Final National Action Plan to Combat Antimicrobial Resistance in Yemen approved by MOPHP

Final National Action Plan to Combat Antimicrobial Resistance in Yemen approved by MOPHP Prepared by Director of AMR Surveillance and Control Program in MOPHPand National focal point for AMR Surveillance Associated prof .Dr. Huda Zaid Al-Shami Under Supervision of Diseases Control and Surveillance General Administration MOPHP General director Dr. Khalid Abdulkareem Al-Moaaed National Professional Officer, NTDs, PIP(IHM) & IHR Officer Communicable Diseases Department- World Health Organization Dr Ahmed Ali Qaid Thabit Ministry of Public Health and Population His Excellency Minster/ Dr. Taha Ahmed Al-Mutawakel Ministry of Public Health And Population Republic of Yemen 2 i. Table Of Content No Title of subject Page No. i Table of content ii Abbreviations and acronyms iii Acknowledgement Arabic summary Executive summary Operational Framework Country Response Situational analyses and assessment Yemen Strategic plan Axis A: Awareness of AMR Operational plan and budget for axis A Monitoring and evaluation plan for axis A Axis B: Surveillance Operational plan and budget for axis B Monitoring and evaluation plan for axis B Axis C: Infection prevention and control (IPC) Operational plan and budget for axis C Monitoring and evaluation plan for axis C Axis D: Antibiotic use Operational plan and budget for axis D Monitoring and evaluation plan for axis D Axis E: Budget Planning and Fund Attraction Operational plan and budget for axis E Monitoring and evaluation plan for axis E Summary of main activities budget References 3 ii .Abbreviations and acronym ABX: Antibiotics ACC Antimicrobial Coordination Committee AMR: Antimicrobial resistance AUY : Agriculture Universty Of Yemen AMS: Antimicrobial Stewardship CERD: Center for Educational Research and Development CIAM: Critically Important Antimicrobials CME: Continuous Medical Education CIAM: Critically Important Antimicrobials DDD: Defined Daily Dose Dpt: Department EMRO: Eastern Mediterranean Region Office ESU: Epidemiological Surveillance Unit ESU: Epidemiological Surveillance Unit FAO: Food and Agriculture Organization GAP: Global Action Plan GLASS: Global Antimicrobial Resistance Surveillance System ID: Infectious Diseases IHR: International Health Regulation IPC: Infection Prevention and Control IT: Information Technology YARI: Yemen Agricultural Research Institute Microbiology DC&S: Diseases Control & Surveillance in MOH LTCF: Long-Term Care Facilities MOA: Ministry of Agriculture MOH: Ministry of Health and population MoA Ministry of Agriculture and animal worth MoE Ministry of Education MoI Ministry of Information NA: Not Available NAP: National Action Plan NGO: Non-governmental Organization NSC National multi-sectoral steering Committee OIE: World organization for animal health PHC: Primary HealthCare PHCC: Primary Health Care Center QC: Quality Control SOCs Strategic Objectives Committees SU: Sana'a University TOR: Terms Of Reference TV: Television UN: United Nations USD: United States Dollars WHO: World Health Organization WHONET: World Health Organization soft wire program 4 ACKNOWLEDGEMENT We wish to appreciate the world health organization for encouraging and providing the support and partnership in the development of this national action plan. We realize the valuable contributions of the ministry of health and population and disease control and surveillance for the development of this national action plan. We hope from world health organization representative for support and assistance on gaining these goals. The national action plan was made through cooperation between multi-sectoral ministries including of public health( infection control department, High Authority for Medicines, National Center of Public Health Laboratories … and community (Higher Education and Researches Agriculture and Livestock …) Finally, we expect great effort of all technical working groups members and hope to give the best works and expertise. 5 التنفٍذيالملخص . الزؤٌة: اىَقبٍٗخ ىيَعبداد اىَٞنشٗثٞخاألٍشاض اىَؼذٝخ ّؾ٘ َِٝ امضش اٍْب ٍِ الزسالة: اسزَشاس اىؼالط اىْبعغ أغ٘ه فزشح ٍَنْخ ٍِ خاله االؽزفبظ ثبىقذساد اى٘غْٞخ ٗرط٘ٝشٕب ىي٘قبٝخ ٍِ AMR رجبع ٍجذأ اىصؾخ اى٘اؽذح ىغَٞغ اىقطبػبد ٗاىسٞطشح ػيٞٔ ثا الهدف الزئٍسً : ٍِ خاله ظَبُ ٗاسزَشاسٝخ اسزخذاً AMR ؽَبٝخ سنبُ اىَِٞ ٍِ األٍشاض اىَؼذٝخ ٗرٖذٝذاد أدٗٝخ فؼبىخ ّٗبعؼخ ٍٗأٍّ٘خ ٍٗعَّ٘خ اىغ٘دح رُسزؼَو ػيٚ ّؾ٘ ٍسإٗه ٍزبؽخ ىَِ ٝؾزبعٖب ٗاىزشصذ نشٗثبد ٗاىَسبَٕخ فٜ اىجؾ٘س اإلقيَٞٞخ ٗاىؼبىَٞخ.اىَسزَش ٍقبٍٗخ ٍعبداد اىَٞ المقدمة: ؽبىٖب مبفخ اىؼبىٌ ثأّؾبء خطٞشح ٍسز٘ٝبد ئىٚ ؼذاسرف (AMR) اىَٞنشٗثٞخ اىَعبداد ٍقبٍٗخ ئُ ( Al-Shami& Al-Haimi;2018) ؽبه اىغَٖ٘سٝخ اىَْٞٞخ ػيٚ رْباقذس رٖذد ٕٜٗ ىؼبىٌا ٍسز٘ٙ ػيٚ ٗاالّزشبس اىظٖ٘س فٜ آخزح عذٝذح آىٞبد ٍقبٍٗخ ٗصَخ ، ػذٗٙ ٍِ ٍزضاٝذح قبئَخ ٗٝ٘عذ . (Al-Hammad& Al-Shamahy;2018 )اىشبئؼخ اىَؼذٝخ األٍشاض ػالط ، ٍسزؾٞو أؽٞبّب أصؼت ثو ػالعٖب أصجؼ اىزٜ ٗاىسٞالُ اىذً ٗرسٌَ ٗاىسو خاىشئ٘ٝ اىؼذٗٙ ٍضو اىؼذٗٙ ألغشاض االسزؼَبه غجٞخ ٗصفخ دُٗ ٍِ عبداداىَ ّزٞغخ صشف. اىؾٞ٘ٝخ اىَعبداد فبػيٞخ رذّٜ ثسجت فٜ أٝعب ٗٝزجِّٞ .مَب اّٖب رسزخذً ثشنو ػش٘ائٜ فٜ ٍغبه اىضساػخ ٗرشثٞخ اىؾٞ٘اّبد; اىؾٞ٘اّٜ أٗ اىجششٛ اىجٞطشِٝٞ اىصؾِٞٞ ٗاألغجبء اىؼبٍيِٞ أُ اىؼالط ٍغبه فٜ ٍؼٞبسٝخ ر٘عٖٞٞخ ٍجبدب رطجق ال اىزٜ اىجيذاُ ارخبر فٜ ّؼّغو ىٌ ٗئُ .ٕ٘ ٍ٘ع٘د فٜ اىَِٞ مَب اىزٜ اىؾٞ٘ٝخ اىَعبداد زخذاًٝفشغُ٘ اس ٍب غبىجب االىزٖبثبد ػذٗٙ فٞٔ رصجؼ أُ َٝنِ اىزٛ اىؾٞ٘ٝخ اىَعبداد ثؼذ ٍب ػصش ػيٚ ٍقذٍُ٘ فاّْب اإلعشاءاد .أخشٙ ٍشح قبريخ اىطفٞفخ اىشبئؼخ ٗاإلصبثبد ئىٚ مو اىَْظَبد اىَٖزَخ ثبىصؾخ ثبىْسجخ قص٘ٙ أٗى٘ٝخ اىَٞنشٗثٞخ اىَعبداد ٍقبٍٗخ ػالط مَب ٝؼذّ ٍبٝ٘ /فٜ أٝبس ٗاىسزُ٘ اىضبٍْخ اىؼبىَٞخ اىصؾخ عَؼٞخ قذ أقشدٗ. اىؼبىَٞخ اىصؾخ ٍْظَخ اىؼبٍخ ٗأثشصٕب اىؼبىَٞخ ىخطخ اىؼَو اػزَبدٕب غشٝق ػِ ٗرىل AMR رضٞشٕب اىزٜ اىؼٍَ٘ٞخ اىصؾخ ٍشنيخ ثإَٔٞخ األٍشاض ٍِ اى٘قبٝخ ظَبُ ٕذفٖب ىَنبفؾخ ٍقبٍٗزٖب رذخالد رْفٞز ىخطخا ٕزٓ ٗرقزشػ AMR ثشأُ :اساسٍة محاور استزاتٍجٍة على خمس تزتكز خطةال وهذة ّٗبعؼخ ٍأٍّ٘خ ثأدٗٝخ ٗػالعٖب اىَؼذٝخ ٗمفبىـخ فَٖٖـب ثشـنو أفعـو ٍـِ خـاله االرصـبه ٗاىزؼيٌٞ ٗاىزذسٝت AMRصٝبدح اى٘ػٜ ثظبٕشح .1 .اىفؼبه اىَؼبسف ٗقبػذح اىجْٞبد ٍِ خاله اىزشصذ ٗئعشاء اىجؾ٘سرؼضٝض .2 6 خفط ٍؼذالد اإلصبثخ ثبىؼذٗٙ ٍِ خاله اىزذاثٞش اىفؼبىخ اىَزؼيقخ ثبإلصؾبػ ٗاىْظبفخ ٗاى٘قبٝخ ٍِ .3 ٗاىسٞطشح ػيٖٞب اىؼذٗٙ اىؼَو ػيٚ ظَبُ اسزخذاً األدٗٝخ اىَعبدح ىيَٞنشٗثبد ػيٚ اى٘عٔ األٍضو فٜ ٍغبه صؾخ .4 ٗاىضسػخاىؾٞ٘اُ اإلّسبُ ٗ ثٞــبُ اىَجــشساد االقزصــبدٝخ ىعَبُ االســزضَبس اىَســزذاً اىــزٛ ٝشاػــٜ اؽزٞبعــبد اىَِٞ ، .5 اىَٞنشٗثبد ٗاألدٗٝخ ٗٗسبئو اىزشخٞص ٍعبداد ٍقبٍٗخ ٍنبفؾخ ٍغبه ٗصٝــبدح االسزضَبس فٜ ٗاىيقبؽبد اىغذٝذح ٗغٞشٕب ٍِ اىزذخالد اىَزؾذح ىألٌٍ اىؼبٍخ اىغَؼٞخ اىزضاٍب فٜ اىَِٞ فٖٞب ثَب اىذٗه سؤسبء ٍؼظٌ قطغ سجزَجش ٗفٜ ػجش AMR ٗساء رقف اىزٜ اىغزسٝخ األسجبة ٍؼبىغخ فٜ ٍْٗسق ٍٗشزشك ٗاسغ ثارجبع ّٖظ ثْٞ٘ٝ٘سك ٗ فٜ اىجٞطشٛ" اىؾٞ٘اُ "اىطت ٗصؾخ "اىجششٛ اىطت "اإلّسبُ ٍزؼذدح ٗخص٘صب صؾخ قطبػبد اىؾٞ٘اُ ىصؾخ اىؼبىَٞخ ٗاىضساػخ ٗاىَْظَخ ىألغزٝخ اىَزؾذح األٌٍ ٍْظَخ عَؼٞزب داىغبّت اىضساػٜ اػزَذ ثبىؾبعخ اػزشافَٖب فٜ ئغبس AMR ثشأُ (GAP)اىؼبىَٞخ اىؼَو رإٝذ خطخ قشاساد ػبً فٜ ٍعبداد ٍِ اىؼذٝذ ىَقبٍٗزٖب ٗٝ٘عذ ىيزصذٛ ثِٞ اىقطبػبد ٍشزشمخ ئعشاءاد ارخبر ئىٚ اىَبسخ َُسزؼَيخ ثبداىَٞنشٗ ْزِغخ فٜ اىؾٞ٘اّبد اى َُ ثٖب رشرجػ أإلّسبُ أٗ ٝسزؼَيٖب اىزٜ ىزيل ٍطبثقخ ىيغزاء اى َُسزؼَيخ اىَٞنشٗثبد ٍؼظٌ ٍعبداد ئىٚ ثبىْسجخ اىؾبه ٗمزىل ٗصٞقب ، اسرجبغب ٍْٖٗب اىْجبربد، ئّزبط فٜ اى ّجبربد اىجسبرِٞ. ٗصاسح رشأسٖب اىَٞنشٗثبد ٍعبداد ىَقبٍٗخ ٗغْٞخ ػَو خطخ سٞزٌ ٗظغ ,اىذٗىٞخ الىزضاٍبرْب اٝفبءا ٗ ٗثاششاف ثبىَِٞ اىؼبىَٞخ اىصؾخ ٍْظَخ ٍنزتٍِ ٗثذػٌ خ اىغٖبد األخشٙٞقاىصؾخ اىؼبٍخ ٗاىسنبُ ٗث اى٘غْٞخ اىخطخ سزشذد ؽٞش . اىؼالقخ راد اىقطبػبد ٍخزيف ٍِ االمبدَِٝٞٞ ٗ اىخجشاء ٍِ ٗاسؼخ ىغْخ اى٘غْٞخ اىخطخ ٗرجْذ اىؼالقخ راد اىقطبػبد مبفخ اششاك ٗإَٞخ اى٘اؽذح صؾخاى ثَفًٖ٘ إَٞخ اىؼَو ػيٚ العالمٍة الخطة علٍها تزتكز التً االستزاتٍجٍة ىالٕذاف اىؼشٝعخ اىخط٘غ اىؾٞ٘ٝخ ىَقبٍٗخ اىَعبداد :االتً مه الىطنٍة الخظة تتكىن العالمٍة و الصحة لمنظمة  داالٗى٘ٝب ٗ االٕذاف ر٘ظؼ اسزشارٞغٞخ خطخ.  اىزنيفخ ٗ ىزْفٞزٕب اىضٍْٜ اىغذٗه ٗ رْفٞزٕب اىٞخ ٗ اىْشبغبد ر٘ظؼ رْفٞزٝخ خطخ.  اىْشبغبد ىنبفخ االّغبص ٗ االداء ٍإششاد ذٝزؾذى ٗاىزقٌٞٞ اىشصذ خطخ اىَزم٘سح اسزشارٞغٞخ ٍؾبٗ خَسخ ؽ٘ه رزَؾ٘س فشػٜ ٕذف (14) ػيٚ اىَْٞٞخ اى٘غْٞخ اىخطخ زشرنضٗس :كالتالً فهدااألح ٕٗزٓ اػالح 7 ٗ اىصؾخ قطبع فٜ اىؼبٍيِٞٞ فئخ فٜ اىؾٞ٘ٝخ ىيَعبداد اىغشاصٌٞ ٍقبٍٗخ ٝخص فَٞب اى٘ػٜ صٝبدح .1 .اىصؾخ اىؾٞ٘اّٞخ االّسبُ صؾخ ػيٚ ٗاصشٕب اىؾٞ٘ٝخ اىَعبداد ىَقبٍٗخ اىؼبً اىَفًٖ٘ رؾسِٞ .2 .اىؾٞ٘ٝخ ىيَعبداد افعو اسزخذاً ّؾ٘ اىؼبً اىسي٘ك رغٞٞش .3 .اىؾٞ٘ٝخ اىَعبداد ٍقبٍٗخ ٍٗؼذالد اَّبغ ىزؾذٝذ خٗغْٞ سصذ شجنخ اّشبء .4 ر٘فٞش ٗ اىَشظٚ ػالط فٜ ػيٖٞب االػزَبد َٝنِ قٞبسٞخ خذٍبد ىزقذٌٝ اىطجٞخ اىَخزجشاد اداء رؼضٝض .5 اى٘غْٞخ اىشصذ ىشجنخ ٍؼيٍ٘بد صؾٞؾخ .اى٘غْٞخ اىشصذ ىشجنخ اىَسزٖذفخ االٗى٘ٝبد رؾذٝذ .6 .اىصؾٞخ سبداىَإس فٜ االٍشاض ٍنبفؾخ ثشّبٍظ رق٘ٝخ .7 اىصْبػبد ٗ اىؾٞ٘اّبد رشثٞخ ٍضاسع ٗ اىجٞطشٝخ اىَشامض فٜ اىجٞ٘ى٘عٜ ىالٍِ ٍَبسسبد اسزؾذاس .8 خٞٗاىضساػ اىغزائٞخ .اىَغزَغ فٜ اىسيٌٞ اىصؾٜ اىصشف ٗ اىْظبفخ رؼضٝض .9 .ػبىٞخ ع٘دح ادر ؽٞ٘ٝخ ىَعبداد دائٌ ر٘فش ظَبُ .11 ٗ اىؾٞ٘اُ سبُاالّ فٜ اىؾٞ٘ٝخ ىيَعبداد األٍضو االسزخذاً ظَبُ .11 اىؾٞ٘ٝخ اىَعبداد اسزٖالك ٗ اسزخذاً ىشصذ ٗغْٞخ شجنخ اّشبء .12 اّشبء األدىخ اى٘غْٞخ السزخذاً اىَعبداد اىَٞنشٗثٞٔ االسزخذاً االٍضو .13 AMRرشغٞغ أّشطخ اىجؾ٘س اىخبصخ ثـ .14 8 Executive summary Vision: Towards Yemen is safer than infectious diseases resistant to microbes the message: Continuation of effective treatment as long as possible through the retention and development of national capacities to prevent and control AMR following the principle of single health for all sectors The main objective : Protecting the population of Yemen from infectious diseases and AMR threats by ensuring the continued use of effective, safe and quality drugs that are responsibly used for those in need, continuous surveillance of antimicrobial resistance and contribution to regional and global research. Antimicrobial medicines (like antibiotics) save millions of lives Modern medicine’s dependence on antibiotics has been phenomenal since the development of these drugs beginning in the 1940s. However, the misuse and overuse of these medicines with humans and animals has facilitated the emergence and spread of antimicrobial resistance (AMR), rendering many of these drugs ineffective. Until recently, diseases such as typhoid fever and gonorrhea and most infections acquired in health-care facilities responded rapidly to affordable antibiotics, but this is no longer true. The pipeline for the development of new classes of antibiotics has also dried up, and it is unlikely that new, effective and affordable medicines will soon be available. The rise of AMR means that many common infections may again be fatal. AMR is deadly and expensive. Current estimates are that AMR now kills 700,000 people worldwide every year. This number is projected to rise to 10 million by 2050. Most of these deaths will occur in developing countries. AMR may have severe adverse effects on the global economy. If AMR is not addressed now, the world may produce around US $8 trillion less per year by 2050, and a cumulative $100 trillion could be wiped off the world’s productivity over the next years The world’s GDP could drop by as much as % Economic losses will be greatest in developing countries. 9 AMR is thus no longer only a health issue. It has grave potential to impede economy, food security and health of the people. AMR has thus become a challenge to global development invoking its political dimensions. The United Nations General Assembly and various other international agencies, especially World Health Organization (WHO), Food and Agriculture Organization (FAO) and World Organization for Animal Health (OIE), have recently witnessed strong petitions by all countries to mount globally coordinated action to prevent and contain AMR. In May 2015, the sixty-eighth World Health Assembly (WHA) endorsed the Global Action Plan on Antimicrobial Resistance (GAP-AMR), including antibiotic resistance, the most urgent drug resistance trend. The WHA resolution 68.7 has urged member states to align their National Action Plans on AMR with GAP-AMR by May 2017. Commitment by global leaders to combat AMR was further strengthened at the High-Level Meeting on AMR at the United Nations General Assembly on 21 September 2016. WHO has developed a framework for the drafting of action plans that are aligned with WHO Global Action Plan on AMR but are implementable in local contexts. In accordance with the commitment in the World Health Assembly, and to contribute to global health, Yemen will be initiated the drafting of its national action plan (NAP) and coordinated by the National Focal Point under the guidance and supervision of the National Committee. The objectives of NAP are aligned with the global action plan based on national needs and priorities. The emphasis is on One Health approach with all sectors especially human health, animal health and environment contributing towards minimizing the emergence and impact of AMR in Yemen. The overall goal of the action plan is to ensure, for as long as possible, continuity of the ability to treat and prevent infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them. 01 OPERATIONAL FRAMEWORK To achieve optimal collaborative actions by different stakeholders in association with developing partners and international organizations aiming to strength healthcare, veterinary medicine, food safety, agriculture and research. However, this work needs to be channeled into a structured plan whereby gaps are identified and tasks are dedicated to specific people who should execute them during a specific period of time. In addition, a tri-sides approach to the problem is needed to ensure a plan with the “One Health Approach” Last but not least, a budget needs to be dedicated for the execution of this plan. In 2015, the World Health Assembly adopted a Global Action Plan (GAP) on AMR, which outlines five strategic objectives including : Improve awareness and understanding of antimicrobial resistance through effective communication, education and training; Strengthen the knowledge and evidence base through surveillance and research Reduce the incidence of infection through effective sanitation, hygiene and infection prevention and control measures Optimizing the use of antimicrobial agents in health, animals and food; and 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 research , innovations and other interventions This commitment on the behalf of the World Health Organization (WHO) has been an opportunity for Yemen to organize its fight against AMR into a National Action Plan (NAP). A National multi-sectorial committee was created for the governance of the plan. The national plan will emphasize the importance of public health work • A strategic plan outlining objectives and priorities • An implementation plan that outlines the activities, mechanism and schedule • Implementation plan and evaluation of performance and achievement indicators for all activities 00 COUNTRY RESPONSE A national governance mechanism is far more likely to be effective if it has political support and authority to act, if it is accountable and if it has dedicated funds and an adequate secretariat to operate. A governance mechanism is essential for coordinating national efforts to combat AMR. in order to comprise a National Steering Committee (NSC), which will establish supporting technical working group as needed. As the AMR issue is multifaceted and requires multidimensional solutions and multi-sectoral cooperation, the following are examples of ministries, agencies, departments, experts, officials, academics and researchers in the areas of antimicrobial resistance. FIRST : National Antimicrobial Resistant Steering Committee (NSC) includes : Minister of Public Health and Population Prof. Dr. Taha Ahmed Al-Mutawakel Deputy or Deputy Minister of the Ministry of Public Health and Population for the Health Care Sector, Prof. Dr. Mohammed Al-Mansour Deputy or Deputy Minister of the Ministry of Public Health and Population for the therapeutic medical sector a. Dr.. Ali Jahaf Deputy or Undersecretary of the Ministry of Agriculture and Irrigation for the Agricultural Services Sector, Dr. Muhammad Al-Ghashem Deputy or Deputy Minister of Higher Education and Research, Prof. Ghaleb Hamid Al Qans Deputy or Undersecretary of the Ministry of Information and culture Mr. Nasr Al-Din Zaid Ali Amer Deputy or Undersecretary of the Ministry of Finance Mr. Mohammed Abdullah Ghaleb Amer General Director of the Disease Control and Surveillance, Dr. Khaled Abdullah Al Moayad General Director of the National Center for Central Public Health Laboratories, Dr. Abdul Ilah Hussein Al Harazi Head of the Supreme Commission for Medicines and Medical Appliances, Ministry of Public Health and Population, Dr. Mohammed Al Ghaili A representative of the World Health Organization, Dr. Ahmed Qaed SECOND: Antimicrobial Coordination Committee ( ACC) includes : National focal point and Director for the National Program of Combating Antimicrobial Resistance in the Department of Disease Surveillance and Control Dr. Huda Zaid Al Shami (Chairman Head) 02 A representative of the Ministry of Agriculture and Livestock (Focal Point) Dr.. Aqeel Al-Mutawakel A representative of the reference laboratory and its branches (National Center of Public Health Laboratories (NCPHL)) (Focal Point) Dr. Huda Zaid Al-Shami and Dr. Mona Mayad 4. A representative of infection prevention and control in the National Center for Disease Control and Surveillance / Ministry of Public Health and Population (Focal Point Coordinator) Dr. Mohammed Abdullah Al-Dawla A representative of the General Administration of Pharmacies (Focal Poin) Dr. Samir Muhammad Al-Sanbani A representative of the Environment and Consumer Protection Authority (Focal Poin) Dr. Abdul Malik Hassan Ahmed Al-Ghazali A representative of the Faculty of Medicine and Health Sciences - Sana'a University (Focal Point) Dr. Arwa Muhammad Othman A representative of the Faculty of Pharmacy, Sana'a University, Dr. Khaled Al Shoba A representative of the private sector (hospitals, pharmacies and laboratories) (Focal Point) Dr. Mohammed Saleh Al-Somali representative of the public sector (hospitals, pharmacies and laboratories) (Focal Point) Dr. A representative of the Fculty of Veterinary Medicine, Prof. Abdul Raouf Mohammed Al Shawkani A representative of the Council of Medical Specialties (Focal Point) Dr. Athmar Hassan Ali Al-Hasani A representative of the drug supply program, Dr. Muhammad Al-Ghaili A representative of the registration of companies, importers, medicines and medical supplies d. Najla Ahmed Al-Shami(Focal Point) Representative of the Legislation and Legal Affairs Ministry of Public Health and Population (Focal Point) The Chairman of each sub-committee (as focal point), which includes five sub-committees to implement the provisions of each axis) of the core objectives and activities of NAP for microbial resistance The core objectives and activities to be executed in NAP in Yemen are as follows: Antimicrobial Awareness Committee (head FP) The Committee for Laboratory Surveillance of Antimicrobial Resistance (head FP) The Infection Control Committee, (head FP) The optimal use of antibiotics Committee (head FP) The Committee on the Economics of Pharmaceutical Studies and Research on Antimicrobial Resistance. (head FP) For each axis, the first activity is the assignment of a focal person and a technical working group (plus Term Of References TOR), which aims at organizing the responsibilities and executing tasks in a timely manner. 03 Terms of Reference(TOR) for a National multi-sectoral steering Committee (NSC) The main purpose of the National Steering Committee(NSC) Is To Oversee Activities. Political support: As human health is the ultimate concern of activities to control AMR, the ministry of health lead the group, but joint leadership with Ministry of Agriculture and animal worth (MoA), Ministry of Education (MoE) and ministry of Information (MoI). Authority to act: The NSC will have sufficient authority to ensure that the Antimicrobial coordination committee (ACC ) recommendations and plans are implemented Dedicated funds: the availability of dedicated funds will increase the operational effectiveness of the ACC. Seed funds from the government and external sources are often required initially, but government funds should be secured as early as possible to ensure political “ownership” and increase the likelihood of programme sustainability Terms of References of AMR coordination committee (ACC) The purpose of the ACC is to oversee and, when necessary, to coordinate AMR-related activities in all sectors to ensure a systematic, comprehensive approach. Roles and Responsibility: Accountability: The ACC should be lead facilitation or a senior executive function in the government and coordination of a national response to the threat of AMR. Its leadership should take the form of officially delegated authority, with more formal procedures and official monitoring, evaluation and reporting. Moreover making recommendations and progress reports and providing a platform for programme planning and implementation to NCC. Secretariat: Operational sustainability is more likely when sufficient dedicated personnel and funding are available to support administrative activities. Information sharing: The ACC should provide a periodic progressing report for information for mutually reinforce activities among sectors to Disease Control and Surveillance (DC&S) and UN partners (WHO and International Office of Displaced people) which will be discussed at the regular meeting of NSC. Facilitation and coordination: ACC should facilitate and, when appropriate and agreed, coordinate efforts to contain and reduce the threat of AMR at sub national, national and supranational levels. Furthermore, ACC 04 should build a collaborative, cooperative, supportive environment for sharing knowledge, information and experience. Each participating party should understand the scope and limits of its own contributions and also its inter-dependence with other parties and with the whole system in order to meet the defined goals. The difficulty of achieving such an environment and building such a system should not be underestimated. External interactions: Collaboration with internal and external agencies and organizations is essential for many countries. WHO country office can support Yemen in identifying and facilitating relations with external partners. ACC will be invited, encouraged and supported to participate in any existing initiatives of the WHO country office, regional office or WHO headquarters. Internal interactions: A national AMR initiative must interact with the health system and public health and disease specific programmes and general national plan. The nature of these internal interactions and the results will depend on ACC. As many agencies and programmes have responsibilities in areas affected by AMR, a guiding principle of the ACC is to find the most appropriate ways to facilitate and provide synergy with new or existing work so that the overall objectives of the programme are achieved. Furthermore, the ACC must be appropriately integrated and have clearly defined roles and responsibilities in existing health system, public health and disease specific programmes, animal health and production, the food sector and environmental initiatives. The cross-cutting nature of the ACC should add value to these systems and programmes, not supplant them. Membership of AMR coordination committee(ACC): The national ACC will be composed of members representing the relevant sectors, notably human health, animal health and production and the food and environment sectors, ideally, the head of the ACC will be the national AMR focal point. Representatives should be given sufficient authority by their institutions to make decisions which will present periodical in NSC regular meeting. While it is important to have sufficient representation of these key stakeholders, the ACC should remain small enough to be functional, striking a balance between full representation and the functionality of the coordinating group. Meeting format and rules The meeting format and rules should conform to national norms. Standard operating procedures may be elaborated, transparently and according to the principles of best practice, to guide the activities of the coordinating committee. Members should be selected to ensure that all relevant stakeholders are equitably represented. NSC members may be invited to propose members of ACC, but the focal point and head of ACC should ensure that the proposed members have sufficient skills, knowledge, authority and influence and can collaborate. It is advisable to achieve a gender balance. 