad activities. These AWPs are detailed, costed and will be implemented following a typical GoM financial year. Stakeholder Roles and responsibilities in AMR NAP Pharmacy, Medicines and Poisons Board • Strengthen legislation on antibiotic use in Malawi • Monitor antibiotic use and provide quality control and quality assurance activities Civil Society Organizations • Advocacy • Provide a link between health services and households in articulating health issues of importance • Participate in joint sector monitoring ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202246 ANNEX 1: SUMMARY OF COSTS ESTIMATES (MALAWI KWACHA) 1. EDUCATION & RESEARCH Annual Costs (MWK) Funding Source Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Total Cost (MK) EDUCATION & RESEARCH 63,100,000 56,358,500 60,098,685 63,477,215 63,801,087 306,835,487 ORT, DPs, NGOs MoH Objective 1: To increase national awareness on AMR 40,000,000 31,940,000 34,437,000 36,508,850 35,459,293 178,345,143 ORT, DPs, NGOs MoH Strategies 1.1 Establishment of an evidence-based awareness programme targeting audiences in general public, policy makers and health care providers, veterinarians and other animal health providers, environmental practitioners and farmers 8,600,000 4,780,000 5,019,000 5,269,950 5,533,448 29,202,398 ORT, DPs, NGOs MoH 1.2 Educate and engage with media, pharmaceutical industries, CSOs, NGOs, politicians, community leaders and other relevant stakeholders 15,350,000 16,117,500 16,923,375 17,769,544 18,658,021 84,818,440 ORT. DPs, NGOs MoH, MoA & DEA 1.3 Conduct an assessment on socio behavioral drivers and determinants 4,000,000 2,000,000 3,000,000 3,500,000 800,000 13,300,000 ORT. DPs, NGOs MoH, MoA & DEA 1.4 Establish a formal multi-sectoral and multi-disciplinary Advocacy, Communication, and Social Mobilization (ACSM) Working group. 3,950,000 3,637,500 3,819,375 4,010,344 4,210,861 19,628,080 ORT. DPs, NGOs MoH, MoA, DEA, DISTMS 1.1 Plan, launch and implement a series of media and public communication events every 2 months, each focused separately on Objectives 1 to 5 of the GAP/NAP 2,100,000 2,205,000 2,315,250 2,431,013 2,552,563 11,603,826 ORT. DPs, NGOs MoH, MoA , DEA, DISTMS 1.2 Develop a mechanism and digital platform that links social behavioral practices to the GLAS AMR surveillance network. 6,000,000 3,200,000 3,360,000 3,528,000 3,704,400 19,792,400 ORT. DPs, NGOs MoH, MoA, DEA, DISTMS, Defense Objective 2: To Impart knowledge of AMR and related topics for human and animal health, agriculture and environmental professionals through pre-service training 6,700,000 7,626,000 8,029,560 8,454,634 8,902,377 39,712,570 ORT, DPs, NGOs MoH Strategies 2.1 Lobbying with training institutions, regulatory bodies and other relevant stakeholders on AMR pre-service training 2,100,000 2,226,000 2,359,560 2,501,134 2,651,202 11,837,895 ORT, DPs, NGOs MoH, MoA , DEA, MIE 2.2 Strengthen and consolidate AMR and related topics as a core component of professional education, training, certification and development for human, animal and environmental professionals 4,600,000 5,400,000 5,670,000 5,953,500 6,251,175 27,874,675 ORT. DPs, NGOs ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 47 ANNEX 1: SUMMARY OF COSTS ESTIMATES (MALAWI KWACHA) CONT’D 1. EDUCATION & RESEARCH Annual Costs (MWK) Funding Source Responsibility2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Total Cost (MK) EDUCATION & RESEARCH 63,100,000 56,358,500 60,098,685 63,477,215 63,801,087 306,835,487 ORT, DPs, NGOs MoH Objective 3: To improve knowledge of AMR and related topics for human and animal health, agriculture and environmental professionals through in-service training 14,800,000 15,150,000 15,907,500 16,702,875 17,538,019 80,098,394 ORT, DPs, NGOs MoH Strategies 3.1 Plan and implement in-service trainings. 14,000,000 14,400,000 15,120,000 15,876,000 16,669,800 76,065,800 ORT. DPs, NGOs MoH, MoA , DEA, MIE 3.2 Development of monitoring and evaluation plan and tools for the in-service training 800,000 750,000 787,500 826,875 868,219 4,032,594 ORT. DPs, NGOs MoH, MoA , DEA, MIE Objective 4: To impart knowledge of AMR and related topics through formal education system at primary and secondary school level 1,600,000 1,642,500 1,724,625 1,810,856 1,901,399 8,679,380 ORT, DPs, NGOs MoH Strategies 4.1 Introduce and strengthen concept of AMR and appropriate use of antimicrobials as part of school curriculum. 750,000 750,000 787,500 826,875 868,219 3,982,594 ORT. DPs, NGOs MoH, MoA , DEA, MIE 4.2 Lobby with Ministry of Education, Malawi Institute of Education and relevant stakeholders on the inclusion or mainstreaming of AMR and related topics in the primary and secondary school curricula 850,000 892,500 937,125 983,981 1,033,180 4,696,787 ORT. DPs, NGOs MoH ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202248 ANNEX 1: SUMMARY OF COSTS ESTIMATES (MALAWI KWACHA) CONT’D 2. OPTIMAL USE Annual Costs (MK) Total Cost (MK) Funding Source Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 OPTIMAL USE 26,900,000 71,470,000 39,856,000 14,548,800 15,276,240 168,051,040 ORT, DPs, NGOs MoH Objective 1: Ensure uninterrupted access to high-quality antimicrobial medicines 25,150,000 54,350,000 25,680,000 5,964,000 6,262,200 117,406,200 ORT, DPs, NGOs MoH Strategy 1.1 Strengthen national regulatory authorities for improved quality, safety and efficacy of antimicrobials 1,500,000 5,000,000 6,500,000 ORT, DPs, NGOs MoH 1.2 Strengthen legislation to regulate prescription and dispensing of antimicrobials 750,000 750,000 ORT, DPs, NGOs MoH 1.3 Develop and enforce an enabling regulatory framework and coordination for regulations on use of antimicrobials in human, animals and agriculture 15,250,000 19,750,000 12,000,000 47,000,000 ORT, DPs, NGOs MoH 1.4 Promote good governance on antimicrobial use 3,500,000 15,000,000 18,500,000 ORT, DPs, NGOs MoH 1.5 Strengthen supply chain systems 4,150,000 14,600,000 13,680,000 5,964,000 6,262,200 44,656,200 ORT, DPs, NGOs MoH Objective 2: Improve appropriate use of antimicrobials in health systems 1,750,000 17,120,000 14,176,000 8,584,800 9,014,040 50,644,840 ORT, DPs, NGOs Strategy 2.1 Establish antimicrobial stewardship programmes in human and animal health systems 1,750,000 17,120,000 14,176,000 8,584,800 9,014,040 50,644,840 ORT, DPs, NGOs MoH / MoAIWD / Health facilities ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 49 ANNEX 1: SUMMARY OF COSTS ESTIMATES (MALAWI KWACHA) CONT’D 3. SURVEILLANCE AND RESEARCH Annual COSTS (MK) Total Cost (MK) Funding Source Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 SURVEILLANCE & RESEARCH 57,750,000 82,325,000 39,191,250 41,150,813 43,208,353 263,625,416 ORT, DPs, NGOs MoH Objective 1: To strengthen the national AMR surveillance system 38,250,000 80,750,000 37,537,500 39,414,375 41,385,094 237,336,969 ORT, DPs, NGOs MoH Strategy 1.1 Incorporate AMR into the existing surveillance system (take into account issues of one health concept when developing activities) 4,500,000 750,000 787,500 826,875 868,219 7,732,594 ORT. DPs, NGOs MoH 1.2 Establish a national coordinating centre for surveillance of AMR 5,450,000 56,250,000 11,812,500 12,403,125 13,023,281 98,938,906 ORT. DPs, NGOs MoH 1.3 Strengthen the national epidemiological surveillance system on AMR in Human Health, Animal Health, Agriculture and Environment 16,800,000 16,250,000 17,062,500 17,915,625 18,811,406 86,839,531 ORT. DPs, NGOs MoH 1.4 Establish mechanism for regular sharing of AMR data across human, animal health, agriculture and environmental sectors 11,500,000 7,500,000 7,875,000 8,268,750 8,682,188 43,825,938 ORT. DPs, NGOs MoH Objective 2 To identify key stakeholders and resources in AMR research 3,000,000 3,000,000 ORT, DPs, NGOs MoH Strategy 2.1 Create a multi-disciplinary AMR research platform 3,000,000 3,000,000 MoH Objective 3: To develop and incorporate AMR research priorities into the National (Health) Research Agenda 16,500,000 1,575,000 1,653,750 1,736,438 1,823,259 23,288,447 ORT, DPs, NGOs MoH Strategy 3.1 Develop AMR research agenda 15,000,000 1,575,000 1,653,750 1,736,438 1,823,259 21,788,447 ORT, DPs, NGOs MoH 3.2 Incorporate AMR research priorities into the National (Health) Research Agenda (Liaise with Agriculture and Environment Ministries) 1,500,000 1,500,000 ORT, DPs, NGOs MoH ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202250 ANNEX 1: SUMMARY OF COSTS ESTIMATES (MALAWI KWACHA) CONT’D 4. INFECTION, PREVENTION AND CONTROL Annual Costs (MK) Total Cost (MK) Funding Source Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 INFECTION, PREVENTION & CONTROL 629,800,000 980,340,000 1,014,072,000 1,012,944,600 1,114,997,730 4,752,154,330 ORT, DPs, NGOs MoH Objective 1: To prevent and control Infection at national level 43,050,000 199,992,500 118,167,125 124,075,481 131,279,255 616,564,362 ORT, DPs, NGOs MoH Strategy 2.1 Establish systems and processes for IPC 12,600,000 13,100,000 1,680,000 1,764,000 2,852,200 31,996,200 ORT, DPs, NGOs MoH 2.2 Develop appropriate infrastructure for IPC implementation 20,000,000 186,000,000 115,550,000 121,327,500 127,393,875 570,271,375 ORT, DPs, NGOs MoH 2.3 Reintroduce Health Promotion week 10,450,000 892,500 937,125 983,981 1,033,180 14,296,787 ORT, DPs, NGOs MoH Objective 2: To prevent and control infection at community level 49,400,000 74,420,000 95,141,000 82,048,050 104,000,453 405,009,503 ORT, DPs, NGOs MoH Strategy 2.1 Promote personal hygiene and sanitation through behaviour change activities in the communities 39,200,000 63,710,000 83,895,500 70,240,275 91,602,289 348,648,064 ORT, DPs, NGOs MoH 2.2 Promote safe disposal of antimicrobials 10,200,000 10,710,000 11,245,500 11,807,775 12,398,164 56,361,439 ORT, DPs, NGOs MoH Objective 3: To prevent and control Infection at health care and animal health setting 246,800,000 279,665,000 308,188,250 307,466,663 337,545,896 1,479,665,808 ORT, DPs, NGOs MoH Strategy 3.1 Strengthen hand hygiene in health care and animal waste 22,300,000 22,865,000 24,008,250 25,208,663 26,469,096 120,851,008 ORT, DPs, NGOs MoH 3.2 Ensure safety of health care and animal health workers 154,500,000 183,300,000 207,005,000 201,224,250 225,991,363 972,020,613 ORT, DPs, NGOs MoH 3.3 Strengthen availability of IPC supplies in health care and animal health settings 70,000,000 73,500,000 77,175,000 81,033,750 85,085,438 386,794,188 ORT, DPs, NGOs MoH Objective 4: To prevent & control Infection in Agriculture 51,500,000 45,000,000 64,250,000 49,612,500 69,943,125 280,305,625 ORT, DPs, NGOs MoH Strategy 4.1 Promote good agriculture practices 30,000,000 31,500,000 50,075,000 34,728,750 54,315,188 200,618,938 ORT, DPs, NGOs MoH 4.2 Ensure workers safety during use of chemicals 21,500,000 13,500,000 14,175,000 14,883,750 15,627,938 79,686,688 ORT, DPs, NGOs MoH Objective 5: To reduce impacts of AMR on the environment 239,050,000 381,262,500 428,325,625 449,741,906 472,229,002 1,970,609,033 ORT, DPs, NGOs MoH Strategy 5.1 Promote safe management of waste from health care, animal health, industry and agriculture 239,050,000 381,262,500 428,325,625 449,741,906 472,229,002 1,970,609,033 ORT, DPs, NGOs MoH ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 51 ANNEX 1: SUMMARY OF COSTS ESTIMATES (MALAWI KWACHA) CONT’D 5. INVESTMENT & SUSTAINABILITY Annual Costs (MK) Funding Source Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Total Costs (MK) INVESTMENT & SUSTAINABILITY 264,300,000 40,687,500 13,441,875 7,813,969 8,204,667 334,448,011 ORT, DPs, NGOs MoH Strategic Objective 1: To develop the economic case for investment that addresses the country’s AMR needs 137,700,000 27,000,000 6,000,000 170,700,000 ORT, DPs, NGOs MoH Strategy 1.1 Develop an all-inclusive plan used for securing and lobbying funding for AMR implementation 137,700,000 27,000,000 6,000,000 170,700,000 ORT, DPs, NGOs MoH Strategic Objective 2: To develop an effective mechanism for a sustainable AMR implementation 113,600,000 4,600,000 118,200,000 ORT, DPs, NGOs MoH Strategy 2.1 Develop an all-inclusive effective plan for sustainable AMR implementation 9,600,000 4,600,000 14,200,000 ORT, DPs, NGOs MoH 2.2 Organization capacity for a sustainable AMR implementation 104,000,000 104,000,000 ORT, DPs, NGOs MoH 2.3 Monitoring and Evaluation ORT, DPs, NGOs MoH Objective 3: Identify operational research priorities for participation in international collaborative research to support the development of new medicines, diagnostic tools and vaccines 3,750,000 2,362,500 2,480,625 2,604,656 2,734,889 13,932,670 ORT, DPs, NGOs MoH Strategy 3.1 Establish procedures for participation in international collaborative research to support the development of new medicine, diagnostic tool and vaccines 3,750,000 2,362,500 2,480,625 2,604,656 2,734,889 13,932,670 ORT, DPs, NGOs MoH Strategic Objective 4: Identify operational research priorities for participation in international collaborative research to support the development of new medicines, diagnostic tools and vaccines 6,000,000 6,725,000 4,961,250 5,209,313 5,469,778 28,365,341 ORT, DPs, NGOs MoH Strategy 4.1 Strengthen and streamline international collaboration on AMR 3,000,000 5,150,000 3,307,500 3,472,875 3,646,519 18,576,894 ORT, DPs, NGOs MoH 4.2 Strengthen inter-sectoral coordination of AMR activities 3,000,000 1,575,000 1,653,750 1,736,438 1,823,259 9,788,447 ORT, DPs, NGOs MoH Strategic Objective 5: Strengthen National collaboration to address AMR containment in disease control programs 3,250,000 3,250,000 ORT, DPs, NGOs MoH Strategy 5.1 Strengthen drug resistance containment activities of disease control programs with AMR program 3,250,000 3,250,000 ORT, DPs, NGOs MoH GRAND TOTAL (MK) 1,041,850,000 1,231,181,000 1,166,659,810 1,139,935,396 1,245,488,077 5,825,114,283 ORT, DPs, NGOs MoH ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202252 ANNEX 2: EDUCATION & AWARENESS (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) Strategic Outcome Improved Awareness and Understanding of Antimicrobial Resistance through Effective Communication, Education and Training Strategic Objective 1 To increase national awareness on AMR Strategy 1.1 Establishment of an evidence-based awareness programme targeting audiences in general public, policy makers and health care providers, veterinarians and other animal health providers, environmental practitioners and farmers Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 AMR awareness and advocacy materials developed, adopted, translated No. of advocacy materials