Training health care workers to fight antimicrobial resistance

Health extension worker Lemlem Worku gives Zara Ahmed amoxicillin antibiotics for her 10 month old baby. Photo by: UNICEF Ethiopia / CC BY-NC-ND

NEW YORK — As the risk of resistance to antibiotics and other drugs continues to worsen, efforts to find solutions for antimicrobial resistance are taking new forms.

Increasing levels of AMR — a result of the misuse of drugs, poor-quality medication and improper prescriptions, among other factors — is a threat not only to people’s health, but also to the global economy, poverty levels, and the achievement of the Sustainable Development Goals.

By 2050, it will take the lives of more than 10 million people annually, surpassing cancer as a cause of death, according to the United Kingdom’s Review on Antimicrobial Resistance.

Now, new industry alliances are emerging in the fight against it, as well as an Interagency Coordination Group on Antimicrobial Resistance launched this spring and led by the United Nations and World Health Organization, following a first of its kind high-level meeting on the topic. The group will present its findings next September.

The international health nonprofit Management Sciences for Health has also been tapping into what it believes is a key factor in the spread of AMR across low-, middle- and high-income countries: Capacity building.

Often, pharmacists, doctors and other health care providers tasked with administering medication are not giving proper instructions to patients, according to Niranjan Konduri, a principal technical adviser at the Systems for Improved Access to Pharmaceuticals and Services, or SIAPS, program, an MSH-led initiative backed by the United States Agency for International Development.

“It is not just about shipping boxes of medicines or delivering medicines. That is just getting half the job done. Where we really need to be concerned, based on what has been going on lately, is the threat of antimicrobial resistance and the concerns of the global health security agenda,” Konduri explained to Devex. “We have done a lot of work on the appropriate use of medicines, making sure clinicians, nurses, pharmacists, community workers, midwives, all of these people under the rubric of health workers are well trained to appropriately dispense medicines.”

“It is not just about shipping boxes of medicines or delivering medicines. That is just getting half the job done.”

— Niranjan Konduri, principal technical adviser at the Systems for Improved Access to Pharmaceuticals and Services program

“If you are trying to save the life of a child from diarrhea, or malaria, you need to make sure they are diagnosed appropriately, that they are quickly referred to the health facility and, if medicines are given, that they are given at the right dose.”

From its inception in October 2011 until this June, the SIAPS program has operated in more than 20 countries and supported 496 local institutions and organizations with provision of training or technical assistance in the strengthening of pharmaceutical systems. That could mean updating old in-country pharmaceutical curriculums that did not include addressing AMR, conducting mentoring sessions with health care workers and increasing the number of qualified pharmacists by supporting degree programs.

“Sometimes, there are misconceptions among the medical community themselves — they would think, ‘What connection do I have? I am just a doctor here, or I am just a pharmacist. I dispense the pills, I do my job, and that’s it.’ We say, ‘No, even if you are dispensing antibiotics, you have got to make sure you communicate with the patient, the caregiver, the importance of completing your dose and not stopping it,’” he said.

There has been increasing interest from partners in countries — often coming from ministries of health — in capacity training on how best to work with the public and patients on administering antibiotics, Konduri said. Partnerships with universities help train more pharmaceutical professionals, part of an effort to discourage people from accessing antibiotics as private commodities without a prescription. In many other cases, patients may receive antibiotics from health care workers with little instruction, and then fail to complete their necessary dosage or return to the health care provider.

“It is not just a one-way dumping of Powerpoint information. Based on what we have seen, case-based learning [and] team-based approaches are very important for anything to do with health system improvement. In other words, applying what you have learned in practice,” he said.

A paper co-authored by Konduri and published in the Journal of Pharmaceutical Policy and Practice earlier this year draws on the programmatic experiences that MSH has implemented on the ground, in a bid to strengthen health worker systems and reduce AMR.

“Sometimes there are misconceptions among the medical community themselves.”

—  Niranjan Konduri, principal technical advisor at the SIAPS program

The paper, which looks at pharmaceutical systems in 12 countries in Africa as well as the Philippines and Ukraine, found a three-tiered need for better training, tools, and staff and facilities to support the work of health care providers. This summer, MSH launched a guide for organizations on how to build coalitions around AMR and engage more effectively in the healthcare space.

The paper, which stresses an individualized, country-tailored approach, validates similar findings from the World Bank on the need for capacity building in the fight against AMR. Identifying the potential benefits of AMR containment measures as ranging from $0.9 trillion to $2.9 trillion in low- and high-income countries, the bank recently recommended that countries should develop systems for tracking AMR. It also allocated $2.5 million to implement a strategic plan on pharmaceuticals and health care in the Democratic Republic of Congo, continuing SIAPS’ work of rebooting the country’s pharmaceutical curriculum.

Extending the life of a short-term project such as this through data and results is another takeaway Konduri draws from their work. Originally scheduled to end this spring, the extended program now has an expected end date of next spring.

“You never know beyond your immediate project what long-term results can be obtained,” he said. “It takes years. You can’t expect magic in two or three years.”

“Why is all of this important? If you have doctors who are diagnosticians, you also need a pharmacist to make sure that the medicines are distributed properly, they are safe, they are effective, and they are of good quality. And that takes a health systems approach.”

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About the author

  • Amy Lieberman

    Amy Lieberman is the U.N. Correspondent for Devex. She covers the United Nations and reports on global development and politics. Amy previously worked as a freelance reporter, covering the environment, human rights, immigration, and health across the U.S. and in more than 10 countries, including Colombia, Mexico, Nepal, and Cambodia. Her coverage has appeared in the Guardian, the Atlantic, Slate, and the Los Angeles Times. A native New Yorker, Amy received her master’s degree in politics and government from Columbia’s School of Journalism.