Scoping and mapping of AMS enablers and bottlenecks in the health care system

Context

Inappropriate use of antimicrobial agents for the treatment of human infections has been widely documented in Cambodia. Therefore, there is a strong need to implement Antimicrobial Stewardship (AMS) practices throughout the country. Cambodia has established a functional AMR surveillance system, and data on AMR has been submitted to Global Antimicrobial Resistance and Use Surveillance System (GLASS) since 2019. Infection prevention and control (IPC) committees and IPC Guidelines for healthcare workers (HCW) have also been in place since 2017 in both national and sub-national healthcare facilities (HCFs). In addition, other activities in line with the Multi-Sectoral Action Plan’s (MSAP) objectives and strategic plans include:

• a knowledge, attitudes, and practices survey on AMR,
• drafting of pre-and in-service training curriculum on AMS,
• implementation of the “National Guidelines for Antimicrobial Stewardship in Health Care Facilities 2019” in 17 national, provincial, and referral hospitals across the country
• establishment of AMS Working Groups in 15 secondary and tertiary hospitals across the country.

Problem

There is still confusion regarding the key concepts of AMR and the relation to AMS, AMC, and AMU, as these are still new concepts for the HCW. At the HCF, there is poor reliance on lab results leading to empiric treatment. The limitation of clear AMS task description, resources, and competencies to implement AMS in HCF emerged as a key gap for the successful implementation and scaleup of AMS programs in Cambodia. Furthermore, there are reports on AMS’s conflicting policies and strategic plans; for example, the national social health insurance scheme for formal sector workers under the National Social Security Fund (NSSF) doesn’t cover the cost of culture and AST of samples.

In addressing the critical issue of Antimicrobial Resistance (AMR) in Cambodia, we recognize the vital role of collaboration and government commitment. It’s heartening to witness the commitment of key stakeholders like KHANA, Ministry of Health and the Institute of Public Health of Cambodia. Through this one-year scoping project, we aspire to lay the groundwork for enduring solutions, paving the way for sustained impact in addressing the global problem of AMR.

Wesal Zaman, Science Officer, ICARS

Project overview

This is a scoping project to undertake preliminary health system analysis (policy and economics included) to understand the drivers and enablers in the healthcare system, from the health care facility level (micro level) to the national policy level (macro level), to support an antimicrobial stewardship program ecosystem. The project will also undertake a stakeholder mapping and organize stakeholder consultations to prepare the ground for a longer AMS pilot project with MoH and other stakeholders in Cambodia. 

Implementing one of our strategic goals, KHANA is committed to contributing to addressing the critical issue of Antimicrobial Resistance (AMR) in Cambodia. As the recipient of the ICARS fund, KHANA is now collaborating with the Ministry of Health and the Institute of Public Health with the support of the National University of Singapore and ICARS to implement a one-year scoping project named “Scoping and mapping of AMS enablers and bottlenecks in the health care system in Cambodia.

Mr. Choub Sok Chamreun, KHANA Executive Director 

Outcomes

Conduct AMS-PPS training in select provincial and national hospitals, aligning with AMS policy and guidelines while gathering essential data for scoping the overall AMS landscape.

Analyse AMS facilitators and barriers within the healthcare system across various levels, employing desktop literature reviews, consultations, and qualitative research with identified key stakeholders, including decision-makers and healthcare personnel.

Develop a stakeholder map to guide the expansion of an AMS project, utilizing the Intervention-Implementation Research (IIR) framework of ICARS for support.

Perform a needs assessment among frontline healthcare workers through online surveys and Knowledge, Attitudes, and Practices (KAP) studies, aiming to grasp the AMS capacities and requirements of both national and provincial hospital teams.

Facilitate two stakeholder consultations to raise awareness among key stakeholders about the significance of intervention implementation research in AMS, disseminate and validate study findings, and foster consensus among participating stakeholders for an ICARS-supported demonstration project.