05 ACC will form subcommittees Strategic Objectives Committees (SOCs) aligned with global strategic objectives of AMR: awareness raising and behavior changes, knowledge, surveillance, Infection Prevention and Control (IPC), hygiene and biosecurity and rational antimicrobial consumption and Use. Each committee has a clearly defined mandate and an appointed chair person. In addition, technical working groups can be established and mandated for tasks that include providing technical input for ACC decision-making. The ACC should be supported by an appropriately resourced secretariat responsible for the logistics of meetings; minute-taking; preparation and circulation of documents (e.g. background papers, reports and advisory notes to NSC); and storage and archiving. The committee should has a mechanism (with appropriate records) to ensure that its members have no conflicts of interests and that the work of the ACC in the interests of public health is transparent. Failure to ensure these elements could undermine the credibility and limit the effectiveness of the committee. National AMR Focal Point A national AMR focal point should be designated to coordinate AMR activities and tasks in the health sector. Scope, roles and responsibilities The focal point should: Build sustained partnerships and work nationally and internationally on containment of AMR; Identify stakeholders and facilitate formation of an inclusive NSC and ACC. Lead and coordinate drafting of a national action plan for containment of AMR. Facilitate and oversee implementation, M&E of the plan through the ACC. Ensure regular data collection and information sharing by instituting effective communication and coordination among all stakeholders, the members of ACC and their constituencies, sectors and disciplines. Coordinate national activities for establishment of AMR surveillance systems. Report on the prevalence of and trends in AMR to the global AMR surveillance system (GLASS). The focal point will be the primary contact for all issues related to AMR in the country. Technical working group ACC may decide to form a technical working group (TWG) mandated with specific tasks such as providing technical input, conducting situational analyses or drafting NAPs. Scope, roles and responsibilities The terms of reference (ToR) of the TWG shall be established by the ACC, providing specific scope, role and responsibilities. These will usually be task-specific, and focused on 06 areas which the coordinating group have determined to be of particular focus for the country. The TWG will remain a national group and shall interact with country representatives of the required sectors, as determined by the scope of work. The TWG remains a group mandated by the ACC. As such, reporting and communications with the ACC should be regular and will be defined in the TWG- TOR. Activities may include drafting technical advice and reports, contributing to country situation analyses or participating in national action plan development. Membership Depending on the purpose, scope and tasks of the TWG, membership of a TWG may come from any of the relevant technical specialties. These may include experts from areas such as infectious diseases, microbiology, infection prevention and control, social health, food and drug regulation, surveillance system expertise, environment and others AMR Surveillance Unit (ASU): Establishing AMR surveillance unit affiliated to the IP&C administration at the NCDC to oversee the development and functioning of the national AMR surveillance system and has multidisciplinary team comprising a range of disciplines: epidemiologist, microbiologists, clinicians, data managers and the focal point for AMR surveillance and reporting to GLASS. Term of reference for the ASU: Define AMR surveillance objectives within the national AMR strategy. 2. Facilitate linkages with AMR surveillance across human health, animal health and environmental sectors. 3. Develop or adapt national AMR surveillance standards, protocols and tools and coordinate their dissemination. 4. Provide guidance and information on data collection and reporting to the national reference laboratory and AMR surveillance sites. 5. Monitor and evaluate the AMR surveillance system on an ongoing basis. 6. Define strategy for participation in GLASS. 7. Assure data management structure and format and IT solutions. 8. Select and facilitate enrolment of surveillance sites. 07 9. Coordinate collection and compilation of national AMR data. 10. Conduct data analysis and quality assurance. Analyze and feedback AMR surveillance results to AMR surveillance sites in collaboration with the national reference laboratory. 12. Aggregate and report national AMR data and data on implementation status of national AMR surveillance system to GLASS SITUATIONAL ANALYSES AND ASSESSMENT Resistance to antimicrobial drugs is a major health problem that affects the whole world. The problem is still worse in developing countries where lack of antimicrobial resistance surveys and control policies are the norm. In Yemen, misuse of antimicrobial agents by the professional and public is widespread. As in many developing countries antimicrobials can be purchased from pharmacies without prescription in Yemen. Currently , prospective (continuous/ longitudinal) study was carried out in six major hospitals in Yemen found overall incidence rate for nosocomial infection was 65.4 cases in every 100 and the overall antibiotics Resistant and multidrug Resistant parentages in table (1 to3) ( Al-Shami & Al-Haimi; 2018). 08 09 21 The prevalence of self- medication with antibiotic in children presented to the outpatient department at Sam hospital, Sana’a city Yemen found Of the 2000 patients interviewed, 1200(60%) had taken an antibiotic in the last 15 days without a medical prescription. Respiratory (80%) and gastrointestinal (13%) symptoms were most frequently reported. 312(26%) patients used the previous prescription paper to obtain antibiotics, while 888(74%) obtained antibiotics from pharmacies and drug stores without any prescription required (Mohanna, 2010). Another current study about Antimicrobial Resistance of Urinary Tract Infections, Sana'a- Yemen in 2015 found Gram-negative bacteria constitute 73% of UTI and found to be highly resistance to Nalidixic acid (70%), Co-trimoxazole (64%), and Piperacillin (62%). Gram-positive bacteria that constitutes 27 % found to be highly resistant to Co-trimoxazole (81%), Norfoxacin (69%) and Amoxicillin (67%). E. coli was the most common pathogen (42%), followed by co-agulase negative Staphylococci (10%) and Klebsiella (8%). While E. coli found to be resistant to Co-trimoxazole (66%) and Nalidixic acid (71%), Klebsiella was resistant to Co-trimoxazole (8 %) and Nalidixic acid (64%), and Coagulase Negative Staphylococci to Co-trimoxazole (88%) and Amoxicillin (75%) (Ghaleb et al , ). Moreover, Out of 32,528 TB patients diagnosed during 2014 -2016, 115 (4/1000) were DR-TB. The highest number was reported from Aden (40%) and lowest from Taiz 12%; 59% among males; and 67% among most productive years (24-45 years). Furthermore, 97% was among previously treated TB patients and 3% was positive for HIV. MDR-TB confirmed in 68% and Rifampicin Resistance (RR-TB) in 31%. The treatment success rate was 70% and death rates was 15%. Detection and enrollment rates were 27% and 80%. (Abdulmughni et al , ) Several factors are associated with the increasing emergence and spread of MDR bacteria in Yemeni .It is evident that the unoptimized use of antibiotics is a major factor for AMR development as the overuse of antimicrobial agents from nosocomial patients was 80% , Lack of good administration, resources, maintenance of hospitals, well-trained healthcare workers, and surveillance of different diseases and support of biomedical research. The poor state of health undoubtedly aggravated the problem of antimicrobial resistance in the country. Establishing monitoring systems based on routine testing of antimicrobial susceptibility and education of healthcare workers, pharmacists, and the community on the health risks associated with the problem and benefits of prudent use of antimicrobials are some of the steps that can be taken to tackle the problem in the future. Surveillance of antimicrobial consumption and use is desperately needed. Information from both surveillance programs will provide data required to direct policy on the cautious use of antimicrobials and to apprize and evaluate resistance 20 containment interventions at local and national levels. In addition, reducing the impact of hospital-acquired infection in our hospitals is urgently required. Such action will most likely reduce antimicrobial use in the hospital setting and may lead to a reduction in high rates of antimicrobial resistance reported from hospitals in Yemen. Programs dealing with control of nosocomial infections in the country should be strengthened and updated regularly. A major component of future policies for prevention and control of antimicrobial resistance in Yemen should be education of healthcare workers, pharmacists, students, and the general public. There are many international agencies such as WHO, scientific societies, and other institutions that provide excellent and accurate educational resources that should be used as guidelines. In addition, local scientific and culture societies, sport clubs, mosques, schools, universities, welfare and correctional centers, and the media should be involved in educating the community about prudent use of antibiotics. The crisis of antimicrobial resistance in Yemen has reached a stage that requires the ministries of health, agriculture, information education, and higher education and the research community to join forces in addressing this issue. Axis A: Awareness of AMR A. Develop Awareness And Understanding Of Antimicrobial Resistance Through Effective Communication, Education, Behavior Changes, And Training among all relevant health and non-health sectors at all levels A.1 .Organization of the responsibilities for the execution of the tasks A.1.1 Nominate a focal person in charge of following up the activities of the objectives of this axis A.1.2 Choose the members of the Awareness Technical Working Group (TWG)(Radio/TV Media, Social media expert, Technical, Pharmacist, ID, Microbiologist, Veterinarian, Agriculture, MOH representative, WHO) and nominate them A.1.3 Put the terms of reference(TOR) of this TWG according to NAP A.1.4 Slogan for AMR establishment A.2. Improving AMR awareness among professionals in different fields (e.g. physicians, pharmacists, dentists, healthcare workers, veterinarians, farmers, ecologists, and media specialists) through CME, AMR periodic informational SMS, lectures, etc. offered by Orders/Syndicates, addition to creating an AMR webpage as part of the official websites of MOH and MOA; A.2.1 Raising AMR awareness through syndicates, orders and scientific societies (CME, AMR periodic informational SMS, etc.) A.2.1.1 Diseases Control And Surveillance program (DC&S) scheduled lectures in national conferences of the medical, laboratories 22 ,pharmaceutical ,nursing, veterinary, agricultural and environmental fields across Yemen A.2.1.2 Ask syndicates/orders (human and animal health and agriculture) that for CME credits to be given for any lecture involving ABX use, at least 2-3 slides should be put to increase awareness about AMR and the ways to prevent it including antimicrobial use A.2.1.3 Ask orders of pharmacists, veterinarians, physicians, and dentists to send monthly SMS as reminders to health professionals about the dangers of AMR and/or AMR News. A.2.1.4 Workshops on AMR awareness to media professionals A.2.1.5 Do one workshop per governorate per year to laboratories, veterinarians and agriculture specialist (Train the trainer)$$$ Workshops on AMR awareness to media professionals A.2.2 Raising AMR awareness through Internet A.2.2.1 Create a webpage for AMR on the official websites of MOH and MOA A.2.2.2 Use existing webpages of MOH and WHO and relevant societies on different social networks (Facebook, YouTube, Twitter, Instagram) A -Preparation of broadcasting AMR awareness material to be diffused through the traditional media (radio and television) and social media (Facebook, Twitter, Instagram) A.3.1 Involving traditional (TV, radio) media and social media (Facebook, Instagram) in raising AMR awareness A.4. Raising and improving public awareness on AMR through periodic year-long advertisement and concentrated advertisement in and around the Global AMR Week in November using traditional media (radio, TV spots, interviews, talk shows), advertisement on social media networks and sending SMS periodically through national telecommunication companies; A.4.1 Prepare a yearlong schedule for TV, Radio and social media advertisement A.4.2 AMR to be periodically discussed in highly watched talk shows A.4.3 Public figure(s) associated with AMR A.4.4 Politician(s) involved in AMR week A.4.5 SMS through national telecommunication companies sent four times per year and during the global AMR awareness 23 A.5 Raising/Improving AMR awareness in education curricula on the national leve guideline)$$$ A.5.1 Sensitization about AMR awareness and hygiene in education curricula nationwide ( e.g School Curricula) A.5.1.1 Prepare a checklist including basic information about AMR that should be curricula about AMR and hygiene in school A.5.1.2 Check available school curricula and ask to fill in the gaps when AMR information according to checklist is not available..etc A.5.2 Inclusion of AMR awareness modules in curricula of human health- related specialties in different levels in higher education programs depending on the major/specialty (medicine, laboratories ,dentistry, pharmacy, nursing, veterinary medicine, food chemistry/safety, agriculture, etc A.5.2.1 Prepare checklists for University Curricula of these specialties each one separately Include AMR education Include AMR education A.5.2.2 Check curricula of health specialties to include information on AMR A.5.3 Inclusion of AMR awareness modules in curricula of Veterinary school A.5.3.1 Prepare a checklist for the needed information on AMR for veterinary school curricula A.5.3.2 Fill the gap in AMR information in veterinary school curricula A.5.4. Inclusion of AMR awareness modules in curricula of agriculture school A.5.4.1 Checklist for the needed information on AMR for agriculture school curricula A.5.4.2 Fill the gap in AMR information in agriculture school curricula A.6. Involvement of pharmaceutical companies in raising AMR awareness and provide finding for awareness activities $$$$) A.6.1 MOH and MOA should advise pharmaceutical companies (Human and Veterinary) to include in every presentation related to antimicrobial use at least 3 slides (5%) concerning AMR (Send one letter from each ministry) A.6.2 Seek private funding from Pharmaceutical companies for awareness activities targeting public and professionals A.6.2.1 Meeting with CEO s of main Pharmaceutical companies and working group and present the highlights of the AMR plan in general, awareness specifically and put plan of contribution to awareness activities 24 Axis B: Surveillance of AMR B. Strengthen the knowledge evidence base through surveillance and Research B.1 Organization of the responsibilities for the execution of the tasks B.1.1 Appointment of focal person in charge of following up the activities of the objectives of this axis B.1.1.1. Empower ESU director as focal person B.1.2 Appointment of the members of the technical working group along with its TOR B.2.Pursing reporting AMR data to the Global Antimicrobial Resistance Surveillance System (GLASS) thus optimizing AMR surveillance in humans through: B.2.1Mapping of laboratories that can potentially provide microbiologically reliable and epidemiologically representative data. These labs start reporting their data to the (GLASS). B.2.1.1Make a list of laboratories that will ultimately form an epidemiologic representation of the country and that will be sequentially entered into GLASS after capacity building B.2.2.Put a plan for capacity building for the labs that are chosen to be included in GLASS report in order to be epidemiologically representative based on an incremental plan B.2.2.1 Organize a nationwide workshop about GLASS and the plan of inclusion in GLASS and introduction to WHONE B.2.2.2-Evaluate the quality of work in the selected laboratories and Standardizing laboratory work guidelines (visit), Check 12 laboratories per year, Select the ones that can immediately report to GLASS, Put a plan for 4 laboratories that will undergo improvement in their capacity during coming year, then repeat the same the following year, then the following years B.2.2.3 Do a start up WHONET training workshops for the 12 laboratories that were chosen for the coming 2 years every years B.2.2.4 Do 6 laboratory visits for capacity building/year for 12 laboratories in different areas for building capacity and WHONET training B.2.2.5 Do External Quality Control twice per year for the 12 laboratories chosen for the 2 years, then to add the ones the following 2 years, after the 2nd year 25 B.2.3 Data Entry in GLASS B.2.3.1.Data collection from mature laboratories B. Data cleaning and entry into GLASS B.3. Periodic issuing of an epidemiologically representative national AMR surveillance report with stratification of data according to local needs of scientists, physicians, pharmacists, and researchers (e.g. blood stream infections data, community-acquired resistance, hospital-acquired AMR, healthcare-associated AMR, etc.), in addition to posting this report on AMR webpages (MOH and MOA websites). B.3.1-This report is based on WHONET data, according to local needs of physicians, pharmacists and researchers (stratification of data based on the type of priority organisms, site/region of infection or acquisition, etc.)-This report is posted on AMR webpages (MOH and MOA websites) B.4. Optimize AMR surveillance in the agricultural, food, veterinary, and environmental fields B.4.1 Research project about AMR surveillance in the veterinary field B.4.2 Design an epidemiologically representative sample for AMR surveillance (cattle, poultry, companion animals). B.4.3 Put a list of AMR priority organisms and related resistance genes for surveillance in these fields B.4.4 - Assessment of YARI, agriculture laboratory, and the chamber of manufacturing and commerce in Tripoli for the analysis of surveillance specimens in agricultural, food, veterinary, and environmental fields Suggestion of a plan of the microbiology work in this surveillance B.4.5 - Report results of ABX use and resistance surveillance in agriculture and veterinary world Send a yearly report with recommendations to the animal drug registry about ABX purchasing in the country during the coming 2 years B.4.5 -Report results of ABX use and resistance surveillance in agriculture and veterinary world Send a yearly report with recommendations to the animal drug registry about ABX purchasing in the country during the coming 2years. B.5 Create/Appoint AMR reference lab(s) B.5.1 Define TOR of AMR reference lab B.5.2 Map potential lab(s) across Yemen B.5.3 Task force to visits the potential lab(s) (WHO EMRO) to be discussed with Dr 26 B.5.4 Nominate the reference lab(s) B.5.5 MOH to sign a contract with the lab(s) B.6 Enhance research activities in AMR surveillance B Put and broadcast an AMR Research Agenda including research for alternative agents to antimicrobials B.6.2 Build a platform for researchers to communicate expertise and subjects B.6.3 A yearly or twice yearly meeting of AMR local researchers B.6.4 Organize fund raising for AMR research B.6.4 Provide help for writing proposals to bring national research funds for AMR Axis C Global action plan strategic Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and prevention measures C.1 Organization of the responsibilities for the execution of the tasks C.1.1 Appointment of focal person in charge of following up the activities of the objectives of this axis C.1.2 Appointment of the members of the technical group along with its TOR C.2 Optimize IPC practices in (Hospitals, LTCFs and PHCC) C.2.1 Improve IPC practices in Hospitals C.2.1.1 To establish national IPC guidelines; guidelines to be all-inclusive including requirements and qualifications of IPC officer and physician and checklist C.2.1.2 Inclusion of the checklist of the guidelines in accreditation standards C.2.1.3 Follow up and feedback on IPC practices in hospitals after each accreditation C.2.1.4 Syndicate of hospitals recommends periodic IPC training and workshops to employees hosted by scientific societies, universities, etc C.2.2 Improve IPC practices in hospitals C.2.2.1 To review and update guidelines of IPC in long- term care facilities that are available in Ministry of Social Affairs C.2.2.2 Inclusion of IPC checklist in the MOH licensing criteria of these facilitiesC.2.3 Improve IPC practices in HCC C.2.3 Improve IPC practices in HCC C.2.3.1 Establish guidelines on IPC in the PHCC C.2.3.2 Inclusion of IPC checklist in the MOH licensing criteria of these facilities 27 C.3 Enhance basic IPC education different majors C.3.1 Include IPC-related educational modules in human-health related majors (physicians, nurses, LAB, midwives, physiotherapists, pharmacists, dentists, lab technicians, radiologists, nutrition, medical and paramedical schools)  Basic IPC practices, including standard isolation precautions, hand hygiene, etc.  Make it mandatory and uniform in hospitals, LTCF, PHCC, (at differential level among employees).  Make IPC training available in healthcare facilities, scientific societies, universities, etc. C.3.2 Include IPC-related educational modules in veterinary schools curricula C.3.2.1 Check the current situation of IPC in the ongoing veterinary curriculum C.3.2.2 Review of IPC in regional and global veterinary curricula C.3.2.3 Prepare a proposal for veterinary school for deficit in curricula improvement, if need be C.3.3 IPC-related educational modules in curricula of three schools (Agriculture, Nutrition, Environment) C.3.3.1 Mapping of IPC in three university curricula (Agriculture, Nutrition, Environment) C.3.3.2 Review global and regional recommendations on IPC in curricula of agriculture, nutrition and environment, and formulate what should be included in them C.3.3.3 Include the recommended tricyclic AMR and IPC in curricula when not available C.4 Providing Advanced IPC training for IPC professionals C.4.1 Put TOR for IPC professionals in different healthcare facilities. Put prerequisite training/experience of IPC physicians, officers, and nurses C.4.1.1 Include in the national IPC Guidelines the TOR of the professionals C.4.2 Make training available and affordable in universities and professional societies C.4.2.1 MOH Sends letters to Ministry of Higher Education and to Order of physicians explaining the need and recommending training specialization opportunities and courses related to IPC C.5 Establishing national key performance indicators (process indicators) in IPC through C.5.1 Baseline evaluation of current situation at a national level (research project) and make it a continuous process C.5.2 National indicators to be incrementally applied with time (hand hygiene, PPE, isolation, other standard precautions, etc) C.6 Evaluation/Surveillance of nosocomial infection in hospitals rates: C.6.1 Conduct a point prevalence study on nosocomial infections in Yemen hospitals study in for the surveillance of nosocomial infections, based on the WHO project of global point prevalence surveys 28 C.7.1 Review the OIE biosafety recommendations in the veterinary C.7.2 Check the availability in of these recommendations in local veterinary laws C.7.3 Monitor the application of these laws C.7 MOH recommends to MOA to follow up on the related activities of IPC in Veterinary world Axis D: Antibiotic use Objective 4: Optimize the use of antimicrobial medicines in human and animal health D.1 Organization of the responsibilities for the execution of the tasks D.1.1 Appointment of focal person n charge of following up the activities of the objectives of this axis D.1.2 Appointment of the members of the technical working group along with its TOR D.2 Improve ABX quality control D.2.1 To support and include ABX as priority drugs in the pharmacovigilance project of the Yemeni University and the adverse drug event reporting program of the Order of Pharmacists D.3 Control the use of critically important antimicrobial molecules (CIAM) in humans D.3.1 Define CIAM by Putting a list of Clinically Important Antimicrobial Molecules (CIAM). D.3.1.1 Literature search D.3.1.2 Formulate the list of CIAM D.4 Undergoing sentinel surveillance of ABX consumption in a network of hospitals and benchmark it with international data D.4.1 Workshops on metrics for ABX use measurement D.4.2. Compilation of data from hospitals D.4.2.1 Determine the epidemiologically representative sample of hospitals for surveillance of ABX D.4.2.2 Validate the measurement of hospital consumption by DDD/1000 patient days in a batch of 4 hospitals per year Include the hospitals with adequate measurements in a sequential manner into the surveillance list and data Advice to hospitals that don’t have adequate data D.4.2.3 Surveillance of ABX use in Yemeni hospitals by auto reporting DDDs 29 D.5 Prepare hospitals and build their capacity for Antimicrobial stewardship (AMS) programs D.5 Prepare hospitals and build their capacity for basic Antimicrobial training stewardship D Preparation and dissemination of national treatment guidelines on infectious diseases to standardize the strategies of ABX use based on local epidemiology D.5.2.1 Put a list of essential guidelines D.5.2.2 Prepare the missing guidelines D.5.2.3 Prepare and follow a schedule for the presentation of the guidelines in the respective scientific societies meeting and for the endorsement these guidelines with the respective societies D.5.2.4. Post these guidelines on the AMR/AMS website D.5.3 Inclusion of AMS programs among hospital accreditation standards D.5.4 Auditing the AMS practices during MOH accreditation with feedback to hospitals D.5.5 Development of AMS webpage in the MOH website D.6. Organize the dispensing of antimicrobials in the community pharmacies D.6.1Nominate a task group for the meeting between MOH including Dr. ------ and the Order of pharmacists D.6.2 Meeting between a high-authority-level task force and the President of the Order of Pharmacists to agree over a plan to restrict dispensing of ABX D.7 Control and regulate the use of ABX in the veterinary, agriculture, food production and environment sectors D.7.1 Banning importation and use of CIAM in the veterinary field Establishing Antimicrobial Stewardship (AMS) Programs in hospitals through D.7.1.1 The CIAM list will be sent to the minister to ban their importation for veterinary use D.7.1.2 The veterinary drug office will not import these agents D. Restricting ABX dispensing in community pharmacies After Meeting between a high-authority-level task force and the President of