Tonga National Multisectoral Plan on Antimicrobial Resistance 2017-2022

Page 1 of 30 Tonga National Multi sectoral Plan on Antimicrobial Resistance 2017-2022 Page 2 of 30 Page 3 of 30 Acknowledgement We gratefully acknowledge the effort of different stakeholders who had contributed in developing and finalizing this multi-sectorial plan. Thanks to the Ministry of Health, Ministry of Agriculture, Food, Forests and Fisheries, Environment, Ministry of Education & Training, Ministry of Tourism, Ministry of Internal Affairs, Ministry of Revenue & Custom, Ministry of Finance & National Planning, Crown Law and also private sectors and civil societies. We also extend our thanks to the government of Tonga, the Honourable Prime Minister and other cabinet Ministers for supporting this plan. Finally, thanks to the World Health Organization for providing technical and funding support in all phases of developing this multi-sectorial plan. Page 4 of 30 Table of Contents ACRONYMS .................................................................................................................................. 1. INTRODUCTION....................................................................................................................... 2. SUMMARY OF COUNTRY SITUATION ANALYSIS .......................................................... 3. GOVERNANCE OF ANTIMICROBIAL RESISTANCE...................................................... 4. ACTION PLAN ON ANTIMICROBIAL RESISTANCE ....................................................... GOAL.. ............................................................................................................................................. STRATEGIC OBJECTIVES ........................................................................................................... 5. ANTIMICROBIAL RESISTANCE OPERATIONAL PLAN ............................................... OBJECTIVE 1: ESTABLISH AND ENSURE GOVERNANCE, SUSTAINABLE INVESTMENT AND ACTIONS TO COMBAT AMR ............................................................................................................... OBJECTIVE 2: IMPROVING AWARENESS AND UNDERSTANDING OF AMR ACROSS ALL INSTITUTIONS AND SECTORS............................................................................................................... OBJECTIVE 3: STRENGTHEN SURVEILLANCE, DIAGNOSTIC CAPACITY AND RESEARCH ON AMR ................................................................................................................................................. OBJECTIVE 4: REDUCING INCIDENCE OF AMR THROUGH EFFECTIVE INFECTION PREVENTION AND CONTROL MEASURES, FOOD SAFETY AND HYGIENE ................................................ OBJECTIVE 5: OPTIMIZE THE USE OF ANTIMICROBIAL MEDICINES IN HUMAN AND ANIMAL HEALTH ............................................................................................................................................. REFERENCES ................................................................................................................................ Page 5 of 30 Acronyms AMR Antimicrobial Resistance AST Antibiotic susceptibility testing CSA Country situational analysis EQA External quality assessment IEC Information, Education, and Communication IPC Infection prevention and control MAFFF Ministry of Agriculture and Food, Forests and Fisheries MOH Ministry of Health DTC Drugs & Therapeutic Committee M&E Monitoring and evaluation NGO Non-governmental organization PPE Personal Protective Equipment QMS Quality management system TOR Terms of Reference WASH Water, Sanitation and Hygiene WHO World Health Organization Page 6 of 30 1.0 Introduction In 2014, the World Health Organisation (WHO) declared antimicrobial resistance as a global health threat that requires urgent collaborative action. High rates of resistance to hospital and community-acquired infections have been reported globally, with some of the highest rates reported in the Western Pacific Region. The Ministry of Health in Tonga (MOH) has identified antimicrobial resistance (AMR) as one of the priority agenda item following series of infectious disease outbreaks which has overburdened the current health care system. Given the complexity of AMR issue in Tonga, only a comprehensive approach involving all stakeholders is likely to succeed. This commitment is in line with the recommendation of the 68th session of the World Health Assembly in 2015 where all Member States committed to developing national plans on AMR within the two years following endorsement. This National Action Plan on AMR is supported by the priority actions listed in the Action Agenda for Antimicrobial Resistance in the Western Pacific Region, which was endorsed by the 65th session of the Regional Committee for the Western Pacific