ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN - 2017-2021 Strategic Framework, Operational Plan, and Monitoring and Evaluation ...
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ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN 2017-2021 Strategic Framework, Operational Plan, and Monitoring and Evaluation Plan September, 2017
CONTENTS
ABBREVIATIONS AND ACRONYMS ..................................................................................... ii
FOREWORD ..........................................................................................................................iv
ACKNOWLEDGEMENTS ........................................................................................................ v
1.0 BACKGROUND AND SITUATION ON AMR .................................................................... 1
2.0 EXECUTIVE SUMMARY .................................................................................................. 4
3.0 GOVERNANCE ............................................................................................................... 6
3.1 Governance structure ................................................................................................ 6
3.2 Leadership ............................................................................................................... 6
3.2.1 Roles of the appointed positions ........................................................................
7
3.3 Guiding principles ����������������������������������������������������������������������������������������������������� 9
4.0 STRATEGIC FRAMEWORK ............................................................................................ 10
4.1 STRATEGIC PLAN AND STRATEGIC OBJECTIVES FOR AMR IN ZIMBABWE ........... 11
4.1.1 Strategic objective 1 – Education, training and awareness: To raise awareness
and educate the population, professionals and policy makers on AMR.......................
11
4.1.2 Strategic objective 2 – Surveillance: Improve detection and understanding of the
AMR and antimicrobial use patterns and trends through surveillance........................ 11
4.1.3 Strategic objective 3 – Infection prevention & control, good animal husbandry
and biosecurity: Reduce the need for antimicrobials by improving IPC, animal health
and management practices including biosecurity, WASH and immunisation............... 13
4.1.4 Strategic Objective 4 – Rational use of antimicrobials: Improve controlled access
and optimise the use of antimicrobials in humans and animals..................................14
4.1.5 Strategic objective 5 – Sustainable Investment into AMR interventions and re-
search into new antimicrobials and alternatives to antimicrobials................................ 15
5.0 OPERATIONAL PLANS...................................................................................................16
5.1 Strategic objective 1 – Education, training and awareness..........................................16
5.2 Strategic objective 2 – Surveillance.......................................................................... 23
5.3 Strategic objective 3 – Infection prevention and control and biosecurity...................... 29
5.4 Strategic Objective 4 – Rational use of antimicrobials................................................ 34
5.5 Strategic objective 5 – Investment into research and development.............................39
6.0 MONITORING AND EVALUATION................................................................................. 42
6.1 Approach and components of M&E........................................................................... 42
ABBREVIATIONS AND ACRONYMS
AMR Antimicrobial resistance ICAZ Infection Control Association of
Zimbabwe
AMU Antimicrobial use
IDSR Integrated Disease Surveillance
CDC Centers for Disease Control and and Response
Prevention IPC Infection Prevention and Control
CDDEP Center for Disease Dynamics,
IEC Information, Education and
Economics & Policy
Communication
CEO Chief Executive Officer
LMAC Livestock & Meat Advisory
CIA Critically Important Council
Antimicrobials MAMID Ministry of Agriculture,
CPD Continuous Professional Mechanization and Irrigation
Development Development
CSO Civil Society MCAZ Medicine Control Authority
Zimbabwe
CVL Central Veterinary Laboratory MDRO Multi-drug resistant organism
DDD Defined Daily Doses MEWC Ministry of Environment, Water
and Climate
DLS Directorate Laboratory Services
MLCSCZ Medical Laboratory and Clinical
DLVS Department of Livestock and Scientists Council Zimbabwe
Veterinary Services MoHCC Ministry of Health and Child
Care
DPS Department of Pharmacy