developed One meeting Two workshops Two meetings Two meetings Two meetings Two meetings Minutes Core team Output 2 Targeted awareness activities to the specific audiences Implemented No. of targeted activities implemented Four workshops Four workshops Four workshops Four workshops Four workshops Minutes Lack of funds MOH, MOA, DEA Output 3 Conduct a behaviour change study on AMR Behaviour change study conducted One study One study One study One study One study Study report Output 4 Awareness raising events in line with world AMR awareness week Implemented No. of events in line with WAMR awareness week implemented One field day; two press releases; one press conference; one panel discussion; 20 press airings One field day; two press releases; one press conference; one panel discussion; 20 press airings One field day; two press releases; one press conference; one panel discussion; 20 press airings One field day; two press releases; one press conference; one panel discussion; 20 press airings One field day; two press releases; one press conference; one panel discussion; 20 press airings Minutes, reports Lack of funds MOH, MOA, DEA, Information Output 5 A platform to communicate information on AMR (Website) Launched and running Digital platform for AMR launched One development meeting; one field pretesting; 33 training sessions Four quarterly meetings Four quarterly meetings Four quarterly meetings Four quarterly meetings Website MOH, MOA, DEA, Information ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 53 ANNEX 2: EDUCATION & AWARENESS (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) CONT’D Strategy 1.2 Educate and engage with media, pharmaceutical industries, CSOs, NGOs, politicians, community leaders and other relevant stakeholders Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Regional seminars with media, Pharmaceutical industries and other stakeholders on AMR conducted No. of regional seminars with relevant stakeholders on AMR conducted Three seminars Three seminars Three seminars Three seminars Three seminars Minutes Lack of funding MOH, MOA, DEA, Information Output 2 District seminars with community leaders, politicians, religious leaders and other relevant stakeholders conducted No. of district seminars with relevant stakeholders on AMR conducted Twenty nine seminars Twenty nine seminars Twenty nine seminars Twenty nine seminars Twenty nine seminars Minutes Lack of funding MOH, MOA, DEA, Information Output 3 Media and other stakeholders in all AMR activities in Malawi engaged Media and other stakeholders engaged in all AMR activities in Malawi Four media briefings Four media briefings Four media briefings Four media briefings Four media briefings Minutes MOH, MOA, DEA, Information Output 4 Media coverage of AMR activities Monitored and Evaluated No of media coverage of AMR activities monitored and evaluated Six media coverage reviews Six media coverage reviews Six media coverage reviews Six media coverage reviews Six media coverage reviews Minutes, reports Lack of funding MOH, MOA, DEA, Information Strategy 1.3 Conduct an assessment on socio-behavioral drivers and determinants Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Rapid qualitative assessment among patients, communities, healthcare providers, pharmacists, drug dispensers, pharmaceutical sales representatives, animal production units, farmers, feed producers and environmental workers conducted No of rapid qualitative assessment conducted One baseline assessment One baseline assessment One mid-term assessment One end of programme assessment One end of programme assessment Study report Lack of funding MOH, MOA, DEA Output 2 A national quantitative survey on knowledge, awareness and practices (KAP) among public healthcare, animal production, agriculture and pharmaceutical sector conducted No. of national quantitative survey conducted One baseline assessment One baseline assessment One mid-term assessment One end of programme assessment One end of programme assessment Study report Lack of funding MOH, MOA, DEA ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202254 ANNEX 2: EDUCATION & AWARENESS (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) CONT’D Strategy 1.4 Establish a formal multi-sectoral and multi-disciplinary advocacy, communication and social mobilization (ACSM) working group Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 TORs of the ACSM WG, with members nominated from key constituencies and stakeholders developed No. of meetings to develop TORs conducted One orientation meeting; one development and finalization of TORs meeting Four quarterly review meetings Four quarterly review meetings Four quarterly review meetings Four quarterly review meetings TOR document MOH, MOA, DEA Output 2 A robust evidence-based ACSM strategy and action plan to respond to the social behavioural drivers and determinants of AMR developed No. of meetings conducted One evidence based strategic action plan One evidence based strategic action plan One evidence based strategic action plan One evidence based strategic action plan One evidence based strategic action plan Minutes MOH, MOA, DEA Output 3 Resources from government and donors to finance strategy development, research studies, and implementation of ASCM activities identified No. of meetings to identify source of resources Three regional resource mobilization meetings Three regional resource mobilization meetings Three regional resource mobilization meetings Three regional resource mobilization meetings Three regional resource mobilization meetings Minutes MOH, MOA, DEA Strategy 1.5 Plan, launch and implement a series of media and public communication events every two months, each focused separately on Objectives 1 to 5 of the GAP/NAP Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Activities to commemorate annual world AMR awareness week planned and implemented Number of activities to commemorate annual world AMR awareness week planned and implemented One field day; two press releases; one press conference; one panel discussion; twenty press airings One field day; two press releases; one press conference; one panel discussion; twenty press airings One field day; two press releases; one press conference; one panel discussion; twenty press airings One field day; two press releases; one press conference; one panel discussion; twenty press airings One field day; two press releases; one press conference; one panel discussion; twenty press airings Minutes, reports Lack of funds MOH, MOA, DEA, Information, Defense ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 55 ANNEX 2: EDUCATION & AWARENESS (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) CONT’D Strategy 1.5 Plan, launch and implement a series of media and public communication events every two months, each focused separately on Objectives 1 to 5 of the GAP/NAP Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 2 Sets of specific activities and events grouped around each of objectives 1 to 5, developed and implemented every two months spread over 2021 to enhance and sustain awareness among professionals and the public No. of sets of specific and events developed and implemented. Four review meetings Four review meetings Four review meetings Four review meetings Four review meetings Minutes MOH, MOA, DEA, Information Strategy 1.6 Develop a mechanism and digital platform that links social behavioural practices to the GLAS AMR surveillance network. Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Protocols and cross-referenced data collection and analysis for establishing an AMR behavioural surveillance system to help inform target policy, regulatory, and practice reforms including community and hospital-based stewardship programmes No. of protocols and cross-referenced data collection and analysis for establishing an AMR developed and implemented One development workshop; one finalization Two review meetings Two review meetings Two review meetings Two review meetings Study report, minutes Lack of funding MOH, MOA, DEA Output 2 Use of digital platform developed, trained, implemented, monitored and evaluated Number of digital platforms developed and implemented One workshop to develop and pretest the digital platform 33 training sessions Four review meetings Four review meetings Four review meetings Four review meetings Minutes Lack of funding MOH, MOA, DEA ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202256 ANNEX 2: EDUCATION & AWARENESS (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) CONT’D Strategic Objective 2 To Impart knowledge of AMR and related topics for human and animal health, agriculture and environmental professionals through preservice training Lobbying with training institutions, regulatory bodies and other relevant stakeholders on AMR preservice training Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Meetings with training institutions (human and animal health), regulatory bodies and other relevant stakeholders on AMR pre-service training conducted No. of meetings with training institutions, regulatory bodies and relevant stakeholders on AMR conducted Three regional meetings Three regional meetings Three regional meetings Three regional meetings Three regional meetings Minutes MOH, MOA, DEA, Education Strategy 2.3 Strengthen and consolidate AMR and related topics as a core component of professional education, training, certification and development for human and animal health and environmental professionals Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Curriculum review committee with clear TORs and road map established. No. of review committee meetings conducted One orientation meeting; one development and finalization of TORs meeting Two regional review meetings Two regional review meetings Two regional review meetings Two regional review meetings Minutes Lack of funding MOH, MOA, DEA, Education Output 2 Curriculum in relation to AMR for human and animal health, agriculture and environmental pre service training reviewed. Number of review meetings conducted Four curriculum review meetings One review meeting One review meeting One review meeting One review meeting Minutes, review finding report Lack of funding MOH, MOA, DEA, Education Strategy 2.2 ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 57 ANNEX 2: EDUCATION & AWARENESS (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) CONT’D Strategy 2.3 Strengthen and consolidate AMR and related topics as a core component of professional education, training, certification and development for human and animal health and environmental professionals Output 3 Tutors and lecturers in relevant sectors trained. No. of trainings conducted Three regional training sessions Three regional training sessions Three regional training sessions Three regional training sessions Three regional training sessions Lack of funding Strategic Objective 3 To improve knowledge of AMR and related topics for human and animal health, agriculture and environmental professionals through in-service training Strategy 3.1 Plan and implement in-service trainings Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Training manuals and materials developed, pretested and adopted Number of training manuals developed and adopted One workshop for development; one workshop to pretest and finalize One review meeting for training manuals One review meeting for training manuals One review meeting for training manuals One review meeting for training manuals Minutes, training manuals Lack of funds MOH, MOA, DEA, Education Output 2 Training of trainers conducted Number of trainings conducted Three training sessions Three training sessions Three training sessions Three training sessions Three training sessions Training reports Lack of funds MOH, MOA, DEA, Education Output 3 In-service training for human and animal health, agriculture and environmental professionals conducted Number of in-service trainings conducted 100 training sessions (3 per central/ DHO) 100 training sessions (3 per central/DHO) 100 training sessions (3 per central/DHO) 100 training sessions (3 per central/DHO) 100 training sessions (3 per central/ DHO) Training reports Lack of funds MOH, MOA, DEA, Education ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202258 ANNEX 2: EDUCATION & AWARENESS (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) CONT’D Strategy 3.2 Development of monitoring and evaluation plan and tools for the in-service training (Establish indicators for various cadres ) Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Monitoring and evaluation plan and tools for the in-service training developed Number of monitoring and evaluation plan tools developed One development; one pretesting and finalization One review meeting One review meeting One review meeting One review meeting Evaluation tool Lack of funds MOH, MOA, DEA, Education Strategic Objective 4 To Impart knowledge of AMR and related topics through formal education system at primary and secondary school level Strategy 4.1 Introduce and strengthen concept of AMR and appropriate use of antimicrobials as part of school curriculum. Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Curriculum review committees for primary and secondary schools with clear TORs and roadmap established. Number of review meetings conducted One orientation meeting; one development and finalization of TORs meeting One review meeting One review meeting One review meeting One review meeting Minutes Lack of funds MOH, MOA, DEA, Education Strategy 4.2 Lobby with Ministry of Education, Malawi Institute of Education and relevant stakeholders on the inclusion or mainstreaming of AMR and related topics in the primary and secondary school curricula Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Meetings conducted with the Ministry of Education, Malawi Institute of Education and relevant stakeholders Number of meetings conducted One stakeholder’s meeting One stakeholder’s meeting One stakeholder’s meeting One stakeholder’s meeting One stakeholder’s meeting Minutes MOH, MOA, DEA, Education ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 59 ANNEX 3: SURVEILLANCE & RESEARCH (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) Strategic Outcome Improved knowledge and evidence of AMR through research and surveillance Strategic Objective 1 To strengthen the national AMR surveillance system Strategy 1.1 Incorporate AMR into the existing surveillance system Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Document listing AMR priority pathogens for Malawi developed AMR priority pathogen document Three meetings (60 participants each) Three meetings (60 participants each) Three meetings (60 participants each) Three meetings (60 participants each) Three meetings (60 participants each) Output 2 AMR incorporated into the national surveillance system Number of review meetings conducted Three meetings (60 participants each) Strategy 1.2 Establish a national coordinating centre for surveillance of AMR Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 A multi-disciplinary Taskforce to formalize utilization of the national coordinating centre formed Formation of a Taskforce Two meetings (20 participants each) Output 2 TORs for AMR National Coordinating Centre developed TOR Document developed; Number of sensitization meetings conducted One Meeting ( 20 participants); Four sensitization meetings Output 3 Laboratory based surveillance on AMR strengthened Training manual developed; Number of staff trained One workshop to develop manual; Three TOT trainings - one per region; Ten staff trained per district; Sample transport system established 150 new staff trained; One refresher for previously trained staff 150 new staff trained; One refresher for previously trained staff 150 new staff trained; One refresher for previously trained staff 150 new staff trained; One refresher for previously trained staff ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202260 ANNEX 3: SURVEILLANCE & RESEARCH (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) CONT’D Strategy 1.2 Establish a national coordinating centre for surveillance of AMR Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 4 Equipment and supplies procured National AMR Coordinating Centre office established and equipped; Number of sites identified for infrastructure development (equipment/supplies procured) Develop essential and standardized equipment list; equip National Coordinating Centre, Two National reference (CHS and Veterinary) and four central hospital laboratories. Equip 10 more labs with basic equipment for cultures identification to be done at Central Hospitals Strategy 1.3 Strengthen the national epidemiological surveillance system on AMR in Human Health, Animal Health, Agriculture and Environment Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Source and Means of Verification Risks and Assumptions Responsibility Output 1 Standardized surveillance protocols developed Protocols and Forms developed Protocols and Forms developed Output 2 Trainings on systematic data collection done Training manual developed; Number of staff trained One workshop to develop manual; Three TOT trainings one per region; Ten staff trained per district 150 new staff trained; One refresher for previously trained staff 150 new staff trained; One refresher for previously trained staff 150 new staff trained; One refresher for previously trained staff 150 new staff trained; One refresher for previously trained staff Output 3 AMR Surveillance Web Database developed Web database developed Web database development ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 61 ANNEX 3: SURVEILLANCE & RESEARCH (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) CONT’D Strategy 1.3 Strengthen the national epidemiological surveillance system on AMR in Human Health, Animal Health, Agriculture and Environment Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Source and Means of Verification Risks and Assumptions Responsibility Output 4 AMR External Quality Assurance (EQA) System established EQA program developed Study tour to NICD; Lab enrolment into EQA; EQA sample preparation and distribution; EQA review meeting Lab enrolment into EQA; EQA sample preparation and distribution; EQA review meeting EQA sample preparation and distribution; EQA review meeting EQA sample preparation and distribution; EQA review meeting EQA sample preparation and distribution; EQA review meeting Output 5 Quarterly reporting system established Quarterly reports Four supervision visits; refresher training Four supervision visits Four supervision visits Four supervision visits Four supervision visits Establish mechanism for regular sharing of AMR data across human, animal health, agriculture and environmental sectors Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 MoU of sharing existing surveillance platforms developed MoU developed MoU developed Output 2 Establishment of a taskforce to review abstracts Taskforce established One meeting to establish, One review meeting Two abstracts review meetings Two abstracts review meetings Two abstracts review meetings Two abstracts review meetings Output 3 Dissemination of surveillance data and research findings Conferences conducted; Number of meetings done One conference; three meetings; ten workshops targeting media, church and schools Two conferences; four meetings Two conferences; four meetings Two conferences; four meetings Two conferences; four meetings Strategy 1.4 ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202262 ANNEX 3: SURVEILLANCE & RESEARCH (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) CONT’D Strategic Objective 2 To identify key stakeholders and resources in AMR research Strategy 2.1 Create a multi-disciplinary AMR research platform Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 AMR TWG for research composing membership from all key stakeholders established TWG established Two meetings 30 participants each Output 2 TORs for TWG developed TOR document developed; Number of meetings conducted One meeting 10 participants Output 3 A directory of key stakeholders and resources on AMR research across all sectors – government, academia, NGOs formed Directory developed; number of meetings conducted One meeting -30 participants Strategic Objective 3 To develop and incorporate AMR research priorities into the National (Health) Research Agenda Strategy 3.1 Develop AMR research agenda Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Task force to develop a research agenda formed Taskforce formed One meeting (10 participants) Output 2 TORs of the Taskforce developed TOR document developed; number of meetings One meeting (10 participants) Output 3 AMR research gaps identified AMR research gaps document; survey conducted One survey done across the country Output 4 Existing situational analysis of AMR research in Malawi updated Situation analysis document; number of meetings Two meetings 30 participants Two meetings - 30 participants Two meetings - 30 participants Two meetings - 30 participants Two meetings 30 participants ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 63 ANNEX 3: SURVEILLANCE & RESEARCH (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) CONT’D Strategic Objective 3 To develop and incorporate AMR research priorities into the National (Health) Research Agenda Strategy 3.2 Incorporate AMR research priorities into the National (Health) Research Agenda () Output Description Objectively Verifiable Indicator OUTPUT TARGETS (PER FINANCIAL YEAR) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 AMR research agenda to the National Commission of Science and Technology (NCST) Submitted AMR research agenda document submitted; AMR research priorities incorporated into national research agenda 1 ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202264 ANNEX 4: INFECTION, PREVENTION & CONTROL (OUTCOMES, OBJECTIVES, STRATEGIES & OUTPUTS) Strategic Outcome Reduced the incidence of infection through effective sanitation, hygiene and prevention measures Strategic Objective 1 To prevent and control infection at national level Strategy 1.1 Establish systems and processes for IPC Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Systems and processes established TORs developed One TOR One TOR Number of policies, guidelines, standards and SOPs developed One IPC policy Six guidelines, six SOPs Number of trainings conducted Six training sessions Output 2 National Coordinating Unit strengthened Presence of national coordinating unit One coordinating unit Output 3 IPC assessments conducted Number of IPC assessments conducted One IPC assessment Output 4 Adherence to policies monitored Number of monitoring visits Two monitoring visits Two monitoring visits Two monitoring visits Two monitoring visits Two monitoring visits Strategy 1.2 Develop appropriate infrastructure for IPC implementation Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Incinerators constructed No. of incinerators constructed Two Incinerators Two Incinerators Two Incinerators Output 2 Isolation rooms constructed/renovated No. of Isolation rooms constructed / renovated Four isolation rooms Two isolation rooms Two isolation rooms Two isolation rooms Output 3 Hand washing facilities constructed/ renovated No. of hand washing facilities 50 hand washing facilities 50 hand washing facilities 50 hand washing facilities 50 hand washing facilities 50 hand washing facilities Output 4 Quarantine facilities constructed No. of quarantine facilities constructed Two quarantine facilities One quarantine facility One quarantine facility One quarantine facility ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 65 ANNEX 4: INFECTION, PREVENTION & CONTROL (OUTCOMES, OBJECTIVES, STRATEGIES & OUTPUTS) CONT’D Strategy 1.2 Develop appropriate infrastructure for IPC implementation Output 5 IPC infrastructure inspected No. of inspections Four inspections Four Inspections Four Inspections Four Inspections Four Inspections Strategy 13 Reintroduce Health Promotion week Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Health promotion week re-introduced No. of consultation meetings Four consultation meetings No. of workshops Three regional workshops No. of press releases Eight press releases in different media houses Observance of health promotion week One health promotion week One health promotion week One health promotion week One health promotion week Strategic Objective 2 To prevent and control infection at community level Strategy 2.2 Promote personal hygiene and sanitation through behaviour change activities in the communities Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Personal hygiene and sanitation promoted No. of assessments on personal hygiene and sanitation One personal hygiene and sanitation assessment No. of refresher courses conducted 28 trainings 84 trainings 84 trainings 84 trainings 84 trainings No. of awareness campaigns conducted 28 awareness campaigns 28 awareness campaigns 28 awareness campaigns 28 awareness campaigns 28 awareness campaigns Output 2 Behaviour change surveys conducted No. of surveys on personal hygiene conducted One survey on personal hygiene One survey on personal hygiene ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202266 ANNEX 4: INFECTION, PREVENTION & CONTROL (OUTCOMES, OBJECTIVES, STRATEGIES & OUTPUTS) CONT’D Strategy 2.3 Promote safe disposal of antimicrobials Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Awareness campaigns on proper disposal conducted No. of awareness campaigns conducted 28 awareness campaigns 28 awareness campaigns 28 awareness campaigns 28 awareness campaigns 28 awareness campaigns Strategic Objective 3 To prevent and control Infection at health care and animal health setting Strategy 3.1 Strengthen hand hygiene in health care and animal waste Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Hand hygiene strengthened No. assessments conducted One hand hygiene assessment No. of workshops conducted on hand hygiene Six TOT workshops on hand hygiene Six TOT workshops on hand hygiene Six TOT workshops on hand hygiene Six TOT workshops on hand hygiene Six TOT workshops on hand hygiene No. of IEC materials developed 1,000 posters; 1,000 fliers; 2,500 t-shirts; 4 bill boards 20 banners; 1,000 posters, 1,000 fliers; 3000 t-shirts 20 banners; 1,000 posters, 1,000 fliers; 3000 t-shirts 20 banners; 1,000 posters, 1,000 fliers; 3000 t-shirts 20 banners; 1,000 posters, 1,000 fliers; 3000 t-shirts Output 2 World hand hygiene day observed No. of hand hygiene campaigns conducted 28 campaigns 28 campaigns 28 campaigns 28 campaigns 28 campaigns Observance of hand hygiene day One hand hygiene day One hand hygiene day One hand hygiene day One hand hygiene day One hand hygiene day Output 3 Hand hygiene standards monitored No. of monitoring visits Four monitoring visits Four monitoring visits Four monitoring visits Four monitoring visits Four monitoring visits ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 67 ANNEX 4: INFECTION, PREVENTION & CONTROL (OUTCOMES, OBJECTIVES, STRATEGIES & OUTPUTS) CONT’D Strategy 3.2 Ensure safety of health care and animal health workers Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Safety of health care and animal health workers ensured No. of safety policies, standards and protocols developed Four policies on safety of workers No. of heavy duty gloves procured 10,000 heavy duty gloves 15,000 heavy duty gloves 20,000 heavy duty gloves 15,000 heavy duty gloves 20,000 heavy duty gloves No. of aprons procured 15,000 heavy duty aprons 20,000 heavy duty aprons 20,000 heavy duty aprons 20,000 heavy duty aprons 20,000 heavy duty aprons No of gumboots procured 15,000 gumboots 20,000 gumboots 20,000 gumboots 20,000 gumboots 20,000 gumboots No. of head gears procured 15,000 head gear 20,000 head gear 20,000 head gear 20,000 head gear 20,000 head gear No. of face shields/ masks procured 15,000 Masks 20,000 masks 20,000 masks 20,000 masks 20,000 masks No. of overalls, work suits and uniforms procured 15,000 uniforms 20,000 uniforms 20,000 uniforms 20,000 uniforms 20,000 uniforms No. of workers vaccinated 5,000 vials 7,000 vials 7,000 vials 7,000 vials 7,000 vials No. of workers gone for medical checkups 20,000 workers 20,000 workers 20,000 workers 20,000 workers 20,000 workers Output 2 Inspections conducted No. of inspections Two inspections Four inspections Four inspections Four inspections Four inspections ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202268 ANNEX 4: INFECTION, PREVENTION & CONTROL (OUTCOMES, OBJECTIVES, STRATEGIES & OUTPUTS) Strategy 3.2 Strengthen availability of IPC supplies in health care and animal health settings Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 IPC supplies made available No. of chemicals procured 2,000L Chlorine; 500L Iodine; 500 L chlorhexidine; 1,000 L; methylated spirit, 1,000L hand rub 2,000L Chlorine; 500L Iodine; 500 L chlorhexidine; 1,000 L; methylated