Malaika Ludman, SIAPS Technical Advisor; Claire Tindula, SIAPS Project Associate
Does antimicrobial resistance mean the end of modern medicine as we know it? Not quite yet. However, in a report recently released on global surveillance of antimicrobial resistance (AMR), the World Health Organization (WHO) warned that “a post-antibiotic era – in which common infections and minor injuries can kill – is a very real possibility for the 21st century.”[1] The first-ever report, which made international headlines, outlined the AMR situation in 129 countries. Data from the report show a disturbing rise in drug resistance to medicines currently used to prevent and treat malaria, HIV and AIDS, tuberculosis, and common bacterial infections. The threat was once again made clear when the World Health Assembly passed its third resolution (WHA 67.25) on AMR in May of this year.
Increased resistance to medicines used to treat these conditions necessitates more complicated and expensive treatment, which can limit access and make adherence to treatment regimens difficult for many people in low-resource settings. These factors can in turn lead to higher morbidity and mortality rates and further exacerbate the spread of resistant strains. Combating AMR requires an integrated and well-coordinated response, involving a range of partners from the global level to the community, and interventions that include large-scale strategic plans, surveillance methods, regulatory policies, uninterrupted access to quality medicines, and infection prevention and control practices.
Cognizant of the serious public health dangers posed by AMR, the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program, funded by the US Agency for International Development, builds on the work of its predecessor programs to improve antimicrobial use and contain AMR at all levels of the health system. SIAPS works with regional organizations in Africa and South America and with multiple countries, including Ethiopia, Namibia, and South Africa, to raise awareness of AMR, create advocacy coalitions, develop and implement containment strategies, and improve information collection and sharing of best practices.
SIAPS leverages several key mechanisms to help combat AMR including developing and strengthening of Drug and Therapeutics Committees (DTCs) for improved management of medicines in health care facilities, assessing infection control practices, implementing antimicrobial stewardship programs, and monitoring the performance of infection control practices through continuous quality improvement (CQI) methodologies. SIAPS is also working to help contain AMR in low-resource settings through community case management, development and use of standard treatment guidelines, support for measuring and improving medication adherence, and revision of training curricula for health care professionals to include more in-depth training on AMR-related topics. These interventions build the capacity of health facilities, health care professionals, government officials, and communities to implement contextually appropriate interventions which strengthen multiple aspects of the health system, a particularly necessary approach when addressing the multifaceted and multidimensional problem of AMR.
In Jordan, SIAPS worked with three Ministry of Health hospitals to improve antibiotic prophylaxis practices for cesarean sections through a medicines use evaluation. After gathering data and developing proper protocols for the prophylactic use of antibiotics, hospital staff used the principles of CQI to monitor their progress. Following the implementation of new protocols and procedures, the hospitals found that antibiotic use for cesarean sections improved with respect to the prophylactic antibiotic prescribed, the timing of administration, and the number of doses. Project implementers also noted that the new practices resulted in cost savings for the hospitals, and that similar medicine use evaluation programs were being applied to other medical procedures and at other hospitals.
With the WHO’s report as the latest call to action, the global community must renew and intensify its efforts to address AMR, a threat which could undermine the progress already made in tackling some of the world’s worst public health problems. We have not yet reached the post-antibiotic era of which the WHO warns, but avoiding that reality will hinge on strengthening and expanding AMR surveillance and containment efforts, particularly in resource-limited settings.
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For more information on our AMR work, please read our technical program update. Additional background on AMR can be found on the USAID Global Health eLearning website.
[1] World Health Organization, 2014. Antimicrobial Resistance Global Report on Surveillance. Accessed at: http://www.who.int/drugresistance/documents/surveillancereport/en/. Retrieved: 19 May 2014.