Region in 2014. While the development of resistance is recognised as a significant human health issue, it also inter-linked with animal health, marine life, environment, food and agriculture farming. However, effective action on AMR will require a coordinated response from government, relevant ministries and international agencies as well as research institutions. Strategic actions will need to involve and will affect clinicians, pharmacists, patients, veterinarians and farmers, all of whom have contributed to the current AMR problem and all of whom will be part of a long-term solution. Page 7 of 30 1.1 Summary of Country Situational Analysis on Antimicrobial Resistance in Tonga Tonga has identified antimicrobial resistance as a priority agenda, with support and commitment from government. Country has recognised the complexity of AMR and the obvious interdependency of human, animal, environment and economic sectors in determining health impact and considerations of country, the ‘One Health Approach’ would be the best platform to tackle AMR and its risks. Policy makers are aware of the threat of antimicrobial resistance; however the awareness in the general public is low and continues to be one of the key challenges. To illustrate this lack of awareness, people are still sharing antibiotics with relatives or friends while some had stopped taking their antibiotics after they felt better. Tonga had started experiencing the threat of AMR as evidenced from the lab-based surveillance that Methicillin Resistant Staphylococcus Aureus (MRSA) is widely spreading throughout the island groups of Tonga, and had started to overwhelm the health care delivery and the health systems at present. The rate of MRSA in Tonga was high (42%) in 2016 compared to New Zealand (10%), the Cook Islands (12%) and Australia (26%) but low compared to Samoa (48% in 2016) and the USA (50-60%). Tonga does not have a national AMR surveillance and no dedicated AMR unit in the MOH or MAFFF to coordinate the AMR surveillance for both human and animal health. However, MOH has a functional clinical laboratory with well- trained but limited number of staffs, not spacious and also challenged by logistics and funding. This is the first situational analysis on AMR for Tonga and it highlights and introduces new issues to prescribers, dispensers/ pharmaceutical enterprises both public and private, consumers/users of antimicrobials, politicians, media, and communities at large, that while we are all responsible for addressing and containing AMR, concerted efforts are needed to maintain effective and efficient supply and effectiveness of antibiotics ensuring access to these life-saving drugs. In summary, CSA indentified areas that needs strengthening such as 1) awareness raising on AMR in all areas; 2) formulation of national comprehensive plan on antimicrobial resistance; 3) coordinated national surveillance systems to monitor AMR and antimicrobial use in all sectors; and 4) organized regulatory framework and governance Page 8 of 30 to implement the AMR plan. These findings will inform the development of National Action Plan on AMR in Tonga. Page 9 of 30 1.2 Multi-sectoral Governance on Antimicrobial Resistance in Tonga Multi-level governance is the key for successful action in containment strategies for AMR. It requires significant leadership to recognize the importance of AMR using a clear framework and coordinated mechanism. In Tonga, three main bodies are suggested to oversee and coordinate AMR agenda: i. Cabinet Committee – for decision making role ii. Tonga National Strategy for Emerging and Infectious Diseases Committee (TNSED) – coordinate country response to AMR and implementation of Asia Pacific Strategy for Emerging Diseases (APSED) iii. Secretariat – Ministry of Health to act as secretariat to both technical committee iv. AMR Steering committee - to implement the AMR plan and reporting to TNSED v. Technical working group (TWG) - prioritize activities outlined in the national action plan and assist in implementation of plan Page 10 of 30 Tonga National Emerging Infectious Diseases Committee (TNSED) Members (CEO's): • Chair: Ministry of Health (Hon Minister of Health) • Vice chair: Ministry of Agriculture & Food, Forests • Ministry of Health • Ministry of Fisheries • Ministry of Revenue & Customs • Ministry of Finance & Planning • Ministry of Internal Affairs • Ministry of Education &Training • Ministry of Tourism • MEIDECC • Crown Law • Food Council • Pharmacy Society • Council of Churches Draft Terms of reference: • Purpose: To coordinate and monitor country response to AMR and APSED • Reporting to the cabinet • Evaluate policies, regulations and guidelines related to AMR before passing for Cabinet endorsement • Guide and direct the AMR steering committee on the