the Order of Pharmacists to agree over a plan on this issue D.7.2 Check if CIAM are used in agriculture and environment D.7.2.1 -Review the list of drugs and pesticides officially imported in agriculture. Check if CIAM are included in this list D.7.2.2 Check if any of these molecules are used in agriculture or environment from outside the official import channel D.7.2.3 Get results of ABX residues in food items being done in Yemen D.7.3 Surveillance of importation of regularly used ABX to Yemen D.7.3.1 Form a registry of imported ABX in veterinary world 31 D.7.4 Research study about ABX consumption D.7 4.1 Research project by one of Masters Student at Sana'a University (SU) D.7 4. Research project in Agriculture school (Quantify the use of ABX in poultry farms nationally) D.7.5 Research study about unofficial importation of ABX to Yemen D.7.5 .1 Research project in Agriculture school Axis E: Budget planning and fund attraction Objective 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 E.0 Organization of the responsibilities for the execution of the tasks E.0.1 Nominate a focal person in charge of following up the activities of the objectives of this axis E.0.2 Nominate members of the technical working group E.1 AMR budget planning E.1.1 Budget for each activity of the plan has been studied E.1.1. Budget for every sub- activity is put in the NAP E.1.2. Overall budget of the plan has been assessed E.1.2. Meeting between Dr. Dr. - WHO and Dr. MOH finalize the budget E.2 Looking for sources of funding for NAP E.2.1 Meeting with WHO, MOH, MOA, NGOs to check for investment in NAP E.2.1.1 Financing from WHO discussed E.2.1.2 Financing from MOH discussed E.2.1.3 Financing from MOA discussed E.2.1.4 Financing from NGO (FAO, Foundation Merieux) discussed E.2.2 Look for other funding sources (agencies or bodies or countries) E.2.2.1 Allocate a professional that will prepare proposals for funding E.2.2.2 The allocated professional prepares the general proposal E.2.2.3 Allocate a specialized person to do mapping of funders E.2.2.4 Send proposals to agencies or organizations that are potential funders 30 E. Include private organizations interested in AMR into the NAP E.2.3.1 Mapping of private organizations interested in AMR E.2.3.2 Present collaboration proposals to these organizations E.3 Mapping of organizations for potential collaboration in the investigation of natural sources of biodiversity and Bio repositories as sources of new antimicrobial molecules E.3.1 Mapping of international organizations/countries for potential collaboration in the investigation of natural sources of biodiversity and bio- repositories as sources of new antimicrobial molecules E.3. Nominate the person who will be in charge of doing this mapping and having a list of these organizations E.3.1.2 Do the mapping plus list E.3.1.3 Approach these organizations through showing them the achieved research in Yemen as well as potential for benefit sharing with these organizations E.3.2 Mapping of existing or ongoing local research that deals with biodiversity as source of antimicrobial molecules E.3.2.1 Communication with WHO/MOH to organize a yearly meeting where researchers in Yemen expose and discuss their studies in the field of biodiversity for alternatives to ABX E.3.2.2 Create a section of AMR Website where local studies, posters, articles, projects in biodiversity are posted E.4 Establishing communication with public and private sector for collaboration to NAP E.4.1 Establish a network of researchers in public and private sectors E.4.1.1 DC&S to host yearly workshop for researchers to discuss AMR research E.4.2 Mapping of potential private partners to encou rage research E.4.2.1 Nominate the person who will do the mapping E.4.2.2 Produce a list of potential partners E.4.3 Establish communication and collaboration with private partners E.4.3.1Preparation of specific proposals for collaboration with specific partners E.4.3.2 Establish communication and collaboration with these private partners 32 The plan for economic sustainability will replace mainly by a plan for budget preparation and preparation of the ground for fund raising for the execution of the NAP. Budget Allocation:  Calculation of the budget for the whole plan.  Identify funding gaps.  Put a strategic plan to attract funds into the NAP The activities of different axes should be executed within the coming 5 years (2020 to 2024. One cannot deny the influence of the political instability in the country that might hinder the execution of the plan AMR action plan underscores the need for effective “one health” approach involving coordination among numerous international sectors and actors, including human and veterinary medicine, agriculture, finance, environment, and well-informed consumers in a time-bound manner to meet the targets set in this NAP. A monitoring and Evaluation (M&E) Plan has also been proposed to keep track of the progress made and modifying the operational plan, if needed. Provisional costing has been done to have an overview of the resources needed which shall be mobilized from National sources and International development partners such as WHO are major contributors to the hoped success of this NAP. 33 Yemen Strategic plan ( to ) Strategic plan Axis A: Awareness of AMR Global action plan strategic Objective (1) Develop awareness and understanding of antimicrobial resistance through effective communication, education, behavior changes, and training Potential measures of effectiveness: Extent of reduction in national human consumption of antibiotics (with allowance for the need for improved access in some settings), and reduction in the volume of antibiotic use in food production Strategic Objective 1 interventions Activity / Sub-activity Milestone / Date A.1 Organization of the responsibilities for the execution of the tasks A.1.1 Nominate a focal person in charge of following up the activities of the objectives of this axis A.1.2 Choose the members of the Awareness Technical Working Group (TWG)(Radio/TV Media, Social media expert, Technical, Pharmacist, Infectious Diseases physicians, dentists ecologists, Microbiologist, Veterinarian, Agriculture, MOH and WHO representative) A.1.3 Put the terms of reference(TOR) of this TWG according to NAP A.1.4 Slogan for AMR establishment A.1.1 time “zero” A.1.2 time “zero” A.1.3 three months from time “zero” A.1.4 three months from time “zero A.2 Improving national AMR awareness among professionals from different sectors A.2.1 Raising AMR awareness through syndicates, orders and scientific societies (CME, AMR periodic informational SMS, etc.) A.2.1.1 DC&S scheduled Lectures in national conferences of the medical, laboratories ,pharmaceutical ,nursing, veterinary, agricultural and environmental fields across Yemen A.2.1.2 Ask syndicates/orders (human and animal health and agriculture) that for CME credits to be given for any lecture involving ABX use, at least 2-3 slides should be put to increase awareness about AMR and the ways to prevent it including antimicrobial use. A.2.1.3 Ask orders of pharmacists, veterinarians, physicians, and dentists to send monthly SMS as reminders to health professionals about the dangers of AMR and/or AMR News A.2.1.4 Workshops on AMR awareness to media professionals A.2 5 years ( - ) A.2.1.1 Three months from time “zero” A.2.1.2 Six months from time “zero A.2.1.3 36 months from time zero A.2.1.4 Beginning of November each year over 5 years 34 Strategic Objective 1 interventions Activity / Sub-activity Milestone / Date A.2 Improving national AMR awareness among professionals from different sectors A Do one workshop per governorate per year to laboratories, veterinarians and agriculture specialists (Train the trainer) A.2.1.5 Six months from time zero A.2.2 Raising AMR awareness through Internet A.2.2.1 Create a webpage for AMR on the official websites of MOH and MOA A.2.2.2 Use existing webpages of MOH and WHO and relevant societies on different social networks (Facebook, YouTube, Twitter, Instagram) A.2.2.1 Three months from time “zero” A.2.2.2 One year from time zero A.3 Involving traditional (TV, radio) media and social media (Facebook, Instagram) in raising AMR awareness A.3.1 Prepare broadcasting material that includes all sectors of the One health approach for Radio/TV/Social media spots A.3 Six months from time zero A.3.1 Six months from time zero A.4 Raising and improving public awareness using traditional media, social media and telecommunication companies A.4.1 Prepare a yearlong schedule for TV, Radio and social media advertisement. A.4.2 AMR to be periodically discussed in highly watched talk shows A.4.3 Public figure(s) associated with AMR A.4.4 Politician(s) involved in AMR A.4.5 SMS through national telecommunication companies sent four times per year and during the global AMR awareness week A.4 Two years from time zero A.4.1 Six months from time zero A.4.2 One year from time zero A.4.3 One year from time zero A.4.Two years from time zero A.4.5 Starting end of first year from time zero A.5 Raising/Improving AMR awareness in education curricula on the national level (guideline) A.5.1 Sensitization about AMR and hygiene in school curricula A.5.1.1 Prepare a checklist including basic information about AMR that should be included in school curricula A.5.1.2 Check available school curricula and ask to fill in the gaps when AMR information according to checklist is not available A.5 9 months from time zero \A.5.1.1 Start 3 months from time zero,Ready at end of first year from time zero A.5.1.2 Start three months from time zero Ready at 6 months from time zero 35 Strategic Objective 1 interventions Activity / Sub-activity Milestone / Date A.5.2 Inclusion of AMR awareness modules in curricula of human health- related specialties (medicine, dentistry, pharmacy, nursing A.5.2.1 Prepare checklists for university curricula of these specialties each one separately A.5.2.2 Check curricula of health specialties to include information on AMR Include AMR education A.5.2.1 & A.5.2.2 Start 3 months from time zero Finalized 9 months from time zero A.5.3 Inclusion of AMR awareness modules in curricula of veterinary school A.5.3.1 Prepare a checklist for the needed information on AMR for veterinary school curricula A.5.3.1 Three months from time zero A.5.3.2 Fill the gap in AMR information in veterinary school curricula A.5.3.2 Six months from time zero A.5.4.1. Inclusion of AMR awareness modules in curricula of agriculture school A.5.4.2Checklist for the needed information on AMR for agriculture school curricula A.5.4.2 Fill the gap in AMR information in agriculture school curricula A.5.4.1& A.5.4.2 Six months from time zero \ A.6 Involvement of pharmaceutical companies in raising AMR awareness and provide finding for awareness activities$$$$ A.6.1 MOH and MOA should advise pharmaceutical companies (Human and Veterinary) to include in every presentation related to antimicrobial use at least 3 slides (5%) concerning AMR (Send one letter from each ministry) A.6.2 Seek private funding from Pharmaceutical companies for awareness activities targeting public and professionals A.6.2.1 Meeting with CEO s of main Pharmaceutical companies and working group and present the highlights of the AMR plan in general, awareness specifically and put plan of contribution to awareness activities A.6 1 year A.6.1 Starting end of first year from time zero A.6.2 6 months 36 Operational plan and budget for axis A Objective- Activity /Sub- activity Unit Quantity Date Location Responsible entity Cost Source Of funding Indicator A.1 Organization of the responsibilities for the execution of the tasks A.1.1 Nominate a focal person in charge of following up the activities of the objectives of this axis A.1.1 Letter of appointment A.1.1 One A.1.1 time “zero” A.1.1 MOH A.1.1 WHO National Professional Officer (Dr. MOH General Director (Dr. -------) A.1.1 0.25 time employee (Secretarial functions) USD (incentive ) A.1.1 MOH/WHO A.1.1 Focal person nominated (---------) A.1.2 Choose the members of the Awareness TWG (Radio/TV Media, Social media expert, Technical, Pharmacist, Infectious Diseases , Microbiologist, Veterinarian, Agriculture , MOH representative WHO) and nominate them A.1.2 One focal person One technical group Suggestions: Focal person: ( Dr. -----) TWG members: Dr. ---, Dr. ---, Dr. Dr .---Dr. --- Dr. Dr-----, WHO technical pers A.1.2 One focal person One technical group A.1.2 time “zero ” A.1.2 MOH WHO A.1.2 WHO National Professional Officer (Dr. ------) MOH General Director (Dr. -----) A.1.2 USD (incentive ) A.1.2 MOH/WHO A.1.2 Technical group formed and posted on AMR website. 37 Objective- Activity /Sub- activity Unit Quantity Date Location Responsible entity Cost Source Of funding Indicator A.1 Organization of the responsibilities for the execution of the tasks A.1.3 Put the terms of TOR of this technical group according to NAP A.1.3 Document A.1.3 One A.1.3 two months from time “zero” A.1.3 MOH WHO MOA A.1.3 Focal person WHO National Professional Officer (Dr------) A.1.3 USD A.1.3 WHO A.1.3 TOR of technical group posted on website A.1.4 Slogan for AMR A.1.4 Awareness technical working group (PAC) A.1.4 One A.1.4 three months from time “zero A.1.4 MOH WHO A.1.4 Awareness technical working group A.1.4 USD A.1.4 WHO A.1.4 Slogan is posted on AMR website 38 Objective- Activity / Sub- activity Unit Quantity Date Location Responsible entity Cost Source Of funding Indicator A.2 Improving AMR awareness among professionals from different sectors A.2.1 Raising AMR awareness through syndicates, orders and scientific societies (CME, AMR periodic Informational SMS, etc.) A.2.1.1 DC&S, University OF medicine scheduled lectures in national conferences of the medical, pharmaceut ical, nursing, veterinary, agricultural and environmen tal fields across Yemen A.2.1.1 Schedule A.2.1.1 One A.2.1.1 two months from time “zero” A.2.1.1 DC&S, MOH WHO MOA A.2.1.1 DC&S, president (Dr.-----) Awareness technical working group A.2.1.1 USD A.2.1.1 WHO A.2.1.1 Official schedule from DC&S, A.2.1.2 Ask syndicates/ orders (human and animal health and agriculture) that for CME credits to be given for any lecture involving ABX use, at least 2-3 slides should be put to increase awareness about AMR and the ways to prevent it including antimicrobial use. A.2.1.2 Letters to syndicates/ orders A.2.1.2 depending on number of syndicates/ orders A.2.1.2 Six months from time “zero” A.2.1.2 Order of physicians A.2.1.2 Focal person DC&S president (Dr. ) President of the Order of physicians endorsed by the IHR technical committee A.2.1.2 USD A.2.1.2 WHO A.2.1.2 Percentage of lectures involving ABX that contain the message in 2-3 slides DC&S(Diseases Control &Surveillance)IN MOH 39 Objective- Activity / Sub- activity Unit Quantity Date Location Responsible entity Cost Source Of funding Indicator A.2 Improving AMR awareness among professionals from different sectors A.2.1.3 Ask orders of pharmacists Veterinarians, physicians, and dentists to send monthly SMS as reminders to health professionals about the dangers of AMR and/or AMR News A.2.1.3 Letters to orders from MOH/MOA to send SMS to health professionals A.2.1.3 three A.2.1.3 36 months from time zero A.2.1.3 Order of pharmacists MOA A.2.1.3 Focal person endorsed by a national multisectoral group A.2.1.3 USD$ A.2.1.3 WHO / MOH A.2.1.3 Percentage compliance to this request of sending monthly SMS to health professiona ls. Number of months where SMS were sent from each order/total number of months audited A.2.1.4 Workshops on AMR awareness to media professionals A.2.1.4 Workshops A.2.1.4 Once/ year 5/5 years A.2.1.4 Beginning of November each year over 5 years A.2.1.4 Hotel A.2.1.4 Focal person MOH Director of Public Relations & Health Education Dpts (DR--.---) MOH Public Health Officer (Ms. -----) A.2.1.4 USD/year A.2.1.4 AMR Fund WHO UNSAFE A.2.1.4 Percentage of target media personnel whom attend these workshops. 41 Objective- Activity / Sub- activity Unit Quantity Date Location Responsible entity Cost Source Of funding Indicator (MOA) Ministry Of Agriculture A.2.1.5 Do one workshop Per governorate per year to veterinarians and agriculture specialists(Train the trainer) A.2.1.5 Workshops A.2.1.5 12 per year A Six months from time zero A.2.1.5 MOA A.2.1.5 MOA Head of Animal Health Service (Dr. ----) A.2.1.5 USD per year TOTAL: USDX12X5 = USD $$ A.2.1.5 AMR Fund/WHO MOA A.2.1.5 Number of workshops per governorate per year MOA Head of Poultry Husbandry Dpt (Eng A.2.2 Raising AMR awareness through Internet A.2.2.1 Create a webpage for AMR on the official websites of MOH and MOA A.2.2.1 AMR blog present on websites of MOH and MOA A.2.2.1 One A.2.2.1 Three months from time “zero” A.2. MOH MOA A.2.2.1 Focal Person MOH Director of Public Relations & Health Education Dpts (Dr. -----) A.2.2.1 USD WHO MOH A.2.2.1 AMR fund A.2.2.1 AMR section is put on MOH/ MOA websites MOH Head of DC&S Dpts (Dr. MOH-IT specialist 40 Objective- Activity / Sub activity Unit Quantity Date Location Responsible entity Cost Source Of funding Indicator A.2.2.2 Use existing Webpages of MOH and WHO and relevant societies on different social networks (Facebook, YouTube, Twitter,Instagram) A.2.2.2 Webpages A.2.2.2 Four A.2.2.2 One year from time zero A.2.2.2 MOH A.2.2.2 Webpage designer A.2.2.2 USD A.2.2.2 WHO A.2.2.2 Webpages available Out sourcing call for citations at WHO MOH National E-Health Program Director (Mrs. ---) A.3 Involving traditional (TV, radio) media and social media(Facebook, Instagram) in raising AMR awareness A.3.1 Prepare broadcasting material that includes all sectors of the One health approach for Radio/TV/ Social media spots A.3.1 Broadcasting material for Radio/TV/ Social media spots A.3.1 One set of material A.3.1 Six months from time zero A.3.1 WHO A.3.1 All broadcastin g messages will be prepared and supported by WHO A.3.1 USD A.3.1 WHO A.3.1 Broadcasting material available, they are tricyclic 42 Objective- Activity / Sub- activity Unit Quantity Date Location Responsible entity Cost Source Of funding Indicator A.4 Raising and improving public awareness using traditional media, social media and tele-commu nication companies A.4.1 Prepare a yearlong schedule for TV, Radio and social media advertisem ent. A.4.1 Schedule A.4.1 One A.4.1 Six months from time zero A.4.1 MOH A.4.1 MOH Director of Public Relations & Health Education Dpts (Dr. ) A.4.1 USD per year TOTAL: USD A.4.1 WHO A.4.1 Schedules put and spots A.4.2 AMR to be periodically discussed in highly watched talk shows A.4.2 Talk shows A.4.2 Multiple A.4.2 One year from time zero A.4.2 MOH A.4.2 Focal person AMR Committee members. A.4.2 USD A.4.2 WHO A.4.2 Number of talk shows that discuss AMR per trimester A.4.3 Public figure(s) associated with AMR A.4.3 Person A.4.3 One or more A.4.3 One year from time zero A.4.3 MOH MOA A.4.3 DC&S president (Dr. ---) MOH Director of Public Relations & Health Education Dpts (Dr. A.4.3 USD A.4.3 WHO A.4.3 Number of appearances in media/ public to discuss the subject 43 Objective - Activity / Sub activity Unit Quantity Date Location Responsible entity Cost Source Of funding Indicator A.4 Raising and improving public awareness using traditional media, social media and tele commu nication companies A.4.4 Politician(s) involved in AMR A.4.4 Politicians public statements on TV, radio or social media A.4.4 Three from three different political sides A.4.4 Two years from time zero A.4.4 TV, Radio, social media A.4.4 Focal person MOH WHO A.4.4 USD A.4.4 WHO A.4.4 Number of appearance s in media/publ ic to discuss the subject A.4.5 SMS through national telecommu nication companies sent four times per year and during the global AMR awareness week A.4.5 SMS A.4.5 four per year A.4.5 Starting end of first year from time zero A.4.5 National telecommu nication MOH MOA A.4.5 MOH Ministry of Communic ation MOH General Director (Dr. ---) A.4.5 USD /year Total USD A.4.5 MOH/ Ministry of Communic ation/ MOA WHO A.4.5 SMS sent A.5 Raising/ Improving AMR awareness in education curricula on the national level A.5.1 Sensitization about AMR and hygiene in School curricula A.5.1.1 Prepare a checklist guidelines Including basic Information about AMR that should be included in school curricula A.5.1.1 Documents Basic for schools (Based on One Health /E-health) A.5.1.1 One A.5.1.1 Start 3 months from time zero, Ready at end of first year from time zero A.5.1.1 Ministry of education MOA MOH A.5.1.1 Focal person-WHO National Professional Officer (Dr. ---) MOA Head of Poultry Husbandry Dpt (Eng. Private sector, WHO consultant (Dr. ---) A.5.1.1 USD A.5.1.1 Ministry of education/ WHO A.5.1 Percentage of school curricula that include the message 44 CERD: Center for Educational Research and Development Objective- Activity / Sub- activity Unit Quantity Date Location Responsible entity Cost Source Of funding Indicator A.5 Raising/ Improving AMR awareness in education curricula on the national level A.5.1.2 Check available school curricula and ask to fill in the gaps when AMR information according to checklist is not available A.5.1.2 Report and letter A.5.1.2 Three A.5.1.2 Start three months from time zero Ready at 6 months from time zero A.5.1.2 Ministry of education MOA MOH A.5.1.2 WHO National Professional Officer (Dr. ) Ms (private sector CERD A.5.1.2 USD A.5.1.2 WHO A.5 Inclusion of AMR awareness modules in in curricula of human health- related specialties (medicine, NCPHLs dentistry, pharmacy, nursing) A.5.2.1 Prepare checklists for university curricula of these specialties each one separately A.5.2.1 Checklists for different curricula of health specialties A.5.2.1 Number of curricula of health specialties A.5.2.1 Start 3 months from time zero Finalized 9 months from time zero A.5.2.1 Universitie s WHO A.5.2.1 Privae secto, WHO consultant, former DC&S president (Dr. --) A.5.2.1 USD A.5.2.1 AMR fund WHO A.5.2 Percentage of curricula of health specialties that include chapters about AMR/IPC according to checklist 45 Objective- Activity / Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source Of funding Indicator A.5 Raising/ Improving AMR awareness in education curricula on the national level A.5.2.2 Check curricula of health specialties to include information on AMR Include AMR tricyclic education A.5.2.2 Report and detailed list of objectives that are to be included and are missing in each health curriculum A.5.2.2 One A.5.2.2 Start 3 months from time zero Finalized 9 months from time zero A.5.2.2 Universitie s A.5.2.2 Private sector, WHO consultant , former DC&S presiden t (Dr. ) A.5.2.2 USD* USD A.5.2.2 AMR fund WHO A.5.3 Inclusion of AMR awareness modules in curricula of veterinary school A.5.3.1 Prepare a checklist for the needed information on AMR for veterinary school curricula A.5.3.1 Checklist A.5.3.1 One A.5.3.1 Three months from time zero A.5.3.1 MOA A.8.1 MOA Head of Animal Health Service (Dr. B Bazzal) A.5.3.1 USD A.5.3.1 AMR fund WHO A.5.3 Veterinary school curricula include chapters about AMR/IPC A.5. Fill the gap in AMR information in veterinary school curricula A.5.3.2 Report to Yemeni University veterinary school A.5.3.2 One A.5.3.2 Six months from time zero A.5.3.2 Veterinary School Yemen University A.5.3.2 MOA Head of Animal Health Service (Dr. ) A.5.3.2 USD A.5.3.2 AMR fund WHO 46 Objective- Activity / Sub- activity Unit Quantity Date Location Responsible entity Cost Source Of funding Indicator A.5 Raising/ Improving AMR awareness in education curricula on the national level A.5. Inclusion of AMR awareness modules in curricula of agriculture school A.5.4.1 Checklist for the needed information on AMR for agriculture school curricula A.5.4.1 Checklist A.5.4.1 One A.5.4.1 Six months from time zero A.5.4.1 MOA Universit ies A.5.4.1 MOA-Head of Poultry Husbandry Dpt (Eng. A Sirawan) A.5.4.1 USD A.5.4.1 AMR fund WHO A.5.4.1 Agriculture school curricula include chapters about AMR/IPC A.5.4.2 Fill the gap in AMR information in agriculture school curricula A.5.4.2 Letter from the Ministries of Health, Education and Agriculture toagricultur e schools A.5.4.2 One A.5.4.2 Six months from time zero A.5.4.2 MOA Universitie s A.5.4. MOA-Head of Poultry Husbandry Dpt (Eng. ------) A.5.4.2 USD A.5.4.2 AMR fund WHO A.6 Involvement of pharmaceutical companies in raising AMR awareness and provide finding for awareness A.6.1 MOH and MOA should advice pharmaceutical companies (Human& Veterinary) to include in every presentation related to antimicrobial use at least 3 slides (5%) concerning AMR(Send one letter from each ministry) A.6.1 Letters to Ministries of Health and Agriculture A.6.1 Four A.6.1 Starting end of first year from time zero A.6.1 MO H MO A A.6.1 MOH Director of Public Relations & Health Education Dpts (Dr. MOA Head of Animal Health Service (Dr. ) MOA Head of Poultry Husbandry Dpt (Eng.) A.6.1 USD A.6.1 MOH WHO A.6.1 Percentage of pharmaceut ical companies presentatio ns that include the message about AMR 47 Objective- Activity / Sub- activity Unit Quantity Date Location Responsible entity Cost Source Of funding Indicator A.6 Involvement of pharmaceutical companies in raising AMR awareness and provide finding for awareness A.6.2 Seek private funding from Pharmaceut ical companies for awareness activities targeting public and professiona ls A.6.2.1 Meeting with CEO s of main Pharmaceut ical companies and working group and present the highlights of the AMR plan in general, awareness specifically and put plan of contribution to awareness activities A.6.2.1 Meeting A.6.2.1 Three A.6.2.1 6 months A.6.2.1 MOH A.6.2.1 Technical working group A.6.2.1 USD A.6.2.1 AMR Fund WHO 48 Monitoring and evaluation plan for axis A Objective- Activity /Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline A.1 Organization of the responsibiliti es for the execution of the tasks A.1.1 Nominate a focal person in charge of following up the activities of the