ZNPHI Spearheads the Antimicrobial Stewardship Program in Zambia

ZNPHI Spearheads the Antimicrobial Stewardship Program in Zambia

Dr Jabbin Mulwanda Permanent Secretary for Health Services (seated at the centre) with participants during the Antimicrobial Stewardship Workshop

                                                                                     Photo credit: David Phiri – ZNPHI

As part of Implementation of Zambia’s Multisectoral National Action Plan on Antimicrobial Resistance (AMR), The Zambia National Public Health Institute (ZNPHI) in partnership with Action on Antibiotic Resistance (ReACT) and The Ecumenical Pharmaceutical Network (EPN) organized a one-day workshop to develop and adopt an Antimicrobial Stewardship (AMS) implementation and monitoring framework. The meeting held on June 4 at the Lusaka Intercontinental Hotel also provided a platform to share and update participants on the AMR National Action Plan implementation status and develop/adopt an implementation as well as monitoring and evaluation framework for Antimicrobial Stewardship.

This meeting was preceded by plans set by the Antimicrobial Resistance Coordinating Committee (AMRCC) to pilot the stewardship program in some health facilities at all levels of the healthcare system with the goal of scaling up these programs country wide as part of the AMR National Action Plan. Stewardship of antimicrobials, in particular antibiotics should be done at all levels of care and therefore, the critical need to employ a stepwise approach in implementation through building of coalitions of champions within health facilities. Participants consisting of Pharmacist, Clinicians, Epidemiologists, Laboratory Technicians among others identified initial priority areas under Anti-microbial stewardship with best practices from implementing countries including South Africa and Kenya.

The primary goal of antimicrobial stewardship is to optimize clinical outcomes while minimizing unintended consequences of antimicrobial use which might include the selection and emergence of resistant pathogens. Speaking during the meeting the Ministry of Health Permanent Secretary in charge of Health Services, Dr Jabbin Mulwanda underscored the need for this program in Zambia in slowing down the emergence of AMR. “It is critical that we scale up the proper use of antimicrobials in all sectors to reduce on the incidences of AMR. The Ministry of Health is committed to ensuring implementation and adherence and has also welcomed the proposal by the AMRCC to integrate the fight against antimicrobial resistance information in learning materials for school going children, who are good information consumers,” he said.

Speaking at the meeting, ZNPHI Acting Director, Dr Kunda Musonda said he was confident that the lessons learnt regarding the AMS had put the participants on a better footing to address the problem of AMR in Zambia. ‘’I am confident that with the way forward that we have developed and the AMR champions that have been awakened today, we will efficiently and effectively implement AMS programs in our health facilities’’, Dr Musonda said.

The meeting marked a successful take off of implementation of the anti-microbial stewardship program in Zambia, highlighting the need for leadership commitment in instilling a culture of stewardship, accountability, action in implementing policies and best practices, tracking and review of antibiotic therapy outcomes, reporting and education. In addition, community engagement on antimicrobial resistance is imperative to empower the public on the risks and preventive measures. Other best practices shared were need for guidelines and clinical pathways, order forms, de-escalation and dose optimization.

Two core intervention strategies were recommended for a smooth establishment of the program including prospective audit with intervention and feedback as well as formal restriction and preauthorization of access to antimicrobials. “Pharmacists have a big role to play in the stewardship process as they have direct contact with the patients,” emphasized Prof. Marc Mendelson the Head of Infectious Diseases an HIV medicine at the University of Cape Town Department of Medicine.