implementation of AMR plan • Meet 4 times a year (and other times on an ad hoc basis) • Secretariat to be appointed by committee • Quorum of the meeting is deemed fulfilled in presence of 6 members. The meeting may commence if the quorum is fulfilled and Chairperson not available. A vice chair will lead the meeting during the absence of the Chairperson. • Internal or external persons may be invited to attend the meetings at the request of the Chairperson on behalf of the committee to provide advice and assistance Page 11 of 30 where necessary. They have no voting rights and may be requested to leave the meeting at any time by the chairperson National AMR Steering Committee Members (Technical Unit Representative): • Chair: Ministry of Health • Vice chair: Ministry of Agriculture & Food, Forests • Ministry of Health – Public Health, Pharmacy, MS & Lab • Quarantine • Livestock • Ministry of Fisheries • Ministry of Customs • Ministry of Finance & Planning • Ministry of Internal Affairs • Ministry of Education & Training • Ministry of Tourism • Department of Environment • Crown Law • Food Council • Pharmacy Society • Tonga Medical Association • Council of Churches • Academia (USP, QSN) • Co-opted members: HMAF, Police Advisors: WHO and FAO Draft Terms of reference: • Purpose: To implement the AMR action plan in Tonga • Reporting to the TNSED (reporting time to be determined by TNSED committee) Page 12 of 30 • Chair to rotate every year among the two co-chairs • Meet 4 times a year (and other times on an ad hoc basis) • Mobilize resources and prioritize allocation of funds • Monitoring and evaluation of outcomes • Review and update the national action plan and operational plan every 2 years • Chairperson may communicate with APSED when required AMR Technical Working Group Members (depending on activity): • Team leader • 4-5 members Draft Terms of reference: • Purpose: To prioritize activities outlined in the national action plan • Reporting to the AMR steering committee • Reporting time to be determined by AMR steering committee APSED Committee Please refer to relevant documents at MOH, which outlines TOR and Memberships of this committee. Page 13 of 30 2.0 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. 2.1 Strategic Objectives 1. Establish and ensure governance, sustainable investment and actions to combat AMR • Establish AMR governance structure for finalizing and implementing the national action plan • Ensure political commitment on the implementation of the national action plan • Enforcement of appropriate legislations in all sectors • Ensure sustainable investment in combating AMR 2. Improving awareness and understanding of AMR across all institutions and sectors • Promote information sharing on current update of AMR and use of antimicrobials across institutions and sectors • Raise awareness on AMR to health-care workers and veterinarians 3. Strengthen surveillance, diagnostic capacity and research on AMR • Develop a national AMR surveillance system with a reference laboratory • Strengthen food safety capacity to combat AMR • Strengthen research and information sharing on AMR 4. Reducing incidence of AMR through effective infection prevention and control measures, food safety and hygiene • Establish a national infection prevention and control programme • Implement the Water, Sanitation and Hygiene (WASH) program to promote safe water and hygiene practices • Promote good infection control and biosecurity practices in animal husbandry • Implement Good Hygienic Practices (GHP) and Hazard Analysis and Critical Control Point (HACCP) in food handling and processing Strengthening of vaccination program in human and animal sectors 5. Optimize the use of antimicrobial medicines in human and animal health • Strengthen regulations to promote responsible use of antimicrobials • Strengthen procurement and supply of antimicrobials 1 3.0 Tonga National Antimicrobial Resistance Operational plan (Years: 2017-2022) SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR 1. Establish and ensure governance, sustainable investment and actions to combat antimicrobial resistance 1.1 Establish AMR governance structure for finalizing and implementing the national action plan 1.1.1 Formalize the establishment of a National AMR committee Identify a regulatory body to govern AMR multi-sectoral committee Q1 2019 AMR task force Regulatory body formalized Establish a national AMR multi-sectorial committee empowered by a regulatory body Q1 2019 AMR task force AMR committee formalized and endorsed by Cabinet Identify reporting structure and communication channel for the national AMR committee Q1 2019 AMR task force AMR committee structure established Develop a clear terms of reference for the national AMR committee Q4 2018 AMR task force ToR developed 1.1.2 Develop