objectives of this axis A.1.1 Focal person nominated A.1.1, A.1.2 Organize and follow up the tasks in the plan A.1.1, A.1.2 Yes/No A.1.1, A.1.2 Once/5 years A.1.1, A.1.2 MOH WHO A.1.1, A.1.2 Appointment A.1.1, A.1.2 NA A.1.2 Choose the members of the technical working group (Radio/TV Media, Social media expert, Technical, Pharmacist, ID, Microbiologi st, Veterinarian, Agriculture, MOH representativ e, WHO) and nominate them A.1.2 Awareness technical working group formed and posted on AMR website. A.1.3 Put the terms of reference of Awareness technical working group according to NAP A.1.3 TOR of technical working group posted on website A.1.3 Specify its activities A.1.3 Yes/No A.1.3 Once/5 years A.1.3 MOH WHO A.1.4 Slogan for AMR A.1.4 Slogan is posted on AMR website A.1.4 not applicable A.1.4 Yes/No A.1.4 Once/5 years A.1.4 MOH WHO A.1.4 Slogan A.1.4 NA 49 Objective- Activity /Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline A.2 Improving AMR awareness among professionals from different sectors A.2.1 Raising AMR awareness through syndicates, orders and scientific societies (CME, AMR periodic informationa l SMS, etc.) A.2.1.1 DC&S scheduled lectures in national conferences of the medical pharmaceuti cal, nursing, veterinary, agricultural& environment al fields across Yemen A.2.1.1 Official schedule from DC&S A.2.1.1 Having the commitment from DC&S in giving these lectures. A.2.1.1 Number of lectures given per governorate per year A.2.1.1 every 6 months A.2.1.1 DC&S A.2.1.1 Document A.2.1.1 No schedule available, talks concentrated in Yemen area, not to all professionals A.2.1.2 Ask syndicates/ orders (human and animal health and agriculture) that for CME credits to be given for any lecture involving ABX use, at least 2-3 slides should be put to increase awareness about AMR and the ways to prevent it including antimicrobial use. monthly SMS as reminders to health professionals about the dangers of AMR and/or AMR News A.2.1.2 Percentage of lectures involving ABX that contain the message in 2-3 slides A.2.1.2 Reminder of AMR in all ABX lectures. A.2.1.2 Number of lectures with the message/ number of lectures audited*100 A.2.1.2 every year A.2.1.2 NAP audit of lectures given A.2.1.2 Audit A.2.1.2 NA 51 Objective- Activity /Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline A.2 Improving AMR awareness among professionals from different sectors A.2.1.3 Ask Orders of pharmacists, veterinarians, physicians, and dentists to send monthly SMS as reminders to health professionals about the dangers of AMR and/or AMR News. A.2.1.3 Percentage compliance to this request of Sending monthly SMS to health professionals Number of months where SMS were sent from each Order/total number of months audited A.2.1.3 Permanent reminding A.2.1.3 Number of months where SMS were sent from each Order/total A.2.1.3 every six months A.2.1.3 Orders A.2.1.3 Report from Orders A.2.1.3 NA A.2.1.4 Workshops on AMR awareness to media professionals A.2.1.4 Percentage of target media personnel whom attend these workshops. A.2.1.4 Sensitize the media to propagate the message and gain their interest in bringing it up in their programs, sites, and newspapers A.2.1.4 Number of attendees /number of target media personnel A.2.1.4 Once per year A.2.1.4 Awarene ss technical working group A.2.1.4 Data collec tion A.2.1.4 NA 50 Objective- Activity /Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline A.2 Improving AMR awareness among professionals from different sectors A.2.1.5 Do one workshop per governorate per year to veterinarians and agriculture specialists (Train the trainer A.2.1.5 Number of workshops per governorate per year A.2.1.5 Raise post graduate AMR awareness among professionals A.2.1.5 Number of workshops per governorate per year A.2.1.5 Once/year A.2.1. MOA WHO A.2.1.5 Workshop A.2.1. NA A.2.2 Raising AMR awareness through Internet A.2.2.1 Create a webpage for AMR on the official websites of MOH andMOA A.2.2.1 AMR section is put on MOH/MOA websites A.2.2.1 Increase visibility A.2.2.1 Yes/No A.2.2.1 Once/5 years A.2.2.1 MOH MOA A.2.2.1 Section on website A.2.2.1 NA A.2.2.2 Use existing webpages of MOH and WHO and relevant societies on different social networks (Facebook, YouTube, Twitter, Instagram) A.2.2 Webpages available A.2.2.2 Reach the young population and broaden the spectrum of people receiving the message A.2.2.2 Yes/No Presence of webpages A.2.2.2 Every three months A.2.2.2 Awarene ss technical working group A.2.2.2 Webpage A.2.2.2 NA 52 Objective- Activity /Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline A.3 Involving traditional (TV, radio) media and social media (Facebook, Instagram) in raising AMR awareness A.3.1 Prepare broadcasting material that includes all sectors of the One health approach for Radio/TV/Social media spots A.3.1 Broadcasting material available, A.3.1 Percentage of media type for which they are tricyclec A.3.1 Yes/No For each type of media broadasting messages have been prepared A.3.1 every three months A.3.1 Awareness technical working group A.3.1 Counting A.3.1 Few TV spots available regarding human health, not tricyclic A.4 Raising and improving public awareness using traditional media, social media and telecommuni cation companies A Prepare a yearlong schedule for TV, Radio and social media advertisements A.4.1 Schedules put and spots A.4.1 Emphasize the importance of the subject A.4.1 Number of talk shows per 3 months that discuss AMR A.4.1 every three months A.4.1 Awareness technical working group A.4.1 Schedule A.4.1 Erratic, in few morning shows A.4.2 AMR to be periodically discussed in highly watched talk shows A.4.2 Number of talk shows that discuss AMR per trimester A.4.2 Reach more people A.4.2 Number of activities per trimester per governorate A.4.2 every three months over 5 years A.4.2 Awareness technical working group A.4.2 Talk show A.4.2 NA A.4.3 Public figure(s) associated with AMR A.4.3 Number of appearances in media/public to discuss the subject A. Reach more people A.4.3 Number of appearances A.4.3 every three months over 5 years A.4.3 Awareness technical working group A.4.3 Statement A.4.3 NA 53 Objective- Activity /Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline A.4 Raising and improving public awareness using traditional media, social media and telecommuni cation companies A.4.4 Politician(s) involved in AMR A.4.4 Number of appearances in media/ public to discuss the subject A.4.4 Reach more people A.4.4 Number of appearances A.4.4 every three months over 5 years A.4.4 Awareness technical working group A.4.4 Statement A.4.4 NA A.4.5 SMS through national telecommuni cation companies sent four times per year and during the global AMR awareness week A.4.5 SMS sent A.4.5 Reach more people A.4.5 Number of messages sent A.4.5 every three months over 5 years A.4.5 Awareness technical working group A.4.5 Message A.4.5 NA A.5 Raising/Impr oving AMR awareness in education curricula on the national level A.5.1 Sensitization about AMR and hygiene in school curricula A.5.1.1 Prepare a checklist including basic information about AMR that should be included in school Curricula A.5.1.2 Check available school curricula and ask to fill in the gaps when AMR information according to checklist is not available A.5.1 Percentage of school curricula that include the message A.5.1 Include AMR-related information in school curricula A.5.1 number of curricula that included the message/ total number of curricula * A.5.1 Once/5 years A.5.1 Ministry of education WHO A.5.1 Checking and filling the gaps 54 Objective- Activity /Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline A.5 Raising/Impr oving AMR awareness in education curricula on the national level A.5.2 Inclusion of AMR awareness modules in in curricula of human health related specialties (medicine, dentistry, pharmacy,nnursing) A.5.2.1 Prepare checklists for university curricula of these specialties each one separately A.5.2.2 Check curricula of health specialties to include information on AMR Include AMR tricyclic education A.5.2 Percentage of curricula of health specialties that include chapters about AMR according to checklist A.5.2 Include AMR modules in curricula of health sciences specialties A.5.2 number of curricula that included the message/ total number of curricula * A.5.2 Once/5 years A.5.2 Ministry of education Universities MOH WHO A.5.2 Checking and filling the gaps A.5.2 Partially available A.5.3 Inclusion of AMR awareness modules in curricula of veterinary school A.5.3.1 Prepare a checklist for the needed information on AMR for veterinary school curricula A.5.3.2 Fill the gap in AMR information in veterinary school curricula A.5.3 Veterinary school curricula include chapters about AMR A.5.3 Include AMR modules in curricula of veterinary school A.5.3 number of curricula that included the message A.5.3 Once/5 years A.5.3 Ministry of education Universities WHO A.5.3 Checking and filling the gaps A.5.3 NA 55 Objective- Activity /Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline A.5 Raising/Impr oving AMR awareness in education curricula on the national level A.5.4 Inclusion of AMR awareness modules in curricula of agriculture school A.5.4.1 Checklist for the needed information on AMR for agriculture school Curricula A.5.4.2Fill the gap in AMR information in agriculture school curricula A.5.4.1 Agriculture school curricula include chapters about AMR/IPC A.5.4 Include AMR/IPC modules in curricula of agriculture school A.5.4 number of curricula that included the message A.5.4 Once/5 years A.5.4 Ministry of education Universities MOA WHO A.5.4 Checking and filling the gaps A.5.4 NA A.6 Involvement of pharmaceuti cal companies in raising AMR awareness and provide finding for awareness activities A.6.1 MOH and MOA should advice pharmaceutical companies (Human and Veterinary) to include in every presentation related to antimicrobial use at least 3 slides (5%) concerning AMR (Send one letter from each ministry) A.6.1 Percentage of pharmaceuti cal companies presentations that include the message about AMR A.6.1 involving pharmaceuti cal companies in raising AMR awareness among professionals in all health fields A.6.1 number of presentations including message/ total number of presentations * A.6.1 Once/5 years A.6.1 MOH MOA A.6.1 Letter A.6.1 Sporadic 56 Objective- Activity /Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline A.6 Involvement of pharmaceuti cal companies in raising AMR awareness and provide finding for awareness activities A.6.2 Seek private funding from Pharmaceutical companies for awareness activities targeting public and professionals A.6.2.1 Meeting with CEO s of main Pharmaceutical companies and working group and present the highlights of the AMR plan in general, awareness specifically and put plan of contribution to awareness activities A.6.2.1 Percentage of pharmaceuti cal companies that promote antimicrobial s that are contributing into the budget of the awareness campaign A.6.2.1 Involving pharmaceuti cal companies in raising AMR awareness among professionals in all health fields A.6.2.1 Number of companies contributing to the project/total number of companies promoting ABX A.6.2.1 Once or more/5 years A.6.2.1 MOH MOA A.6.2.1 Meeting( s) A.6.2.1 NA 57 Axis B: Surveillance Strategic Plan ESU: Epidemiological Surveillance Unit Global action plan Strategic Objective 2: Strengthen the knowledge evidence base through surveillance and Research Potential measure of effectiveness: extent of reduction in the prevalence of antimicrobial resistance, based on data collected through integrated programmes for surveillance of antimicrobial resistance in Yemen Strategic Objective interventions Activity Sub-activity Date /Milestone B.1 Organization of the responsibilities for the execution of the tasks B.1.1 Appointment of focal person in charge of following up the activities of the objectives of this axis B.1.1.1 Empower ESU director as focal person B.1.1.1 three months from time zero B.1 three months from time zero B.1.2 Appointment of the members of the technical working group along with its TOR B.1.2 three months from time zero B.2 Reporting of AMR data to GLASS thus optimizing AMR surveillance in humans through: B.2.1 Mapping of labs that can potentially provide microbiologically reliable and epidemiologically representative data. These labs start reporting their data to the (GLASS). B.2.1.1 Make a list of laboratories that will ultimately form an epidemiologic representation of the country and that will be sequentially entered into GLASS after capacity building B.2.1.1 Three months from time zero B.2 5 years B.2.2 Put a plan for capacity building for the labs that are chosen to be included in GLASS report in order to be epidemiologically representative based on an incremental plan B.2.2.1 Organize a nationwide workshop about GLASS and the plan of inclusion in GLASS and introduction to WHONET B.2.2.1 Three months from time zero 58 Strategic Objective interventions Activity / Sub-activity Date from operational plan Milestone B.2 Reporting of AMR data to GLASS thus optimizing AMR surveillance in humans through: B.2.2.2 Evaluate the quality of work in the selected laboratories (visit), Check 12 laboratories per year, Select the ones that can immediately report to GLASS, Put a plan for 4 laboratories that will undergo improvement in their capacity during coming year, then repeat the same the following year, then the following years B.2.2.2 End of first year from time zero: 5 laboratories Second year from time zero: 5 laboratories Each year 5 laboratories B.2.2.3 Do a start up WHONET training for the 12 laboratories that were chosen for the coming 2 years every 2 years B.2.2.3 Three months from time zero B.2.2.4 Do 6 laboratory visits for capacity building/year for 12 laboratories in different areas for building capacity and WHONET training B.2.2.4 Three visits per lab each year for 6 laboratories starting year 1 B.2.2.5 External Quality Control twice per year for the 12 laboratories chosen for the 2 years, then to add the ones of the following 2 years, after the 2nd year. B.2.2.5 Six months from time zero B.2.3 Data Entry in GLASS B.2.3.1 Data collection from mature laboratories B.2.3.1 Start end of 1st year from time zero B. Data cleaning and entry into GLASS B.2.3.2 Start end of 1st year from time zero 59 Strategic Objective interventions Activity / Sub-activity Date /Milestone B.3 Periodic issuing of an epidemiologically representative national AMR surveillance report in humans B.3.1 This report is based on WHONET data, according to local needs of physicians, pharmacists and researchers (stratification of data based on the type of priority organisms, site/region of infection or acquisition, etc.) This report is posted on AMR webpages (MOH and MOA websites) B.3.1 Once/year starting end of 1st year B.3 1 year B.4 Optimize AMR surveillance in the agricultural, foodveterinary, and environmental fields B.4.1 Research project about AMR surveillance in the veterinary field. B.4.1 6 months from time zero B.4 2 years B.4.2 Design an epidemiologically representative sample for AMR surveillance (cattle, poultry, companion animals). B.4.2 9 months from time zero B.4.3 Put a list of AMR priority organisms and related resistance genes for surveillance in these fields B.4.3 6 months from time zero B.4.4 Assessment of YARI, agriculture laboratory, and the chamber of manufacturing and commerce in Tripoli for the analysis of surveillance specimens in agricultural, food, veterinary, and environmental fields Suggestion of a plan of the microbiology work in this surveillance B.4.4 Six months from time zero and completed nine months from time zero B.4.5 Report results of ABX use and resistance surveillance in agriculture and veterinary world Send a yearly report with recommendations to the animal drug registry about ABX purchasing in the country during the coming 2 years B.4.5 First report should be ready at end of year 2 from time zero 61 YARI: Yemen Agricultural Research Center Strategic Objective interventions Activity / Sub-activity Date / Milestone B.5 Create/Appoint AMR reference lab (s) B.5.1 Define TOR of AMR reference lab B.5 9 months from B.5.1 3 months from time zero time zero Map potential lab(s) across Yemen Start at time zero Mapping finalized 3 months from time zero B.5.2 Map potential lab(s) across Yemen B.5.2 Start at time zero Mapping finalized 3 months from time zero B.5.3 Task force to visits the potential lab(s) (WHO EMRO) to be discussed with Dr B.5.3 5 months from time zero B.5.4 Nominate the reference lab(s) B.5.4 6 months from time zero B.5.5 MOH to sign a contract with the lab(s) B.5.5 9 months from time zero B.6 Enhance research activities in AMR surveillance B.6.1 Put and broadcast an AMR Research Agenda including research for alternative agents to antimicrobials. B.6 1.5 years from time zero B.6.1 st agenda sent 1.5s year from time zero 60 Operational Plan budget for Axis B Objective Activity/Sub- activity Unit Quantity Date Location Responsible Entity Cost Source Of Funding Indicator B.1 Organization of the responsibili ties for the execution of the tasks B.1.1 Appointme nt of focal person n charge of following up the activities of the objectives of this axis B.1.1.1 Empower ESU director as focal person. B.1.1.1 Appointmen t B.1.1.1 One B.1.1.1 three months from time zero B.1.1.1 MOH ESU B.1.1.1 WHO National Professiona l Officer (Dr. MOH General Director (Dr. ---) B.1.1.1 ½ time extra employee for ESU USD B.1.1.1 WHO B.1.1.1 Focal person nominated B.1.2 Appointment of the members of the Technical Working Group along with its TOR B.1.2 Appointmen t B.1.2 One B.1.2 three months from time zero B.1.2 MOH ESU B.1.2 WHO National Professiona l Officer (Dr. MOH General Director (Dr---) B.1.2 ½ time extra employee for ESU USD B.1.2 MOH B.1.2 Technical working group assigned 62 Objective Activity/Sub- activity Unit Quantity Date Location Responsibl e Entity Cost Source Of Funding Indicator B.2 Reporting of AMR data to GLASS B.2.1 Mapping of labs that can potentially provide microbiologically reliable and epidemiologically representative data. These labs start reporting their data to the (GLASS). B.2.1.1Make a list of laboratories that will ultimately form an epidemiologic representation of the country and that will be sequentially entered into GLASSafter capacity building B.2.1.1 List B.2.1.1 One B.2.1.1 Three months from time zero B.2.1 MOH ESU B.2.1.1 Focal person B USD B.2.1.1 WHO B.2.1.1 List available to technical working group B.2.2 Put a plan for capacity building for the labs that are chosen to be included in GLASS report in order to be epidemiologically representative based on an incremental plan B. Organize a nationwide workshop about GLASS and the plan of inclusion in GLASS and introduction to WHONET repeat the same the following year, then the following years B.2.2.1 Workshop B.2.2.1 one every 5 years B.2.2.1 Three months from time zero B.2.2.1 WHO B.2.2.1 Technical working group Focal Person B.2.2.1 USD * USD per workshop B.2.2.1 AMR Fund WHO B.2.2.1 Workshop given 63 Objective Activity/Sub- activity Unit Quantity Date Location Responsible Entity Cost Source Of Funding Indicator B.2 Reporting of AMR data to GLASS B.2.2.3 Do a start up WHONET training for the 12 laboratories that were chosen for the coming 2 years every 2 years B.2.2.3 Workshop B.2.2.3 One every two years B.2.2.3 Three months from time zero B.2.2.3 WHO B.2.2.3 Private sector, WHO consultant (Dr. ---) Private sector (Dr. Technician s B.2.2.3 USD * USD/ year B.2.2.3 AMR Fund WHO B.2.2.3 Workshop is done B.2.2.4 Do 3 laboratory visits for capacity building/year for laboratories in different areas for building capacity and WHONET Training workshop B.2.2.4 Laborato ry visits B.2.2.4 Two visits per lab each year for laboratori es B.2.2.4 starting year B.2.2.4 The chosen laboratorie s B.2.2.4 Technical working group B.2.2.4 Two capacity building workshop s per year years: workshop USD per workshop = USD B.2.2.4 AMR Fund B.2.2.4 Number of laboratories that are passing the external QC / Total external QC tests sent*100 USD 64 Objective Activity/Sub- activity Unit Quantity Date Location Responsibl e Entity Cost Source Of Funding Indicator B.2 Reporting of AMR data to GLASS B.2.2.5 External quality control twice per year for the 12 laboratories chosen for the 2 years, then to add the ones of the following 2 years, after the 2nd year. B.2.2.5 Send the quality control specimens and collect them B.2.2.5 Years 1 &2 = sample /year * years 120 samples B.2.2.5 Six months from time zero B.2.2.5 Reference laboratory (ies) B.2.2.5 Technical working group B.2.2.5 100 USD /specimen ( * * )* years = * USD/ for years B.2.2.5 AMR Fund WHO B.2.2.5 Number of laboratories having external QC B.2.3 Data Entry in GLASS B.2.3.1 Data collection from mature laboratories B.2.3.1 Data collection B.2.3.1 Once/year B.2.3.1 Start end of st year from time zero B.2.3.1 ESU B.2.3.1 ESU B.2.3.1 USD * USD * year Total USD USD B.2.3.1 WHO/MOH B.2.3 Number of laboratories reporting to GLASS B.2.3.2 Data cleaning and entry into GLASS B.2.3.2 Data cleaning and entry B.2.3.2 Once/year B.2.3.2 Start end of st year from time zero B.2.3.2 ESU B.2.3.2 ESU MOH Head of Epidemiolo gical Surveillanc e Program (Dr. ----) B.2.3.2 ½ time Extra employee B.2.3.2 MOH/ WHO 65 Objective Activity/Sub- activity Unit Quantity Date Location Responsible Entity Cost Source Of Funding Indicator B.3 Periodic issuing of an epidemiolo gically representati ve national AMR surveillanc e report in humans B.3.1 This report is based on WHONET data, according to local needs of physicians, pharmacists and researchers (stratificati on of data based on the type of priority organisms, site/region of infection or acquisition, etc.) This report is posted on AMR webpages (MOH and MOA websites B.3.1 Report B.3.1 Once/year starting end of 1st year B.3.1 Once/year starting end of 1st year B.3.1 University hospitals DC&S B.3.1 Technical working group or interested researchers assigned by technical working group B.3.1 USD B.3.1 WHO B.3.1 Epidemiolo gic report posted on AMR website yearly B.4.1 AUY-Dpt of Agriculture (Dr. ----) MOA Head of Animal Health Service (Dr. ---) MOA Head of Poultry Husbandry Dpt (Eng. MOH Head of Epidemiolo Surveillanc e Program (Dr. B.4 Optimize AMR surveillanc e in the agricultural , food, veterinary, and environme n tal fields B.4.1 Research project about AMR surveillanc e in the veterinary field. B.4.1 Project B.4.1 One B.4.1 6 months from time zero B.4.1 MOA Department of agriculture (AUY) B.4.1 USD B.4.1 WHO B.4.1 Surveillanc e report every 2 years 66 Objective Activity/Sub- activity Unit Quantity Date Location Responsibl e Entity Cost Source Of Funding Indicator B.4 Optimize AMR surveillanc e in the agricultural , food, veterinary, and environmen tal fields B.4.2 Design an epidemiologically representative sample for AMR surveillance (cattle, poultry, companion animals). B.4.2 Organizatio n project B.4.2 one B.4.2 9 months from time zero B.4.2 MOA B.4.2 MOA-Head of Animal Health Service (Dr. ---) MOA Head of Poultry Husbandry Dpt (Eng. B.4.2 USD B.4.2 AMR fund B.4.2 None B.4.3 Put a list of AMR priority organisms and related resistance genes for surveillance in these fields B. List B.4.3 One B.4.3 6 months from time zero B.4.3 MOA MOH WHO B.4.3 MOA-Head of Animal Health Service (Dr. ---) Technical working group B.4.3 USD B.4.3 AMR fund B.4.3 None 67 Objective Activity/Sub- activity Unit Quantity Date Location Responsibe Entity Cost Source Of Funding Indicator B.4 Optimize AMR surveillanc e in the agricultural , food, veterinary, and environmen tal fields B.4.4 Assessment of YARI, agriculture laboratory, and the chamber of manufacturing and commerce in Sana'a for the analysis of surveillance e specimens in agricultural , food, veterinary, and environmental fields Suggestion of a plan of the microbiology work in this surveillance B.4.4 Visits to three laboratories with audit result B.4.4 Three B.4.4 Six months from time zero and completed nine months from time zero B.4.4 YARI Sana'a chamber of manufactur ing and commerce AUY laboratory B.4.4 Technical working group YARI Sana'a chamber of manufactur ing and commerce AUY laboratory B.4.4 USD per visit Total: 3 visits USD B.4.4 AMR Fund B.4.4 Report about the capacity of these laboratories to do AMR surveillanc e in the veterinary world B.4.5 Report results of ABX use And resistance surveillance in agriculture and veterinary world Send a yearly report with Recommendations to the animal drug registry about ABX purchasing in the country during the coming 2 years B. Report B.4.5 Once every 2 years B.4.5 First report should be ready at end of year 2 from time zero B.4.5 MOA B.4.5 MOA Head of Animal Health Service (Dr. --) Technical working group B.4.5 USD/report (Every 2 years) Total USD years B.4.5 AMR Fund B.4.5 Quantity of purchased ABX that are listed in the “restricted use list” in the veterinary world 68 Objective Activity/Sub- activity Unit Quantity Date Location Responsib e Entity Cost Source Of Funding Indicator B.5 Create/ Appoint AMR reference lab(s) B.5.1 Define TOR of AMR reference lab B.5.1 Document B.5. ONE B.5.1 3 months from time zero B.5.1 ESU MOH B.5.1 Technical working group B.5.1 USD B.5.1 WHO B.5 Reference laboratory/ laboratories appointed and B.5.2 Map potential lab(s) across Yemen B.5.2 List B.5.2 One B.5.2 Start at time zero Mapping finalized 3 months from time zero B.5.2 ESU MOH Potential laboratories B.5.2 Technical working group B.5.2 USD B.5.2 WHO B.5.3 Task force to visits the potential lab(s) (WHO EMRO) to be discussed with Dr B.5.3 Visit done by EMRO consultant B.5.3 one to each potential reference laboratory B.5.3 5 months from time zero B.5.3 Potential laboratories B.5.3 EMRO B.5.3 USD B.5.3 EMRO B.5.4 Nominate the reference lab(s) B.5.4 Nominaticn B.5.4 One nominatio n of one or more