South Africa was amongst the first countries in Africa to develop a National Action Plan, this is called the National Antimicrobial Resistance Strategy Framework, said Prof Essack. This plan was recently updated, and the new 2017-2024 action plan now includes a strong One Health component.
Part of the implementation strategy is a stewardship guideline. Regional training centres have been established where people from provincial hospitals are trained on how to implement an antimicrobial stewardship programme. There are pockets of excellence in various provinces throughout the country, such as the Western Cape, said Prof Essack.
South Africa has also adopted the Antibiotic Guardian initiative from the UK and will be implementing pledges in time for WAAW this year. In addition, they will soon be publishing the first surveillance report, demonstrating that it is possible to take data from both the public and private sectors in South Africa and publish as one consolidated report.
From a regional perspective, Prof Essack explained that the Africa Centres for Disease Control and Prevention (CDC) has published its own AMR framework. The Regional Action Plan brought together the Africa CDC, the regional Food and Agricultural Organisation of the United Nations (FAO) office, the regional World Organisation for Animal Health (OIE) office, the WHO, React Africa, the African Ecumenical Pharmaceutical
Network and several others such as the African Society of Laboratory Medicine. This Regional Action Plan is currently in an intense phase of consultation and is expected to reach
One of the challenges Africa faces is that a number of different organizations are working in the same countries, trying to address the same issues necessitating review and rationalization of efforts. Therefore, Prof Essack emphasized the importance of each agency finding its own niche to avoid duplicating activities.
On a Global level, Prof Essack described how she has been working with the WHO on education and awareness. A competency framework for nurses, doctors, pharmacists and laboratory technicians has been developed. A stewardship toolkit adapted specifically for low and middle income countries is also in development with the aim of piloting this in a couple of countries that were also involved in the development of the National Action Plan.