a National Action and Operational Plan for AMR Finalize the draft national action and operational plan on AMR Q1 2019 AMR taskforce National AMR committee AMR plan endorsed by cabinet Establish technical working group (TWG) to implement the AMR plan Q1 2019 National AMR committee TWG established 1.1.3 Develop a budget for implementation of the action plan and identify funding sources Consultation with key stakeholders for costing the AMR activities outlined in the AMR plan Q1 2019 National AMR committee MOH MAFFF Costing completed 2 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR Donor Partners Submit a costed plan to the cabinet for endorsement Q1 2019 National AMR committee Costed plan endorsed by cabinet Dedicated budget for AMR Conduct consultation meeting with key partners for the identification of funding sources Q1 2019 National AMR committee Funding sources identified 1.1.4 Regular monitoring and evaluation of the implementation of the national action plan Hold a quarterly meeting to discuss implementation of the national action plan Quarterly Meeting minutes disseminated Annual meeting for evaluating the AMR action plan implementation and making amendments to the plan Yearly National AMR committee Annual review conducted Amended plan endorsed Conduct impact cost assessment on AMR Q4 2020 National AMR committee Donor Partners Assessment completed and report submitted 1.2 Ensure political commitment on the implementation of the national action plan 1.2.1 Establish a high level commitment between national level Develop an AMR memorandum of understanding between key sectors Q1 2019 National AMR committee MoU signed by different sectors 3 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR 1.3 Enforcement of appropriate legislations in all sectors 1.3.1 Strengthen legislation of AMR in both human and animal sector Review of existing legislation and medicine policies to ensure it incorporate clauses related to the use of antimicrobials in both human and animal sectors Q4 2019 National AMR committee Legislation and medicine policies revised and endorsed 1.4 Ensure sustainable investment in combating AMR 1.4.1 Invest in appropriate human resources and infrastructure to ensure sustainable implementation of the national action plan Establish position for an AMR project officer to assist AMR committee and TWG in implementing AMR plan Q1 2019 MOH National AMR committee AMR project officer appointed Identify AMR champions in each sectors Q1 2019 AMR champions identified and endorsed Provide and support formal training of paravet, veterinarians, infectious disease specialist either in country or overseas Ongoing National AMR committee "n" numbers of paravet trained and certified "n" numbers of veterinarians trained and certified "n" numbers of infectious disease 4 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR specialist trained and certified Develop a checklist for facilities assessment specific to AMR response Q2 2019 National AMR committee Checklist developed Identify and assess all facilities to ensure its adequate to prevent, control and respond to AMR using checklist Q2 2019 National AMR committee 100% of facilities assessed Develop human resource and training plan for staff to sustain the implementation of AMR plan Q2 2019 National AMR committee Human resource and training plan developed and endorsed 2. Improve awareness and understanding of antimicrobial resistance across all institutions and sectors 2.1 Promote information sharing on current update of AMR and use of antimicrobials across institutions and sectors 2.1.1 Develop awareness raising materials and conduct awareness activities Develop IEC materials on AMR for the general public and policy makers Q2 2019 TWG – Awareness WHO FAO IEC materials printed and distributed Conduct regular AMR advocacy and awareness using all means of communication/ mass media 6 monthly TWG – Awareness WHO FAO 2 awareness raising conducted annually Hold annual awareness campaign to celebrate World Annually MOH MOH Awareness week 5 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR Antibiotic Awareness Week WHO campaigns conducted annually Conduct regular awareness raising for farmers, importers, exporters, food processors, and animal production officers 6 monthly TWG – Awareness Donor Partners 4 awareness raising conducted annually Engage & train community leaders, NGO’s , Civil societies, churches, sports groups to raise awareness on AMR 6 monthly TWG – Awareness Donor Partners 4 training session conducted Conduct public perception survey on AMR Biennium TWG – Awareness Donor Partners Perception survey completed and report submitted 2.1.2 Promote effective sanitation and hand hygiene in the community setting Participate in the world hand hygiene day and develop promotional