Table 1.
Situation analysis and monitoring of antimicrobial resistance in Indonesia: results summary June 2016
| Indicators | Phases | Phase achieved in Indonesia | ||||||
|---|---|---|---|---|---|---|---|---|
| 1—Exploration and adoption | 2—Programme installation | 3—Initial implementation | 4—Full operation | 5—Sustainable operation | ||||
| 1. National AMR action plan | ||||||||
| NAP in line with GAP-AMRGAP | No action plan or no national multisectoral committee or AMR committee established but involving one ministry | AMR working group established and national action plan under way | Action plan aligned with GAP including operational plan with defined activities and respective budget available | Action plan includes operational plan being rolled out and scaled up with defined activities and respective budget | Action plan includes operational plan being rolled out and scaled up with defined activities and respective budget | 2+ | ||
| 2. Awareness raising | ||||||||
| Awareness campaigns to the public | Government not involved in awareness raising activities on antibiotic resistance | Some government led activities in parts of the country to raise awareness about AMR and actions to tackle it | Nationwide, government led antibiotic awareness campaign targeting the general public or professionals | Nationwide, government led antibiotic awareness campaign targeting public and professionals | Assessing effects of government led awareness campaigns on behaviour changes in public and professionals | 3+ | ||
| Education and training strategies for professionals | No policy or strategy | Relevant policies developed but ad hoc training courses in some disciplines | AMR included in some preservice training or special courses or both OR Continuous professional development and regular audit of learning |
AMR included in some preservice training or some special courses or both AND Continuous professional development and regular audit of learning |
AMR included in preservice training for all relevant cadres Regular continuing professional development |
3+ | ||
| 3. National AMR surveillance system | ||||||||
| National human AMR surveillance | No capacity for AMR laboratory or limited reporting or both, or no surveillance guidelines | Guidelines developed but not fully implemented. Limited quality data and analysis and not fully representative of country | Standardised national AMR surveillance in place and representative of country but limited number of operational sites | Surveillance in place and functional to monitor AMR trends accurately and timely but no contributing data to GLASS | National AMR surveillance regularly assessed and adjusted; and contributing to GLASS | 2− | ||
| National laboratory network strengthening | No national network developed | A national network with testing according to the international standards is planned | A national reference laboratory is identified, and quality assured laboratory networks have been developed only at few surveillance sites | A national network of EQA health laboratories has been developed in most or all surveillance sites | A laboratory network is established, EQA measures are in place, and the reference laboratory has demonstrated capacity for research | 1 | ||
| 4. Rational use of antimicrobials and surveillance of use and sale (community based) | ||||||||
| A national AMR containment policy for control of human use of antimicrobials; AMR stewardship (AMS) | No or weak national policy and plan, regulations for antimicrobial use, and availability | National AMS programme (AMSP) planned and under development | AMSP is developed, including tools to implement and monitor AMS progress and impact | AMSP implemented by relevant institutions. Regulations for antimicrobial use and availability are implemented in limited capacity | A national AMSP for control of human use of antimicrobials has been implemented and enforced for more than 2 years | 4 | ||
| National Regulatory Authorities (NRA) or Drug Regulatory Authorities (DRA) | No official NRA or DRA or those existing have limited capacity | NRA or DRA with limited capacity but strategic planning in place for capacity building and appropriate budgeting | NRA or DRA system set up for oversight but not fully functional | Tools for quality assurance and registration of antibiotics in place and inspection implemented but limited capacity for enforcement of policies and regulation | Competent and functional NRA or DRA with capacity to ensuring or enforcing antibiotic quality standards,to take measures against substandard products and to inspect pharmacies | 4 | ||
| Surveillance of antimicrobial use and sales in humans | No guidelines for surveillance of use or sales of antimicrobials or both | National policy and plan on surveillance of use of antimicrobials under development or developed and approved but not implemented (surveillance in individual facilities and national level sales) | Monitoring sales of antimicrobials at national level not implemented. Monitoring of use is irregular and limited to few facilities that are not representative | National sales data are collected on a regular basis (every 1-2 years). Data are collected from a small and not representative sample individual healthcare facilities. No established analysis with national AMR laboratory based surveillance | National sales data are collected on a regular basis (every 1-2 years). AMU surveys are conducted in a representative sample of facilities and translated into actions. Links with national AMR surveillance data are analysed and reported | 3 | ||
