Introduction
Since 2018, the ASEF Public Health Network (ASEF PHN) has been playing a leadership role in highlighting the links between addressing AMR and achieving UHC. Building upon the outcomes of the 2018 High-level Meeting, a high-level conference on “Universal Health Coverage (UHC) in an Era of Antimicrobial Resistance (AMR) and Pandemics” was organised by ASEF, together with the AMR Clinical Reference Center and the Ministry of Foreign Affairs of Japan in February 2023 . The conference demonstrated the benefit of tackling AMR while progressing towards UHC, which leads to better Pandemic Preparedness and Response (PPR).
The conference concluded that most health systems have been developed based on the assumption that effective and affordable antimicrobials would be readily available. However, due to AMR, the effectiveness of antimicrobials is no longer guaranteed. This places the sustainability of health systems in jeopardy.
Elements required within health systems in order to effectively address AMR, such as surveillance and the capacity to develop and produce new therapeutic agents, are also useful features in the context of PPR. Addressing AMR under health systems will strengthen PPR capacities contributing to Global Health Security (GHS).
As a result of the conference, a WHO-ASEF joint project “Addressing antimicrobial resistance (AMR) by strengthening primary health care (PHC): Piloting the WHO AMR People-Centred Approach in priority countries” emerged.
Addressing antimicrobial resistance (AMR) by strengthening primary health care (PHC): Piloting the WHO AMR People-Centred Approach in priority countries
While a multisectoral, One Health, response is essential given the complex drivers of AMR across sectors, there is also an urgent need to strengthen the human health sector response to AMR. To enable a sustainable and comprehensive response to AMR, it is crucial to link/mainstream AMR interventions at the country level more firmly with health systems strengthening efforts, including achieving UHC through primary health care (PHC) and building capacity for PPR efforts.
Mainstreaming AMR requires a shift from addressing AMR as purely a biological phenomenon, and instead placing people and their health needs and health system challenges at the centre of the response. This approach also requires a greater understanding of, and the need to address AMR interventions at different levels of care from primary care to secondary and tertiary care, under a broader national and/or subnational policy framework while ensuring community engagement and empowerment across the continuum. “Leaving no one behind” should be the guiding principle.
To provide guidance to countries for a more comprehensive and programmatic response to AMR in the human health sector linked with health systems strengthening efforts, WHO has developed the “People-centred approach to addressing antimicrobial resistance in human health“. With many countries looking to revise their National Action Plans (NAPs) on AMR, and given the urgent need to accelerate sustainable implementation, this framework provides a core set of 13 high-level priority interventions that can be integrated into broader health system strengthening efforts at country level, in particular, into primary health care initiatives:
The AMR core set of 13 high-level interventions are well aligned with both the WHO “Operational framework for primary health care” and its core strategic and operational levers, and International Health Regulations (IHR)/joint external evaluation (JEE) Core country capacities.
The joint WHO-ASEF project will support a needs assessment and the mainstreaming of core AMR interventions into primary health care plans, programmes and budgets in four priority countries in Asia and Europe. This will achieved through piloting the specific country guidance being developed to implement the 13 high-level priority interventions of the AMR PCF. WHO Collaborating Centres, including from Sweden and Japan, will be invited to closely engage in this initiative and provide technical assistance to countries.
The countries identified are Indonesia; Thailand; and Kazakhstan (4th country tba).
Expected Results & Impact
National level – Key Results:
- Assessment of the status of implementation of AMR and PHC strategies in the country.
- Identification of critical gaps in both AMR and PHC programmes that require action and prioritization of activities.
- Development of a work plan for mainstreaming and implementing prioritized AMR interventions under primary health care plans, programmes and budgets, and that will contribute to broader health systems strengthening efforts.
Impact:
- Health impact: The outcomes of this joint activity should contribute to strengthened PHC system in the country that benefits people through reduced infections, improved access to quality health services, improved access to quality assured and timely diagnostic services, and improved access to quality-assured and appropriate treatment and care.
- Efficiency: This joint AMR-PHC activity should result in greater efficiency in the use of scarce resources across multiple programmes and help avoid duplication of activities and interventions.
- Reduce health inequities: This joint AMR-PHC activity and prioritized interventions should contribute to increased community participation and reduced health inequities with regards to gender, key vulnerable populations, and geographies. It will support the guiding principle of “Leaving no one behind.”