materials Annually MOH MOH Donor Partners World hand hygiene day celebrated annually Promotional materials distributed Raise awareness on hand hygiene and effective sanitation in the community Quarterly MOH MIA MOH Donor Partners 4 awareness conducted annually 6 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR 2.1.3 Integrate AMR in educational programme for schools at all levels (primary & secondary) Revise the education curriculum to capture AMR, basic sanitation and hand hygiene Q2 2019 Education – Curriculum unit MOET MOH MAFFF Donor Partners Curriculum updated and endorsed 2.2 Raise awareness on AMR to health-care workers and veterinarians 2.2.1 Include AMR as core component of professional education, training for health-care professionals and veterinarians Ongoing continuous professional development on AMR for health-care workers and veterinarians/livestock officers Quarterly MOH MAFFF MOH MAFFF Donor Partners 4 CPD completed on AMR per year Include AMR as core component of professional education in health, agricultural and fisheries sector in tertiary institution Q4 2019 AMR included in the course modules Enrolling health-care workers and veterinarians/livestock officers on any AMR online course offered on POLHN or from other institutions Annually MAFFF MOH Donor Partners Participants completed online course and receive certificates Conduct AMR perception survey of health-care workers and veterinarians/livestock officers Biennium MOH MAFFF Donor Partners Perception survey completed and report submitted 3. Strengthen surveillance, diagnostic capacity and research on AMR 3.1 Develop a national AMR surveillance system with a reference laboratory 3.1.1 Strengthen laboratory staff capacity for training on microbiology and quality antimicrobial susceptibility testing Build capacity of laboratory staff in microbiology testing and Q2 2019 MOH – MOH All laboratory 7 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR analysis of antibiogram using the existing information system Laboratory WHO Donor Partners staff trained Train laboratory staff in conducting external quality assessment on AMR Q2 2019 MOH – Laboratory All laboratory staff trained 3.1.2 Strengthen laboratory capacity and infrastructure for AMR surveillance Identification of a designated National Reference Laboratory for AMR to cater for human health, animal health and food sector Q4 2019 MOH MAFFF MOH MAFFF Donor Partners National reference laboratory identified Identify overseas referral laboratory for genotyping Q2 2019 MOH WHO Overseas referral laboratory identified Develop and review standard operating procedures for overseas referral of specimen (human & animal specimen) for genotyping Q2 2019 MOH – Laboratory MOH SOP's updated and endorsed Develop and review standard operating procedures for antibiotic testing and quality management system in all laboratories Q2 2019 MOH – Laboratory MOH SOP's updated and endorsed Implement QMS and EQA programmes in all laboratories that conduct antibiotic susceptibility testing Q4 2019 MOH – Laboratory MOH MAFFF Donor Partners EQA & QMS conducted annually Develop national database for real-time information on emergence of AMR that links to the national information system - WHONET Q4 2019 MOH – Laboratory MOH MAFFF Donor Partners AMR Database developed Equip the national reference laboratory to conduct antibiotic testing for all sectors Q4 2019 Donor Partners National reference 8 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR laboratory conducting laboratory test for all sectors Establish and improve the electronic laboratory information system for AMR reporting and surveillance, including critical isolates in the national reference laboratory - WHONET Q2 2019 MOH Donor Partners Electronic system fully operational in all laboratories Ensure consistent availability of laboratory consumables and reagents Ongoing MOH 100% availability of supplies 3.2 Strengthen food safety capacity to combat AMR 3.2.1 Promote random and regular testing on meat and other food product imports for AMR pathogens and antibiotic residues Undertake random sample collection and testing for AMR and antibiotic residues.in food Q2 2020 National reference lab MOH Food Unit Donor Partners 2 samples randomly selected and tested per year 3.3 Strengthen research and information sharing on AMR 3.3.1 Promote collaborative research projects on AMR in human and animal health and the environment Provide research grant for human and animal health research for addressing knowledge gaps in combating AMR Q2 2020 AMR Committee Donor Partners 2 publications submitted to journals Conduct AMR symposium for all key stakeholders Q2 2020 AMR Committee Donor Partners Annual conference held 9 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR Conduct antimicrobial