Getting National AMR Containment Plans on the Road in Mozambique
The world is facing an unprecedented global health crisis as antibiotics are increasingly becoming ineffective to treat common infectious diseases, such as tuberculosis and pneumonia, threatening a backward slide in gains made in public health. The death toll from antimicrobial resistance (AMR) reached 1.27 million in 2019, with the largest burden in low- and middle-income countries. A survey conducted in 2019-20 revealed that 88% of the responding 136 countries had a national action plan (NAP) in place to contain AMR, in response to the World Health Assembly’s call for a Global Action Plan on AMR. But the survey also found country implementation of NAPs to be a mere 20%.
Mozambique endorsed its National Action Plan Against Antimicrobial Resistance 2019-2023 by the end of 2018. But when Tomas Zimba joined USAID MTaPS to support the program’s Global Health Security Agenda (GHSA) portfolio in Mozambique in March 2021, the activities of NAP had yet to begin.
Mozambique’s multisectoral coordination (MSC) committee charged with implementing the NAP is composed of diverse members, in alignment with the One Health approach: the Ministries of Health, Agriculture, and Environment; Mozambican Agricultural Research Institute; National Institute of Health (INS); and Faculty of Veterinary from Eduardo Mondlane University.
“The onset of COVID-19 pandemic in early 2020 made the task of convening diverse stakeholders to activate the NAP even more challenging,” reflects Zimba, an AMR researcher and teacher who contributed to the development of Mozambique’s AMR NAP in 2018.
First Things First: Setting Up Governance
The first meeting of MSC committee for AMR was held in March 2021, with coordination support from MTaPS and successfully convening members virtually, under the strict national pandemic guidelines of physical distancing. The meeting, held in collaboration with the Food and Agriculture Organization (FAO), provided a launch pad for MTaPS to kickstart implementation of the NAP. Following the meeting, the MTaPS team proposed a governance structure and developed terms of reference (TOR) for its various functions—the MSC committees; five technical working groups (TWGs) to achieve the objectives of the five pillars of AMR (infection prevention and control, antimicrobial stewardship [AMS], research, surveillance, and awareness); and a secretariat. The team reviewed and validated their TOR with the AMR-MSC.
Facilitating Stakeholder Alignment
The key focal point for AMR in Mozambique was shifted from INS, which hosts the country’s One Health platform for tracking and addressing vector and zoonotic diseases, to ANARME, the national medicine regulatory agency. Although the responsibility for AMR now resides within ANARME, INS continues to be the focal point for GHSA, which provides the overarching framework for AMR, exemplifying the difficulties of separating ownership from responsibility.
“The most challenging part we faced was that people did not have clarity on their responsibilities and roles in implementing the NAP. Since the ownership of AMR is diffused, different staff and departments brought in their own ideas to lead the process. We facilitated negotiation across departments and institutions and helped align them on designation of different roles and responsibilities on NAP implementation,” shares Zimba.
To ensure One Health approach in AMR activities, MTaPS collaborated with the FAO and CIRAD (French Agricultural Research Centre for International Development) to engage animal sector stakeholders. The team facilitated a shared role to host meetings to foster ownership of planned activities. The IPC and AMS TWGs started to meet for the first time in June 2021, with the TWGs developing and instituting protocols and guidance on IPC and using antimicrobials. So far, the guidance has been disseminated to seven health facilities (three onsite support and four remotely) in seven provinces.
Fueling the Momentum and Sustaining It
The MSC committee has started regular meetings and prioritizing the NAP activities to undertake, although a schedule of routine quarterly meetings is still being worked on—an area of continued support from MTaPS. The secretariat is working to set up processes for fully operationalizing the MSC committee.
In a sign of decisive progress, the animal sector, FAO, the Ministry of Agriculture, and Faculty of Veterinary have co-developed an action plan and started implementing it to improve AMR surveillance in the food and agriculture sectors.
By implementing MSC, MTaPS has helped measurably increase national IPC and AMS capacities, reaching halfway from “limited capacity” (assessed in 2018) to the next higher level per the WHO IPCAF assessment tool. In the meantime, MTaPS continues to facilitate meetings of MSC-AMR bodies and their TWGs—the foundation for continued momentum on IPC and AMS activities as part of implementing the NAP.
“We are also working to achieve greater harmonization between ANARME and the One Health platform under INS for greater collaboration, which can ensure sustainability in effectively and efficiently advancing the AMR agenda in the country,” adds Zimba.
Continued focus and investment in these areas can ensure gains made in the country are not lost.