Journal Article

A road-map for addressing antimicrobial resistance in low- and middle-income countries: lessons learnt from the public private participation and co-designed antimicrobial stewardship programme in the State of Kerala, India

Warrier, Anup, Charani, Esmita, Sharma, Anuj, Singh, Sanjeev, Edathadathil, Fabia, Ellangovan, K., Jaykrishnan, A. V., Kumar, Anil, Devi, Sarada, Shareek, P. S.

2021

Overview

Background The global concern over antimicrobial resistance (AMR) is gathering pace. Low- and middle-income countries (LMICs) are at the epicentre of this growing public health threat and governmental and healthcare organizations are at different stages of implementing action plans to tackle AMR. The South Indian state of Kerala was one of the first in India to implement strategies and prioritize activities to address this public health threat. Strategies Through a committed and collaborative effort from all healthcare related disciplines and its professional societies from both public and private sector, the Kerala Public Private Partnership (PPP) has been able to deliver a state-wide strategy to tackle AMR A multilevel strategic leadership model and a multilevel implementation approach that included developing state-wide antibiotic clinical guidelines, a revision of post-graduate and undergraduate medical curriculum, and a training program covering all general practitioners within the state the PPP proved to be a successful model for ensuring state-wide implementation of an AMR action plan. Collaborative work of multi-professional groups ensured co-design and development of disease based clinical treatment guidelines and state-wide infection prevention policy. Knowledge exchange though international and national platforms in the form of workshops for sharing of best practices is critical to success. Capacity building at both public and private institutions included addressing practical and local solutions to the barriers e.g. good antibiotic prescription practices from primary to tertiary care facility and infection prevention at all levels. Conclusion Through 7 years of stakeholder engagement, lobbying with government, and driving change through co-development and implementation, the PPP successfully delivered an antimicrobial stewardship plan across the state. The roadmap for the implementation of the Kerala PPP strategic AMR plan can provide learning for other states and countries aiming to implement action plans for AMR.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Antibiotics / Antimicrobial agents / Antimicrobial resistance / Antimicrobial Stewardship / Biomedical and Life Sciences / Biomedicine / Capacity development / Collaboration / Coronaviruses / COVID-19 / Curriculum / Developing Countries / Disease control / Drug Resistance / Drug resistance in microorganisms / Drug Resistance, Bacterial / Education, Medical / Epidemics / Health aspects / Health care / Health care reform / Health Policy and the Management of Antimicrobial Resistance in LMICs / Health risks / India / Infectious Diseases / Initiatives / KARSAP / Kerala model / Low income groups / Medical Microbiology / Medical research / Mortality / Nosocomial infections / Pathogens / Pneumonia / Practice Guidelines as Topic / Prevention / Private sector / Public health / Public private partnership / Public private partnerships / Public-private sector cooperation / Public-Private Sector Partnerships / Review / Sepsis / State government / Tuberculosis