spirit, 1,000L hand rub 2,000L Chlorine; 500L Iodine; 500 L chlorhexidine; 1,000 L; methylated spirit, 1,000L hand rub 2,000L Chlorine; 500L Iodine; 500 L chlorhexidine; 1,000 L; methylated spirit, 1,000L hand rub 2,000L Chlorine; 500L Iodine; 500 L chlorhexidine; 1,000 L; methylated spirit, 1,000L hand rub No. of soaps procured 2,000 cartons soap, 1,000L liquid soap 2,000 cartons soap, 1,000 L liquid soap 2,000 cartons soap, 1,000L liquid soap 2,000 cartons soap, 1,000L liquid soap 2,000 cartons soap, 1,000L liquid soap No. of mops procured 1,0000 mops 15,000 mops 15,000 mops 15,000 mops 15,000 mops No. of moping buckets procured 100,000 buckets 100,000 buckets 150,000 buckets 150,000 buckets 150,000 buckets No. of scrub brushes procured 10,000 brushes 10,000 brushes 10,000 brushes 10,000 brushes 10,000 brushes Strategic Objective 4 To prevent and control Infection in Agriculture Strategy 4.1 Promote good agriculture practices Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Good agriculture practices promoted No of trainings conducted Six trainings sessions Six trainings sessions Six trainings sessions Six trainings sessions Six trainings sessions ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 69 ANNEX 4: INFECTION, PREVENTION & CONTROL (OUTCOMES, OBJECTIVES, STRATEGIES & OUTPUTS) Strategy 4.1 Promote good agriculture practices Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output1 Good agriculture practices promoted No. of trainings conducted Six trainings sessions Six trainings sessions Six trainings sessions Six trainings sessions Six trainings sessions No. of farmers trained Six training sessions Six training sessions Six training sessions Six training sessions Six training sessions No. of collaborative sessions conducted Six sessions Six sessions Six sessions Six sessions Six sessions Output 2 A survey on existing practices conducted No. of surveys conducted One survey One survey Strategy 4.2 Ensure workers safety during use of chemicals Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Workers safety ensured No. of safety policies, standards and protocols developed Four safety policies, standards and protocols No. workers gone for medical checkups 20,000 workers 20,000 workers 20,000 workers 20,000 workers 20,000 workers Output 2 Routine Inspections conducted No. of routine inspections Two inspections Four Inspections Four Inspections Four Inspections Four Inspections Strategic Objective 5 To reduce impacts of AMR on the environment Strategy 5.1 Promote safe management of waste from health care, animal health, industry and agriculture Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Safe management of waste promoted Availability of waste management plans in all sectors Four waste management plans No. of waste receptacles procured 50,000 bins 60,000 bins 60,000 bins 70,000 bins 70,000 bins ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202270 ANNEX 4: INFECTION, PREVENTION & CONTROL (OUTCOMES, OBJECTIVES, STRATEGIES & OUTPUTS) Strategy 4.1 Promote safe management of waste from health care, animal health, industry and Agriculture Output 1 Safe management of waste promoted No. of bin liners procured 100,000 bin liners 120,000 bin liners 120,000 bin liners 140,000 bin liners 140,000 bin liners No. of lobbying meetings Ten meetings Ten meetings Ten meetings Ten meetings Ten meetings No. of sensitization meetings Three regional meetings Three regional meetings Three regional meetings Three regional meetings Three regional meetings No. workers trained on proper waste disposal Three regional training sessions Three regional training sessions Three regional training sessions Three regional training sessions Three regional training sessions No. of inspection conducted Two inspections Four Inspections Four Inspections Four Inspections Four Inspections ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 71 ANNEX 5: OPTIMAL USE (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) Strategic Outcome Optimimal use of antimicrobials medicines in Human and Animal Health and Agriculture Strategic Objective 1 Ensure uninterrupted access to high-quality antimicrobial medicines Strategy 1.1 Strengthen national regulatory authorities for improved quality, safety and efficacy of antimicrobials Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 National regulatory authority strengthened and regulations implemented Number of regulatory tools and guidelines updated and disseminated One consultation meeting; one inception meeting; one review meetings 6,640 copies printed; Four regional dissemination meetings Reports and documents Coordination and funding MoH Strategy 1.2 Strengthen legislation to regulate prescription and dispensing of antimicrobials Output Description Output 1 Legislation and regulations strengthened and implemented to regulate prescription and dispensing Number of prescription and dispensing guidelines developed One consultation meeting; one review meeting; 19,500 copies printed Produced documents Funding MoH Strategy 1.3 Develop and enforce an enabling regulatory framework and coordination for regulations on use of antimicrobials in human, animals and agriculture Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Updated and disseminated guidelines of antimicrobial use in human, animal and agriculture Number of updated and disseminated guidelines of antimicrobial use One consultation meeting; one review meeting; and 20,000 copies printed; dissemination of guidelines The document and report on dissemination Dissemination funding availability MoH Output 2 Regulatory mechanism established for assuring rational use of antibiotics in human, animal and agriculture Number of regulatory mechanisms established Two consultation meetings; One review meetings; One workshop on documentation of mechanisms One review meeting; 6,640 copies printed The document Stakeholder cooperation MoH/MoAIWD ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202272 ANNEX 5: OPTIMAL USE (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) Strategy 1.3 Develop and enforce an enabling regulatory framework and coordination for regulations on use of antimicrobials in human, animals and agriculture Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 3 Developed Integrated Essential Medicines list for use in human, animal and agriculture Integrated EML One consultation meeting; One review meeting; One workshop for developing EML; 6,640 EML copies printed; 4 dissemination sessions of EML One consultation meeting; one review meeting; one workshop for developing EML; 6,640 EML copies printed; Four dissemination sessions of EML Report/s and EML copies Cooperation MoH/ MoAIWD Output 4 Developed policy document guiding the use of critically important antibiotics in animals and agriculture Developed policy Two consultation meetings; one review meeting; one workshop on documentation of policy. Print 6,640 policy document copies Four dissemination sessions Report/s and policy document Lack of funding and coordination MoH/ MoAIWD/NCC Strategy 1.4 Promote good governance on antimicrobial use Output description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Structured reporting system established on corruption and theft in human, animal and agriculture Number of reporting systems established Three consultation meetings; four workshops for sensitization of the system Reports Lack of interest in some stakeholders NCC and Regulatory bodies Number of guidelines produced and disseminated One multi sectoral workshop; 6,640 copies printed and distributed Guidelines document; distribution report MoH/MoAIWD ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 73 ANNEX 5: OPTIMAL USE (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) Strategy 1.4 Promote good governance on antimicrobial use Output description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 2 Adopted WHO model framework for Good Governance in the Pharmaceutical sector (Malawi Framework for Good Governance in the Pharmaceutical sector) Number of documents products Three consultation meeting; One workshop to adopt the document Reports and produced document MoH/MoAIWD Strategy 1.5 Strengthen supply chain systems Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Disseminated drug donation guidelines to donors and recipients Number of guidelines disseminated 6,640 copies printed Guidelines documents PMPB and MoH Output 2 Developed importation and sale guidelines for veterinary medicines Number of guidelines developed One consultation meeting; one workshop to develop the guidelines 3,000 copies printed and disseminated Printed guidelines Funds available MoAIWD / Regulatory bodies Output 3 Minimized utilization of informal antimicrobial supply chains by public Proportion of facilities utilizing formal antimicrobial supply chain Two country wide supervisions Four country wide supervision Four country wide supervision Four country wide supervision Supervision reports Funds available MoH / MoAIWD / Regulatory bodies Output 5 Developed monitoring systems for antimicrobial medicines supply chains Number of monitoring tools developed and disseminated Two consultation meeting; 1 workshop to develop the monitoring tools One test for M& E tools ; printing M&E 40,00 copies; Four distribution sessions of tools 4,000 copies printed and distributed 4,000 copies printed and distributed 4,000 copies printed and distributed M&E tools Funds available MoH / MoAIWD / Regulatory bodies ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202274 ANNEX 5: OPTIMAL USE (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) Strategic Objective 2 Improve appropriate use of antimicrobials in health systems Strategy 2.1 Establish antimicrobial stewardship programmes in human and animal health systems Output Description Objectively Verifiable Indicator OUTPUT TARGETS (PER FINANCIAL YEAR) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Antimicrobial stewardship programmes implemented in human, animal and agriculture facilities Number of stewardship committees formed at facility level Four regional briefings; 32 committees formed 384 committee monthly meetings 384 committee monthly meetings 384 committee monthly meetings Reports / minutes Funds available MoH / MoAIWD / Health facilities Output 2 Regular review of antimicrobial stewardship programmes done Number of programmes reviewed Two consultation meeting; One workshop to develop the monitoring tools One test for M& E tools ; printing M&E 40 copies; one supervisory visit 40 copies printed; 1 annual supervisory visit 40 copies printed; 1 annual supervisory visit 40 copies printed; 1 annual supervisory visit M&E tools Funds available MoH / MoAIWD / Regulatory bodies Output 3 Developed structured (and mandatory) training materials / tool on optimal antimicrobial use Number of training materials/tools developed Two consultation meetings; Two workshops to develop training tool; testing training tool Testing training tools ; 20,000 copies MoH / MoAIWD / Regulatory bodies Number of trainings conducted Four regional sessions Four regional sessions Four regional sessions MoH / MoAIWD / Regulatory bodies % of attendance at training session 50% 60% 70% Report / Register Funds available MoH / MoAIWD / Regulatory bodies ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 75 ANNEX 6: INVESTMENT & SUSTAINABILITY (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) Strategic Outcome Ensure sustainable investment through research and development. Strategic Objective 1 To Develop the economic case for investment that address the country’s AMR needs Strategy 1.1 Develop an all-inclusive plan used for securing and lobbing funding for AMR implementation Output Description Objectively Verifiable Indicator Annual Output Targets Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Economic impact needs assessment Conducted on AMR Economic Impact Needs Assessment report produced and disseminated 46 stakeholder meetings 1,780 copies of the report MoH Output 2 Economic gaps identified to inform priorities for investment in AMR implementation Report on economic gap compiled Ten inspection reports 1,000 Copies printed Six Stakeholder meetings MoH Output 3 Funding investment plan developed Investment plan produced and disseminated Six dissemination meetings MoH Output 4 Donors and key implementing partners mapped out List of donors and key implementing partners produced Six stakeholder meetings Two review meetings MoH Output 5 Increased funding within government ministries AMR activities incorporated with ORT funding with government ministries 20 stakeholder meeting 10 review meetings MoH Output 6 Monitoring and Evaluation plan developed M&E tools developed and implemented 30 stakeholder meeting, 10 review meeting, 1 piloting tool Five review meetings MoH Output 7 Adaptation mechanism of AMR activities developed M&E plan adapted Six dissemination meeting, six trainings Six review meetings MoH ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202276 ANNEX 6: INVESTMENT & SUSTAINABILITY (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) Strategic Objective 2 To develop an effective mechanism for a sustainable AMR implementation Strategy 2.1 Develop an all-inclusive effective plan for sustainable AMR implementation Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Source and Means of Verification Risks and Assumptions Responsibility Output 1 Investment need for a sustainable AMR National Action Plan established Investment needs produced and disseminated Six dissemination meetings MoH Output 2 Policy makers and other stake holders engaged in implementation of AMR activities Report on engagement meetings with policy makers and stakeholders compiled Three meetings on development of TORs Four meetings to share and disseminate TORs MoH Output 3 Partnership strengthened both at national, regional and international level for AMR implementation. MOU for partnership signed Four quarterly meetings Four review meetings MoH Strategy 2.2 Strengthen organization capacity for a sustainable AMR implementation Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Infrastructure constructed No. of infrastructure constructed, No of vehicles procured and No of computers procured Three vehicles procured; four computers procured Output 2 Equipment improved for AMR implementation No. of equipment procured, No. of office supplies procured Ten office supplies procured Strategy 2.3 Monitoring and