Antimicrobial resistance national strategic framework
A commitment to principles and objectives
In a previous article, mention was made of a number of commitments included in the Antimicrobial Resistance (AMR) National Strategic Framework that emanated from the Antimicrobial Resistance Summit that took place during October 2014 in Johannesburg. Participating stakeholders from various sectors publically signed a document outlining these commitments, thereby committing to work collaboratively to invest relevant resources and implement sound strategies and interventions in order to manage antimicrobial resistance in South Africa and to preserve the effectiveness of antimicrobials for future generations. From the animal health sector, representatives from DAFF and the SAVC signed the document.
The Strategy articulates the vision, mission and goals for improving the appropriate use of antimicrobials by all users over the next five years. It is recognised that for the Strategy to achieve its goals, national government must lead, support and guide its implementation.
The stakeholders committed to the following principles: 1. To collaborate as intersectoral, interdisciplinary organisations and departments to strengthen, co-ordinate and institutionalise efforts to address AMR. This will require setting
up a National lntersectoral Ministerial Advisory Committee for AMR . 2. To establish a national surveillance system to track AMR and antimicrobial use in animals, crops and humans. This will be preceded by the development of an AMR map for South Africa, through data sharing between the private and public sector laboratory services. 3. To enhance the processes, structures, resources and supplies needed for effective infection prevention & control (IPC) and antimicrobial stewardship (AMS). All human health establishments will be encouraged to meet compliance of the National Core Standards (NCS) relating to AMR by 2016 (see comments later). 4. To promote the appropriate use of antimicrobials in human and animal health through suitable enabling legislation and
regulations. 5. To build the expertise and strengthen the competency of health care professionals and veterinary professionals and improve the staffing levels of the workforce in AMR and IPC. To develop a strategy and implementation plan for the integration and implementation of AMR and IPC training into the undergraduate and postgraduate medical, veterinary and allied health professional student curricula of South African training establishments. 6. To promote research into novel diagnostics and clinical trials in IPC and AMR 7. To increase the community awareness of AMR. The AMR strategic framework consists of four (4) strategic objectives that are underpinned by 4 key enablers.
The strategic objectives are:
i. Strengthen, coordinate and institutionalize interdisciplinary efforts through national and health→
establishment level governance structures.
ii. Optimise surveillance and early detection of antimicrobial resistance to enable reporting of local, regional, and national resistance patterns to optimise empiric and targeted antibiotic choice.
iii. Enhance infection prevention and control of the spread of resistant microbes to patients in healthcare settings, focusing on improvement in hand hygiene and the identification and isolation of patients with resistant organisms. Community measures include preventing infection through wide-reaching vaccination programmes and improvements in water quality and sanitation.
iv. Promote appropriate use of antimicrobials in human and animal health through antimicrobial stewardship.
The key enablers of these strategic objectives are:
i. Legislative and policy reform for health systems, strengthening these to support the quality of antimicrobials in the country and to enable control over prescribing of antimicrobials in the animal health sector.
ii. Education of all levels of health providers in human health and agriculture in the critical concepts of antimicrobial stewardship, infection control, infectious diseases, microbiology and pharmacology.
iii. Communication to educate the public, create awareness and enhance patient advocacy of the dangers of inappropriate antimicrobial use.
iv. Research into novel diagnostics and clinical trials in IPC and AMR.
Members of the veterinary profession may not be familiar with a number of acronyms and terms used and included in the National Strategic Framework. However, the concepts and principles that underpin these terms are all applicable to the veterinary profession albeit in some cases with a different emphasis. These include inter alia IPC, PPE and NCS.
In the medical profession, IPC places heavy emphasis on hand hygiene, respiratory hygiene, cough etiquette and personal protective equipment (PPE). Health care workers that focus on IPC are known as IPC practitioners.
In the veterinary profession the same standard precautions apply to a lesser or greater extent, but in terms of animal health, the conceptual, structural and procedural components of biosecurity will be of greater importance.
The NCS for human health establishments in South Africa have been created to improve the quality of human health care and do not apply to the veterinary profession. Through a national process of certification, an external body will formally assess each health establishment for compliance with these NCS’S.
It is clear from the Strategic Framework that the use of antibiotics in the water and feed of livestock (including aquatic species) will be put under the spotlight. This frame of mind is not unique to South Africa. The US Food and Drug Administration is making attempts to reduce the public health threat of antimicrobial resistance by restricting livestock uses of antimicrobials that are in the same drug classes as those used in human medicine.
The FDA has set a December 2016 deadline to eliminate production uses (such as performance enhancing) of those drugs and to remove over-thecounter access to any antimicrobials that are important for human medicine and are administered to livestock through their feed or water. A positive development in this respect will be increased veterinarian oversight of antimicrobial use in food-producing animals. There is general consensus that increased veterinarian oversight and supervision of such drug use will contribute to efforts to control the spread of antimicrobial resistance.
Veterinary practitioners in South Africa will sooner rather than later experience major changes in the way that antimicrobial drugs will be prescribed and dispensed. The Minister of Health, Dr. Aaron Motswaledi pointed out at the recent AMR Summit that self-regulation by private industries, as far as antimicrobial drugs are concerned will not help to evade the disaster that advanced AMR will represent and emphasised that serious regulation is now required.¡