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Fostering patient and public engagement (PPE) to counter antimicrobial resistance (AMR) is referred to as participatory antimicrobial stewardship. PPE is recognised as an important target only in a few national policies for managing AMR.
On October 19, 2023, the World Health Organization (WHO) issued guidelines with regard to the importance of having a people-centred approach to addressing antimicrobial resistance in human health. It puts people and their needs at the centre of the AMR response and guides policymakers in taking programmatic and comprehensive actions to mitigate AMR in line with a proposed package of core interventions.
These interventions are based on a review of four pillars and two foundational steps that are critical to overcome barriers faced by people and health systems in addressing AMR. The four pillars are: (1) prevention of infections; (2) access to essential health services; (3) timely, accurate diagnosis; and (4) appropriate, quality-assured treatment.
The pillars are supported by the two foundational steps: Effective governance, awareness and education; and strategic information through surveillance and research.
The Government of Kerala realised the importance of PPE in AMR and hence during the November 2019 annual review of Kerala Antimicrobial Resistance Strategic Action Plan (KARSAP) activities by the health minister, it was decided to make Kerala an antibiotic literate / aware state .
The broad objectives envisaged under Antibiotic Literate Kerala campaign are:
To make Kerala an antibiotic literate state, several initiatives have been launched by the state government, which includes preparation of online training modules on antimicrobial stewardship for doctors, AMR training modules for students, public, grassroots-level healthcare workers, pharmacists and farmers.
AMR awareness messages in the regional language (Malayalam) for the public, farmers and students have been prepared, collated and released as an AMR flip book and IEC dossier for ready reference. Public engagement through visual and print medium is routinely done.
In 2023, Kerala achieved a significant milestone by becoming the first state in India to establish AMR committees in all districts and also block-level AMR committees in all 191 health blocks. The AMR committees at district- and block-level are truly One Health-based and have representatives from the departments of health, animal husbandry, fisheries, agriculture and environment.
The antibiotic Kerala campaign is implemented through block AMR committees and is monitored by district and state AMR committees. These block AMR committees are the subdistrict bodies to disseminate the mandates on AMR programmes in the field and among healthcare professionals.
The committees also monitor AMR activities happening in each local self-government department under the block, including urban areas against the mandates of KARSAP and its goals. Monitoring and evaluation framework and standard operating procedures for block AMR committees have been issued as a Kerala government order in 2023.
The broad objectives under the Antibiotic Literate Kerala Campaign are disseminated to the public through the block AMR committees. A hub-and-spoke model of AMR surveillance has been initiated in almost all districts to facilitate diagnostic stewardship in secondary care centres.
Family Health Centre Kakkodi in Kozhikode district is set to become the first antibiotic-smart hospital in the state under the Antibiotic Literate Kerala Campaign. To be declared as antibiotic smart, just like FHC Kakkodi, a hospital should satisfy the following 10 criteria.
|
MONITORING PARAMETERS |
STATUS | |
|---|---|---|
|
1 |
Posters on AMR in Malayalam should be displayed in hospitals |
Yes |
|
2 |
All healthcare workers should be trained in infection prevention and control and antimicrobial stewardship |
Yes |
|
3 |
Prescription audit must be conducted quarterly |
Yes |
|
4 |
Functional hospital infection control and antimicrobial stewardship committee must be present |
Yes |
|
5 |
IEC for public should be conducted every fortnight |
Yes |
|
6 |
Antibiotic utilisation metrics with regard to dispensed antibiotics from pharmacy based on AWaRe classification should be calculated quarterly |
Yes |
|
7 |
Hospital should be NQAS certified / should have a plan to work for obtaining certification in next one year |
NQAS attained |
|
8 |
Posters on AWaRe classification of antibiotics should be displayed in all prescribing areas |
Yes |
|
9 |
More than 95 per cent antibiotics prescription in OPDs should be from access category |
95 per cent is from access |
|
10 |
PROUD programme or initiative for proper disposal of expired, unused antibiotics |
Yes |
Aravind Reghukumar, HOD Infectious diseases, GMC Thiruvananthapuram, Kerala.
Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth.