1. Capacity-Building for Country- and Regional- Level Advocacy and Interventions to Contain Antimicrobial Resistance in Africa Mohan P. Joshi*, Terry Green*, Oliver Hazemba**, Rosalind Kirika***, Tenaw Andualem****, Wonder Goredema*, Gabriel Daniel*, Negussu Mekonnen**** *Strengthening Pharmaceutical Systems (SPS) Program, Management Sciences for Health (MSH), Arlington, VA, USA, **MSH/SPS Zambia, ***MSH/SPS Kenya, ****MSH/SPS Ethiopia Oral presentation made at the Third International Conference for Improving Use of Medicines (ICIUM 2011 ) November 14–18, 2011, Antalya, Turkey

2. MSH/SPS activities World Health Organization (WHO) Global Strategy published in 2001, but not implemented widely* Bridge needed from global strategy to country- and regional-level actions The USAID-supported SPS Program and its predecessor, RPM Plus, helped build country and regional capacity to generate coalitions for AMR advocacy – Country—Zambia, Ethiopia – Regional—Ecumenical Pharmaceutical Network (EPN), Regional Pharmaceutical Forum (RPF) * WHA58.27

3. Elements of the SPS-Supported Country-Level Approach Initiate the process (Identify key issues and players) Identify a local champion group Gain additional understanding of the local situation Expand advocacy and initiate interventions Monitor and Evaluate Build and Expand Coalition

4. Coalition-Building Guidebook to Jump- Start the Process SPS recently revised the guidebook that is used to help jump-start the process— Building Local Coalitions for Containing Drug Resistance Key guidebook components— – Identifying and engaging AMR stakeholders – Advocacy and coalition-building guidelines – Practical implementation examples from country- and regional-level initiatives – User-friendly implementation tools and templates

5. Accomplishments (1) The Zambian and Ethiopian AMR working groups, EPN, and RPF generated widespread advocacy through their AMR call- to-action meetings and documents The Zambian working group facilitated in-country stakeholders’ efforts to— – Revise the national standard treatment guidelines – Improve the medicine quality assurance system – Increase public awareness of AMR through mass media – Reform the medical curriculum to include AMR topics The Ethiopian working group— – Catalyzed a national AMR baseline survey; developed intervention plans – Facilitated journalist training; carried out AMR media coverage

6. Accomplishments (2) EPN spearheaded advocacy and actions through its members: Regional EPN–SPS workshop participants carried out more than 40 AMR-related activities within one year RPF revised its regional pharmaceutical strategy to include AMR components and advocated for AMR at high-level meetings

7. Lessons Learned (1) Involve stakeholders from various sectors to help achieve “concerted” actions to tackle the “common” problem of AMR Take immediate steps to initiate advocacy as soon as key players and issues are identified Identify a local champion group to lead the in-country or regional process Ensure that the champion group functions as a “catalyst” rather than a “one-and-only action body” Diversify funding and harness internal resources to support sustainability

8. Lessons Learned (2) Frame AMR advocacy and containment as “value added” to existing programs, NOT as a competing vertical program Use unifying concepts such as “preserving drug effectiveness” to promote a shared positive vision Emphasize the continuous nature of the AMR containment process Build on existing foundations Pay attention to overall health systems strengthening

9. Policy Implications WHO has provided a Global Strategy on AMR, but few countries are implementing it (ICIUM 2004) Effective advocacy and coalition-building is vital for catalyzing an organized, coordinated, and sustained response to the AMR challenge Only when AMR is identified as an urgent priority can policy level decisions take place related to antibiotic policies, drug regulation, antimicrobial use in animals, and AMR surveillance, education, and research Therefore, donors, development partners, and key national stakeholders need to support the creation of sustained advocacy efforts and local coalitions around AMR

10. Future Research Existing Evidence Gap for Advocacy Little data, especially from developing countries, on AMR’s effect on morbidity, mortality, and cost increase and diversion AMR impact is not obvious to policy makers and even health care providers Future Research Need More data urgently needed on short- and long-term effects of AMR in resource-constrained countries Such data will serve as a powerful advocacy tool to convince policy-makers to give AMR a high priority