laboratories B.5.4 6 months from time zero B.5.4 EMRO WHO MOH B.5.4 EMRO WHO MOH B.5.4 USD B.5.4 WHO 69 Objective Activity/Sub- activity Unit Quantity Date Location Responsib e Entity Cost Source Of Funding Indicator B.5.5 MOH to sign a contract with the lab(s) B.5.5 Contract B.5.5 one or more depending on number of chosen reference laboratories B.5.5 9 months from time zero B.5.5 MOH B.5.5 MOH General Director Dr. B.5.5 USD B.5.5 WHO B.6 Enhance research activities in AMR surveillanc e B.6.1 Put and broadcast an AMR Research Agenda including research for alternative agents to antimicrobi als. B.6.1 Agenda B.6.1 One/2 years B.6.1 st agenda sent 1.5 years from time zero B.6.1 MOH WHO ESU Universitie s B.6.1 Technical working group ESU B.6.1 USD B.6.1 WHO B.6.1 Research agenda listed on AMR website 71 Monitoring and evaluation plan Objective Activity /Sub-activity Indicator Purpose Calculation Frequency Data source Method baseline B.1 Organization of the responsibiliti es for the execution of the tasks B.1.1 Appointment of focal person charge of following up the activities of the objectives of this axis B.1.1.1 Empower ESU director as focal person B.1.1.1 Focal person Onominated B.1.1.1 Follow up on the activities of this axis B.1.1.1 Yes/No B.1.1.1 Once/5 years B.1.1.1 MOH WHO B.1.1.1 Letter B.1.1.1 Partially, unofficially B.1.2 Appointment of the members of the technical working group along with its TOR B.1.2 Technical working group assigned B.1.2 Execution of most of the activities of the axis B.1.2 Yes/No B.1.2 Once/5 years B.1.2 MOH WHO B.1.2 Letter B.1.2 NA B.2 Reporting of AMR data to GLASS B.2.1 Mapping of labs that can potentially provide microbiologically reliable and epidemiologically B.2.1.1 Make a list of laboratories that will ultimately form an epidemiologic representatio n of the representative data. These labs start reporting their data to the (GLASS). B.2.1.1 List available to technical working group country and that will be sequentially entered into GLASS after capacity building B.2.1.1 Mapping of potential laboratories and in order to have an epidemiolo gi cally representati v e sample B.2.1.1 Yes/No B.2.1.1 Once/4 years B.2.1.1 ESU MOH B.2.1.1 Listing B.2.1.1 NA 70 Objective Activity Sub-activity Indicator Purpose Calculation Frequency Data source Method baseline B.2 Reporting of AMR data to GLASS B.2.2 Put a plan for capacity building for the labs that are chosen to be included in GLASS report in order to be epidemiologi cally representativ e based on an incremental plan B.2.2.1 Organize a nationwide workshop about GLASS and the plan of inclusion in GLASS and introduction to WHONET B.2.2.1 Workshop given B.2.2.1 Introduction to GLASS and the plan, mainly because recruitment of the laboratories is based on voluntary enrollment into the project B.2.2.1 Yes/No B.2.2.1 Once/5 years B.2.2.1 WHO MOH B.2.2.1 workshop B.2.2.1 Done partially B.2.2.2 Evaluate the quality of work in the selected laboratories (visit), Check laboratories per year, Select the ones that can immediately report to GLASS, Put a plan for 6 laboratories that will undergo improvement in their capacity during coming year, then repeat the same the following year, then the following years B.2.2.2 List of laboratories that will immediately report is listed on website Schedule for other laboratories is put B.2.2.2 Organization of the work and a 4 year schedule B.2.2.2 Schedule is put. Yes/No B.2.2.2 Once/year B.2.2.2 WHO Chosen laboratories B.2.2.2 Laboratory visits B.2.2.2 NA 72 Objective activity sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline B.2 Reporting of AMR data to GLASS B.2.2.3 Do a start up WHONET training for the 12 laboratories that were B.2.2.3 Workshop is done chosen for the coming years every years B.1.1.4 WHONET training for laboratories that will report to GLASS B.2.2.3 Yes/No B.2.2.3 Once every two years B.2.2.3 WHO MOH B.2.2.3 Workshop B.2 Once done not focused to laboratories that will enter GLASS B.2.2.4 Do 3 laboratory visits for capacity building/year for 6 laboratories in different areas for building capacity and WHONET training B.2.2.4 Number of laboratories that are passing the external QC / Total external QC tests sent*100 B.2.2.4 Recommend ation for GLASS entry B.2.2.4 Number of laboratories that are passing the external QC / Total external QC tests sent*100 B.2.2.4 Once/Year B.2.2.4 Chosen laboratories B.2.2.4 Laboratory visits B.2.2.4 NA B.2.2.5 External quality control twice per year for the 12 laboratories chosen for the 2 years, then to add the ones of the following 2 years, after the 2nd year B.2.2.5 Number of laboratories having external QC B.2.2.5 Measure the progress of the capacity building. B.2.2.5 Number of quality control specimen sent /year B.2.2.5 Once/year B.2.2.5 Reference laboratory (ies) B.2.2.5 Send the quality control specimens and collect them B.2.2.5 Few labs in the country have it B.2.3 Data Entry in GLASS B.2.3.1 Data collection from mature laboratories B.2.3.2 Data cleaning and entry into GLASS B.2.3 Number of laboratories reporting to GLASS B.2.3 Reach epidemiologi c representativ eness B.2.3 Number of laboratories reporting to GLASS B.2.3 Once/Year B. WHO MOH B.2.3 Data collection and entry B.2.3 Two laboratories have already submitted data to GLASS.Not epidemiologi cally representative 73 Objective activity sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline B.3 Periodic issuing of an epidemiologi cally representativ e national AMR surveillance report in humans B.3.1 This report is based on WHONET data, according to local needs of physicians, pharmacists and researchers (stratification of data based on the type of priority organisms, site/region of infection or acquisition, etc.) This report is posted on AMR webpages (MOH and MOA websites) B.3.1 Epidemiolog ic report posted on AMR website yearly B.3.1 Improve awareness in scientific society B.3.1 Compilation of WHONET data B.3.1 Once/5 years B.3.1 University hospital(s) B.3.1 Project B.3.1 NA B.4 Optimize AMR surveillance in the agricultural, food, veterinary, and environment al fields B.4.1 Research project about AMR surveillance in the veterinary field. B.4.1 Surveillance report every 2 years B.4.1 Standardized AMR surveillance in cattle and poultry B.4.1 Yes/No B.4.1 every two years B.4.1 Agriculture school MOA B.4.1 Project B.4.1 NA B.4.2 Design an epidemiologi cally representativ e sample for AMR surveillance (cattle, poultry, companion animals). B.4.2 None 74 Objective activity sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline B.4 Optimize AMR surveillance in the agricultural, food, veterinary, and environment al fields B.4.3 Put a list of AMR priority organisms and related resistance genes for surveillance in these fields B.4.3 None B.4.4 Assessment of YARI, agriculture laboratory, and the chamber of manufacturin g and commerce in Tripoli for the analysis of surveillance specimens in agricultural, food, veterinary, and environment al fields Suggestion of a plan of the microbiology y work in this surveillance B.4.4 Report about the capacity of these laboratories to do AMR surveillance in the veterinary world B.4.4 Standardized AMR surveillance in the veterinary world B.4.4 Yes/No B.4.4 once/5 years B.4.4 YARI Sana'a chamber of manufacturin g and commerce AUY laboratory B.4.4 Report B.4.4 NA B.4.5 Report results of ABX use and resistance surveillance in agriculture and veterinary world Send a yearly report with recommenda tions to the animal drug registry about ABX purchasing in the country during the coming years B.4.5 Quantity of purchased ABX that are listed in the “restricted use list” in the veterinary world B.4.5 Control ABX use in the veterinary world B.4.5 Quantity of purchased ABX B.4.5 Once every 2 years B.4.5 MOA B.4.5 Report B.4.5 NA 75 Objective activity sub activity Indicator Purpose Calculation Frequency Data source Method Baseline Objective B.5 Create/ Appoint AMR reference lab(s) B.5.1 Define TOR of AMR reference lab B.5 Reference laboratory/ laboratories appointed and contracts done B.5 Have a reference for difficult situations and catch alarming and emerging resistance trends B.5 No of specimens/ activities of reference Lab in AMR B.5 Once/Year B.5 WHO MOH B.5 Appointment B.5 NA B.5.2 Map potential lab(s) across Yemen B.5.3 Task force to visits the potential lab(s) (WHO EMRO) to be discussed with Dr B.5.4 Nominate the reference lab(s) B.5.5 MOH to sign a contract with the lab(s) B.6 Enhance research activities in AMR surveillance B.6.1 Put and broadcast an AMR Research Agenda including research for alternative agents to antimicrobial s. B.6.1 Research agenda listed on AMR website B.6.1 Involve and update concerned facilities in research activities in surveillance B.6.1 number of projects B.6.1 Once/2 years B.6.1 MOH WHO ESU B.6.1 Agenda B.6.1 NA 76 .Axis C: Infection prevention and control (IPC) Strategic plan Global action plan strategic Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and prevention measures Potential measures of effectiveness: extent of reduction in the prevalence of preventable infections, and in particular the incidence of drug resistant infections in health care settings Strategic Objective interventions Activity / Sub-activity Milestone C.1 Organization of the responsibilities for the execution of the tasks C.1.1 Appointment of focal person in charge of following up the activities of the objectives of this axis C.1 three months from “time zero” C.1.2 Appointment of the members of the technical group along with its TOR C.2 Optimize IPC practices in (Hospitals, LTCFs and PHCC C.2.1 Improve IPC practices in Hospitals C.2.1.1 To establish national IPC guidelines; guidelines to be all-inclusive including requirements and qualifications of IPC officer and physician and checklist C.2 3 years C.2.1.1 three months from “time zero C.2.1.2 Inclusion of the checklist of the guidelines in accreditation standards C.2.1.2 six months from “time zero” C.2.1.3 Follow up and feedback on IPC practices in hospitals after each accreditation C.2.1.3 three years from “time zero” C.2.1.4 Syndicate of hospitals recommends periodic IPC training and workshops to employees hosted by scientific societies, universities, etc C.2.1.4 , years from “time zero” C.2.2 Improve IPC practices hospitals C.2.2.1 To review and update guidelines of IPC in long- term care facilities that are available in Ministry of Social Affairs C.2.2.1 three months from “time zero” C.2.2.2 Inclusion of IPC checklist in the MOH licensing criteria of these facilities C.2.2.2 six months from “time zero” C.2.3 Improve IPC practices in HCC C.2.3.1 Establish guidelines on IPC in the PHCC C.2.3.2 Inclusion of IPC checklist in the MOH licensing criteria of these facilities C.2.3.1 six months from “time zero” C.2.3.2 nine months from “time zero” 77 Strategic Objective interventions Activity / Sub-activity Milestone C.3 Enhance IPC education different majors C.3.1 Include IPC-related educational modules in human-health related majors (physicians, nurses, LAB, midwives, physiotherapists, pharmacists, dentists, lab technicians, radiologists, nutrition, medical and paramedical schools) C.3 years from “time zero” C.3.1 one year from “time zero” C.3.2 Include IPC-related educational modules in veterinary schools curricula C.3.2.1 Check the current situation of IPC in the ongoing veterinary curriculum C.3.2.1 three months from “time zero” C.3.2.2 Review of IPC in regional and global veterinary curricula C.3.2.2 three months from “time zero” C.3.2.3 Prepare a proposal for veterinary school for deficit in curricula improvement, if need be. C.3.2.3 six months from “time zero” C.3.2.2 Review of IPC in regional and global veterinary curricula C.3.2.2 three months from “time zero” C.3.2.3 Prepare a proposal for veterinary school for deficit in curricula improvement, if need be. C.3.2.3 six months from “time zero” C.3.3 IPC-related educational modules in curricula of three schools (Agriculture, Nutrition, Environment) C.3.3.1 Mapping of IPC in three university curricula (Agriculture, Nutrition, Environment) C.3.3.1 six months from “time zero” C.3.3.2 Review global and regional recommendations on IPC in curricula of agriculture, nutrition and environment, and formulate what should be included in them C.3.3.2 six months from “time zero” 78 Strategic Objective interventions Activity / Sub-activity Milestone C.4 Advanced IPC training for IPC professionals C.3.3.3 Include the recommended tricyclic AMR and IPC in curricula when not available C.3.3.3 years from “time zero” C.4.1 Put TOR for IPC professionals in different healthcare facilities. Put prerequisite training/experience of IPC physicians, officers, and nurses C. Include in the national IPC Guidelines the TOR of the professionals C.4 3 months C.4.1.1 3 months C.4.2 Make training available and affordable in universities and professional societies C.4.2.1 MOH Sends letters to Ministry of Higher Education and to Order of physicians explaining the need and recommending training specialization opportunities and courses related to IPC C.4.2.1 3 months C.5 National Process Indicators in IPC C.5.1 Baseline evaluation of current situation at a national level (research project) and make it a continuous process C.5 Four years from “time zero” C.5.1 One year from “time zero” C.5.2 National indicators to be incrementally applied with time (hand hygiene, PPE, isolation, other standard precautions, et C.5.2 Four years from “time zero” C.6 Survey of Nosocomial Infections in hospitals C.6.1 Conduct a point prevalence study on nosocomial infections in Yemen's hospitals C.6 2 years C.6.1 2 years C.7 IPC in the veterinary world C.7.1 Review the OIE biosafety recommendations C.7 6 months C.7.1 3 months C.7.2 Check the availability in of these recommendations in local veterinary laws C.7.2 5 months C.7.3 Monitor the application of these laws C.7.3 .1 MOH recommends to MOA to follow up on the related activities of IPC in Veterinary world C.7.3 6 months 79 Operational plan and budge Objective Activity Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source Of funding Indicator C.1 Organization of the responsibili ties for the execution of the tasks C.1.1 Appointment of focal person n charge of following up the activities of the objectives of this axis C.1 Appointme nt C.1 One person and one technical group C.1 three months from “time zero” C.1 MOH C.1 MOH General Director (Dr. ---) appoints of the technical working group Focal person is appointed by the technical working group C.1 One full time employee USD C.1 AMR Fund C.1 Appointme nt letter with job description C.1.2 Appointment of the members of the IPC TWG along with its TOR 81 Objective Activity Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source Of funding Indicator C.2 Optimize IPC practices in Hospitals, HCC C.2.1 Improve IPC practices in Hospitals C.2.1.1 To establish national IPC guidelines; guidelines to be all inclusive including requirements and qualifications of IPC officer and physician and checklist C.2.1.1 Document C.2.1.1 one C.2.1.1 three months from “time zero” C.2.1.1 MOH DC&S WHO C.2.1.1 IPC expert C.2.1.1 USD C.2.1.1 AMR Fund C.2.1.1 Guidelines on MOH site C.2.1.2 Inclusion of the checklist of the guidelines in accreditation standards C.2.1.2 Checklist C.2.1.2 one C.2.1.2 six months from “time zero” C.2.1.2 MOH DC&S WHO C.2.1.2 IPC expert MOH Project Coordinator (Dr----) C.2.1.2 USD C.2.1.2 AMR Fund C.2.1.2 Letter from team to IPC Officer C.2.1.3 Follow up and feedback on IPC practices in hospitals after each accreditation C.2.1 Report C.2.1.3 one every 5 years C.2.1.3 three years from “time zero” C.2.1.3 MOH C.2.1.3 IPC coordinator or temporary consultant Accreditati on team C.2.1.3 USD C.2.1.3 Syndicate of hospitals C.2.1.3 Percentage of hospitals with acceptable results for IPC in accrediting 80 Objective Activity Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source Of funding Indicator C.2 Optimize IPC practices in Hospitals, HCC C.2.1.4 Syndicate of hospitals recommend s periodic IPC training and workshops to employees hosted by scientific societies, universities , etc. C.2.1.4 Schedule C.2.1.4 five C.2.1.4 1,5 years from “time zero” C.2.1.4 Hospitals Universitie s C.2.1.4 MOH Head of Preventive Medicine and Communic able Diseases Dpts (Dr C.2.1.4 USD C.1.1.4 WHO C.2.1.4 Number of IPC workshops per year C.2.2 Improve IPC practices in hospital C.2.2.1 To review and update guidelines of IPC in hospital that are available in Ministry of Social Affairs C Guidelines C.2.2.1 One C.2.2.1 three months from “time zero” C.2.2.1 MOH C.2.2.1 Order of nurses (Ms ) Private sector (Dr. ) C.2.2.1 USD C.2.2.1 AMR fund C.2.2.1 Updated guidelines on website C.2.2.2 Inclusion of IPC checklist in the MOH licensing criteria of these facilities C.2.2.2 Checklist C.2.2.2 One C.2.2.2 six months from “time zero” C.2.2.2 MOH C.2.2.2 MOH Project Coordinato r (Dr---)) C.2.2.2 USD C.2.2.2 None C.2.2.2 Checklist of IPC in accreditatio n standards 82 Objective Activity Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source Of funding Indicator C.2 Optimize IPC practices in Hospitals, HCC C.2.3 Improve IPC practices in HCC C.2.3.1 Establish guidelines on IPC in the PHCC C.2.3.1 Guidelines C.2.3.1 One C.2.3.1 six months from “time zero” C.2.3.1 MOH DC&S WHO C.2.3.1 Private Sector (Dean of School of Nursing- University) (Dr.---) C.2.3.1 USD C.2.3.1 AMR fund WHO C.2.3.1 Guidelines on website C.2.3.2 Inclusion of IPC checklist in the MOH licensing criteria of these facilities C.2.3.2 Checklist C.2.3.2 One C.2.3.2 nine months from “time zero” C.2.3.2 MOH C.2.3.2 Private Sector (Dean of School of Nursing- University) (Dr.---) C.2.3.2 USD C.2.3.2 AMR fund C.2.3.2 Checklist of IPC in accreditatio n standards. C.3 Enhance IPC education different majors C.3.1 Include IPC-related educational modules in human- health related majors (physicians , nurses, midwives, physiotherapists, pharmacist s, dentists, lab technicians, radiologists , nutrition, medical and paramedical schools) C.3.1 Basic recommend ations to be included IPC Letters from Ministry of education to different teaching establishme nts C.3.1 one per year 2 types: 1.General 2.Specific to nurses, midwives medical students. C.3.1 one year from “time zero” C.3.1 Ministry of Education MOH C.3.1 One appointed consultant helped by: Order of nurses- Director (Ms. ---) Order of Midwives member (Ms MOH- PHC Dpt Dental Coordinator (Dr ) Technical Schools (Ms. ” h/specialist C.3.1 USD C.3.1 AMR Fund C.3.1 Percentage of health curricula that contain IPC modules 83 Objective Activity Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source Of funding Indicator C.3 Enhance IPC education different majors C.3.2 Include IPC-related educational modules in veterinary schools curricula C.3.2.1 Check the current situation of IPC in the ongoing veterinary curriculum C.3.2.1 Report C.3.2.1 One C.3.2.1 three months from “time zero” C.3.2.1 MOA C.3.2.1 MOA Head of Animal Health Service (Dr. C.3.2.1 USD C.3.2.1 AMR fund C.3.2.1 None C.3.2.2 Review of IPC in regional and global veterinary curricula C.3.2.2 Report C.3.2.2 One C.3.2.2 three months from “time zero” C.3.2.2 MOA C.3.2.2 MOA Head of Animal Health Service (Dr. ---) C.3.2.2 USD C.3.2.2 AMR fund C.3.2.2 None C.3.2.3 Prepare a proposal for veterinary school for deficit in curricula improvement C.3.2.3 Proposal C.3.2.3 One C.3.2.3 six months from “time zero” C.3.2.3 MOA C.3.2.3 MOA Head of Animal Health Service (Dr. ---) AUY-Dpt of Agriculture (Dr. ---) C.3.2.3 USD C.3.2.3 AMR fund C.3 Proposal is sent to veterinary school, and IPC included in program 84 Objective Activity Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source Of funding Indicator C.3 Enhance IPC education different majors C.3.3 IPC- related educational modules in curricula of three schools (Agriculture, Nutrition, Environment) C.3.3.1 Mapping of IPC in three university curricula (Agriculture, Nutrition, Environment) C.3.3.1 Report C.3.3.1 One C.3.3.1 six months from “time zero” C.3.3.1 MOH Agriculture schools (AUY, SU) C.3.3.1 MOA Head of Poultry Husbandry Dpt (Eng. ) C.3.3.1 USD C.3.3.1 AMR fund C.3.3 IPC module to be included in the three curricula of sent from respective ministries as recommen dation to the schools C.3.3.2 Review global and regional recommend ations on IPC in curricula of agriculture, nutrition and environment, and formulate what should be included in them C.3.3.2 Report C.3.3.2 One C.3.3.2 six months from “time zero” C.3.3.2 MOH Agriculture schools (AUY, SU) C.3.3.2 SU-Dpt of Agriculture (Dr. ---) C.3.3.2 USD C.3.3.2 AMR fund C.3.3.3 Include the recommended AMR and IPC in curricula when not available C.3.3.3 Memo to Ministry of Education C.3.3.3 One C.3.3.3 2 years from “time zero” C.3.3.3 MOH Agriculture schools (AUY, SU) C.3.3.3 MOA Head of Poultry Husbandry Dpt (-----) Private sector ( C.3.3.3 USD C.3.3.3 AMR fund 85 Objective Activity Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source Of funding Indicator C.4 Advanced IPC training for IPC professiona ls C.4.1 Put TOR for IPC professional ls in different healthcare facilities. Put prerequisite training/experience of IPC physicians, officers, and nurses C.4 Include in the national IPC Guidelines the TOR of the professionals C.4.1.1 Part of IPC guidelines C.4.1.1 One C.4.1.1 3 months C.4.1.1 MOH WHO C.4.1.1 Same as guidelines C.4.1.1 Within cost of guidelines C.4.1 AMR Fund C.4.1.1 TOR of IPC professiona ls are included in the IPC guidelines C.4.2 Make training available and affordable in universities and professional societies C.4.2.1 MOH Sends letters to Ministry of Higher Education and to Order of physicians explaining the need and recommending training specialization opportunities and courses related to IPC C.4.2.1 Letter C.4.2.1 One C.4.2.1 3 months C.4.2.1 MOH C.4.2.1 Technical working group C.4.2.1 USD C.4.2.1 WHO C.4.2.1 As curricula 86 Objective Activity Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source Of funding Indicator C.5 National Process Indicators in IPC C.5.1 Baseline evaluation of current situation at a national level (research project) and make it a continuous process C.5.1 Research project C.5.1 One C.5.1 One year from “time zero” C.5.1 MOH ICD&S Hospitals C.5.1 Private sector, WHO consultant, former DC&S president (Dr. ) Private sector, former DC&S president (Dr--i) Private sector (---) ESU C.5.1 USD C.5.1 Fund raising C.5.1 Results are posted on AMR website C.5.2 National indicators to be incrementally applied with time (hand hygiene, PPE, isolation, other standard precautions, etc) C.5.2 Research project C.5. One C.5.2 Four years from “time zero” C.5.2 MOH ICD&S Hospitals C DC&S ESU C.5.2 USD C.5.2 Fund raising C.5.2 Percentage of hospitals that report results of process indicators C.6 Survey of Nosocomia l Infections in hospitals C.6.1 Conduct a point prevalence study on nosocomial infections in Yemeni hospitals C.6.1 Survey C.6.1 one C.6.1 2 years C.6.1 Yemeni Hospitals C.6.1 Technical working group C.6.1 USD C.6.1 AMR Fund C.6.1 Results of study published 87 Objective Activity Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source Of funding Indicator C.7 IPC in the veterinary world C.7.1 Review the OIE biosafety recommendations C.7.1 Report C.7.1 one C.7.1 3 months C.7.1 MOA C.7.1 Technical working group C.7.1 USA C.7.1 WHO C.7.1 None C.7.2 Check the availability in of these recommend ations in local veterinary laws C.7.2 Report C.7.2 one C.7.2 5 months C.7.2 MOA C.7.2 Technical working group MOA Head of Animal Health Service (Dr. C.7.2 USD C.7.2 AMR Fund C.7.2 None C.7.3 Monitor the application of these laws C.7.3 MOH recommends to MOA to follow up on the related activities of IPC in Veterinary world C.7.3 Letter C.7.3 one C.7.3 6 months C.7.3 MOH C.7.3 Technical working group C.7.3 USD C.7.3 WHO C.7.3 None 88 Monitoring and evaluation plan objective 3 Objective Activity /Sub-activity Indicator Purpose Calculation Frequency Of Data collection Data Source Method Baseline C.1 Organization of the responsibiliti es for the execution of the tasks C.1.1 Appointment of focal person n charge of following up the activities of the objectives of this axis C.1 Appointment letter with job description C.1 Follow up on activities C.1 Letter C.1 NA C.1 NA C.1 NA C.1 Not appointed C.1.2 Appointment of the members of the technical group along with its TOR C.2 Optimize IPC practices in Hospitals, long term care facilities and PHCC C.2.1 Improve IPC practices in Hospitals C.2.1.1 To finalize national IPC guidelines; guidelines to be all- inclusive including requirements and qualification s of IPC officer and physician and checklist C.2.1.1 Guidelines on MOH site C.2.1.1 Update and standardizati on of IPC C.2.1.1 Yes/no C.2.1.1 Once/5 years C.2.1.1 International guidelines C.2.1.1 Scientific review C.2.1.1 In progress 89 Objective Activity /Sub-activity Indicator Purpose Calculation Frequency Of Data collection Data Source Method Baseline C.2 Optimize IPC practices in Hospitals, long term care facilities and PHCC C.2.1.2 Inclusion of the checklist of the guidelines in accreditation standards C.2.1.2 Letter from team to IPC Officer C.2.1.2 Audit IPC during the accreditation audit in hospitals C.2.1.2 Yes/No C.2.1.2 Once/5 years C.2.1.2 Accreditatio n checklists C.2.1.2 Letter Meeting Accreditatio n committee C.2.1.2 Partial C.2.1.3 Follow up and feedback on IPC practices in hospitals after each accreditation C.2.1.3 Percentage of hospitals with acceptable results for IPC in accreditation C.2.1.3 Increase the number of hospitals that are compliant with national IPC guidelines. C.2.1.3 (Number of compliant hospitals/Tot al number of audited hospitals) x100 C.2.1.3 Once/3 years C.2.1.3 Accreditatio n audit results C.2.1.3 Checklist in accreditation audit C.2.1.3 Not started yet C.2.1.4 Syndicate of hospitals recommends periodic IPC training and workshops to employees hosted