Feasibility Study of the World Health Organization Health Care Facility-Based Antimicrobial Stewardship Toolkit for Low- and Middle-Income Countries

Abstract

Antimicrobial stewardship (AMS) has emerged as a systematic approach to optimize antimicrobial use and reduce antimicrobial resistance. To support the implementation of AMS programs, the World Health Organization developed a draft toolkit for health care facility AMS programs in low- and middle-income countries. A feasibility study was conducted in Bhutan, the Federated States of Micronesia, Malawi, and Nepal to obtain local input on toolkit content and implementation of AMS programs. This descriptive qualitative study included semi-structured interviews with national- and facility-level stakeholders. Respondents identified AMS as a priority and perceived the draft toolkit as a much-needed document to further AMS program implementation. Facilitators for implementing AMS included strong national and facility leadership and clinical staff engagement. Barriers included lack of human and financial resources, inadequate regulations for prescription antibiotic sales, and insufficient AMS training. Action items for AMS implementation included improved laboratory surveillance, establishment of a stepwise approach for implementation, and mechanisms for reporting and feedback. Recommendations to improve the AMS toolkit’s content included additional guidance on defining the responsibilities of the committees and how to prioritize AMS programming based on local context. The AMS toolkit was perceived to be an important asset as countries and health care facilities move forward to implement AMS programs.

Antimicrobial Stewardship Programmes in Saudi Hospitals: Evidence from a National Survey

“…We previously reported that the lack of enforcement of policies and guidelines from the MoH and hospital administration remains a significant barrier to ASP adoption and implementation [ 7 ]. This barrier has also been highlighted in Maki et al’s 2020 study [ 31 ]. MOH hospitals are clearly expecting the MOH to enforce the adoption, implementation and regular monitoring of ASPs in its hospitals.…”

“…Alternative ASP implementation models have been suggested to address this challenge [ 28 , 29 , 30 ]. Senior management in Saudi hospitals is supportive of the adoption of ASPs and implementation; this is a key facilitator, as reported in Maki et al’s feasibility study [ 31 ], to ensure resource allocation, and ASP monitoring and evaluation. Senior managers’ support needs to extend beyond the “no objection to implementation” stance, to actively secure the necessary funds, skills and expertise to implement ASPs.…”

Designing a National Veterinary Prescribing Champion Programme for Welsh Veterinary Practices: The Arwain Vet Cymru Project

“…Educational interventions have been shown to improve knowledge of pharmacovigilance [ 50 ] and prescribing competency [ 51 ] as well as to strengthen AMS [ 52 , 53 , 54 ], although the effects may be short-lived. Online learning as part of AMS programmes has been playing an increasing role [ 55 ] and online training of GPs has been shown to reduce antimicrobial prescribing for respiratory disease [ 56 ].…”

Health Care–Acquired Infections in Low- and Middle-Income Countries and the Role of Infection Prevention and Control

“…18 In creation of the toolkit, interviews were undertaken in order to evaluate the feasibility of the toolkit within LMIC. 50 Input was gathered from national leaders, health care facility leadership, and health care facility staff. This input was then incorporated into the toolkit to ensure the most usability.…”

“…During the feasibility studies of the WHO AMS toolkit, it was noted that strong leadership support at the national and senior facility management levels was needed for successful implementation. 50 The WHO AMS toolkit is a resource for facilities within LMIC to create a strong AMS program and serves as a reference to continue to build on structures put in place, such as current IPC committees, in an effort to continue to control the development and spread of AMR. 18…”