09 004 pokharel
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Antibiotic resistance: National actions contribute to a global solution
NEPAL
Professor Paras K PokharelVice Chair
GARP Nepal
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AMR Activities in Nepal: How it Began
• 1978: GoN, Drug Act• 1995: GoN, National Drug Policy, Nepal• 1998: GoN, Infectious Disease Control Program launched
– to develop a sustainable national surveillance of AMR
• 1999: GoN, NPHL started Laboratory Based AMR Surveillance – Network of 13 laboratories
• 1999: APUA (Alliance for Prudent Use of Antibiotics) – Nepal was formed
• 2001: National Drug Policy Amended- “prudent use of antibiotics added”
• 2013: Global Antibiotic Resistance Partnership (GARP)-Nepal was formed; CDDEP & NPHF collaboration
• 2014: GoN, National Antibiotics Treatment Guidelines
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Before GARP Nepal
• APUA Nepal– Started with Assisting GoN with drafting of
National Antibiotic Policy (Major Contributor)– Pharmacologist & Microbiologists mostly from
Kathmandu– Prudent use of Antibiotics; Major Focus
• Laboratory Surveillance : NPHL– Laboratory Based Surveillance Network ; Many
hospitals around the country (Training Laboratorians, Quality Assuarance)
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GARP Nepal
• GARP: International network that sensitizes AMR issues locally and gives Nepal a voice in antibiotic resistance in the international arena.
• GARP-Nepal Working Group formed 2013– Civil Society, National Public Health Body
Engagement: NPHF– Academicians/Practitioners in Public Health,
Medicine, Microbiology, Policy, Lab Science, Veterinary Medicine, from all over the country.
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GARP Nepal
• Long-term goal: – To lay the groundwork for a national action plan
for antibiotic resistance in Nepal• Specific objectives: – Carry out situation analysis of antibiotic use,
resistance and related topics—human and animal—in Nepal
– Develop Policy Brief(s) for mitigating antibiotic resistance in humans and animals
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AMR
• This is not just about rational use of drugs.• Not confined to hospital practice and medical
specialty.• Broadly anything that reduces the need for
antibiotics will reduce antibiotic resistance.
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AMR
• Vaccines (both antibacterial and antiviral)• Clean water• Sewage Disposal• Rapid Diagnostics (reliable ones, not Widal tests,
more like Gene Xpert vs AFB stains) • Sub therapeutic use of Antibiotics in
Animal/bird/fish farming• Phasing out widespread use of antibiotics in
poultry, cattle and fish farms.
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AMR
Hospitals are not “off the hook”•Hospital-acquired infections are the most resistant: NDM1, for example.•Hand washing between patients ( Not standard practice in Nepal)•Antibiotics “ just in case”
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GARP-Nepal Situation Analysis, 2014
• Respiratory infections (one-half of the cases were resistant)
• Diarrhea (one-third of the cases were resistant)
• Bloodstream infections, STDs, UTI: no better
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GARP-Nepal Situation Analysis, 2014
• “By prescription only” laws have limited usefulness in Nepal
• Not enough for only a small group of people to know about AMR.
• Health care workers at all levels, ( humans and veterinarians) in collaboration with professionals and policy makers.
• Government support is critical.
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GARP-Nepal Situation Analysis, 2014
• Multi-sectoral engagement– Health Academia/Research– Medical Practitioners/ Lab Scientists– Agriculture/Veterinary Sectors– Policy Makers – Ministry of Health Owned Health Sciences Universities
• Policy Advocacy one of the objectives• Engaging Government support at Ministerial Level• Global Network– Celebrated Global Antibiotics Awareness Week 2015– Health Sciences University, Agricultural University & Civil
Society Engagement in Awareness & Campaigns
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Working with Government
• Autonomous/Semiautonomous Govt bodies represented on GARP-Nepal Working Group
• GoN, MoHP on board since 2014, since the Situation Analysis was launched.
• Interest of MoH remains; supported by current minister as well
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Challenges
• Political Instability / Humanitarian crisis• National Health Policy 2071 (2014)
Implementation plan for transition between the old policy and new policy
• Lack of National coordination body mandated by Government
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Way Forward
• Engagement of local stakeholders• Community based research– Participatory (Qualitative) research– Behavior change Initiatives for people/drug shops
• Generate more research from animal/fish sectors• Partner with existing rational drug use &
laboratory surveillance networks esp. National Public Health Laboratory, GoN
• Engage more private sector health groups
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Way Forward
National Action Plan for Antibiotic Resistance•Collaborative, covering all sectors, building on GARP framework
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Mount Fish Tail
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Thank you