by scientific societies, universities,etc C.2.1.4 Number of IPC workshops per year C.2.1.4 Have qualified HCW in charge of IPC, and have more efficient programs in hospitals C.2.1.4 Number of workshops/ Number of universities providing health sciences programs C.2.1.4 Once/5 years C.2.1.4 International standards C.2.1.4 Scientific review C.2.1.4 Workshops are being done but not followed up 91 Objective Activity /Sub-activity Indicator Purpose Calculation Frequency Of Data collection Data Source Method Baseline C.2 Optimize IPC practices in Hospitals, long term care facilities and PHCC C.2.2 Improve IPC practices in long-term care facilities C.2.2.1 To review and update guidelines of IPC in long term care facilities that are available in Ministry of Social Affairs C.2.2.1 Updated guidelines on website C.2.2.1 Standardize IPC in long term C.2.2.1 Yes /no C.2.2.1 Once C.2.2.1 Ministry of social affairs Guidelines C.2.2.1 Review and update C.2.2.1 NA C.2.2.2 Inclusion of IPC checklist in the MOH licensing criteria of these facilities C.2.2.2 Checklist of IPC in accreditation standards C.2.2.2 Improve application of IPC in these facilities C.2.2.2 Yes /no C.2.2.2 Once C.2.2.2 Long term care facilities MOH Ministry of social affairs C.1.2.2 Letter Meeting C.1.2.2 NA C.2.3 Improve IPC practices in PHCC C.2.3.1 Establish guidelines on IPC in the PHCC C.2.3.1 Guidelines on website C.2.3.1 Standardize IPC in PHCC C.2.3.1 Yes/No C.2.3.1 Once per 6 months C.2. Guidelines AMS/AMR website C.2.3.1 Checking C.2.3.1 NA C.2.3.2 Inclusion of IPC checklist in the MOH licensing criteria of these facilities C.2.3.2 Checklist of IPC in accreditation standards. C.2.3.2 Improve application of IPC in these facilities C.2.3.2 Yes/No C.2.3.2 Once per 6 months C.2.3.2 Accreditatio n guidelines C.2.3.2 Letter Meeting Accreditatio n committee C.2.3.2 NA 90 Objective Activity /Sub-activity Indicator Purpose Calculation Frequency Of Data collection Data Source Method Baseline C.3 Enhance IPC education different majors C.3.1 Include IPC- related educational modules in human- health related majors (physicians, nurses, midwives, physiotherap ists, pharmacists, dentists, lab technicians, radiologists, nutrition, medical and paramedical schools) C.3.1 Percentage of health curricula that contain IPC modules C.3.1 Include IPC in basic education of health professionals C.3.1 (Number of curricula that have IPC module/Tota l number of health sciences curricula) * C. Once/5 years C.3.1 Curricula IPC guidelines C.3.1 Letters to universities C.3.1 IPC included but non standardized and unorganized C.3.2 Include IPC- related educational modules in veterinary schools curricula C.3.2.1 Check the current situation of IPC in the ongoing veterinary Curriculum C.3.2.2 Review of IPC in regional and global veterinary curricula C.3.2.1 None C.3.2.2 None 92 Objective Activity /Sub-activity Indicator Purpose Calculation Frequency Of Data collection Data Source Method Baseline C.3 Enhance IPC education different majors C.3.2.3 Prepare a proposal for veterinary school for deficit in curricula improvement , if need be. C.3.2.3 Proposal is sent to veterinary school, and IPC included in program C.3.2.3 Improve IPC education in veterinary school C.3.2.3 Yes/No C.3.2.3 Once C.3.2.3 Veterinary school MOA C.3.2.3 Check if proposal sent C.3.2.3 NA C.3.3 IPC- related educational modules in curricula of three schools (Agriculture, Nutrition, Environment) C.3.3.1 Mapping of IPC in three university curricula (Agriculture, Nutrition, Environment) C.3.3 IPC module to be included in the three curricula of sent from respective ministries as recommenda tion to the schools C.3.3 Improve IPC education in Agriculture, Nutrition, Environment Schools C.3.3 Number of university programs that include IPC according to recommenda tion/Total number of audited programs C.3.3 Once/year C.3.3 The 3 schools C.3.3 Checking C.3.3 In a superficial way C.3.3.2 Review global and regional recommendations on IPC in curricula of agriculture, nutrition and environment, and formulate what should be included in them C.3.3.3 Include the recommende d tricyclic AMR and IPC in curricula when not available 93 Objective Activity /Sub-activity Indicator Purpose Calculation Frequency Of Data collection Data Source Method Baseline C.4 Advanced IPC training for IPC professionals C.4.1 Put TOR for IPC professionals in different healthcare facilities. -Put prerequisite training/ expe rience of IPC physicians, officers, and nurses C.4.1.1 Include in the national IPC Guidelines the TOR of the professionals C.4.1.1 TOR of IPC professionals are included in the IPC guidelines C.4.1.1 To standardize the work and follow-up on the performance C.4.1.1 Yes/No C.4.1.1 Once C.4.1.1 MOH WHO C.4.1.1 Checking C.4.1.1 NA C.4.2 Make training available and affordable in universities and professional societies C.4.2.1 MOH Sends letters to Ministry of Higher Education and to Order of physicians explaining the need and recommending training specialization opportunities and courses related to IPC C.4.2.1 None 94 Objective Activity /Sub-activity Indicator Purpose Calculation Frequency Of Data collection Data Source Method Baseline C.5 National Process Indicators in IPC C.5.1 Baseline evaluation of current situation at a national level(research project) and make it a continuous process C.5.1 Results are posted on AMR website C.5.1 Have a baseline evaluation C.5.1 Percentage of hospitals that do have milestones of IPC C.5.1 Once C.5.1 Hospitals that are epidemiologi cally representativ e C.5.1 Project C.5.1 NA C.5.2 National indicators to be incrementall y applied with time (hand hygiene, PPE, isolation, other standard precautions, etc) C.5.2 Percentage of hospitals that report results of process indicators C.5.2 improve application of IPC principles C.5.2 For each process indicator 5 hospitals that have a follow up of the indicator C.5.2 Once/3 years C.5.2 Hospitals that are epidemiologi cally representativ e C.5.2 Project C.5.2 NA C.6 Survey of Nosocomial Infections in hospitals C.6.1 Conduct a point prevalence study on nosocomial infections in Yemeni hospitals C.6.1 Results of study published C.6.1 To join the WHO point prevalence HAI study, and benchmark with global data C.6.1 NA C.6.1 Once C.6.1 Hospitals MOH C.6.1 Study C.6.1 NA C.7 IPC in the veterinary world C.7.1 Review the OIE biosafety recommendations C.7.1 None 95 Objective Activity /Sub-activity Indicator Purpose Calculation Frequency Of Data collection Data Source Method Baseline C.7 IPC in the veterinary world C.7.2 Check the availability in of these recommenda tions in local veterinary laws C.7.2 None C.7.3 Monitor the application of these laws C.7.3 MOH recommends to MOA to follow up on the related activities of IPC in Veterinary world C.7.3 None 96 Axis D: Antibiotic use Strategic plan Objective 4: Optimize the use of antimicrobial medicines in human and animal health Potential measure of effectiveness: extent of reduction in National human consumption of antibiotics (with allowance for the need for improved access in some settings), the consumption of antibiotics used in food production (terrestrial and aquatic livestock, and other agricultural practices), and the use of medical and veterinary antimicrobial agents forapplications other than human and animal health Strategic objective 4 interventions Activity / Sub-activity Milestone / Date (operational plan) D.1 Organization of the responsibilities for the execution of the tasks D.1.1 Appointment of focal person n charge of following up the activities of the objectives of this axis D.1 three months from time zero D.1.1 three months from time zero D.1.2 Appointment of the members of the technical working group along with its TOR D.1.2 three months from time zero D.2 Improve ABX quality control D.2.1 To support and include ABX as priority drugs in the pharmacovigilance project of the Yemeni University and the adverse drug event reporting program of the Order of Pharmacists D.2 One year from time zero D.2.1 One year from time zero D.3 Control the use of critically important antimicrobial molecules (CIAM) in humans D.3.1 Define CIAM D.3.1.1 Literature search D.3 Six months from time zero D.3.1.1 Three months from time zero D.3.1.2 Formulate the list D.3.1.2 Six months from time zero D.4 Sentinel Surveillance of ABX (CIAM) consumption from a network of hospitals and benchmark with international data D.4.1 Workshops on metrics for ABX use measurement D.4 5 years D.4.1 Six months from time zero and 1 year from time zero CIAM: Critically Important Antimicrobials 97 Strategic objective 4 interventions Activity / Sub-activity Milestone / Date (operational plan) D.4 Sentinel Surveillance of ABX (CIAM) consumption from a network of hospitals and benchmark with international data D.4.2 Compilation of data from hospitals D.4.2.1 Determine the epidemiologically representative sample of hospitals for surveillance of ABX D.4.2.1 three months from time zero D.4.2.2 Validate the measurement of hospital consumption by DDD/1000 patient days in a batch of 4 hospitals per year Include the hospitals with adequate measurements in a sequential manner into the surveillance list and data Advice to hospitals that don’t have adequate data D.4.2.2 One year and three months from time zero and continue yearly for 5 years D.4.2.3 Surveillance of ABX use in Yemeni hospitals by auto reporting DDDs D.4.2.3 1.5 years from time zero then yearly for 5 years D.5 Prepare hospitals and build their capacity for Antimicrobial stewardship (AMS) programs D.5.1 Workshops on AMS twice per year D.5 5 years D.5.1 Six months from time zero then yearly for 5 years D.5.2 Preparation and dissemination of national treatment guidelines on D.5.2.1 Put a list of essential guidelines infectious diseases to standardize the strategies of ABX use based on local epidemiology D.5.2.1 six months from time zero D.5.2.2 Prepare the missing guidelines D.5.2.2 Finalize within 1 year from time zero D.5.2.3 Prepare and follow a schedule for the presentation of the guidelines in the respective scientific societies meeting and for the endorsement of these guidelines with the respective societies D.5.2.3 Starting 1 year from time zero and finalized 3 years from time zero 98 AMS: Antimicrobial Stewardship Strategic objective 4 interventions Activity / Sub-activity Milestone / Date (operational plan) D.5 Prepare hospitals and build their capacity for Antimicrobial stewardship (AMS) programs D.5.2.4 Post these guidelines on the AMR/AMS website D.5.2.4 1.5 years from time zero D.5.3 Inclusion of AMS programs among hospital accreditation standards D.5.3.1 Three months from time zero D.5.4 Auditing the AMS practices during MOH accreditation with feedback to hospitals. D.5.4 2021 and after each accreditation audit for 5 years D.5.5 Development of AMS webpage in the MOH website D.5.5 six months from time zero D.6 Organize the dispensing of antimicrobials in the community pharmacies D.6.1 Nominate a task group for the meeting between MOH including Dr. ------ and the Order of pharmacists D.63 month D.6.13 month D.6.2 Meeting between a high-authority-level task force and the President of the Order of Pharmacists to agree over a plan to restrict dispensing of ABX D.6.2 To be finalized 3 months from time zero D.7 Control and regulate the use of ABX in the veterinary, agriculture, food production and environment sectors D.7.1 Banning importation and use of CIAM in the veterinary field D.7.1.1 The CIAM list will be sent to the minister to ban their importation for veterinary use D.7 Two years from time zero D.7.1.1 Will be sent nine months from time zero D.7.1.2 The veterinary drug office will not import these agents D.7.1.2 one year from time zero D.7.2 Check if CIAM are used in agriculture and environment D.7.2.1 Review the list of drugs and pesticides officially imported in agriculture. Check if CIAM are included in this list. D.7.2.1 nine months from time zero D.7.2.2 Check if any of these molecules are used in agriculture or environment from outside the official import channel. D.7.2.2 two years from time zero D.7.2.3 Get results of ABX residues in food items being done in Yemen D.7.2.3 three months from time zero 99 Strategic objective 4 interventions Activity / Sub-activity Milestone / Date (operational plan) D.7 Control and regulate the use of ABX in the veterinary, agriculture, food production and environment sectors D.7.3 Surveillance of importation of regularly used ABX to Yemen D.7.3.1 Form a registry of imported ABX in veterinary world D.7.3.1 Six months from time zero D.7.4 Research study about ABX consumption D.7 4.1 Research project by one of Masters Student at Sana'a University (SU) D.7 4.1 starting at time zero for one year D.7 4.2 Research project in Agriculture school (Quantify the use of ABX in poultry farms nationally) D.7 4.2 Two years from time zero D.7.5 Research study about unofficial importation of ABX to Yemen D.7.5 Research project in Agriculture school D.7.5 Two years from time zero 011 Operational plan and budget objective 4 objective Activity/ Sub- activity Unit Quantity Date Location Responsible Entity Cost Source Of Funding Indicator D.1 Organization of the responsibili ties for the execution of the tasks D.1.1 Appointme nt of focal person n charge of following up the activities of the objectives of this axis D.1.1 Letter D.1.1 One D.1.1 three months from time zero D.1.1 MOH D.1.1 WHO National Professiona l Officer (Dr.---- ) MOH General Director (Dr. D.1.1 USD D.1.1 WHO D.1.1 Focal person nominated D.1.2 Appointm nt of the members of the technical working group along with its TOR D.1.2 Letter D.1.2 One D.1.2 three months from time zero D.1.2 MOH D.1.2 WHO National Professiona l Officer (Dr. MOH General Director (Dr. ) D.1.2 USD D.1.2 WHO D.1.2 Technical working group assigned 010 objective Activity/ Sub- activity Unit Quantity Date Location Responsible Entity Cost Source Of Funding Indicator D.2 Improve ABX quality control D.2.1 To support and include ABX as priority drugs in the pharmacovi gilance project of the Yemeni University and the adverse drug event reporting program of the Order of Pharmacist s D.2.1 Network D.2.1 One D.2.1 One year from time zero D.2.1 MOH D.2.1 MOH Head of Preventive Medicine and Communic able Diseases Dpts (Dr. MOH Quality Assurance of Pharmaceut ical Products Program Director (Dr. --) D.2.1 USD D.2.1 WHO MOH D.2.1 Number of generic antibiotics that are tested by the pharmacovi gilance programs D.3 Control the use of critically important antimicrobi al molecules (CIAM) in humans D.3.1 Define CIAM D.3.1.1 Literature search survey D.3.1.1 List D.3.1.1 One D.3.1.1 Three months from time zero D.3.1.1 MOH MOA D.3.1.1 Private sector, WHO consultant, former DC&S president (Dr. ---) D.3.1.1 USD D.3.1.1 WHO MOH D.3.1 List of CIAM posted on AMR/AMS website 012 objective Activity/ Sub- activity Unit Quantity Date Location Responsible Entity Cost Source Of Funding Indicator D.3.1.2 Formulate the list of CIAM D.3.1.2 National list of CIAM D.3.1.2 One D.3.1.2 Six months from time zero D.3.1.2 MOH MOA D.3.1.2 MOA Head of Animal Health Service (Dr. ---) Private sector, WHO consultant, former DC&S president (Dr. ---) Private sector (Dr , Dr-----) D.3.1.2 USD D.3.1.2 AMR Fund D.4 Sentinel Surveillanc e of ABX (CIAM) consumptio n from a network of hospitals and benchmark with international ldata D.4.1 Workshops on metrics for ABX use measurement D.4.1 Workshops D.4.1 Six D.4.1 Six months from time zero and 1 year from time zero D.4.1 3 in Sana'a, 1 in Aden, 1 in the , 1 in Alhodiedah the Hadramout and 1 in Ibb D.4.1 Focal person D.4.1 USD ( workshops) D.4.1 AMR fund D.4.1 Percentage of hospitals that sent attendees 013 objective Activity/ Sub- activity Unit Quantity Date Location Responsible Entity Cost Source Of Funding Indicator D.4 Sentinel Surveillance of ABX (CIAM) consumptio n from a network of hospitals and benchmark with international ldata D.4.2 Compilation of data from hospitals D.4.2.1 Determine the epidemiologically representative sample of hospitals for surveillance of ABX D.4.2.1 List D.4.2.1 One D.4.2.1 three months from time zero D.4.2.1 MOH D.4.2.1 MOH Head of pharmacy service (Dr. MOH Head of Epidemiolo gical Surveillanc e Program (Dr---) D.4.2.1 USD D.4.2.1 MOH WHO D.4.2.1 The list is available D.4.2.2 Validate the measurement of hospital consumption by DDD/1000 Patient days in a batch of 4 hospitals per year Include the hospitals with adequate measurements in a sequential manner into the surveillance list and data Advice to hospitals that don’t have adequate data D.4.2.2 Hospital data assessment 4 times per year over 5 years D.4.2.2 Four per year over 5 years D.4.2.2 One year and three months from time zero and continue yearly for 5 years D.4.2.2 MOH WHO D.4.2.2 AMS expert D.4.2.2 USD per year for 5 years = USD D. AMR fund D.4.2.2 None 014 objective Activity/ Sub- activity Unit Quantity Date Location Responsible Entity Cost Source Of Funding Indicator D.4 Sentinel Surveillanc e of ABX (CIAM) consumptio n from a network of hospitals and benchmark with international ldata D.4.2.3 Surveillance of AB X use in Yemeni hospitals by auto reporting DDDs D.4.2.3 Report D.4.2.3 Once per year D.4.2.3 1.5 years from time zero then yearly for 5 years D.4.2.3 MOH WHO D.4.2.3 MOH Head of pharmacy service (Dr. MOH Head of Epidemiolo gical Surveillanc e Program (Dr. ) D.4.2.3 USD D.4.2.3 WHO MOH D.4.2.3 Report on ABX use for / posted on website D.5 Prepare hospitals and build their capacity for Antimicrob ial stewardship (AMS) programs D.5.1 Workshops on AMS twice per year D.5.1 Workshops D.5.1 two per year over 5 years D.5.1 Six months from time zero then yearly for 5 years D.5.1 MOH WHO DC&S D.5.1 Private sector, (Dr. Private sector, WHO consultant, former DC&S president Dr D.5.1 USD * = USD/year D.5.1 AMR fund D.5.1 Number of workshops on AMS per year D.5.2 Preparation and dissemination of national treatment guidelines on infectious diseases to Standardize D.5.2.1 Put a list of essential guidelines the strategies of ABX use based on local epidemiology D.5.2.1 List D.5.2.1 One D.5.2.1 six months from time zero D.5.2.1 WHO DC&S D.5.2.1 Private sector, (Dr. ) Private sector, WHO consultant two (Dr. , Dr. ---) D.5.2. Three guidelines USD D.5.2.1 AMR fund D.5.2.1 D.5.2.2 Number of guidelines published and posted on AMR/AMS website 015 objective Activity/ Sub- activity Unit Quantity Date Location Responsibl e Entity Cost Source Of Funding Indicator D.5 Prepare hospitals and build their capacity for Antimicrob ial stewardship (AMS) programs D.5.2.2 Prepare the missing guidelines D.5.2.2 List D.5.2.2 One D.5.2.2 Finalize within 1 year from time zero D.5.2.2 WHO DC&S D.5.2.2 Focal person will distribute the tasks according to the list. D.5.2.2 Included in D.5.2.1 D.5.2.2 AMR fund D.5.2.3 Prepare and follow a schedule for the presentation of the guidelines in the respective scientific societies meeting and for the endorsement of these guidelines with the respective societies D.5.2.3 Schedule D.5.2.3 One D.5.2.3 Starting 1 year from time zero and finalized 3 years from time zero D.5.2.3 MOH Focal person DC&S president (Dr. --) D.5.2.3 Workshops 3 times per year (USD per workshop) * * USD D.5.2.3 AMR fund D.5.2.3 Percentage of guidelines endorsed by respective scientific societies D.5.2.4 Post these guidelines on the AMR/AMS website D.5.2.4 Guidelines D.5.2.4 to be assigned later D.5.2.4 1.5 years from time zero D.5.2.4 MOH D.5.2.4 Focal person IT consultant D.5.2.4 None D.5.2.4 None D.5.2.4 Number of guidelines posted on AMR/AMS website. 016 objective Activity/ Sub- activity Unit Quantity Date Location Responsibl e Entity Cost Source Of Funding Indicator D.5 Prepare hospitals and build their capacity for Antimicrobial stewardship (AMS) programs D. Inclusion of AMS programs among hospital accreditation standards D.5.3.1 AMS checklist in accreditatio n D.5.3.1 One D.5.3.1 Three months from time zero D.5.3.1 MOH D.5.3.1 Private sector, WHO consultant, former DC&S president (Dr. --) MOH Project Coordinato r (Eng. --) D.5.3.1 USD D.5.3.1 WHO D.5.3.1 AMS and its checklist available in accreditatio n standards D.5.4 Auditing the AMS practices during MOH accreditation with feedback to hospitals. D.5.4 Report D.5.4 One D.5.4 2021 and after each accreditatio n audit for 5 years D.5.4 MOH D.5.4 MOH accreditatio n team D.5.4 USD D.5.4 WHO D.5.4 Number of feedback given/num ber of hospitals D.5.5 Development of AMS webpage in the MOH website D.5.5 AMS on website D.5.5 One D.5.5 six months from time zero D.5.5 MOH MOA D.5.5 IT consultant D.5.5 USD D.5.5 AMR fund D.5.5 AMS section present on AMR/MOH website 017 objective Activity/ Sub- activity Unit Quantity Date Location Responsibl e Entity Cost Source Of Funding Indicator D.6 Organize the dispensing of antimicrobi als in the community pharmacies D.6.1 Nominate a task group for the meeting between MOH including Dr. ---- and the Order of pharmacists D.6.1 Group D.6.1 one D.6.1 3 months D.6.1 MOH D.6.1 Technical working group D USD D.6.1 WHO D.6.1 None D.6.2 Meeting between a high- authority- level task force and the President of the Order of Pharmacist s to agree over a plan to restrict dispensing of ABX D.6.2 Meeting D.6.2 One D.6.2 To be finalized 3 months from time zero D.6.2 MOH Order of Pharmacist s D.6.2 MOH Head of pharmacy service (Dr. MOH General Director(Dr. Private sector, WHO consultant, former DC&S president (Dr. --) MOH Director of Public Relations & Health Education Dpts (Dr. D.6.2 USD D.6.2 WHO D.6.2 Agenda for collaborati on put 018 objective Activity/ Sub- activity Unit Quantity Date Location Responsibl e Entity Cost Source Of Funding Indicator D.7 Control and regulate the use of ABX in the veterinary, agriculture, food production and environment sectors D.7.1 Banning importation and use of CIAM in the veterinary field D.7.1.1 The CIAM list will be sent to the minister to ban their importation for veterinary use D.7.1.1 Letter D.7.1.1 One D.7.1.1 Will be sent months from time zero D.7.1.1 MOA D.7.1 MOA Head of Animal Health Service (Dr. --l) FAO represnt ative D.7.1 USD D.7.1 AMR fund D.7.1 DDD of CIAM molecules imported per year D.7.1.2 The veterinary drug office will not import these agents D.7.1.2 Memo D.7.1.2 One D.7.1.2 one year from time zero D.7.1.2 MOA D.7.2 Check if CIAM are used in agriculture and environment D.7.2.1 Review the list of drugs and pesticides officially imported in agriculture. Check if CIAM are included in this list. D.7.2.1 List D.7.2.1 One D.7.2.1 months from time zero D.7.2.1 MOA D.7.2 MOA Head of Poultry Husbandry Dpt (Eng. ) D.7.2 USD D.7.2 AMR fund D.7.2.1 Report on antimicrobi als officially imported for agriculture use 019 objective Activity/ Sub- activity Unit Quantity Date Location Responsibl e Entity Cost Source Of Funding Indicator D.7 Control and regulate the use of ABX in the veterinary, agriculture, food production and environment sectors D.7.2.2 Check if any of these molecules are used in agriculture or environmen t from outside the official import channel D.7.2.2 List D.7.2.2 One D.7.2.2 two years from time zero D.7.2.2 MOA D.7.2.2 None D.7.2.3 Get results of ABX residues in food items being done in Yemen D.7.2.3 Report D.7.2.3 One D.7.2.3 three months from time zero D.7.2.3 MOA D.7.2.3 MOA Head of Animal Health Servic(Dr--) D.7.2.3 USD D.7.2.3 None D.7.2.3 None D.7.3 Surveillance of importation of regularly used ABX to Yemen D.7.3.1 Form a registry of imported ABX in veterinary world D.7.3.1 Registry D.7.3.1 One D.7.3.1 Six months from time zero D.7.3.1 MOA D.7.3.1 MOA Head of Animal Health Service (Dr. --) D.7.3.1 USD D.7.3.1 None D.7.3.1 Presence of annual data of imported veterinary ABX on registry 001 objective Activity/ Sub- activity Unit Quantity Date Location Responsibl e Entity Cost Source Of Funding Indicator D.7 Control and regulate the use of ABX in the veterinary, agriculture, food production and environment sectors D.7.4 Research study about ABX consumption D.7 4.1 Research project by one of Masters Student at Sana'a University (SU) D.7 4.1 Project D.7 4.1 One D.7 4.1 starting at time zero for one year D.7 4.1 SU MOA D.7 4.1 SU coordinator of Masters degree in Food Safety and Analys (Dr --) Private sector, WHO consultant, former DC&S president (Dr. ---) MOA Head of Animal Health Service (Dr. --) D.7 4.1 USD SU) D.7 4.1 SU WHO MOH D.7 4.1 Percenta ge and list 000 objective Activity/ Sub- activity Unit Quantity Date Location Responsibl e Entity Cost Source Of Funding Indicator D.7 Control and regulate the use of ABX in the veterinary, agriculture, food production and environment sectors D.7 4.2 Research project in Agriculture school (Quantify the use of ABX in poultry farms nationally) D.7 4.2 Project D.7 4.2 One D.7 4.2 Two years from time zero D.7 4.2 MOA Agriculture school (SU) DC&S D.7 4.2 DC&S Member SU-Dpt of Agriculture (Dr. --) MOA Head of Poultry Husbandry Dpt (Eng. ) D.7 4.2 USD D.7 4.2 SU Research WHO MOH D.7 4.2 Report on the national use of ABX in poultry farms D.7.5 Research study about unofficial importation of ABX to Yemen D.7.5 Research project in Agriculture school D.7.5 Project D.7.5 One D.7.5 Two years from time zero D.7.5 MOA Agriculture school (SU) D.7.5 SU-Dpt of Agriculture (Dr. --) D.7.5 USD D.7.5 USD D.7.5 SU Research WHO MOH D.7.5 Report on the unofficial ABX importation used in veterinary world 002 Monitoring and evaluation plan OF Axis D objective Activity Sub-activity Indicator Purpose Calculation Frequency of Data collection Data Source Method Baseline D.1 Organization of the responsibiliti es for the execution of the tasks D.1.1 Appointment of focal person n charge of following up the activities of the objectives of this axis D.1.1 Focal person nominated D.1 Follow up of activities and to be in charge of some of them D.1 Yes/No D.1 Once/5 years D.1 MOH WHO D.1 Letter D.1 NA D.1.2 Appointment of the members of the technical working