consumption survey in both human and animal sectors Q2 2019 MOH WHO AMC survey completed and report submitted Build relationship with other research institutions and collaborating centre for AMR Q2 2019 All Ministries Donor Partners MoU in place 3.3.2 Conduct bacteria susceptibility survey/profile Develop antibiogram for both human and animal focusing on critical pathogens Q4 2019 MOH MAFFF MOH MAFFF National antibiogram data available 3.3.3 Ensure sharing of AMR surveillance and use data Regular sharing of AMR surveillance and antimicrobial consumption to key stakeholders, including regional and international Q2 2020 MOH MAFFF AMR data available for sharing Develop a standard template and mechanism for reporting AMR across all sectors Q2 2020 National Reference Lab AMR standard template and mechanism in place 4. Reducing incidence of AMR through effective infection prevention and control measures, food safety and hygiene 4.1 Establish a national infection prevention and control programme 4.1.1 Endorse the national infection prevention and control policy Establish and strengthen a national infection prevention and control committee across all sectors Q1 2019 IPC committee established Review the national infection prevention and control policy Q1 2019 National IPC policy update and endorsed 10 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR Print and disseminate the national infection prevention and control policy and guidelines to key stakeholders Q1 2019 100 copies printed for for hospitals and health centres Conduct training on infection prevention and control policy and guidelines targeting patients, health care workers and health administrators Q1 2019 4 trainings per year Conduct infection prevention and control audit on hospitals and health centres Q1 2019 6 IPC audits per facility per year Develop PPE list for both health and animal sector for IPC and infectious disease outbreak Q1 2019 MOH MAFFF PPE list finalized and endorsed Ensure consistent availability of laboratory consumables and reagents Ongoing MOH MAFFF MOH MAFFF Donor Partners 100% availability of supplies 4.1.2 Disposal of expired drugs and medical waste Assess medical waste disposal system including disposal of antimicrobials Q2 2019 MOH Department of Environment MOH Environment Donor Partners Assessment report submitted Develop guidelines on disposal of unused antibiotics (including veterinary medicines) Q2 2019 MOH Department of Environment MOH Environment Donor Partners Guidelines endorsed Establish a model site for the disposal a)pharmaceuticals, b) medical waste and, c) veterinary waste Q2 2019 MOH Department of MOH Environment 3 model sites established and 11 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR Environment Donor Partners checklist developed Conduct environment impact assessment on disposal of antimicrobials Q2 2020 MOH Department of Environment MOH Environment Donor Partners Assessment report submitted 4.2 Implement the Water, Sanitation and Hygiene (WASH) program to promote safe water and hygiene practices (Note: CMO Public Health to review this section) 4.2.1 Develop the WASH program in communities and schools Conduct consultation to communities and school on WASH program MOH Public Health HWASH Cluster WASH program endorsed by communities and schools Develop a WASH program and guidelines for communities and schools MOH Public Health HWASH Cluster WASH program and guidelines endorsed Implement WASH program in communities and schools MOH Public Health HWASH Cluster WASH program implemented Conduct awareness training on WASH program in communities and schools MOH Public Health HWASH Cluster 4 trainings per year 4.3 Promote good infection control and biosecurity practices in animal husbandry 4.3.1 Strengthen infection prevention and control in animal husbandry 12 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR Develop infection prevention and control policy specific for animal farms and clinics Q1 2019 IPC policy endorsed Conduct training on infection prevention and control policy to farmers and veterinarians Q1 2019 4 trainings per year Print and distribute infection prevention and control policy to all key stakeholders Q1 2019 100 copies printed for each state hospital and clinics Conduct infection prevention and control audit on Veterinary Clinic Q1 2019 6 IPC audits per facility per year 4.4 Implement Good Hygienic Practices (GHP) and Hazard Analysis and Critical Control Point (HACCP) in food handling and processing Develop a National GHP and HACCP program and guidelines Q1 2019 Food unit Food unit Donor Partners GHP & HACCP program and guidelines endorsed Implement and strengthen the National GHP and HACCP program Q2 2019 Food unit Food unit Donor Partners GHP & HACCP program implemented Conduct awareness training on