Evaluation Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Data capturing tools developed for AMR implementation No. of data capturing tools developed Three workshops to develop the tools ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 77 ANNEX 6: INVESTMENT & SUSTAINABILITY (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) Strategic Objective 3 Identify operational research priorities for participation in international collaborative research to support the development of new medicines, diagnostic tools and vaccines Strategy 3.1 Establish procedures for participation in international collaborative research to support the development of new medicine, diagnostic tool and vaccines Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Research priorities for AMR innovation defined No. of defined research priorities for AMR innovation A workshop to compile a document on research priorities MoH Output 2 Need for new medicines and diagnostic tools and vaccines analyzed No. of needs identified for AMR innovation One workshop to compile needs MoH Output 3 Plan to promote research for innovation to address AMR developed No. of meetings conducted to promote research for AMR innovation Three regional meetings Three regional meetings Three regional meetings Three regional meetings Three regional meetings MoH Strategic Objective 4 Identify operational research priorities for participation in international collaborative research to support the development of new medicines, diagnostic tools and vaccines Strategy 4.1 Strengthen and streamline international collaboration on AMR Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Existing collaboration on AMR reviewed MOU signed 100 copies printed MoH Output 2 Collaboration at national, Regional and international level No. of collaboration meetings conducted Four meetings Four meetings Four meetings Four meetings Four meetings MoH Strategy 4.2 Strengthen inter-sectoral coordination of AMR activities Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Cross-cutting inter-sectoral coordination mechanism on AMR established No. of meetings on inter-sectoral coordination Two meetings Two meetings Two meetings Two meetings Two meetings MoH Output 2 Priority areas of action to strengthen coordination mechanism identified No. of priority areas documented Two workshops to compile priority areas MoH ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202278 ANNEX 6: INVESTMENT & SUSTAINABILITY (OUTCOMES, OBJECTIVES, STRATEGIES AND OUTPUTS) Strategic Objective 5 Strengthen National collaboration to address AMR containment in disease control programs Strategy 5.1 Strengthen drug resistance containment activities of disease control programs with AMR program Output Description Objectively Verifiable Indicator Output Targets (Per Financial Year) Source and Means of Verification Risks and Assumptions Responsibility 2017/2018 2018/2019 2019/2020 2020/2021 2021/2022 Output 1 Linkages between HIV drug resistance activities and MDR/XDR-TB activities established Percentage of HIV &MDR/XDR-TB activities linked to AMR containment activities Two workshops to link HIV drug resistance activities to IDSR programme MoH Output 2 AMR containment activities in alignment with IDSR program integrated No. of integrated activities for IDSR & AMR containment Three workshops to align AMR containment activities to IDSR programme MoH ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 79 ANNEX 7: ANNUAL WORK PLAN (2017/18) EDUCATION AND RESEARCH Strategic Objective To Increase National Awareness of AMR Strategy Monthly Costs (MK) (2017/18) Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Establishment of an evidence-based awareness programme targeting audiences in general public, policy makers and health care providers, veterinarians and other animal health providers, environmental practitioners and farmers AMR awareness and advocacy materials Developed / adopted / translated Form a task force 1 Form a task force Translate materials Conduct a meeting to adopt materials Lack of funds MOH; MOA; DEA; MoEST Conduct meetings to review advocacy materials 1 Conduct meetings to review advocacy materials Pre-test the materials Disseminate materials Pre-test the materials 1 Print materials Conduct a meeting to adopt materials 4 Translate materials Print materials 1 Disseminate materials 6 ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202280 ANNEX 7: ANNUAL WORK PLAN (2017/18) EDUCATION AND RESEARCH Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Establishment of an evidence-based awareness programme targeting audiences in general public, policy makers and health care providers, veterinarians and other animal health providers, environmental practitioners and farmers Targeted awareness activities to the specific audiences Implemented Conduct planning meetings for targeted awareness activities Conduct planning meetings for targeted awareness activities Distribute awareness and advocacy materials Conduct awareness campaigns Conduct awareness campaigns Conduct planning meetings for targeted awareness activities Plan and conduct TV and radio programmes Distribute awareness and advocacy materials Plan and conduct TV and radio programmes Output 2 Conduct a behaviour change study on AMR Plan to conduct study Start a baseline study Study implementation Data collection and supervision Analysis of data M&E of the study Printing Dissemination ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 81 ANNEX 7: ANNUAL WORK PLAN (2017/18) EDUCATION AND RESEARCH Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Establishment of an evidence-based awareness programme targeting audiences in general public, policy makers and health care providers, veterinarians and other animal health providers, environmental practitioners and farmers Awareness raising events in line with world AMR awareness week Implemented Form a task force Form a task force Printing of awareness materials · Implement awareness raising events · Review meeting Implement awareness-raising events Printing of awareness materials Review meeting Output 2 A platform to communicate information on AMR (Website) Launched and running Plan, launch and run a platform to communicate Plan, launch and run a platform to communicate Educate and engage with media, pharmaceutical industries, CSOs, NGOs, politicians, community leaders and other relevant stakeholders Output 1 Regional seminars with media, Pharmaceutical industries and other stakeholders on AMR conducted Plan and conduct seminar Plan and conduct seminar Print materials Print materials Book conference centre ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202282 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D EDUCATION AND RESEARCH Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Output 2 Media and other stakeholders in all AMR activities in Malawi engaged Plan and conduct review meetings Plan and conduct seminar Print materials Print materials Output 3 Media coverage of AMR activities monitored Conduct assessment of media coverage Conduct assessment of media coverage Conduct an assessment on socio behavioural drivers and determinants Output 1 Media coverage of AMR activities Monitored Conduct assessment of media coverage Conduct assessment of media coverage Rapid qualitative assessment among patients, communities, healthcare providers, pharmacists, drug dispensers, pharmaceutical sales representatives, animal production units, farmers, feed producers and environmental workers conducted Plan to conduct an assessment Start a qualitative study Run and implement the study Collect data Analyze data Supervision M&E of study ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 83 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D EDUCATION AND RESEARCH Output 2 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 A national quantitative survey on knowledge, awareness and practices (KAP) among public healthcare, animal production, agriculture and pharmaceutical sector conducted Plan to conduct an assessment Start a quantitative assessment Run and implement the study Collect data Analyze data Supervision M&E of study Establish a formal multi-sectoral and multi-disciplinary advocacy, communication, and social mobilization (ACSM) working group Output 1 TORs of the ACSM WG, with members nominated from key constituencies and stakeholders developed Form a task-force team Form a task-force team Plan and conduct a workshop with the team Develop TORs for the task-force Plan and conduct a workshop with the team Print materials for the workshop ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202284 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D EDUCATION AND RESEARCH Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Output 2 A robust evidence-based ACSM strategy and action plan to respond to the social behavioural drivers and determinants of AMR developed Plan and conduct review meeting on study findings Plan and conduct review meeting on study findings Develop strategic action plan Develop strategic action plan Output 3 Resources from government and donors to finance strategy development, research studies, and implementation of ASCM activities identified Conduct and Plan review meetings with stakeholders Conduct and Plan review meetings with stakeholders Plan, launch and implement a series of media and public communication events every 2 months, each focused separately on Objectives 1 to 5 of the GAP/NAP Output 1 Activities to commemorate annual world AMR awareness week planned and implemented Form a task force Form a task force Implement awareness-raising events Implement awareness-raising events · Printing of awareness materials · Review meeting ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 85 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D EDUCATION AND RESEARCH Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Activities to commemorate annual world AMR awareness week planned and implemented Printing of awareness materials Review meeting Output 2 Sets of specific activities and events grouped around each of objectives 1 to 5, developed and implemented every two months spread Plan and conduct review meetings Plan and conduct review meetings Plan and conduct review meetings Plan and conduct review meetings Plan and conduct review meetings Develop a mechanism and digital platform that links social behavioural practices to the GLASS AMR surveillance network Output 1 Protocols and cross-referenced data collection and analysis for establishing an AMR behavioural surveillance system to help inform target policy, regulatory, and practice reforms including community and hospital based stewardship programmes Form a task-force Form a task force M&E meeting Briefing meeting Briefing meeting M&E meeting ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202286 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D EDUCATION AND RESEARCH Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Output 2 Use of digital platform developed, trained, implemented, monitored and evaluated Develop and pre-test of the platform Hire a consultant Train the users Develop and pre-test of the platform Implementation Train the users M&E M&E Hire a consultant Lobbying with training institutions, regulatory bodies and other relevant stakeholders on AMR pre-service training Output 1 Meetings with training institutions (human and animal health), regulatory bodies and other relevant stakeholders on AMR pre-service training conducted Plan and conduct a meeting Plan and conduct a meeting ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 87 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D EDUCATION AND RESEARCH Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Output 2 Curriculum review committee with clear TORs and road map established Form a review committee Develop clear TORs Print materials Conduct a review meeting Output 3 Curriculum in relation to AMR for human and animal health, agriculture and environmental pre-service training reviewed Plan and conduct review meetings Plan and conduct review meetings Plan and conduct review meetings Meeting to present review findings Output 4 Curriculum in relation to AMR for human and animal health, agriculture and environmental pre-service training reviewed Plan and conduct review meetings Plan and conduct review meetings Meeting to present review findings ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202288 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D EDUCATION AND RESEARCH Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Output 5 Tutors and lecturers in relevant sectors trained Plan and conduct trainings Plan and conduct trainings Print training materials Output 6 Training manuals and materials developed, pretested and adopted Develop and pre-test training manuals Develop and pre-test training manuals Adoption and printing of manuals Adoption and printing of manuals Development of monitoring and evaluation plan and tools for the in-service training 2.3.2 Establish indicators for various cadres Output 1 Monitoring and evaluation plan and tools for the in-service training developed Develop and pre test tools for in service training Adoption and implementation of tools ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 89 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D EDUCATION AND RESEARCH Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Output 2 Curriculum review committees for primary and secondary schools with clear TORs and roadmap established Form a review committee Form a review committee Develop clear TORs Develop clear TORs Print materials Print materials Conduct a review meeting Form a review committee Conduct a review meeting Lobby with Ministry of Education, Malawi Institute of Education and relevant stakeholders on the inclusion or mainstreaming of AMR and related topics in the primary and secondary school curricula Output 1 Meetings conducted with the Ministry of Education, Malawi Institute of Education and relevant stakeholders Plan and conduct meetings Plan and conduct meetings ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202290 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D SURVEILLANCE & RESEARCH Strategic Objective 1 To strengthen the national AMR surveillance system Strategy 1.1 Incorporate AMR into the existing surveillance system Monthly Costs (MK) (2017/18) Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Document listing AMR priority pathogens for Malawi