Services MoE Ministry of Education
DR&SS Department of Research and MoF Ministry of Finance
Specialist Services
DVS Division of Veterinary Services MoS&T Ministry of Science &
Technology
EMA Environmental Management NAP National Action Plan
Agency
EML Essential Medicines List NBA National Biotechnology Authority
FAO Food Agricultural Organisation of NGO Non-governmental organisation
the United Nations
NHIS National Health Information
GAL Government Analyst Laboratory System
GARP Global Antibiotic Resistance NIPCC National Infection and
Partnership Prevention Control Committee
HAI Health-care associated NMRL Naitonal Microbiology Reference
infections Laboratory
HCW Health-care workers NMTPAC National Medicine &
Therapeutics Policy Advisory
HMTC Hospital medicines therapeutic Committee
committees
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 vOIE World Organization for Animal
Health
PATAM Health-care workers
RCZ Hospital medicines therapeutic
committees
ReAct Infection Control Association of
Zimbabwe
STG Standard Treatment Guideline
STI Sexually Transmitted Infections
TMPC Traditional Medical Practitioners
Council
TMD Traditional Medicines
Department
TWG Technical Working Group
UZ University of Zimbabwe
VHW Village Health Workers
VMDG Veterinary Medicines General
Dealers
WASH Water Sanitation and Hygiene
WHO World Health Organization
ZACH Zimbabwe Association of
Church-related Hospitals
ZiMA Zimbabwe Medical Association
ZIMCHE Zimbabwe Council for Higher
Education
ZIMRA Zimbabwe Revenue Authority
ZINATHA Zimbabwe National Traditional
Healers Association
ZINQAP Zimbabwe National Quality
Assurance Programme
ZINWA Zimbabwe National Water
AUthority
ZRP Zimbabwe Republic Police
ZVA Zimbabwe Veterinary Association
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 viForeward
Antimicrobial resistance (AMR) has become an increasingly serious threat to national and global public
health that requires prioritised action across all government sectors and society. Antimicrobials have
been hailed as one of the most important discoveries in medical history as they have successfully
treated many diseases in both animals and humans promoting the health and well-being of individu-
als. AMR is threatening the effective prevention and treatment of an ever increasing range of infec-
tions caused by bacteria, viruses, parasites and fungi and impacting on the health and productivity of
livestock. It is important that we preserve the current antimicrobials that are available as it takes an
average of 12 years for new antimicrobials to be available for use.
Following the adoption of the Global Action Plan (GAP) on Antimicrobial Resistance by the 68th World
Health Assembly in May 2015, Zimbabwe immediately put in place a framework towards developing
the AMR National Action Plan by starting with a situational analysis to help understand the situation
around AMR and any efforts to contain it that were in place. The Global Action Plan urges Member
States “to have in place, national action plans on antimicrobial resistance and with standards and
guidelines established by relevant intergovernmental bodies.”
Findings of the AMR situation analysis that was carried out showed that AMR will grow in Zimbabwe
if it is not tackled in a holistic manner. This national action plan is in line with the Global Action Plan
and outlines the following 5 strategic objectives:-
• To improve awareness and understanding of AMR through effective communication, education and
training;
• To strengthen the knowledge and evidence base through surveillance and research;
• To reduce the incidence of infection through effective sanitation, hygiene and infection prevention
measures;
• To optimize the use of antimicrobial medicines in human and animal health;
• To develop the economic case for sustainable investment that takes into account the needs of all
countries and to increase investment in new medicines, diagnostic tools, vaccines and other inter-
ventions.
Therefore, the three governmental departments and other relevant stakeholders whose responsibili-
ties intersect on human, animal and environmental health outcomes, and therefore are responsible
for implementing the ‘One Health’ approach in Zimbabwe, have committed themselves to investing
resources in designing sound strategies and interventions to preserve the effectiveness of our antimi-
crobial agents, in order to ensure sustainable dependence on them and to slow down the emergence
and spread of AMR in Zimbabwe. This National Action Plan on AMR will be implemented by all sectors
in coordinated manner to significantly slow down the development of antimicrobial resistance.