GHP and HACCP program in communities 4 trainings per year 4.5 Strengthening of vaccination program in human and animal sectors Review current immunization policy and guidelines for health sector Q1 2019 MOH MOH Donor Partners Immunization policy and guidelines updated Develop immunization policy and guidelines for health sector Q1 2019 MAFFF MAFFF 13 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR Donor Partners Conduct awareness to public on vaccination program Ongoing MOH MOH Donor Partners 4 awareness per year Conduct awareness to farmers on vaccination of animals Ongoing MAFFF MAFFF Donor Partners 4 awareness per year 5. Optimize the use of antimicrobial medicines in human and animal health 5.1 Strengthen regulations to promote responsible use of antimicrobials 5.1.1 Enforce the use of prescription on antimicrobials in the human and animal sector Review existing Therapeutic Goods Act 2001 to cover the prescribing and use of antimicrobials in both human and animal health Q1 2019 MOH MOH WHO Legislation updated and endorsed Conduct awareness on medicine legislation to veterinarians, medical doctors, other key health workers and public Q4 2019 MOH MAFFF Donor Partners 2 awareness Conduct inspection on pharmacy, medical clinic and animal clinic on the counter sales of antimicrobials Q1 2019 MOH – regulatory unit MOH 4 inspections per year 5.1.2 Develop and finalized antibiotic guidelines based on country antibiogram for human and animal use Finalize the national antibiotic guidelines for human use Q4 2018 MOH MOH Guidelines 14 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR Donor Partners published Develop a national antibiotic guideline for animal use Q1 2019 MAFFF MAFFF Donor Partners Guidelines published Develop and updating of essential medicine list for both human and animal use Q2 2019 MOH MAFFF MOH MAFFF Donor Partners List published Conduct training on antibiotic guideline and rational prescribing to veterinarians, medical doctors and other key health workers Annually MOH MOH MAFFF Donor Partners 1 training per year 5.1.3 Support the role of Medicines Therapeutic Committee in hospital Review the ToR of MTC to ensure that it cover AMR Q1 2019 MOH MOH Donor Partners ToR updated and endorsed Conduct training workshops for MTCs members on their role on AMR Q2 2019 MOH MOH Donor Partners 1 training completed 5.1.4 Strengthen border control for detection of imported antimicrobials Review of boarder control legislation to cover the declaration of all antimicrobials that enters the country Q1 2019 Customs & Revenue Food Unit Boarder control legislation updated and endorsed 5.1.5 Support patient information and counseling Establishing a medicine information center at MOH to cater for both health professionals and veterinarians Q2 2019 MOH – Pharmacy MOH Donor Partners MOH drug information 15 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR established Train pharmacist(s) on provision of medicine information services Q1 2019 MOH – Pharmacy MOH Donor Partners 1 pharmacist trained 5.1.6 Strengthen Antimicrobial Stewardship Program Develop and implement antimicrobial stewardship (AMS) program in the main hospital Q2 2019 MOH – Vaiola Hospital MOH Donor Partners AMS program developed and implemented Roll out AMS program in other hospitals, medical centre and agriculture Q2 2019 MOH MAFFF MOH MAFFF Donor Partners AMS program implemented 5.2 Strengthen procurement and supply of antimicrobials 5.2.1 Strengthen product registration of antimicrobials to ensure quality assured antimicrobials Review and streamline registration of antimicrobials use for both health and animal sector Q2 2019 MOH MAFFF MOH MAFFF Donor Partners All antimicrobials registered Review the policy and guideline on prequalification of antimicrobials that are imported to the country Q2 2019 MOH MOH MAFFF Donor Partners Prequalification policy and guideline updated and endorsed Conduct training on product assessment and physical verifications to pharmacy inspectors, customs, para-vet Q2 2019 MOH MAFFF MOH MAFFF Donor Partners 2 trainings conducted 16 SUB-ACTIVITY TIMELIN E COST (TOP) IMPLEMENT ER POSSIBLE SOURCE OF FUNDING INDICATOR 5.2.2 Ensure the availability and accessibility of quality antimicrobials Conduct in depth assessment of the medicine supply system in health sector Q3 2019 MOH MOH Donor Partners Assessment report completed Develop a procurement and supply strategies of antimicrobials in both human and animal sector Q3 2019 MOH MOH Donor Partners Procurement plan developed Review the antimicrobial medicines price in private sectors Q3 2019 Labour Commerce Antimicrobials pricing revised Review the procurement regulation and policies of medicines Q1 2019 MOH MAFFF MOH MAFFF Donor Partners Procurement regulation and policies updated and endorsed 1