developed Conduct a meeting to define AMR Malawi priority pathogens to report and incorporate them into the existing surveillance system Three meetings 60 participants each First & second meetings Third meeting AMR incorporated into the national surveillance system Conduct a table-top review on existing surveillance system to identify AMR gaps and surveillance platforms Three meetings 60 participants each First & second meetings Third meeting Strategy 1.2 Establish a national coordinating centre for surveillance of AMR A multi-disciplinary Taskforce to formalize utilization of the national coordinating centre formed Form a multi disciplinary Taskforce to formalize utilization of the national coordinating centre Two meetings 40 participants each First & second meetings TORs for AMR National Coordinating Centre developed Conduct a working session to develop TORs for AMR for the national coordinating centre One meetings 20 participants each Meeting ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 91 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D SURVEILLANCE & RESEARCH Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Strategy 1.2 Establish a national coordinating centre for surveillance of AMR TORs for AMR National Coordinating Centre developed Conduct a sensitization meeting on the formalization of the coordinating centre to the public and other stakeholders Four sensitization meetings Four sensitization meetings Laboratory based surveillance on AMR strengthened Conduct a working session to develop standardized laboratory surveillance protocols One workshop - 40 participants One workshop Train TOT Three trainings - 2 participants per district (56 total) Three trainings Train staff on AMR surveillance 15 trainings (3 per zone) - 280 participants in total 15 trainings Equipment and supplies procured Identify sites for infrastructure development for lab One meeting - 40 participants Site Identification Site Assessment of equipment One site visit Assessment Visit Procurement of lab equipment and supplies, consumables Essential equipment based on site need Procurement of office equipment and supplies Essential equipment based on site need ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202292 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D SURVEILLANCE & RESEARCH Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Strategy 1.2 Establish a national coordinating centre for surveillance of AMR Equipment and supplies procured Procurement of motor vehicles Three vehicles Vehicle Procurement Strategy 1.3 Strengthen the national epidemiological surveillance system on AMR in human health, animal health, agriculture and environment Standardized surveillance protocols developed Conduct active and passive surveillance data collection on AMR from the satellite labs Monthly visits - 6 sites Document surveillance data Computers, printers, toner, data entry clerks, stationery Trainings on systematic data collection done Conduct trainings on systematic collection of data 15 trainings (3 per zone) - 280 participants in total 15 trainings AMR surveillance web database developed Design a programme and web database Procure Consultant Consultant Conduct trainings on web database use One training One training AMR External Quality Assurance System established Conduct a study tour to NICD One study tour Tour Test and adopt the procedures National reference laboratory enrolled · Procure EQA · Review results ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 93 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D SURVEILLANCE & RESEARCH Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Strategy 1.3 Strengthen the national epidemiological surveillance system on AMR in Human Health, Animal Health, Agriculture and Environment AMR External Quality Assurance System established AMR External Quality Assurance System established AMR External Quality Assurance System established Five laboratories enrolled Preparation of EQA samples EQA materials EQA Distribution of EQA sample to enrolled labs Courier/Transport Consolidate EQA data and provide feedback Quarterly meetings First meeting Second meeting Third meeting Fourth meeting Conduct refresher training EQA system One training EQA training Quarterly reporting system established Conduct supervisory visits Three supervisory visits First meeting Second meeting Third meeting Conduct review meetings Three meetings First meeting Second meeting Third meeting Strategy 1.4 Establish mechanism for regular sharing of AMR data across human, animal health, agriculture and environmental sectors MoU of sharing existing surveillance platforms developed Conduct a meeting to develop MoU with existing surveillance platforms for data sharing One meeting Meeting ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202294 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D SURVEILLANCE & RESEARCH Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Strategy 1.4 Establish mechanism for regular sharing of AMR data across human, animal health, agriculture and environmental sectors Standardized surveillance protocols developed Conduct active and passive surveillance data collection on AMR from the satellite labs Monthly visits - 6 sites Document surveillance data Computers, Printers, Toner, Data entry clerks, Stationery Trainings on systematic data collection done Conduct trainings on systematic collection of data 15 trainings (3 per zone) - 280 participants in total 15 trainings AMR surveillance web database developed Design a programme and web database Procure Consultant Consultant Conduct trainings on web database use One training One training AMR External Quality Assurance System established Conduct a study tour to NICD One study Tour Tour Test and adopt the procedures National reference laboratory enrolled · Procure EQA · Review results AMR External Quality Assurance System established AMR External Quality Assurance System established Five laboratories enrolled Preparation of EQA samples EQA materials EQA ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 95 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D SURVEILLANCE & RESEARCH Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Strategy 1.4 Establish mechanism for regular sharing of AMR data across human, animal health, agriculture and environmental sectors AMR External Quality Assurance System established Preparation of EQA samples EQA materials EQA Distribution of EQA sample to enrolled laboratory Courier/Transport Consolidate EQA data and provide feedback Quarterly meetings First meeting Second meeting Third meeting Fourth meeting Conduct refresher training EQA system One training EQA training Quarterly reporting system established Conduct Supervisory visits Three supervisory visits First meeting Second meeting Third meeting Conduct Supervisory visits Three supervisory visits First meeting Second meeting Third meeting Conduct review meetings Three meetings First meeting Second meeting Third meeting Strategy 1.5 Establish mechanism for regular sharing of AMR data across human, animal health, agriculture and environmental sectors MoU of sharing existing surveillance platforms developed Conduct a meeting to develop MoU with existing surveillance platforms for data sharing One meeting Meeting Establishment of a taskforce to review abstracts Development of ToRs for the Taskforce One meeting ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202296 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D SURVEILLANCE & RESEARCH Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Strategy 1.5 Establish mechanism for regular sharing of AMR data across human, animal health, agriculture and environmental sectors Establishment of a taskforce to review abstracts Development of tools for grading and selection of abstracts One meeting Meeting Conduct meetings to select abstracts for dissemination One meeting Meeting Conduct biannual AMR conferences for human, animal health, agriculture and environmental sectors One conference Conference Dissemination of Surveillance data and research findings Disseminate surveillance data through workshops, Media, website, churches and schools. 10 workshops Five workshops Five workshops Conduct multi sectoral (human, animal health, agriculture and environment) quarterly meetings to share AMR data Three meetings First meeting Second meeting Third meeting ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 97 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D SURVEILLANCE & RESEARCH Strategic Objective 2 To identify key stakeholders and resources in AMR research Strategy 2.1 Create a multi-disciplinary AMR research platform Monthly Costs (MK) (2017/18) Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 AMR TWG for research composing membership from all key stakeholders established Create an AMR TWG for research composing membership from all key stakeholders Two meetings Two meetings TORs for TWG developed Conduct meetings to develop ToRs for TWG for research One meeting One meeting Conduct quarterly meetings for TWG Three meetings First meeting Second meeting Third meeting A directory of key stakeholders and resources on AMR research across all sectors – government, academia, NGOs formed Conduct a meeting with stakeholders involved in AMR research across all sectors – government, academia, NGOs One meeting One meeting Collect information on on-going studies in AMR in Malawi One visit Visits Assess the human / infrastructure / equipment / financial resources that already exists for AMR research in Malawi One visit Visits ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 202298 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D SURVEILLANCE & RESEARCH Strategic Objective 3 To develop and incorporate AMR research priorities into the National (Health) Research Agenda Strategy 3.1 Develop AMR research agenda Monthly Costs (MK) (2017/18) Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Task force to develop a research agenda formed Hold task force meetings to develop a research agenda First and second meetings TORs of the Taskforce developed Hold a meeting to develop ToRs for the task force Meeting AMR research gaps identified Conduct a baseline survey on research gaps in relation to AMR Survey (procure consultant) Survey Conduct a literature review on AMR research that has been performed in Malawi to date Computer, internet Completed Compile an abstract of past and present (both published and unpublished) AMR studies in Malawi Computer, internet Existing situational analysis of AMR research in Malawi updated Conduct meetings to update the existing situational analysis of AMR research in Malawi Two meetings First meeting Second meeting ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 99 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D SURVEILLANCE & RESEARCH Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Strategy 3.2 Incorporate AMR research priorities into the National (Health) Research Agenda AMR research agenda to the National Commission of Science and Technology (NCST) Submitted To submit AMR research agenda to the National Commission of Science and Technology (NCST) One meeting Meeting Incorporation done ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022100 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INFECTION, PREVENTION AND CONTROL Strategic Objective 1 To prevent and control infection at national level Strategy 1 Establish systems and processes for IPC Monthly Costs (MK) (2017/18) Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Systems and processes established List down all activities under each output Specify quantities Conduct workshops to review existing IPC policies, guidelines, standards and SOPs Four workshops One review workshop One review workshop One review workshop One review workshop Print and disseminate the reviewed IPC policies, guideline, standards and SOP Train all relevant stake holders on how to use the reviewed IPC policies, guidelines standards and SOPs Output 2 National co coordinating unit strengthened Strengthen and expand the TORs for the national coordinating unit for IPC to include animal health Agriculture and environment One TOR One workshop to develop TORs ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 101 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INFECTION, PREVENTION AND CONTROL Strategic Objective 1 To prevent and control infection at national level Strategy 1 Establish systems and processes for IPC Monthly Costs (MK) (2017/18) Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Conduct consultative workshops to strengthen national coordinating unit Three workshops One consultative workshop Two consultative workshop s Output 3 IPC assessments conducted Conduct IPC assessment and Gap analysis in animal health Agriculture and environment One assessment to identify gaps One assessment to identify gaps Output 4 Adherence to policies monitored Monitor adherence to the national policies, guidelines, standards and SOPs Strategy 2 Develop appropriate Infrastructure for IPC implementation Monthly Costs (MK) (2017/18) Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Incinerators constructed Construction of incinerators for central hospitals (KCH and QECH) Two incinerators constructed Construct two incinerators ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INFECTION, PREVENTION AND CONTROL Strategic Objective 1 To prevent and control infection at national level Strategy 2 Establish systems and processes for IPC Monthly Costs (MK) (2017/18) Output 2 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Isolation rooms constructed / renovated Two Isolation rooms constructed / renovated for KCH and QECH Two isolation rooms constructed Construct two Isolation rooms Output 3 Hand washing facilities constructed / renovated Hand washing facilities constructed / renovated Fifty hand washing facilities constructed / renovated Construct 25 hand washing facilities Construct 25 hand washing facilities Output 4 Quarantine facilities constructed Quarantine facilities constructed One Quarantine facility constructed in Lilongwe Construct one quarantine facility Output 5 IPC infrastructure inspected Conduct one inspection of construction Conduct one inspection of construction Conduct one inspection of construction Strategy 3 Reintroduce health promotion week Output 1 Health promotion week reintroduced Conduct consultation meetings on re introduction of Health Promotion week