group along with its TOR D.1.2 Technical working group assigned D.2 Improve ABX quality control D.2.1 To support and include ABX as priority drugs in the pharmacovigilance project of the Yemeni University and the adverse drug event reporting program of the Order of Pharmacists D.2.1 Number of generic antibiotics that are tested by the pharmacovig ilance programs D.2.1 Evaluate post marketing efficacy and safety of generic ABX that are licensed by MOH and used in Yemen D.2.1 No of reports /month (Including Zero report) D.2.1 Once/5 years D.2.1 AMS website D.2.1 Network D.2.1 NA 003 objective Activity Sub-activity Indicator Purpose Calculation Frequency of Data collection Data Source Method Baseline D.3 Control the use of critically important antimicrobial molecules (CIAM) in humans D.3.1 Define CIAM D.3.1.1 Literature search D.3.1.2 Formulate the list D.3.1 List of CIAM posted on AMR/AMS website D.3.1 Make sure it is prepared and accessed by all D.3.1 Yes/No D.3.1 Once/5 years D.3.1 Literature search D.3.1 Search D.3.1 NA D.4 Sentinel Surveillance of ABX (CIAM) consumption from a network of hospitals and benchmark with international data D.4.1 Workshops on metrics for ABX use measurement D.4.1 Percentage of hospitals that sent attendees D.4.1 To standardize measurement in Yemen D.4.1 Number of hospitals that sent attendees/ number of invited hospitals* D.4.1 Once/5 years D.4.1 Workshop D.4.1 Workshop D.4.1 NA D.4.2 Compilation of data from hospitals D.4.2.1 Determine the epidemiologi cally representativ e sample of hospitals for surveillance of ABX D.4.2.1 The list is available D.4.2.1 Establish epidemiologi cally representativ e surveillance of AMR D.4.2.1 Yes/No D.4.2.1 Once/5 years D.4.2.1 MOH ESU D.4.2.1 Epidemiolog ic sampling D.4.2.1 NA 004 objective Activity Sub-activity Indicator Purpose Calculation Frequency of Data collection Data Source Method Baseline D.4 Sentinel Surveillance of ABX (CIAM) consumption from a network of hospitals and benchmark with international data D.4.2.2 Validate the Measurement of hospital consumption by DDD/1000 patient days in a batch of 4 hospitals per year Include the hospitals With adequate measurements in a sequential manner into the surveillance list and data Advice to hospitals that don’t have adequate data D.4.2.2 None D.4.2.3 Surveillance of ABX use in Yemeni hospitals by auto reporting DDDs D.4.2.3 Report on ABX use for / posted on website D.4.2.3 Baseline evaluation and follow up In preparation for national outcome AMS indicators D.4.2.3 Yes /No D.4.2.3 June every year D. Yemeni hospitals D.4.2.3 Compilation of results from hospital reports D.4.2.3 NA 005 objective Activity Sub-activity Indicator Purpose Calculation Frequency of Data collection Data Source Method Baseline D.5 Prepare hospitals and build their capacity for Antimicrobia l stewardship (AMS) programs D.5.1 Workshops on AMS twice per year D.5.1 Number of workshops on AMS per year D.5.1 Standardizati on of AMS and follow up of indicators. D.5.1 Number of workshops twice per year D.5.1 Yearly D.5.1 AMS focal person D.5.1 Workshop D.5.1 Sporadic availability D.5.2 Preparation and disseminatio n of national treatment guidelines on infectious diseases to standardize the strategies of ABX use based on local epidemiology D.5.2.1 Put a list of essential guidelines D.5.2.2 Prepare the missing guidelines D.5.2.1 D.5.2.2 Number of guidelines published and posted on AMR/AMS website D.5.2.1 D.5.2.2 Standardize ABX prescription habits among professionals D.5.2.1 D.5.2.2 Number of guidelines published and posted on AMR/AMS website D.5.2.1 D.5.2.2 Once/5 years D.5.2.1 D.5.2.2 International guidelines plus local epidemiolog y from surveillance reports D.5.2.1 D.5.2.2 Writing D.5.2.1 D.5.2.2 The available national guidelines are in complete D. Prepare and follow a schedule for the presentation of the guidelines in the respective scientific societies meeting and for the endorsement of these guidelines with the respective societies D.5.2.3 Percentage of guidelines endorsed by respective scientific societies D.5.2.3 Improve application of these guidelines by professionals D.5.2.3 (Number of scientific target societies that endorse these guidelines/ Number of target societies) * D.5.2.3 Once/5 years D.5.2.3 Scientific societies D.5.2.3 Meetings Lectures Workshops D.5.2.3 NA 020 objective Activity Sub-activity Indicator Purpose Calculation Frequency of Data collection Data Source Method Baseline D.5 Prepare hospitals and build their capacity for Antimicrobia l stewardship (AMS) programs D.5.2.4 Post these guidelines on the AMR/AMS website D.5.2.4 Number of guidelines posted on AMR/AMS website. D.5.2.4 Improve the visibility of these guidelines D.5.2.4 Yes/No D.5.2.4 Once/5 years reviewing and updating guidelines if needed D.5.2.4 AMS Website D.5.2.4 Posting on MOH website D.5.2.4 NA D.5.3 Inclusion of AMS programs among hospital accreditation standards D.5.3.1 AMS and its checklist available in accreditation standards D.5.3.1 Standardizati on D.5.3.1 Yes /No D.5.3.1 Once/5 years D.5.3.1 Accreditatio n standards D.5.3.1 Checking D.5.3.1 NA D.5.4 Auditing the AMS practices during MOH accreditation with feedback to hospitals. D.5.4 Number of feedback given/numbe r of hospitals D.5.4 Improve AMS work in hospitals D Number of feedback given/numbe r of hospitals*10 D.5.4 Every 3 years depending on the frequency of accreditation renewal D.5.4 Accreditatio n audit results analysis D.5.4 data analysis and report D.5.4 NA D.5.5 Developmen t of AMS webpage in the MOH website D.5.5 AMS section present on AMR/MOH website D.5.5 Improve visibility of AMS and make guidelines available to all professionals D.5.5 Yes/No Report of anonymous hospitals National indicators results D.5.5 Once/5 years Yearly reports D.5.5 MOH Website D.5.5 Checking D.5.5 NA 022 objective Activity Sub-activity Indicator Purpose Calculation Frequency of Data collection Data Source Method Baseline D.6 Organize the dispensing of antimicrobial s in the community pharmacies D.6.1 Nominate a task group for the meeting between MOH including Dr. W Ammar and the Order of pharmacists D.6.1 None D.6.2 Meeting between a high authority- level task force and the President of the Order of Pharmacists to agree over a plan to restrict dispensing of ABX D.6.2 Agenda for collaboration put D.6.2 Discuss and put a plan that is acceptable by pharmacists about dispensing of ABX over-the counter D.6.2 Minutes of meeting and activities added to the plan D.6.2 Once D.6.2 Meeting D.6.2 Meeting D.6.2 Previous work with pharmacists at lower levels that did not lead to official action 023 objective 4 Activity Sub-activity Indicator Purpose Calculation Frequency of Data collection Data Source Method Baseline D.7 Control and regulate the use of ABX in the veterinary, agriculture, food production and environment sectors D.7.1 Banning importation and use of CIAM in the D.7.1.1 The CIAM list will be sent to the minister to veterinary field D.7.1 DDD of CIAM molecules imported per year ban their importation for veterinary use D.7.1 Establish baseline and follow up of the quantity D.7.1 Report on 2022 and 2023 data and type of ABX used in the country per year. D.7.1 Once for / then every year Veterinary ABX registry available and yearly report posted on AMR website D.7.1 Veterinary drug office D.7.1 Research project for 1 year D.7.1 NA D.7 Control and regulate the use of ABX in the veterinary, D.7.1.2 The veterinary drug office will not import these agents D.7.2 Check if CIAM are used in agriculture and environment D.7.2.1 Review the list of drugs and pesticides officially imported in agriculture. Check if CIAM are included in this list. D.7.2.1 Report on antimicrobial s officially imported for agriculture use D.7.2.1 To check the extent of the use CIAM in agriculture D.7.2.1 Report D.7.2.1 Once/year D.7.2.1 MOA D.7.2.1 Research project for 1 year D.7.2.1 NA D.7.2.2 Check if any of these molecules are used in agriculture or environment from outside the official import channel D.7.2.2 None 024 objective 4 Activity Sub-activity Indicator Purpose Calculation Frequency of Data collection Data Source Method Baseline D.7 Control and regulate the use of ABX in the veterinary, agriculture, food production and environment sectors D.7.2.3 Get results of ABX residues in food items being done in Yemen D.7.2.3 None D.7.3 Surveillance of importation of regularly used ABX to Yemen D.7.3.1 Form a registry of imported ABX in veterinary world D.7.3.1 Presence of annual data of imported veterinary ABX on registry D.7.3.1 Yearly report of imported ABX in veterinary world on AMR website D.7.3.1 Yes/No D.7.3.1 Yearly report. D.7.3.1 Veterinary drug office D D.7.3.1 Registry D NA D.7.4 Research study about ABX consumption D.7 4.1 Research project by one of Masters Student at Beirut Arab University (SU) D.7 4.1 None 025 objective 4 Activity Sub-activity Indicator Purpose Calculation Frequency of Data collection Data Source Method Baseline D.7 Control and regulate the use of ABX in the veterinary, agriculture, food production and environment sectors D.7 4.2 Research project in Agriculture school (Quantify the use of ABX in poultry farms nationally) D.7 4.2 Report on the national use of ABX in poultry farms D.7 4.2 Determine baseline ABX use in poultry in Yemen. D.7 4.2 Yes/No D.7 4.2 Once D.7 Pou ltry farms D.7 Partially available not standardized surveillance D.7.5 Research study about unofficial importation of ABX to Yemen D.7.5 Research project in Agriculture school D.7.5 Report on the unofficial ABX importation used in veterinary world D.7.5 Evaluate the ABX purchases outside the official routing D.7.5 Yes/No D.7.5 Once D.7.5 Veterinary pharmacies D.7.5 Market research D.7.5 NA 026 Axis E: Budget Planning and Fund Attraction The plan for economic sustainability was replaced mainly by a plan for budget preparation and preparation of the ground for fund raising for the execution of the NAP. Strategic plan Objective 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 Potential measures of effectiveness: extent of increase in sustainable investment in capacity to counter antimicrobial Strategic Objective 5 interventions Activity / Sub-activity Mile stone/ Date (from operational plan) E.0 Organization of the responsibilities for the execution of the tasks E.0.1 Nominate a focal person in charge of following up the activities of the objectives of this axis E.0 three months from time zero E.0.1 three months from time zero E.0.2 Nominate members of the technical working group E.0.2 three months from time zero E.1 AMR budget planning E.1.1 Budget for each activity of the plan has been studied E.1.1.1 Budget for every sub- activity is put in the NAP E.1 Finalized February 2021 E.1.1.1 Ready at “time zero E.1.2 Overall budget of the plan has been assessed E.1.2 Meeting between Dr. Dr. - WHO and Dr. MOH finalize the budget E.1.2 th December 2022 E.2 Looking for sources of funding for NAP E.2.1 Meeting with WHO, MOH, MOA, NGOs to check for investment in NAP E.2.1.1 Financing from WHO discussed E.2.1.2 Financing from MOH discussed E.2.1.3 Financing from MOA discussed E.2.1.4 Financing from NGO (FAO, Foundations Merieux) discussed E.2 Nine months from “time zero E.2.1.1 six months from “time zero” E.2.1.2 six months from “time zero” E.2.1.3 st Jan E.2.1.4 six months from “time zero” 027 Strategic Objective 5 interventions Activity / Sub-activity Mile stone/ Date (from operational plan) E.2 Looking for sources of funding for NAP E.2.2 Look for other funding sources (agencies or bodies or countries) E.2.2.1 Allocate a professional that will prepare proposals for funding E.2.2.2 The allocated professional prepares the general proposal E.2.2.3 Allocate a specialized person to do mapping of funders E.2.2.4 Send proposals to agencies or organizations that are potential funders E.2.2.1 Three months from “time zero” E.2.2.2 Six months from “time zero” E.2.2.3 Three months from “time zero” E.2.2.4 Nine months from “time zero” E.2.3 Include private organizations interested in AMR into the NAP E.2.3.1 Mapping of private organizations interested in AMR E.2.3.2 Present collaboration proposals to these organizations E.2.3.1 Three months from “time zero” E.2.3.2 Six months from “time zero” E.3 Mapping of organizations for potential collaboration in the investigation of natural sources of biodiversity and Bio repositories as sources of new antimicrobial molecules E.3.1 Mapping of international organizations /countries for potential collaboration in the investigation of natural sources of biodiversity and E.3.1.1 Nominate the person who will be in charge of doing this mapping and having a list of these organizations E.3.1.2 Do the mapping plus list biorepositories as sources of new antimicrobial molecules E.3.1.3 Approach these organizations through showing them the achieved research in Yemen as well as potential for benefit sharing with these organizations E.3 Nine months from “time zero” E.3.1.1 three months from “time zero E.3.1.2 Six months from “time zero” E.3.1.3 Nine months from “time zero E.3.2 Mapping of existing or ongoing local research that deals with biodiversity as source of antimicrobial molecules E.3.2.1 Communication with WHO/MOH to organize a yearly meeting where researchers in Yemen expose and discuss their studies in the field of biodiversity for alternatives to ABX E.3.2.2 Create a section of AMR Website where local studies, posters, articles, projects in biodiversity are posted E.3.2.1 three months from “time zero” E.3.2.2 three months from “time zero 028 Strategic Objective 5 interventions Activity / Sub-activity Mile stone/ Date (from operational plan) E.4 Establishing communication with public and private sector for collaboration to NAP E.4.1 Establish a network of researchers in public and private sectors E.4.1.1 DC&S to host yearly workshop for researchers to discuss AMR research E.4 One year from “time E.4.1.1 three months from “time zero E.4.2 Mapping of potential private partners to encourage research E.4.2.1 Nominate the person who will do the mapping E.4.2.2 Produce a list of potential partners E.4.2.1 Three months from “time zero” E.4.2.2 Six months from “time zero” E.4.3 Establish communication and collaboration with private partners E.4.3.1 Preparation of specific proposals for collaboration with specific partners E.4.3.2 Establish communication and collaboration with these private partners E.4.3.1 Nine months from “time zero” E.4.3.2 One year from “time zero 031 Operational plan and budget Objective 5 Objective Activity/Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source of funding Indicator E.0 Organizatio n of the responsibili ties for the execution of the tasks E.0.1 Nominate a focal person in charge of following up the activities of the objectives of this axis E.0.1 Letter E.0.1 One E.0.1 three months from time zero E.0.1 MOH E.0.1 WHO National Professiona l Officer (Dr. --) MOH General Director (Dr--) MOA general director E.0.1 USD E.0.1 WHO E.0.1 Focal person nominated E.0.2 Nominate members of the technical working group E.0.2 Letter E.0.2 One E.0.2 three months from time zero E.0.2 MOH WHO National Professiona l Officer (Dr. --) MOH General Director (Dr--) E.0.2 USD E.0.2 WOH E.0.2 Technical working group assigned 030 Objective Activity/Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source of funding Indicator E.1 AMR budget planning E.1.1 Budget for each activity of the plan has been studied E.1.1 Budget for every sub activity is put in the NAP E.1.1 Budget for every sub activity E.1.1 One E.1.1 Ready at “time zero” E.1.1 WHO E.1.1 Private sector, WHO consultant, former DC&S president (Dr.---) WHO National Professiona l Officer (Dr. --) E.1.1 Included in NAP preparation budget USD E.1.1 AMR Plan E.1.1 Budget finalized E.1.2 Overall budget of the plan has been assessed E.1.2 Meeting between Dr. ---- and Dr. to finalize the budget E.1.2 Meeting E.1.2 One E.1.2 th December E.1.2 WHO Beirut E.1.2 Private sector, WHO consultant, former DC&S president(Dr. ) WHO National Professiona l Officer (Dr. ) E.1.2 Included in NAP preparation budget USD E.1.2 AMR Plan E.1.2 Budget finalized 032 Objective Activity/Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source of funding Indicator E.2 Looking for sources of funding for NAP E.2.1 Meeting with WHO, MOH, MOA, NGOs to check for investment in NAP E.2.1.1 Financing from WHO discussed E.2.1.2 Financing from MOH discussed E.2.1.3 Financing from MOA discussed E.2.1.4 Financing from NGO (FAO,Fondation) discussed E.2.1.1 Meeting E.2.1.1 one E.2.1.1 six months from “time zero” E.2.1. WHO E.2.1.1 Focal person Technical working group E.2.1 USD E.2.1 WHO E.2.1 Percentage of budget is available E.2.1.2 Meeting with Dr E.2.1.2 one E.2.1.2 six months from “time zero” E.2.1.2 MOH E.2.1.2 Focal person Technical working group E.2.1.3 Meeting with MOA general director E.2.1.3 one E.2.1.3 st Jan E.2.1.3 MOA E.2.1.3 Focal person Technical working group E.2.1.4 Meetings with agencies E.2.1.4 E.2.1.4 six months from “time zero” E.2.1.4 Agencies E.2.1.4 Focal person Technical working group 033 Objective Activity/Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source of funding Indicator E.2 Looking for sources of funding for NAP E.2.2 Look for other funding sources (agencies or bodies or countries) E.2.2.1 Allocate a professional that will prepare proposals for funding E.2.2.2 The allocated professional prepares the general proposal E.2.2.3 Allocate a specialized person to do mapping of funders E.2.2.4 Send proposals to agencies or organizations that are potential funders E.2.2.1 Team E.2.2.1 One E.2.2.1 Three months from “time zero” E.2.2.1 MOH WHO E.2.2.1 Technical working group E.2.2.1 USD E.2.2.1 WHO E.2.2 Number of proposals sent to organizations that are potential funders E.2.2.2 Proposal E.2.2.2 One E.2.2.2 Six months from “time zero” E.2.2.2 WHO MOH MOA E.2.2.2 Technical working group E.2.2.2 USD E.2.2.2 AMR fund E.2.2.3 Person E.2. One E.2.2.3 Three months from “time zero” E.2.2.3 WHO MOH MOA E.2.2.3 Technical working group E.2.2.3 USD E.2.2.3 E.2.2.4 Proposal E.2.2.4 One E.2.2.4 Nine months from “time zero” E.2.2.4 WHO MOH MOA E.2.2.4 Focal person E.2.2.4 USD E.2.2.4 AMR fund 034 Objective Activity/Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source of funding Indicator E.2 Looking for sources of funding for NAP E.2.3 Include private organizatio ns interested in AMR into the NAP E.2 Mapping of private organizatio ns interested in AMR E.2.3.2 Present collaboratio n proposals to these organizations E.2.3.1 List E.2.3.1 One E.2.3.1 Three months from “time zero” E.2.3.1 WHO MOH MOA E.2.3.1 Person in charge mapping of potential funders E.2.3.1 USD E.2.3.1 AMR fund E.2.3 Number of private organizations that are collaborating with NAP E.2.3.2 Proposal E.2.3.2 One E.2.3.2 Six months from “time zero” E.2.3.2 WHO MOH MOA E.2.3.2 Proposal specialist E.2.3.2 Included in E.2.2.4 E.2.3.2 Budget for E.3 Mapping of organizatio ns for potential collaboratio n in the investigatio n of natural sources of biodiversity and bioreposito ries as sources of new antimicrobi al molecules E.3.1 Mapping of international organizations /countries for potential collaboration in the investigation of natural sources of biodiversity and bio-repositories E.3.1.1 Nominate the person who will be in charge of doing this mapping and having a list of these organizations E.3.1.2 Do the mapping plus list ries as sources of new antimicrobial molecules E.3.1.1 Person E.3.1.1 One E.3.1.1 3 three months from “time zero E.3.1.1 WHO MOH MOA E.3.1.1 Person in charge mapping of potential funders E.3.1.1 Included in E.2 E.3.1.1 Budget for E.3.1 Number international of organizations collaborating on this issue E.3.1.2 List E.3.1.2 One E.3.1.2 Six months from “time zero” E.3.1.2 WHO MOH MOA E.3.1.2 Person in charge of mapping organizatio ns and funds E.3.1.2 Included in E.2.2.4 E.3.1.2 Budget for 035 Objective Activity/Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source of funding Indicator E.3 Mapping of organizatio ns for potential collaboratio n in the investigatio n of natural sources of biodiversity and bioreposito ries as sources of new antimicrobi al molecules E.3.1.3 Approach these organizatio ns through showing them the achieved research in Yemen as well as potential for benefit sharing with these organizations E.3.1.3 Proposal E.3.1.3 One E.3.1.3 Nine months from “time zero” E.3.1.3 WHO MOH MOA E.3.1.3 Focal person E.3.1.3 USD E.3.1.3 E.3.2 Mapping of existing or ongoing local research that deals with biodiversity as source of antimicrobial molecules E Communic ation with WHO/MOH to organize a yearly meeting where researchers in Yemen expose and discuss their studies in the field of biodiversity for alternatives to ABX E.3.2.1 Meeting E.3.2.1 Once/year E.3.2.1 3 three months from “time zero” E.3.2.1 DC&S E.3.2.1 President of DC&S (Dr. ---) E.3.2.1 USD E.3.2.1 E.3.2 Number of local research bodies that support biodiversity as a source of antimicrobial molecules E.3.2.2 Create a section of AMRWebsite where local studies, posters, articles, projects in biodiversity are posted E.3.2.2 Section on AMR website E.3.2.2 One E.3.2.2 three months from “time zero” E.3.2.2 MOH WHO E.3.2.2 IT speciali st MOH WHO E.3.2.2 Included in budget of website E.3.2.2 AMR Website Budget 036 Objective Activity/Sub- activity Unit Quantity Date Location Responsibl e entity Cost Source of funding Indicator E.4 Establishin g communica tion with public and private sector for collaboratio n to NAP E.4.1 Establish a network of researchers in public and private sectors E.4.1.1 DC&S to host yearly workshop for researchers to discuss AMR research E.4.1.1 Workshop E.4.1.1 One E.4.1.1 three months from “time zero” E.4.1.1 DC&S E.4.1 Private sector, WHO consultant, former DC&S president (Dr. President of DC&S (Dr. --) E.4.1 USD/ E.4.1 DC&S E.4.1 Number of studies that are posted on AMR website about biodiversity in research for ABX E.4 Establishin g communica tion with public and private sector for collaboratio n to NAP E.4.2 Mapping of potential Private partners to Encourage research E.4.2.1 Nominate the person who will do the mapping E.4.2.2 Produce a list of potential partners E.4.2.1 Person E.4.2.1 One E.4.2.1 Three months from “time zero” E.4.2.1 WHO MOH MOA E.4.2 Person in charge of NAP E.4.2 Part of website budget E.4.2 AMR fund E.4.2 Number of private partners that are collaborating to research E.4.2.2 List E.4.2.2 One E.4.2.2 Six months from “time zero” E.4.2.2 WHO MOH MOA E.4.2.2 Nominated person for mapping E.4.2.2 Included in E. Budget of E.4.3 Establish communication andcollaboration with private partners E.4.3.1 Preparation of specific proposals for collaboration with specific partners E.4.3.2 Establish communica tion and collaboration with these private partners E.4.3.1 Proposal E.4.3.1 One E.4.3.1 Nine months from “time zero” E.4.3.1 WHO MOH MOA E.4.3.1 Proposal specialist E.4.3.1 Focal person E.4.3.1 None E.4.3 Number of private partners that are collaborating to AMR E.4.3.2 Communic ation E.4.3.2 Number of potential partners E.4.3.2 One year from “time zero” E.4.3.2 WHO MOH MOA E.4.3.2 Person in charge of NAP E.4.3.2 Focal person E.4.3.2 None 037 Monitoring and evaluation plan For Axis E Objective Activity Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline E.0 Organization of the responsibiliti es for the execution of the tasks E.0.1 Nominate a focal person in charge of following up the activities of the objectives of this axis E.0.2 Nominate members of the technical working group E.0.1 Focal person nominated E.0 Organization of the responsibiliti es for the execution of the tasks E.0 Yes/No E.0 Once/5 years E.0 -MOH WHO MOA E.0 Letter E.0 NA E.0.2 Technical working group assigned E.1 AMR budget planning E.1.1 Budget for each activity of the plan has been studied E.1.1 Budget for every sub activity is put in the NAP E.1.2 Overall budget of the plan has been assessed E.1.2 Meeting between Dr. WHO and Dr. MOH to finalize the budget E.1.1 Budget finalized E.1 Mandatory E.1 Yes/No E.1 Once/5 years E.1 WHO Private sector, WHO consultant, former DC&S president (DR… ) E.1 Calculation E.1 NA E.1.2 Budget finalized 038 Objective Activity Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline E.2 Looking for sources of funding for NAP E.2.1 Meeting with WHO, MOH, MOA, NGOs to check for investment in NAP E.2.1.1 Financing from WHO discussed E.2.1.2 Financing from MOH discussed E.2.1.3 Financing from MOA discussed E.2.1.4 Financing from NGO (FAO, Fondation Merieux) discussed E.2.1 Percentage of budget is available E.2.1 Vision of financial needs E.2.1 Yes/No E.2.1 Once/5 years E.2.1 WHO MOH MOA E.2.1 Meetings E.2.1 NA E.2.2 Look for other funding sources (agencies or bodies or countries) E.2.2.1 Allocate a professional that will prepare proposals for funding E.2.2.2 The allocated professional prepares the general proposal E.2.2 Number of proposals sent to organization s that are potential funders E.2.2 Attract Funds E.2.2 Number of proposals sent to organization s that are potential funders E.2.2 Once/5 years E.2.2 WHO MOH MOA E.2.2 Mapping organization s and sending proposal E.2.2 NA 039 Objective Activity Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline E.2 Looking for sources of funding for NAP E.2.2.3 Allocate a specialized person to do mapping of funders E.2.2.4 Send proposals to agencies or organization s that are potential funders E.2.3 Include private organization s interested in AMR into the NAP E.2.3.1 Mapping of private organization s interested in AMR E.2.3.2 Present collaboration proposals to these organizations E.2.3 Number of private organization s that are collaborating with NAP E.2.3 Pool money into the plan to be able to execute it E.2.3 Number of private organization s that are collaborating with NAP E. Once/5 years E.2.3 WHO MOH MOA E.2.3 Mapping organization s and sending proposal E.2.3 NA 041 Objective Activity Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline E.3 Mapping of organization s for potential collaboration in the investigation of natural sources of biodiversity and biorepositori es as sources of new antimicrobial molecules E.3.1 Mapping of international organization s /countries for potential collaboration in the investigation of natural sources of biodiversity and biorepositori es as sources of new antimicrobial molecules E.3.1.1 Nominate the person who will be in charge of doing this mapping and having a list of these organizations E.3.1.2 Do the mapping plus list E.3.1.3 Approach these organizations through showing them the achieved research in Yemen as well as potential for benefit sharing with these organization s E.3.1 Number international of E.3.1 This field needs multinational collaboration E.3.1 Number international of E.3.1 Once/5 years E.3.1 WHO MOH MOA E.3.1 Mapping organization s and E.3.1 NA organization s collaborating on this issue . This is to have win win collaboration organization s collaborating on this issue sending proposal 040 Objective5 Activity Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline E.3 Mapping of organization s for potential collaboration in the investigation of natural sources of biodiversity and biorepositori es as sources of new antimicrobial molecules E.3.2 Mapping of existing or ongoing local research that deals with biodiversity as source of antimicrobial molecules E.3.2.1 Communicat ion with LAS to organize a yearly Meeting where Researchers in Yemen expose and discuss their studies in the field of biodiversity for alternatives to ABX E.3.2.2 Create a section of AMR Website where local studies, posters, articles, projects in biodiversity are posted E.3.2 Number of local research bodies that support biodiversity as a source of antimicrobial molecules E.3.2 Establish continuity of the work nationwide and communicati on among researchers E.3.2 Number of local research bodies that support biodiversity as a source of antimicrobial molecules E.3.2 Once/5 years E.3.2 WHO MOH DC&S E.3.2 Communicat ion E.3.2 NA E.4 Establishing communicati on with public and private sector for collaboration to NAP E.4.1 Establish a network of researchers in public and private sectors E.4.1.1 DC&S to host yearly workshop for researchers to discuss AMR research E.4.1 Number of studies that are posted on AMR website about biodiversity in research for ABX E.4.1 Establish continuity of the work nationwide and communicatio n among researchers E.4.1 Number of studies that are posted on AMR website about biodiversity in research for ABX E.4.1 Once/5 years E.4.1 DC&S E.4.1 Communicat ion E.4.1 NA 042 Objective5 Activity Sub-activity Indicator Purpose Calculation Frequency Data source Method Baseline E.4.2 Mapping of potential private partners to encourage research E.4.2.1 Nominate the person who will do the mapping E.4.2.2 Produce a list of potential partners E.4.2 Number of private partners that are collaborating to research E.4.2 Bring funds from private sector E.4.2 Number of private partners that are collaborating to research E.4.2 Once/5 years E.4.2 WHO MOH DC&S E.4.2 Mapping E.4.2 NA E.4.3 Establish communicati on and collaboration with private partners E.4.3.1 Preparation of specific proposals for collaboration with specific partners E.4.3.2 Establish communicati on and collaboration with these private partners E.4.3 Number of private partners that are collaborating to AMR E.4.3 Bring funds from private sector E.4.3 Number of private partners that are collaborating to AMR E.4.3 Once/5 years E.4.3 WHO MOH DC&S E.4.3 Communicat ion E.4.3 NA 043 Summary of main activities budget Global action plan strategic Objective (1) Develop awareness and understanding of antimicrobial resistance through effective communication, education, behavior changes, and training Potential measures of effectiveness: Extent of reduction in national human consumption of antibiotics (with allowance for the need for improved access in some settings), and reduction in the volume of antibiotic use in food production Activity Work Shop Frequency Year Fund/ USD A.1.1Nominate a focal person in charge of following up the activities of the objectives of this axis المحور هذا أهداف أنشطة متابعة عن مسؤول شخص ترشيح 3000* one person*12 months= , USD A.1.2 Choose the members of the Awareness TWG اجتماعية وسائط خبير ، تلفزيون/ راديو) (TWG) للتوعية الفنية العمل مجموعة أعضاء اختيار ، بيطري طبيب ، الدقيقة األحياء أخصائي ، بيئة أطباء ، معدية أمراض أطباء ، صيدلي ، فني ، شخص( العالمية الصحة منظمة عن وممثل الصحة وزارة ، زراعة قطاع كل من أعضاء 8 - واحدة فنية مجموعة PSERSONS $ 300*10person* 12month= , USD A.1.4 Slogan for AMR A.1.4 one A.1.4 two months from time “zero A.2.1.1 DC&S, University OF medicine scheduled lectures in national conferences of the medical, pharmaceutical, nursing, veterinary, agricultural and environmental fields across Yemen A.2.1.1 One A.2.1.1 two months from time “zero A.2.1.2 Ask syndicates/ orders (human and animal health and agriculture) that for CME credits to be given for any lecture involving ABX use, at least 2-3 slides should be put to increase awareness about AMR and the ways to prevent it including antimicrobial use. A.2.1.2 depending on number ofsyndicates/ orders A.2.1.2 Six months from time “zero Ask orders of pharmacists Veterinarians, physicians, and dentists to send monthly SMS as reminders to health professionals about the dangers of AMR and/or AMR News A.2.1.3 three A.2.1.3 36 months from time zero A.2.1.4 Workshops on AMR awareness to media professionals Workshops Five A.2.1.4 Once/ years A.2.1.4 Once/ year /5 years * , A.2.1. Do one workshop Per governorate per year to veterinarians and agriculture specialists (Train thetrainer) Workshops A.2.1.5 12 per year A.2.2.1 Three months from time “zero , * * , A.2.2.1Create a webpage for AMR on the official websites of MOH and MOA A.2.2.1One A.2.2.1Three months from time “zero A.2.2.1 , 044 Global action plan strategic Objective (1) Develop awareness and understanding of antimicrobial resistance through effective communication, education, behavior changes, and training Potential measures of effectiveness: Extent of reduction in national human consumption of antibiotics (with allowance for the need for improved access in some settings), and reduction in the volume of antibiotic use in food production Activity Work Shop Frequency Year Fund/ USD A.2.2.2 Use existing Webpages of MOH and WHO and relevant societies on different social networks (Facebook, YouTube, Twitter, Instagram A.2.2.2 Four A.2.2.2 One year from time zero A.2.2.2 , A.3.1 Prepare broadcasting material that includes all sectors of the One health approach for Radio/TV/ Social media spots A.3.1 One set of material A.3.1 Six months from time zero A.3.1 , A.4.1 Prepare a yearlong schedule for TV, Radio and social media advertisement A.4.1 12/ year A.4.1 Six months from time zero A.4.1 * A.4.5 SMS through national telecommu nication companies sent four times per year and during the global AMR awareness week A.4.5 four per year A.4.5 Starting end of first year from time zero A.5.1.1 Prepare a checklist Guidelines Including basic Information about AMR that should be included in school curricula A.5.1.1 One A.5.1.1 Start 3 months from time zero, Ready at end of first year from time zero A.5.1.1 , A.5.2.1 Prepare checklists for university curricula of these specialties each one separately A.5.2.1 Based on Number of curricula of health specialties A.5.2.1 Start 3 months from time zero Finalized 9 months from time zero A.5.2.1 , * , A.sssddddd Check curricula of health specialties to include information on AMR Include AMR tricyclic education A.5.3.1 One A.5.2.2 Start 3 months from time zero Finalized 9 months from time zero A.5.2.2 , * , 045 Global action plan strategic Objective (1) Develop awareness and understanding of antimicrobial resistance through effective communication, education, behavior changes, and training Potential measures of effectiveness: Extent of reduction in national human consumption of antibiotics (with allowance for the need for improved access in some settings), and reduction in the volume of antibiotic use in food production Activity Work Shop Frequency Year Fund/ USD A.5.3.1 Prepare a checklist for the needed information on AMR for veterinary school curricula A.5.3.1 Three months from time zero A.5.3.1 Three months from time zero A.5.3.1 A.5.3.2 Fill the gap in AMR information in veterinary school curricula A.5.3.2 One A.5.3.2 Six months from time zero A.5.3.2 , A.5.4.1 Checklist for the needed information on AMR for agriculture school curricula A.5.4.2 One A.5.4.2 Six months from time zero A.5.4.2 , A.6.2.1 Meeting with CEO s of main Pharmaceutical companies and working group and present the highlights of the AMR plan in general, awareness specifically and put plan of contribution to awareness activities A.6.2.1 Three A.6.2.1 6 months A.6.2.1 , Total Grant for five years , USD 046 Global action plan Strategic Objective 2: Strengthen the knowledge evidence base through surveillance and Research Potential measure of effectiveness: extent of reduction in the prevalence of antimicrobial resistance, based on data collected through integrated programmes for surveillance of antimicrobial resistance in Yemen Activity Work Shop Frequency Year Fund/ USD B.1.1Appointment of focal person charge of following up the activities of the objectives ofthis axis One person 3000* one person*12 months= , USD B.1.2Appointment of the members of the technical working group along with its TOR persons $ 300*10person* 12month= , USD B.2.2.1 Organize a nationwide workshop about GLASS and the plan of inclusion in GLASS and introduction to WHONET repeat the same the following year, then the following years Workshop B.2.2.1 one every 5 years B.2.2.1 Three months from time zero B.2.2.1 , * , B.2.2.3 Do a start up WHONET training for the 12 laboratories that were chosen for the coming 2 years every 2 years Workshop B.2.2.3 One every two years B.2.2.3 Three months from time zero B.2.2.3 , * , B.2.2.4 Do 3 laboratory visits for capacity building/year for 6 laboratories in different areas for building capacity and WHONET training Workshop B.2.2.4 Two visits per lab each year for 12 laboratories B.2.2.4 starting year 2 vists*12 lab.*5 years * , = , B.2.2.5 External quality control twice per year for the 12 laboratories chosen for the 2 years, then to add the ones of the following 2 years, after the 2nd year B.2.2.5 Years 1 &2 = 50sample /year *4 years 120 samples B.2.2.5 Six months from time zero B.2.2.5 100 USD /specimen ( * * )* years= 120*100 144000 USD/ for 4 years B.2.3.1 Data collection from mature laboratories B.2.3.1 Once/year B.2.3.1 Start end of 1st year from time zero * , *5year Total , 047 Global action plan Strategic Objective 2: Strengthen the knowledge evidence base through surveillance and Research Potential measure of effectiveness: extent of reduction in the prevalence of antimicrobial resistance, based on data collected through integrated programmes for surveillance of antimicrobial resistance in Yemen Activity Work Shop Frequency Year Fund/ USD B.4.2 Design an epidemiologically representative sample for AMR surveillance (cattle, poultry, companion animals). B.4.2 one B.4.2 9 months from time zero B.4.2 , B.4.3 Put a list of AMR priority organisms and related resistance genes for surveillance in these fields B.4.3 One B.4. 6 months from time zero B.4.3 B.4.4 Assessment of YARI, agriculture laboratory, and the chamber of manufacturing and commerce in Sana'a for the analysis of surveillance e specimens in agricultural, food, veterinary, and environmental fields Suggestion of a plan of the microbiology work in this surveillance B.4.4 Three Visits B.4.4 Six months from time zero and completed nine months from time zero B.4.4 , USD per visit Total: 3 visits , Report results of ABX use And resistance surveillance in agriculture and veterinary world Send a yearly report with Recommendations to the animal drug registry about ABX purchasing in the country during the coming 2 years B.4.5 Once every 2 years B.4.5 First report should be ready at end of year 2 from time zero B.4.5 , /report (Every 2years) Total30,000 B.5.3 Task force to visits the potential lab(s) (WHO EMRO) to be discussed with Dr B.5.3 one to each potential reference laboratory B.5.3 5 months from time zero B.5.3 * , Total Grant for five years USD 048 Global action plan strategic Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and prevention measures Potential measure of effectiveness extent of reduction in the prevalence of preventable infections, and in particular the incidence of drug resistant infections in health care settings Activity Work Shop Frequency Year Fund/ USD C.1.1 Appointment of focal person n charge of following up the activities of the objectives of this axis C.1 One person C.1 three months from “time zero” , C.1.2 Appointment of the members of the IPC TWG along with its TOR 10 persons , C.2.1 Improve IPC practices in Hospitals C.2.1.1 To establish national IPC guidelines; guidelines to be all inclusive including requirements and qualifications of IPC officer and physician and checklist C.2.1.1 five C.2.1.1 three months from “time zero” C.2.1.1 , C.2.1.2 Inclusion of the checklist of the guidelines in accreditation standards C.2.1.2 one C.2.1.2 six months from “time zero” C.2.1.2 , C.2.1.3 Follow up and feedback on IPC practices in hospitals after each accreditation C.2.1.3 one every 5 years C.2.1.3 three years from “time zero” C.2.1.3 , C.2.1.4 Syndicate of hospitals recommend s periodic IPC training and workshops to employees hosted by scientific societies, universities , etc. workshops C.2.1.4 five C.2.1.4 1,5 years from “time zero” C.2.1.4 , C.2.2 Improve IPC practices in hospital C.2.2.1 To review and update guidelines of IPC in hospital that are available in Ministry of Social Affairs C.2.2.1 One C.2.2.1 three months from “time zero” C.2.2.1 , C.2.2.2 Inclusion of IPC checklist in the MOH licensing criteria of these facilities C.2.2. One C.2.2.2 three months from “time zero C.2.2.2 , C.2.3.1 Establish guidelines on IPC in the PHCC C.2.3.1 One C.2.3.1 six months from “time zero” C.2.3.1 , C.3.1 Include IPC-related educational modules in human- health related majors (physicians , nurses, midwives, physiotherapists, pharmacist s, dentists, lab technicians, radiologists, nutrition, medical and paramedical schools) C.3.1 one per year 2 types: 1.General 2.Specific to nurses, midwives medical students. C.3.1 one year from “time zero” C.3.1 , 049 Global action plan strategic Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and prevention measures Potential measure of effectiveness extent of reduction in the prevalence of preventable infections, and in particular the incidence of drug resistant infections in health care settings Activity Work Shop Frequency Year Fund/ USD C.3.2Include IPC-related educational modules in veterinary schools curricula C.3.2.1 Check the current situation of IPC in the ongoing veterinary curriculum C.3.2.1 One C.3.2.1 three months from “time zero” C.3.2.1 , C.3.2.2 Review of IPC in regional and global veterinary curricula C.3.2.2 One C.3.2.2 three months from “time zero” C.3.2.2 , C.3.2.3 Prepare a proposal for veterinary school for deficit in curricula improvement C.3.2.3 One C.3.2.3 six months from “time zero” C.3.2.3 C.3.3.1 Mapping of IPC in three university curricula (Agriculture, Nutrition, Environment) C.3.3.1 One C.3.3.1 six months from “time zero” C.3.3.1 , C.3.3.3 Include the recommended AMR and IPC in curricula when not available C.3.3.3 One C.3.3.3 years from “time zero” C.3.3.3 , C.3.3.2 Review global and regional recommendations on IPC in curricula of agriculture, nutrition and environment, and formulate what should be included in them C.3.3.2 One C.3.3.2 six months from “time zero” C.3.3.2 , C.4.2 Make training available and affordable in universities and professional societies C.4.2.1 MOH Sends letters to Ministry of Higher Education and to Order of physicians explaining the need and recommending training specialization opportunities and courses related to IPC C.4.2.1 One C.4.2.1 3 months C.4.2.1 051 Global action plan strategic Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and prevention measures Potential measure of effectiveness extent of reduction in the prevalence of preventable infections, and in particular the incidence of drug resistant infections in health care settings ACTIVITY WORK SHOP frequency YEAR FUND/ USD C.5.1 Baseline evaluation of current situation at a national level (research project) and make it a continuous process C.5.1 One C.5.1 One year from “time zero” C.5.1 , C.5.2 National indicators to be incrementally applied with time (hand hygiene, PPE, isolation, other standard precautions, etc C.5.2 One C.5.2 Four years from “time zero” C.5.2 , C.6.1 Conduct a point prevalence study on nosocomial infections in Yemeni hospitals C.6.1 one C.6.1 2 years C.6.1 , C.7.1 Review the OIE biosafety recommendations C.7.2 one C.7.2 5 months C.7.2 , Total Grant for five years , 000USD 050 Objective 4: Optimize the use of antimicrobial medicines in human and animal health Potential measure of effectiveness: extent of reduction in National human consumption of antibiotics (with allowance for the need for improved access in some settings), the consumption of antibiotics used in food production (terrestrial and aquatic livestock, and other agricultural practices), and the use of medical and veterinary antimicrobial agents forapplications other than human and animal health Activity Work Shop Frequency Year Fund/ USD D.1.1 Appointment of focal person ncharge of following up the activities of the objectives of this axis One person $ 3000* one person*12 months= 8, USD D.1.2 Appointment of the members of the technical working group along with its TOR persons $ 300*10person* 12month= , USD D.2.1 support and include ABX as priority drugs in the pharmacovigilance project of the Yemeni University and the adverse drug event reporting program of the Order of Pharmacist s D.2.1 One D.2.1 One year from time zero D.2.1 , D.3 Control the use of critically important antimicrobial molecules (CIAM) in humans D.3.1.1 One D.3.1.1 Three months from time zero D.3.1.1 , D.3.1.2 Formulate the list of CIAM D.3.1.2 One D.3.1.2 Six months from time zero D.3.1.2 , D.4 Sentinel Surveillance of ABX(CIAM)consumption from a network of hospitals and benchmark with international ldata Workshops on metrics for ABX use measurement Workshops D.4.1 Six D.4.1 Six months from time zero and 1 year from time zero D.4.1 , D.4.2.1 Determine the epidemiologically representative sample of hospitals for surveillance of ABX D.4.2.1 One D.4.2.1 three months from time zero D.4.2.1 , D.4.2.2 Validate the measurement of hospital consumption by DDD/1000 Patient days in a batch of 4 hospitals per year Include the hospitals with adequate measurements in a sequential manner into the surveillance list and data Advice to hospitals that don’t have adequate data D.4.2.2 Four per year over 5 years D.4.2.2 One year and three months from time zero and continue yearly for 5 years D.4.2.2 ,000 USD per year for 5 years = , D.4.2.3 Surveillance of AB X use in Yemeni hospitals by auto reporting DDDs D.4.2.3 Once per year D.4.2.3 1.5 years from time zero then yearly for 5 years D.4.2.3 , D.5.1 Workshops on Antimicrobial stewardship AMS twice per year Workshops D.5.1 two per year over 5 years D.5.1 Six months from time zero then D.5.1 * * = , 052 yearly for 5 years Objective 4: Optimize the use of antimicrobial medicines in human and animal health Potential measure of effectiveness: extent of reduction in National human consumption of antibiotics (with allowance for the need for improved access in some settings), the consumption of antibiotics used in food production (terrestrial and aquatic livestock, and other agricultural practices), and the use of medical and veterinary antimicrobial agents forapplications other than human and animal health ACTIVITY WORK SHOP frequency YEAR FUND/ USD D.5.2 Preparation and dissemination of national treatment guidelines on infectious diseases to Standardize D.5.2.1 Put a list of essential guidelines the strategies of ABX use based on local epidemiology D.5.2.1 One D.5.2.1 six months from time zero D.5.2.1 Threeg uidelines , D.5.2.3 Prepare and follow a schedule for the presentation of the guidelines in the respective scientific societies meeting and for the endorsement of these guidelines with the respective societies D.5.2.3 One D.5.2.3 Starting 1 year from time zero and finalized 3 years from time zero D.5.2.3 Workshops 3 times per year ( USD per workshop) * * , D.5 Prepare hospitals and build their capacity for Antimicrobial stewardship (AMS) programs D.5.4 Auditing the AMS practices during MOH accreditation with feedback to hospitals D.5.5 Development of AMS webpage in the MOH website D.5.4 One D.5.5 One D.5.4 and after each accreditation audit for 5 years D.5.5 six months from time zero D.5.5 , D.6.1 Nominate a task group for the meeting between MOH including Dr. and the Order of pharmacists Meeting D.6.1 one D.6.1 3 months D , D.6.2 Meeting between a high- authority- level task force and the President of the Order of Pharmacist s to agree over a plan to restrict dispensing of ABX Meeting D.6.2 One D.6.2 To be finalized 3 months from time zero D.6.2 , D.7.1.1 The CIAM list will be sent to the minister to ban their importation for veterinary use D.7.1.1 One D.7.1.1 Will be sent 12 months from time zero D.7.1 , D.7.2.1 Review the list of drugs and pesticides officially imported in agriculture. Check if CIAM are included in this list D.7.2.1 One D.7.2.1 12 months from time zero D.7.2 D.7.2 Check if CIAM are used in agriculture and environment D.7.2 One D.7.2 12 months from time zero D.7.2 053 Objective 4: Optimize the use of antimicrobial medicines in human and animal health Potential measure of effectiveness: extent of reduction in National human consumption of antibiotics (with allowance for the need for improved access in some settings), the consumption of antibiotics used in food production (terrestrial and aquatic livestock, and other agricultural practices), and the use of medical and veterinary antimicrobial agents for applications other than human and animal health Activity Work Shop Frequency Year Fund/ USD D.7 4.1 Research project by one of Masters Student at Sana'a University (SU) D.7 five D.7 4.1 starting at time zero for one per year D.7 4. , D.7 4.2 Research project in Agriculture school (Quantify the use of ABX in poultry farms nationally) D.7 three D.7 4.2 Two years from time zero D.7 4.2 , D.7.5 Research study about unofficial importation of ABX to Yemen D.7.5 two D. Two years from time zero D.7.5 , D.7.5 Research project in Agriculture school D.7.5 two D.7.5.1 Two years from time zero D.7.5 . , Total Grant for five years .000 USD Objective 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 Potential measures of effectiveness: extent of increase in sustainable investment in capacity to counter antimicrobial Activity Work Shop Frequency Year Fund/ Usd E.0.1 Nominate a focal person in charge of following up the activities of the objectives of this axis one $ 3000* one person*12 months= USD E.0.2 Nominate members of the technical working group Three $ 100*3person* 12month= 8 USD E.2 Looking for sources of funding for NAP E.2.2.2 The allocated professional Prepares the general proposal E.2.2.2 One E.2.2.2 Six months from “time zero” E.2.2.2 , E.2.2.4 Send proposals to agencies or organizations that are potential funders E.2.2.4 One E.2.2.4 Nine months from “time zero” E.2.2.4 E.2.3.1 Mapping of private organizations interested in AMR E.2.3.1 One E.2.3.1 Three months from “time zero” E , 054 Total requested fund for all objectives for five years Objective number Cost Objective 1 USD Objective 2 USD Objective 3 , 000USD Objective 4 .000 USD Objective 5 USD SUB TOTAL grand USD For national focal point for 5years For AMR surveillance program and reference labs 15 desktop computer CORE-i8 15 desktop and 15 cupboard 45 chair 15 printer 15 internet router 6700* 15=100,500USD Total grand , 00 USD References Al-Shami HZ, Al-Haimi MA ( ) Nosocomial Infections in Six Major Hospitals in Sana’a Capital City and in Some Governorates in Yemen Appli Microbiol Open Access 4: 154. doi: 10.4172/2471 Al-Hammadi MA, Al-Shamahy HA, Ali AQ (2018). The prevalence and phenotypic characterization of extended-spectrum β-lactamases-producing Escherichia coli strains isolates recovered from tertiary hospitals in Sana’a city, Yemen Universal Journal of Pharmaceutical Research.; 3(6): 23-27.DOI: https://doi.org/10.22270/ujpr.v3i6.220 E.4.1 Establish a network of researchers in public and private sectors DC&S to host yearly workshop for researchers to discuss AMR researches workshop E.4.1.1 One E.4.1.1 three months from “time zero” E.4.1 , Total Grant for five years USD FOR Employees ????? 055 Mohanna M. (2010); the prevalence of self- medication with antibiotic in children presented to the outpatient department at Sam hospital, Sana’a city Yemen. OMJ. 25, 41-43 doi:10.5001/omj Yasser Ghaleb; A Al Serouri; M Alamad; S Nasher; A Alsoumainy ( ) The Growing Antimicrobial Resistance of Urinary Tract Infections, Sana'a- Yemen,2015. EMPHNET Sixth Regional Conference.Vol 4, No 1 . Jihan Abdulmughni; E Mahyoub; A Al Agabri; Y Abdulwareth; A Al-Serouri .(2018)Drug Resistant Tuberculosis: An Emerging Public Health Threat in Yemen, 2014-2016.Iproc; 4(1): e10532 URL: http://www.iproc e10532/ doi: 10.2196/10532.org/2018/1/ Jihan Abdulmughni; E Mahyoub; A Al Agabri; Y Abdulwareth; A Al-Serouri .(2018)Drug Resistant Tuberculosis: An Emerging Public Health Threat in Yemen, 2014-2016.Iproc; 4(1): e10532 URL: http://www.iproc e10532/ doi: 10.2196/10532.org/2018/1/