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Antibiotic resistance:
National actions contribute to a global solution
NEPAL
Professor Paras K Pokharel
Vice Chair
GARP Nepal
AMR Activities in Nepal: How it Began
• 1978: GoN, Drug Act
• 1995: GoN, National Drug Policy, Nepal
• 1998: GoN, Infectious Disease Control Program launched
– to develop a sustainable national surveillance of AMR
• 1999: GoN, NPHL started Laboratory Based AMR Surveillance
– Network of 13 laboratories
• 1999: APUA (Alliance for Prudent Use of Antibiotics) – Nepal was
formed
• 2001: National Drug Policy Amended- “prudent use of antibiotics
added”
• 2013: Global Antibiotic Resistance Partnership (GARP)-Nepal was
formed; CDDEP & NPHF collaboration
• 2014: GoN, National Antibiotics Treatment Guidelines
Before GARP Nepal
• APUA Nepal
– Started with Assisting GoN with drafting of
National Antibiotic Policy (Major Contributor)
– Pharmacologist & Microbiologists mostly from
Kathmandu
– Prudent use of Antibiotics; Major Focus
• Laboratory Surveillance : NPHL
– Laboratory Based Surveillance Network ; Many
hospitals around the country (Training
Laboratorians, Quality Assuarance)
GARP Nepal
• GARP: International network that sensitizes
AMR issues locally and gives Nepal a voice in
antibiotic resistance in the international
arena.
• GARP-Nepal Working Group formed 2013
– Civil Society, National Public Health Body
Engagement: NPHF
– Academicians/Practitioners in Public Health,
Medicine, Microbiology, Policy, Lab Science,
Veterinary Medicine, from all over the country.
GARP Nepal
• Long-term goal:
– To lay the groundwork for a national action plan
for antibiotic resistance in Nepal
• Specific objectives:
– Carry out situation analysis of antibiotic use,
resistance and related topics—human and
animal—in Nepal
– Develop Policy Brief(s) for mitigating antibiotic
resistance in humans and animals
AMR
• This is not just about rational use of drugs.
• Not confined to hospital practice and medical
specialty.
• Broadly anything that reduces the need for
antibiotics will reduce antibiotic resistance.
AMR
•
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•
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Vaccines (both antibacterial and antiviral)
Clean water
Sewage Disposal
Rapid Diagnostics (reliable ones, not Widal tests,
more like Gene Xpert vs AFB stains)
• Sub therapeutic use of Antibiotics in
Animal/bird/fish farming
• Phasing out widespread use of antibiotics in
poultry, cattle and fish farms.
AMR
Hospitals are not “off the hook”
•Hospital-acquired infections are the most
resistant: NDM1, for example.
•Hand washing between patients ( Not standard
practice in Nepal)
•Antibiotics “ just in case”
GARP-Nepal Situation Analysis, 2014
• Respiratory infections (one-half of the cases
were resistant)
• Diarrhea (one-third of the cases were
resistant)
• Bloodstream infections, STDs, UTI: no better
GARP-Nepal Situation Analysis, 2014
• “By prescription only” laws have limited
usefulness in Nepal
• Not enough for only a small group of people
to know about AMR.
• Health care workers at all levels, ( humans and
veterinarians) in collaboration with
professionals and policy makers.
• Government support is critical.
GARP-Nepal Situation Analysis, 2014
• Multi-sectoral engagement
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Health Academia/Research
Medical Practitioners/ Lab Scientists
Agriculture/Veterinary Sectors
Policy Makers
Ministry of Health Owned Health Sciences Universities
• Policy Advocacy one of the objectives
• Engaging Government support at Ministerial Level
• Global Network
– Celebrated Global Antibiotics Awareness Week 2015
– Health Sciences University, Agricultural University & Civil
Society Engagement in Awareness & Campaigns
Working with Government
• Autonomous/Semiautonomous Govt bodies
represented on GARP-Nepal Working Group
• GoN, MoHP on board since 2014, since the
Situation Analysis was launched.
• Interest of MoH remains; supported by
current minister as well
Challenges
• Political Instability / Humanitarian crisis
• National Health Policy 2071 (2014)
Implementation plan for transition between
the old policy and new policy
• Lack of National coordination body mandated
by Government
Way Forward
• Engagement of local stakeholders
• Community based research
– Participatory (Qualitative) research
– Behavior change Initiatives for people/drug shops
• Generate more research from animal/fish sectors
• Partner with existing rational drug use &
laboratory surveillance networks esp. National
Public Health Laboratory, GoN
• Engage more private sector health groups
Way Forward
National Action Plan for Antibiotic Resistance
• Collaborative, covering all sectors, building on
GARP framework
Mount Fish Tail
Thank you