Three consultation meetings Conduct two consultative meetings Conduct one consultative meetings ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 103 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INFECTION, PREVENTION AND CONTROL Strategic Objective 1 To prevent and control infection at national level Strategy 3 Reintroduce health promotion week Monthly Costs (MK) (2017/18) Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Health promotion week reintroduced Conduct workshop to sensitize target groups Three workshops Conduct one consultative meeting Conduct one consultative meeting Conduct one consultative meeting Conduct workshop to sensitize target groups Three workshops Conduct one sensitization workshop Conduct one sensitization workshop Conduct one sensitization workshop Publish and air press releases on reintroduction of health promotion week Four press releases Publish four press releases Observance of health promotion week Observance of health promotion week Strategic Objective 2 To prevent and control infection at community level Strategy 1 Promote personal hygiene and sanitation through behaviour change activities in the communities Output 1 Personal hygiene and sanitation promoted Conduct assessments of gaps on personal hygiene and sanitation One personal hygiene and sanitation assessment One personal hygiene and sanitation assessment One review workshop Conduct refresher courses for village health committees One refresher course training per district Conduct 7 workshops in 7 districts Conduct 21 workshops in 21 districts ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022104 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INFECTION, PREVENTION AND CONTROL Strategic Objective 1 To prevent and control infection at community level Monthly Costs (MK) (2017/18) Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Strategy 1 Promote personal hygiene and sanitation through behaviour change activities in the communities Personal hygiene and sanitation promoted Conduct awareness campaigns on personal hygiene and sanitation in communities One awareness campaign per district Conduct 14 awareness campaigns in 14 districts Conduct 14 awareness campaigns in 14 districts Output 2 Behaviour change surveys conducted. Conduct a survey on personal hygiene No. of surveys on personal hygiene conducted Strategy 2 Develop appropriate Infrastructure for IPC implementation Output 1 Awareness campaigns on proper disposal conducted Conduct 28 awareness campaigns 1 in each district One campaign per district Conduct 14 awareness campaigns in 14 districts Conduct 14 awareness campaigns in 14 districts Strategic Objective 2 To prevent and control Infection at health care and animal health setting Monthly Costs (MK) (2017/18) Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Strategy 1 Strengthen hand hygiene in health care and animal waste Hand hygiene strengthened Conduct an assessments on hand hygiene One assessment conducted Conduct an assessment on hand hygiene ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 105 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INFECTION, PREVENTION AND CONTROL Strategic Objective 1 To prevent and control infection at community level Monthly Costs (MK) (2017/18) Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Strategy 1 Strengthen hand hygiene in health care and animal waste Hand hygiene strengthened Conduct TOT workshops in 6 zones Six TOT workshops conducted on hand hygiene Conduct four TOT workshops Conduct two TOT workshops Develop IEC materials on hand hygiene 1,000 posters, 1,000 fliers, 2,500 T-shirts, 4 bill boards 1,000 posters, 1,000 fliers, 2,500 T-shirts, 4 bill boards Output 2 World hand hygiene day observed Conduct hand hygiene campaigns in each district Twenty eight hand hygiene campaigns conducted Observance of hand hygiene day One hand hygiene day observed Hand hygiene observed Output 3 Hand hygiene standards monitored Conduct monitoring of hand hygiene standards Four monitoring visits One monitoring visit One monitoring visit One monitoring visit One monitoring visit ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022106 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INFECTION, PREVENTION AND CONTROL Strategic Objective 1 To prevent and control infection at community level Monthly Costs (MK) (2017/18) Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Strategy 2 Ensure safety of health care and animal health workers Safety of health care and animal health workers ensured Develop safety policies, standards and protocols Three workshops to develop safety policies, standards and protocols Conduct two workshops to develop policies standards and protocols Conduct one workshop to develop policies standards and protocols Procure PPE 10,000 heavy duty gloves 10,000 heavy duty gloves 15,000 heavy duty aprons 15,000 heavy duty aprons 15,000 gumboots 15,000 gumboots 15,000 head gear 15,000 head gear 15,000 masks 15,000 masks 15,000 uniforms 15,000 uniforms 5,000 virals 5,000 virals Conduct medical checkups of workers 20,000 workers undergo medical check ups 5,000 workers undergo medical checkups 5,000 workers undergo medical checkups 5,000 workers undergo medical checkups 5,000 workers undergo medical checkups Inspections conducted Four inspections conducted One inspection conducted One inspection conducted One inspection conducted One inspection conducted ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 107 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INFECTION, PREVENTION AND CONTROL Strategic Objective 1 To prevent and control infection at community level Monthly Costs (MK) (2017/18) Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Strategy 3 Strengthen availability of IPC supplies in health care and animal health settings IPC supplies made available Procure IPC supplies 2,000 kg chlorine, 500L iodine, 500L chlorhexidine, 1,000L methylated spirit, 1,000L hand rub 2,000 kg chlorine, 500L iodine, 500L chlorhexidine, 1,000L methylated spirit, 1,000L hand rub 2,000 cartons soap, 1,000 L liquid soap 2,000 cartons soap, 1,000L liquid soap 10,000 mops 10,000 mops 10,0000 buckets 10,0000 buckets 10,000 brushes 10,000 brushes Strategic Objective 2 To prevent and control Infection in Agriculture Strategy 1 Promote good agriculture practices Output 1 Good agriculture practices promoted Conduct trainings on good farming practices Six trainings sessions Two trainings sessions Four trainings sessions No. of collaborative sessions conducted Six sessions Six sessions Output 2 A survey on existing practices conducted Conduct surveys to document existing practices One survey conducted ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022108 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INFECTION, PREVENTION AND CONTROL Strategic Objective 2 To prevent and control Infection in Agriculture Monthly Costs (MK) (2017/18) Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Strategy 2 Ensure workers safety during use of chemicals Workers safety ensured Conduct workshops to develop safety policies, standards and protocols developed Four workshops to develop safety policies, standards and protocols developed Two workshops Two workshops Routine Inspections conducted Conduct medical checkups for workers 20,000 workers undergo medical check ups 500 workers undergo checkups 500 workers undergo checkups 500 workers undergo checkups 500 workers undergo checkups Conduct routine inspections No. of routine inspections One inspection One inspection One inspection Strategic Objective 3 To reduce impacts of AMR on the environment Strategy 1 Promote safe management of waste from health care, animal health, industry and Agriculture Output 1 Safe management of waste promoted Develop / revise waste management plans in all sectors Four waste management plans Developing and revision of waste management plans Procure waste receptacles 50,000 bins · Procure 50,000 bins · Conduct two TOT workshops Procure bin liners 100,000 bin liners Procure 100,000 bin liners ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 109 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INFECTION, PREVENTION AND CONTROL Strategic Objective 3 To reduce impacts of AMR on the environment Strategy 1 Promote safe management of waste from health care, animal health, industry and Agriculture Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Safe management of waste promoted Conduct lobbying meetings for proper waste management Ten meetings Ten lobby meetings Conduct sensitization meetings for industries, hospitals, vet clinics and city councils on proper waste management Three regional meetings One regional meeting Two regional meetings Conduct training of workers on proper waste disposal Six zonal training sessions Two zonal training sessions Two zonal training sessions Two zonal training sessions No. of inspection conducted Four inspections conducted One inspection One inspection One inspection One inspection Strategy 2 Strengthen environmental monitoring Output 1 Environmental monitoring strengthened Procure environmental monitoring equipment Various equipment procured Procure environmental monitoring equipment Develop automated water quality monitoring system One water quality system Develop automated water quality system Conduct two TOT workshops ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022110 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INFECTION, PREVENTION AND CONTROL Strategic Objective 3 To reduce impacts of AMR on the environment Strategy 2 Strengthen environmental monitoring Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Environmental monitoring strengthened Procure Environmental monitoring PPE Various PPE Procure PPE for environmental monitoring Conduct environmental monitoring visits Four monitoring visits One monitoring visit One monitoring visit One monitoring visit One monitoring visit ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 111 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D OPTIMAL USE Strategic Objective 1 Ensure uninterrupted access to high-quality antimicrobial medicines Strategy 1 Strengthen national regulatory authorities for improved quality, safety and efficacy of antimicrobials Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 National regulatory authority strengthened and regulations implemented Conduct consultation meeting with stakeholders to evaluate the current regulations on quality, safety and efficacy of antimicrobials One One meeting Coordination and funding availability MoH ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022112 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D OPTIMAL USE Strategic Objective 1 Ensure uninterrupted access to high-quality antimicrobial medicines Strategy 1 Strengthen national regulatory authorities for improved quality, safety and efficacy of antimicrobials Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 National regulatory authority strengthened and regulations implemented Conduct an inception meeting with the stakeholders / consultants on the updating and disseminating regulatory tools One One inception meeting Coordination and funding availability MoH Review meeting to update the current regulatory tools One review meeting Coordination and funding availability MoH Strategy 2 Strengthen legislation to regulate prescription and dispensing of antimicrobials Output 2 Legislation and regulations strengthened and implemented to regulate prescription and dispensing Conduct consultation meeting with regulatory bodies. MoH, MoAIWD on prescription and dispensing of antimicrobial medicines One One consultation meeting Funds available MoH Conduct a review meeting on legislation of prescription and dispensing of antimicrobial medicines One One review meeting Funds available MoH Documentation and printing of the reviewed prescription and dispensing legislation 19,500 copies 19,500 copies Funds available MoH ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 113 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D OPTIMAL USE Strategic Objective 1 Ensure uninterrupted access to high-quality antimicrobial medicines Strategy 1.1 Develop and enforce an enabling regulatory framework and coordination for regulations on use of antimicrobials in human, animals and agriculture Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Updated and disseminated guidelines of antimicrobial use in human, animal and agriculture Consultation meeting with MoH, MoIWD Two Two consultative meetings Disseminating funds availability MoH Review meeting of the current guide lines One Documentation, printing and dissemination of the updated guidelines 20,000 copies 14,000 copies 6,000 copies Disseminating funds availability MoH Dissemination of updated guidelines Four (regional sessions) Four (regional sessions) Output 2 Regulatory mechanism established for assuring rational use of antibiotics in human, animal and agriculture Conduct consultation meetings with regulatory bodies, MoH and MoAIWD Two Two consultative meetings Stakeholder cooperation and funds availability MoH / MoAIWD Conduct a review meeting on the on existing regulatory mechanisms One One review meeting Stakeholder cooperation and funds availability MoH / MoAIWD Documentation and printing of the integrated mechanisms One 13,000 copies 6,500 copies Stakeholder cooperation and funds availability MoH / MoAIWD ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022114 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D OPTIMAL USE Strategic Objective 1 Ensure uninterrupted access to high-quality antimicrobial medicines Strategy 1.2 Develop and enforce an enabling regulatory framework and coordination for regulations on use of antimicrobials in human, animals and agriculture Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Developed Integrated essential medicines list for use in human, animal and agriculture Conduct consultation meeting with stakeholders on EML Conduct a review meeting on existing EML in humans, animal (literature) and agriculture (literature) One One review meeting Cooperation MoH / MoAIWD Workshop for developing the integrated EML; One One workshop Cooperation MoH / MoAIWD Document and print the integrated EML 6,640 2210 copies Cooperation MoH / MoAIWD Carry out dissemination sessions of integrated EML Two · One review meeting · 6640 copies Cooperation MoH/ MoAIWD Output 2 Developed policy document guiding the use of critically important antibiotics in animals and agriculture Conduct consultation meetings with stakeholder of policy document to guide the use of critically important antibiotics in animals and agriculture Two Two consultative meeting s Lack of funding and coordination MoH / MoAIWD / NCC Conduct review meeting on existing policy documents on use of critically important antibiotics in humans, animals and agriculture One One review meeting Lack of funding and coordination MoH / MoAIWD / NCC ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 115 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D OPTIMAL USE Strategic Objective 1 Ensure uninterrupted access to high-quality antimicrobial medicines Strategy 1.2 Develop and enforce an enabling regulatory framework and coordination for regulations on use of antimicrobials in human, animals and agriculture Output 3 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Workshop on documentation of policy One One workshop Lack of funding and coordination MoH / MoAIWD / NCC Print policy document copies 6,640 copies 6,640 copies Lack of funding and coordination MoH / MoAIWD / NCC Strategy 1.3 Promote good governance on antimicrobial use Adopted WHO model framework for Good Governance in the Pharmaceutical sector (Malawi Framework for Good Governance in the Pharmaceutical sector) Three consultation meetings on Adopting WHO model framework for Good Governance in the Pharmaceutical sector Three meetings MoH / MoAIWD Workshop to adopt the document One One workshop MoH / MoAIWD Strategy 1.4 Strengthen supply chain systems Developed importation and sale guidelines for veterinary medicines Consultation meeting on developing importation and sale guidelines for veterinary medicines between MoAIWD and regulatory bodies Two Two meetings Funds available MoAIWD / Regulatory bodies Workshop to develop the guidelines One Funds available MoAIWD / Regulatory bodies ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D OPTIMAL USE Strategic Objective 1 Ensure uninterrupted access to high-quality antimicrobial medicines Strategy 1.5 Develop and enforce an enabling regulatory framework and coordination for regulations on use of antimicrobials in human, animals and agriculture Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Developed monitoring systems for antimicrobial medicines supply chains Consultation meetings on developed monitoring systems for antimicrobial medicines supply chains Two Two consultation meetings Funds available MoH / MoAIWD / Regulatory bodies Workshop to develop the monitoring tools One Strategic Objective 2 Improve appropriate use of antimicrobials in health systems Strategy 2.1 Establish antimicrobial stewardship programmes in human and animal health systems Regular review of antimicrobial stewardship programmes done Consultation meetings on developing structured and mandatory training materials / tools on optimal antimicrobial use Two One consultative meeting One consultative meeting Funds available MoH / MoAIWD / Regulatory bodies Workshop to develop the monitoring tools One Funds available MoH / MoAIWD / Regulatory bodies INVESTMENT AND SUSTAINABILITY Strategic Objective 1 To develop the economic case for investment that addresses the country’s AMR needs Strategy 1 Develop an all-inclusive plan used for securing and lobbying funding for AMR implementation Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Economic impact needs assessment conducted on AMR Form a task force One · One task force · One planning meeting ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022116 ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 117 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INVESTMENT AND SUSTAINABILITY Strategic Objective 1 To develop the economic case for investment that addresses the country’s AMR needs Strategy 1 .1 Develop an all-inclusive plan used for securing and lobbying funding for AMR implementation Output 1 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Economic impact needs assessment conducted on AMR Hire a consultant to conduct assessment One One meeting to develop ToR Output 2 Economic gaps identified to inform priorities for investment in AMR implementation Hire consultant to conduct assessment One One meeting to review Output 3 Funding investment plan developed Conduct meeting to develop a funding investment plan Six Three meetings Three meetings Output 4 Donors and key implementing partners Mapped out Conduct meeting to map out key stakeholders Six Three meetings Three meetings Conduct review meeting Three Three review meetings Three review meetings Three review meetings Output 5 Increased funding within government ministries Conduct stakeholder meetings to lobby for funding with government ministries Twenty Ten meeting s Ten meeting s ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INVESTMENT AND SUSTAINABILITY Strategic Objective 1 To develop the economic case for investment that addresses the country’s AMR needs Strategy 1 .1 Develop an all-inclusive plan used for securing and lobbying funding for AMR implementation Output 6 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Monitoring and evaluation plan developed Conduct meeting to develop M&E plan One One meeting Develop M&E data tools One One workshop Pre-test the tools One One pre testing survey Pilot the tool in three districts One One pilot survey Conduct a meeting to review the tool One One review meeting Output 7 Adaptation mechanism of AMR activities developed Conduct dissemination meetings for M&E adaptation One meeting Conduct training of M&E officers on the M&E tool One training Strategic Objective 2 To develop an effective mechanism for a sustainable AMR implementation Strategy 2.1 Develop an all-inclusive effective plan for sustainable AMR implementation Output 1 Investment need for a sustainable AMR National Action Plan established Hire consultant to conduct assessment One Conduct dissemination meetings Six Four dissemination meetings Two dissemination meetings ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 119 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INVESTMENT AND SUSTAINABILITY Strategic Objective 2 To develop the economic case for investment that addresses the country’s AMR needs Strategy 2 .1 Develop an all-inclusive plan used for securing and lobbying funding for AMR implementation Output 2 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Policy makers and other stake holders engaged in implementation of AMR activities Conduct meeting to develop ToRs One One meeting Output 3 Partnership Strengthened both at National, regional and international level for AMR implementation Develop MOU One One meeting Conduct partnership meetings Ten Four meetings Six meetings Hold AMR conference at national level One One conference Participate in international conferences Six Two conferences Two conferences Two conferences Strategy 2 .2 Strengthen organization capacity for a sustainable AMR implementation Output 1 Infrastructure constructed Perform a baseline assessment for infrastructure needs One One assessment Hire contractor based on infrastructure needs One hire Procure vehicles Four Four vehicles Procure computers Eight Eight computers Procure laptops Eight Eight laptops ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022120 ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INVESTMENT AND SUSTAINABILITY Strategic Objective 2 To develop the economic case for investment that addresses the country’s AMR needs Strategy 2 .2 Develop an all-inclusive plan used for securing and lobbying funding for AMR implementation Output 2 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Equipment improved for AMR implementation Procure laboratory equipment Laboratory equipment Procure Office Furniture and supplies Office furniture and supplies Strategy 2 .3 Monitoring and Evaluation Output 1 Data capturing tools developed for AMR implementation Develop data capturing tools and reporting mechanism for AMR implementation Three Three tools Pre- testing the tool One One pre-testing survey Train M&E officers at all levels One One training workshop Adopt M&E tool for AMR implementation One One workshop Periodic evaluation of the tool Four One evaluation One evaluation One evaluation One evaluation Adaptation of M&E tool for AMR implementation One One workshop Strategic Objective 3 Identify operational research priorities for participation in international collaborative research to support the development of new medicines, diagnostic tools and vaccines Strategy 3.1 Establish procedures for participation in international collaborative research to support the development of new medicine, diagnostic tool and vaccines Output 1 Research priorities for AMR innovation defined Conduct a research priority setting workshop on AMR innovation One One workshop ANNEX 7: ANNUAL WORK PLAN (2017/18) CONT’D INVESTMENT AND SUSTAINABILITY Strategic Objective 3 Identify operational research priorities for participation in international collaborative research to support the development of new medicines, diagnostic tools and vaccines Strategy 3.1 Establish procedures for participation in international collaborative research to support the development of new medicine, diagnostic tool and vaccines Output 2 Sub-Activity Specific Quantities Unit Costs 2017 2018 TOTAL Budget Source of Funds Risks and Assumptions Responsibility Jul–Sep 2017 Oct-Dec 2017 Jan- Mar 2018 Apr-Jun 2018 Need for new medicines, diagnostic tools and vaccines analyzed Conduct a workshop to analyze the need for new medicines, diagnostic tools and vaccines One One workshop Output 3 Plan to promote research for innovation to address AMR developed Hold meetings to promote research for innovation Two Two workshops Plan a study tour in a country where this innovation is underway One One study tour Strategic Objective 4 Identify operational research priorities for participation in international collaborative research to support the development of new medicines, diagnostic tools and vaccines Strategy 4.1 Strengthen and streamline international collaboration on AMR Output 1 Existing collaboration on AMR reviewed Develop MOU One One MOU Review and sign MOU Output 2 Collaboration at national, regional and international level Conduct a collaboration meeting Four One meeting One meeting One meeting One meeting Strategy 4.2 Strengthen inter-sectoral coordination of AMR activities Output 1 Cross-cutting inter-sectoral coordination mechanism on AMR established Conduct a cross cutting meeting One One meeting ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022122 ANNEX 7: AMR STRATEGY CORE INDICATORS Sub Objective Domain Indicator Baseline (source, year) Target 2017 Target 2019 Target 2022 Periodicity of reporting To increase national awareness and understanding on AMR Establishment of an evidence-based awareness programme AMR awareness and advocacy materials developed No 40% 100% Number of targeted activities on AMR awareness conducted 0 100% 100% A behavior change study conducted 0 20% 100% Digital platform for AMR launched 0 50% 100% To determine the socio behavioral drivers and determinants for AMR Health status Rapid qualitative and quantitative assessment conducted To be determined 50% 50% 100% Establish an Advocacy, Communication and Social Mobilization (ACSM) Working group. Health status ACSM TWG established No Yes Percentage of ACSM related issues effectively addressed by the TWG 0 50% 50% 100% Develop a mechanism and digital platform that links social behavioural practices to the GLASS AMR surveillance network. Health status Percentage of district using digital platforms 0 50% 100% 100% Improve knowledge and evidence of AMR through research and surveillance Strengthen the national AMR surveillance system Health status AMR incorporated into the national surveillance system No 50% 100% Coverage of interventions Percentage of district implementing laboratory based surveillance for AMR 0 30% 60% 100% ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 123 ANNEX 7: AMR STRATEGY CORE INDICATORS CONT’D Sub Objective Domain Indicator Baseline (source, year) Target 2017 Target 2019 Target 2022 Periodicity of reporting Strengthen the national epidemiological surveillance system on AMR in Human Health, Animal Health, Agriculture and Environment Coverage of interventions Percentage of districts with epidemiological surveillance system established 0 50% 50% 100% Platform for regular sharing of AMR data across human, animal health, agriculture and environmental sectors established 0 100% 100% 100% To develop and incorporate AMR research priorities into the National (Health) Research Agenda Quality and safety A consolidated chapter of AMR research priorities incorporated in the National Health Research Agenda 0 100% Enhance infection control and prevention To prevent and control spread of resistant microorganisms Quality and safety Percentage of districts effectively implementing IPC To be determined 25% 50% 100% Percentage of communities that promote personal hygiene and sanitation To be determined 50% 100% Access Percentage of Health personnel that have access to all the necessary PPE and Hand hygiene supplies to practice IPC To be determined 25% 50% 100% Optimal use of antimicrobials medicines in human and animal health and agriculture Ensure uninterrupted access to high-quality antimicrobial medicines Access Percentage of availability of antimicrobials according to EML in all health establishments To be determined 100% 100% ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022124 ANNEX 7: AMR STRATEGY CORE INDICATORS CONT’D Sub Objective Domain Indicator Baseline (source, year) Target 2017 Target 2019 Target 2022 Periodicity of reporting Institutionalize antimicrobial stewardship Access Percentage of institutions adhering to the AMR policy To be determined 50% 100% Address the use of antimicrobials in animal health Health security Policy to promote good governance on antimicrobial use developed 0 30% 70% 100% Ensure sustainable investment through research and development. Develop the economic case for investment that address the country’s AMR needs Health security Percentage of financial allocation towards AMR To be determined 50% 100% Strengthen and streamline international collaboration on AMR Health Security MOU with international stakeholders signed To be determined 0 50% Completed ANTIMICROBIAL RESISTANCE STRATEGY, 2017 - 2022 125 Governance Structure GOVERNMENT OF THE REPUBLIC OF MALAWI