AMR action plan in MP a satisfying, progressive endeavour: Experts

Only three states in India — Kerala, Madhya Pradesh and Delhi — action plans to deal with AMR 

By Rajeshwari Sinha
Published: Tuesday 24 November 2020

It has been over three years since the National Action Plan for Anti-microbial Resistance (NAP-AMR) was rolled out across India, in line with the Global Action Plan for Anti-microbial Resistance (GAP-AMR).

Different states have been at various stages of development of the State Action Plan for Anti-microbial Resistance. Till date, only three states (Kerala, Madhya Pradesh and Delhi) have come out with their state action plan.

Pankaj Shukla, additional director, National Urban Health Mission and Sagar Khadanga, assistant professor, Department of Medicine, All India Institute of Medical Sciences Bhopal, spoke with Down to Earth on the scope of such plan in Madhya Pradesh. Edited excerpts: 

Rajeshwari Sinha: How did you ensure the role and involvement of multiple sectors during the process of drafting the Madhya Pradesh State Action Plan for Containment of Antimicrobial Resistance (MP-SAPCAR)?

 Sagar Khadanga

Pankaj Shukla and Sagar Khandaga: To be honest, this part was the most difficult part to execute.

It was challenging to bring departments like the animal husbandry, fishery, farmer welfare and agriculture development, labour, medical education and public work and environment as well as the Department Health and Family welfare on board.

Once the administrative machinery was convinced about the importance of the state action plan, the job was half done. We organised multiple meetings with technocrats of these stakeholder departments for sensitising them on their roles and responsibilities.  

We tried to identify their bottlenecks and discussed feasible solutions, thus winning their confidence.

We identified the technical committee members among these sectors and launched the MP-SAPCAR on July 26, 2019. Looking back, it was the most difficult yet the most satisfying endeavour.

RS: How far have you moved on implementation after the release of MP-SAPCAR? 

PS and SK: The state has progressed quite a bit post the MP-SAPCAR release. State Quality Cell has facilitated human resource development over the last one year.

With the help of All India Institute of Medical Sciences Bhopal and support of Antimicrobial Resistance Surveillance and Research Network, the Indian Council of Medical Research, we have trained about 2,000 healthcare workers across the state on multiple platforms.

Madhya Pradesh is one of the few states with a state antibiotic policy and we are in final stage of its revision. We have made Standard Treatment Guidelines (STG) available to all district hospitals. Systems are in place to identify its practice at the grass root.

Nealry 70 per cent of public sector healthcare delivery facilities have been KAYAKALP-accredited, demonstrating progress in infection control practices (ICP) by leaps and bounds. We have taken on board, important stake holders like private nursing home association and association of pharmacists.

We have arranged successful meetings of the technocrats of animal husbandry, fishery, farmer welfare and agriculture development with the team of Kerala to share each other’s experience.

We have identified the district nodal officers from the Department of Animal Husbandry to move forward. State veterinary department supports in providing veterinary laboratories in 22 districts for culture and sensitivity assessment for animal health.

Having travelled so far, it becomes more and more challenging to achieve new highs in this field.

RS: What is the effort being made by stakeholders belonging to different departments (animal husbandry, food, drug, environment, agriculture)? 

PS and SK: The state drug store association for human health has supported in restricting the over-the-counter (OTC) sell of schedule H drugs. We are working on a proposal to add more antibiotics to this list. 

State pollution control board has almost brought all health care facilities under its radar and the remaining facilities will be covered soon.  We will be facilitating the laboratory culture and sensitivity for animal health in 22 districts for uniform quality.

This ambitious pilot project is aimed at the development of state antibiotic policy for Department of Animal Husbandry, which will be of first of its kind in the country. We are working on the process of testing the animal foods for illegal antibiotic residues so that culprits van be penalised.

We are also aiming to improve the animal health care facilities in line with its human health counterpart ‘KAYA KALP’.

RS: What are some of the key gains or successes that you have achieved so far with respect to MP-SAPCAR implementation?

PS and SK: Madhya Pradesh is only the second state in the country to formulate a state action plan for AMR containment. The ‘Bhopal declaration’ was signed by the state ministers of five departments, showing the trans-sectorial commitment for MP-SAPCAR.

We have more trained human resources than ever, for anti-microbial stewardship practice (AMSP) at primary and secondary care healthcare delivery centers. We have our own state antibiotic policy and STG to be emulated.

All India Institute of Medical Sciences Bhopal, Antimicrobial Resistance Surveillance and Research Network, the Indian Council of Medical Research and WHO have done the necessary hand holding all throughout.

Human health prescription audit is ongoing with support of Atal Bihari Institute of Good Governance, Bhopal to identify the gain in AMSP.

Hand holding of about 100 human resources from the Department of Animal Husbandry and Fishery was provided by the team from Kerala.

The district nodal officers from the department have been identified and we are almost ready to formulate state antibiotic policy for animal health. 

RS: Please share what are some of the challenges you are seeing in MP-SAPCAR implementation efforts? What do you think needs to be done to address these issues?

PS and SK: The most important challenge has been identifying the leaders across the sectors. Once identified, their commitment to the cause is the sole reason of success. It becomes challenging to collaborate and coordinate with so many diverse sectors along the path.

Once the minimum feasible time bound targets are identified, budgetary allocation across the sectors is a challenge. Even with allocated fund, time seems to be the most common limiting factor with so much additional commitments.

Quality check in data collection is of utmost importance and we are yet to make progress in applying WHONET, even in all human microbiology laboratories for uniform antibiogram from primary care setting.

The novel coronavirus disease (COVID-19) pandemic has almost brought to a standstill our efforts for the last couple of months. But we are all geared up to continue with more vigor than ever before. 

Pankaj Shukla is director, SEIRC; additional director, NUHM and QA, National Health Mission; Directorate of Health Services, Madhya Pradesh

Sagar Khadanga is assistant professor, Department of Medicine, All India Institute of Medical Sciences Bhopal

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