| 5. Infection prevention control and AMR stewardship programme | ||||||||
| AMR stewardship programme in healthcare setting | No national AMR stewardship policy or operational plan is available or approved | A national IPC or AMR policy or operational plan is available but weak. SOPs, guidelines, and protocols not available to all hospitals (limited updates) | National IPC, AMR aligned IPC, or AMR plans implemented in limited number of healthcare settings | National IPC, AMR aligned IPC, or AMR plans are implemented in about all healthcare settings | IPC or AMR measures are widely implemented and regularly evaluated and shared | 3 | ||
| IPC programme in healthcare setting | No national IPC policy, guidelines, or action plans to mandate IPC in healthcare settings | A national capacity building programme, or operational plan, is developed. SOPs, guidelines, and protocols are developed and available but not implemented | IPC programme and capacity building plans are implemented in selected healthcare settings | IPC programme and capacity building plans implemented nationwide | IPC capacity building and programme effectiveness are regularly evaluated and shared | 3 | ||
| National HAI and related AMR surveillance | No policies, limited national plan and guidelines to mandate hospitals for HAI surveillance | Few public and private facilities have HAI surveillance but data not centralised at national level | Few public and private facilities have HAI surveillance and share data at national level | Centralised data on HAI from several hospitals but with limited capacity for data analysis and detection | Monitoring and response frameworks established to identify critical HAI events, especially related to emergence of AMR indicator bacteria against critical drugs | 2− | ||
| 6. Research and innovation | ||||||||
| Research and development and innovation on AMR prevention and containment (plus research funding) | No policies fostering research environment although capacity exists for research | Policies planned and existing structure has a plan to foster research and innovation on AMR | Presence of policies and investments to foster research and innovation on AMR | Research consortium and dynamic research programme are ongoing led by government agenda | Government led research outputs related to AMR global research agenda | 2 | ||
| 7. One Health engagement | ||||||||
| A national AMR containment policy and regulatory framework for control of animal use and their registration for use | No national policy or plan to reduce use of antibiotics | National policy and plan on use of antimicrobials developed and approved or regulatory framework for control of animal use and their registration for use is developed but not implemented | Implementation of policy and plan but limited capacity for monitoring use and quality of drugs | Policy and plan implemented with some capacity for monitoring but limited capacity for enforcement | Policy and plan implemented with proper capacity for monitoring and increased capacity for enforcement | 2 | ||
| National surveillance of AMR and use and sales of antimicrobials at national level in the veterinary sector | No or weak national policy and guidelines | Limited capacity for surveillance of sales, AMR, or AMU | Some capacity and data generated from sales, AMR or AMU | Some comparative analysis of surveillance data between AMR and AMU | Comprehensive approach of surveillance with coordinated analysis between humans and animals | 2 | ||
| Infection prevention and control in the animal sector | No policy and national guidelines developed for biosecurity to reduce infection rates in food and both large producers and small holders | Policies and national guidelines in line with international standards planned including vaccination policy and Codex Alimentarius standards | Limited implementation, particularly in large producers | Full implementation | Fully implemented in multiple areas with a monitoring framework in place | 3 | ||
| AMR awareness generation and education in the animal sector | No policies or strategies exist or are only planned | Policies or strategies developed | AMR in some pre-service training or special courses or both OR Continuous professional development and regular audit of learning |
AMR in some pre-service training or special courses or both AND Continuous professional development and regular audit of learning |
Effect of education programme on behaviour changes is assessed | 1 | ||
NAP=national action plan; GAP-AMR=global action plan on antimicrobial resistance; AMR=antimicrobial resistance; GLASS= global AMR surveillance system; EQA= external quality assurance; API=active pharmaceutical ingredient; IPC= infection, prevention, and control; SOP= standard operating procedures; HAI=health associated infection; AMU= antimicrobial use.