Introduction
Antimicrobial resistance (AMR) represents a major global threat across human, animal, plant, food, and environmental sectors. In 2019, it was estimated that globally almost 5 million deaths were associated with bacterial AMR, including 1.27 million deaths being directly caused by it.
AMR continues to be the public health problem in Sri Lanka. In 2021 Sri Lanka reported the rate of resistance to ciprofloxacin as 57.7% for Escherichia coli and 72% for Klebsiella pneumoniae infections. According to the National Strategic Plan for AMR 2023-2028, the third-generation cephalosporin resistance for Escherichia coli was 61.9% and Methicillin resistance for Staphylococcus Aureus organisms was found to be 53.2% in 2020.
Addressing AMR requires a holistic and multi-sectoral approach referred to as a One Health approach. The One Health approach brings together multiple sectors and stakeholders engaged in human, terrestrial, aquatic animal and plant health, food and feed production and the environment to communicate and work together in the design and implementation of programmes, policies, legislation and research to attain better public health outcomes. Globally, countries committed to the framework set out in the Global Action Plan (GAP) 2015 on AMR during the 2015 World Health Assembly and committed to the development and implementation of Multisectoral National Action Plans (NAPs).
As AMR is one of the top 10 global public health threats, WHO South-East Asia (SEA) region has pioneered in identifying AMR as one of the Regional Director’s Flagship areas, designating it a priority for WHO’s work in the SEA Region. By 2022, all 11 Member States in SEA developed AMR NAPs and some countries are in the process of updating their NAPs for the next five-year cycle. In addition, all Member States are enrolled in the Global Antimicrobial Resistance and Use Surveillance (GLASS-AMR) and five Member States are enrolled in GLASS-Antimicrobial Consumption (GLASS-AMC).
The first objective of AMR GAP is improving awareness and understanding of AMR through effective communication, education, and training. Organizing a global annual awareness campaign was identified as an activity to contribute to this objective. On 6 June 2023, the Quadripartite organizations – the Food and Agriculture Organization of the United Nations (FAO), the United Nations Environment Programme (UNEP), the World Health Organization (WHO), and the World Organization for Animal Health (WOAH) - announced the rebranding of WAAW as World AMR Awareness Week.
The theme for WAAW 2023 will remain as in 2022 “Preventing Antimicrobial Resistance Together”.
On 22 November 2023, the event was organized in the MoH to celebrate the World AMR Awareness Week. This event was attended by representatives of MoH, WHO, Department of Animal Production and Health, Department of Fisheries and Aquatic Resources, and Department of Agriculture and Department of Environment.
Activities conducted with WHO
support in 2023
In 2023, WHO supported the Ministry of
Health to conduct an ‘Evaluation of the AMR National Strategic Plan 2017 -2022’
and develop the ‘AMR NSP 2023 – 2028’ using the WHO latest tools. The NSP strategies
will be deliberated further, and a-two-year costed operational plan will be
developed using the Budgeting and Costing tool which was introduced to Sri
Lanka with WHO support in October 2023.
During 2023 the training on WHONET has
also been conducted to improve laboratory-based surveillance of infectious
diseases and antimicrobial resistance.
WHO has also provided laboratory
equipment worth over 25 million SLR to strengthen the One Health surveillance
of pathogens in animal and human health sectors through joint activities
between the Medical Research Institute (MRI) and Veterinary Research Institute
(VRI).
WHO Regional Office for South-East
Asia has initiated an antimicrobial stewardship (AMS) mentoring program to create a Network of SEA Region AMS
programmes early implementing hospitals. Sri Lanka has four hospitals included
in this programme, namely, National Hospital Kandy, Colombo North Teaching hospital,
Sri Jayewardenepura hospital and Lanka hospital. Lessons learnt during the
implementation of AMS programmes in these hospitals could be replicated to
other hospitals starting from 2024. WHO has also supported strengthening of the
mycosis surveillance at national level with equipment and reagents worth over
15 million SLR and provided training to staff on reporting to GLASS Fungi which
will commence from 2024.
In addition, WHO supported the Antimicrobial Consumption (AMC) advocacy
and training activity and built the capacity of the Medical Supplies Division
staff on reporting of antimicrobial consumption data to GLASS.
Activities conducted during the
WAAW week 2023
A prescriber
awareness program for 263 Medical Officers in five provinces was conducted with
support of the members of the Sri Lanka College of Microbiology and other
professional colleges. Western, Central,
Southern, Northern and Eastern provinces were covered in this program. Sessions were conducted to demonstrate the
gravity of the AMR problem and during the events the rational prescription and use
of antibiotics, anti-viral and antifungal medicines were also discussed.
AMR awareness program for 151 Pharmacists (public and private) was
conducted in four provinces (Western, Central, Southern and Eastern). During the sessions roles of pharmacists in
creating awareness in antimicrobial resistance and their functions to tackle
AMR were widely discussed.
Quiz and drama competitions on AMR were organized among medical
students and video clips were developed to promote AMR awareness among the
public.
Way forward
Combating AMR is a WHO priority at all levels and WHO remains committed to support the implementation of the AMR NSP 2023-2028 jointly with partners.