Development of National Guideline for Antimicrobial Stewardship Program in Healthcare Facilities of Nepal

Introduction

Globally, Antimicrobial Resistance (AMR) poses a profound threat to humanity, with consequences ranging from increased mortality and morbidity rates to the compromised effectiveness of healthcare interventions and beyond. Inappropriate use of antimicrobials across various sectors including human health, agriculture, and veterinary sector have accelerated the AMR. Nepal is facing a growing burden of AMR, which has drawn the attention of public health experts, stakeholders, and academics.

To help address this issue, the Ministry of Health and Population (MoHP), in collaboration with WHO Nepal, has tasked HERD International to draft the National Guideline for Antimicrobial Stewardship Program (AMSP) for healthcare facilities in Nepal. This guideline will provide a framework and evidence-based strategies to support effective planning and implementation of antimicrobial stewardship activities to promote the careful and rational use of antibiotics, antifungal, and antiviral medicines. As it is aimed ultimately for health facilities to use, the national guideline will also be tailored to local contexts.

Approach

Drafting the National Guideline for AMSP will involve a systematic and participatory approach. Relevant stakeholders, including federal, provincial, and local governments and development partners, will be engaged in order to ensure that the guideline aligns with national and sub-national policies and procedures and global standards. The guideline will be developed in line with WHO’s global guidance on AMSP and the Government of Nepal’s priorities as stated in the National Action Plan on AMR 2024-2028.

Key Steps

1. Inception period: The first step involves introductory and inception meetings with representatives from QSRD, MoHP, WHO and other key government officials. This is an opportunity for all relevant stakeholders to gain clarity and consensus on objective, scope, and deliverables. These meetings will also support identification of potential risks and uncertainties, as well as planning for strategies to manage these risks. Following this, an inception report, carefully outlining the scope of work with timeline, deliverables, approaches, and methodologies to be employed, and overall strategy for project execution will be developed that will serve as a comprehensive guide.
2. Desk review and consultations: The next step is a desk review focusing on the National Action Plan on AMR, WHO guidelines and toolkits on ASMP in health facilities, and existing AMSP guidelines from other countries to adapt lessons learned and best practices that could inform the National Guideline on AMSP. Consultations at health facility level will also be conducted to better understand the current landscape of antimicrobial stewardship in Nepal. This will result in a detailed map of key stakeholders to establish a technical working group for the development of the guideline and facilitate the multidisciplinary approach required for effective implementation of the AMSP.
3. Drafting of the National Guideline: The technical working group will begin drafting a comprehensive National Guideline for AMSP in Healthcare Facilities that is tailored to the Nepali context in alignment with national priorities and WHO standards. This document will be bolstered by regular consultation with the QSRD and WHO for input, review, and feedback, which will support the finalization of the guideline.
4. Workshop for finalization of the National Guideline: The final step involves coordinating with MoHP and WHO to plan and conduct workshops to disseminate the National Guideline on AMSP to relevant stakeholders. During these workshops, participants will provide their input and feedback, which will be incorporated into the guideline to ensure its alignment with stakeholder perspectives and priorities.