09 004 pokharel

Antibiotic resistance: National actions contribute to a global solution NEPAL Professor Paras K Pokharel Vice Chair GARP Nepal

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

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)

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.

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

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.

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.

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”

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

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.

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

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

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

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

Way Forward National Action Plan for Antibiotic Resistance •Collaborative, covering all sectors, building on GARP framework

Mount Fish Tail

Thank you