Containing Antimicrobial Resistance: Kenya’s Systems Approach
By Ndinda Kusu, Country Project Director, MTaPS Kenya
Antimicrobial resistance (AMR) is a dire problem in Kenya. There are already high levels of resistance to common first-line drugs and rising infections from life-threatening pathogens, including those leading to pneumonia, salmonella, and gonorrhoea.
Just as AMR involves many sectors—human, animal, and environmental health—containing it requires a consultative, comprehensive, and systemic approach. That means first strengthening the institutions, processes, and people who are leading the effort at every level of the health system.
In 2017, Kenya developed a policy and national action plan aimed at reducing the burden of AMR in the country. Under this framework, the USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program has been supporting the government since 2019 to implement an AMR strategy using a systemic approach. The MTaPS team has been working closely with national, county, and health facility managers and health care workers in three key areas, guided by the program’s Global Health Security Agenda mandate:
- Boosting multisectoral coordination
In line with the World Health Organization’s (WHO) One Health approach, MTaPS aims to improve coordination among the human, animal, and agricultural sectors and their shared environment. To that end, we helped Kenya’s Ministry of Health (MOH) launch its National Antimicrobial Steering Inter-Agency Committee (NASIC) in 2019, which is aligned with the country’s AMR policy. MTaPS worked with NASIC’s technical working groups to review their terms of reference and is supporting the development of a monitoring and evaluation framework for the national action plan on prevention and containment of AMR.
- Implementing antimicrobial stewardship programs
Promoting sound antimicrobial stewardship (AMS) at the point of care helps to keep antimicrobials effective by decreasing inappropriate use.
MTaPS supported the launch of the National Medicines and Therapeutics Committee, which subsequently revised Kenya’s essential medicines list and incorporated AWaRe (Access, Watch, Reserve) antibiotics categorization. The country is the first among low- and middle-income countries to do so. MTaPS collaborated with other partners to support the MOH to develop the first national AMS guidelines, with plans for wide dissemination and support for implementation. We made sure the Kenya AMS 2019 guidelines included the appropriate county and health care facility governance structures.
To institutionalize appropriate medicine use practices at the facility level, MTaPS trained Medicines and Therapeutics Committees and AMS health facility teams from health facilities in Nyeri and Kisumu counties and Gertrude’s Children’s Hospital on rational use, antibiotic stewardship, medicine use evaluations, and antibiotic use audits.
The work on AMS extends to preservice pharmaceutical management, and MTaPS is working with the University of Nairobi School of Pharmacy to reform the preservice curriculum to integrate AMS-related topics. The program also provides ongoing technical assistance to the Pharmaceutical Society of Kenya to develop a AMS training course linked to continuing professional development and relicensure for delivery through the professional association.
- Improving infection prevention and control
Kenya has inadequate capacity for implementing infection prevention and control (IPC) interventions, including a weak monitoring, follow-up, feedback, and support system for complying with IPC guidelines and standards. MTaPS worked to build sustainable institutional and human resource capacity. At the national level, we provided technical assistance to the National Infection Prevention and Control Advisory Committee and the MOH Patient and Health Worker Safety Division to review the existing policy for health care workers.
At the county level, we’ve been helping county leadership to establish IPC governance structures and operations in Nyeri and Kisumu counties, but our work reaches frontline health care workers. We’ve also supported 16 health facilities in both counties to implement a continuous quality improvement approach in implementation of their IPC activities. Specifically, MTaPS-supported activities included a baseline assessment, capacity building workshops, establishing IPC committees, supportive supervisory visits, and ongoing professional development.
Group photo of participants during a conference titled “Tackling Antimicrobial Resistance Together” in Kenya during World Antibiotic Awereness Week 2019
MTaPS’ work followed core tenets that have contributed to a solid start for an AMR strategy in Kenya:
Building on existing structures
Throughout, we have focused on strengthening existing core governance structures in all three key areas—multisectoral coordination, AMS, and IPC—rather than setting up parallel structures and activities, which would have led to inefficiencies.
Sensitization and advocacy
MTaPS has participated in key events at the national and county levels. We supported the Kenya MOH in its first commemoration of the World Patient Safety Day in September 2019 through three events in Nairobi, Nyeri, and Kisumu counties. The program also participated in the World Antibiotic Awareness Week campaign in November 2019, creating awareness about these critical issues for the general public to build holistic awareness on AMR.
Consultative and inclusive interventions
MTaPS extended its activities across many groups that have a stake in containing AMR. We collaborated with health leaders and reached out to professional associations, donors, implementing partners, training institutions, students, and communities to establish a broad base of support and consensus.
Continuous quality improvement
Our approach has emphasized building knowledge and skills through mentoring, supportive supervision, and monitoring, including opportunities for review and feedback.
Government ownership and empowerment
Ensuring country ownership is critical to sustainability. We dedicated significant time to trainings of trainers; identifying national, county, and facility champions for our interventions; and continuous professional development.
With this base of work to strengthen each foundational component needed to contain AMR, Kenya is well positioned to expand these activities nationwide. MTaPS will continue to support pilot counties and will document and share approaches, best practices, and lessons learned with national and county MOH departments and stakeholders. We continue to utilize the “Tao of Leadership” principle in all of our work: giving people the tools and inspiring them take control of their own progress.