Dr. Pagwesese David Parirenyatwa Dr. Joseph Made Ms. Oppah Muchinguri-Kashiri
Minister of Health Minister of Agriculture Minister of Environment
and Child Care Mechanization and Irrigation Water and Climate
Development
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 viiAcknowledgements
The Ministry of Health and Child Care, the Ministry of Agriculture Mechanisation and Irrigation De-
velopment and the Ministry of Environment, Water and Climate would like to thank the World Health
Organization (WHO), Food and Agriculture Organization (FAO) of the United Nations for the financial
and technical support during the development of this document. Special thanks also go to the Global
Antibiotic Resistance Partnership (GARP), under the Centers for Disease Dynamics, Economics &
Policy (CDDEP) and Action on Antibiotics Resistance (ReAct) for their support and guidance of both
the Situation Analysis and the National Action Plan (NAP).
The three ministries are grateful for the commitment and involvement of the Zimbabwe Antimicrobial
Resistance Core Group and the 5 technical working groups who have been working tirelessly in the
production of these documents usinga ‘One Health’ approach.
Special thanks also go to the core national action plan writing team who were:-
Sekesai Mtapuri-Zinyowera, Ministry of Health & Child Care
Tapiwanashe Kujinga, Pan-African Treatment Access Movement
Portia Manangazira, Ministry of Health and Child Care
Unesu Ushewokunze-Obatolu, Ministry of Agriculture, Mechanisation and Irrigation Development
Ropafadzai Hove, Ministry of Health and Child Care
Pamela Woods, University of Zimbabwe, Department of Animal Science
Newman Madzikwa, Ministry of Health and Child Care
Valerie Robertson, University of Zimbabwe, Department of Medical Microbiology
Jairus Machakwa, Division of Veterinary Services
Zivanai Makoni, Medicines Control Authority of Zimbabwe
Stanley Midzi, World Health Organisation
Lawrence Dinginya, Division of Veterinary Services
Marcelyn Magwenzi, University of Zimbabwe, Department of Medical Microbiology
Kudzaishe Vhoko, Division of Veterinary Services
Tsitsi Monera-Penduka, University of Zimbabwe, School of Pharmacy
Samuel Swiswa, Division of Veterinary Services
Wilfred Motsi, Ministry of Water, Environment and Climate
Jose Alves Phiri, Ministry of Health & Child Care
Jonathan Mufandaedza, National Biotechnology Authority of Zimbabwe
Elizabeth Gonese, Centers for Disease Control and Prevention
Francisca Mutapi, University of Edinburgh, Institute for Infection and Immunology Research
Takafira Mduluza, University of Zimbabwe, Biochemistry Department
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 viii1. BACKGROUND AND SITUATION ON AMR
The Government of Zimbabwe through the antimi- diarrheal diseases. One major driver of resistance is
crobial resistance (AMR) core group conducted an increased antimicrobial consumption in both humans
analysis of the AMR situation in Zimbabwe in the and animals. However the data on antimicrobial use
human, animal and environmental sectors follow- and patterns of AMR in humans and animals in Zim-
ing the ‘One Health’ approach advocated by World babwe are limited.
Health Organization (WHO), World Organisation
for Animal Health (OIE), and Food and Agriculture Although the country’s vaccination coverage rate for
Organization of the United Nations (FAO). This in- children under 1 year is at 89%, more can be done
terest is borne out of the fact that AMR is a cross to prevent infections, including improving general
cutting problem affecting human, animal and the hygiene and sanitation and implementing infection
environment that calls for coordinated action across prevention and control (IPC) measures in all health
these sectors. It develops from changes at genetic institutions. A significant dent has been made in the
levels through mutations or as acquired traits in the occurrence of rotavirus diarrhoea through vaccina-
microorganism. As a naturally occurring phenom- tion; however the persistent challenges of poor water,
enon, AMR is accelerated by selection pressure in sanitation and hygiene practices have kept diarrhoea
the environment of the microorganism. Because cases related to typhoid and other bacteria causes as
microorganisms are present in the natural environ- common occurrences. Whilst oral rehydration with
ment, when AMR develops, it can also escalate and Zinc, is the standard treatment of choice for diarrhoea,
spread in the environment with implications on the antibiotics are often used and resistance is spreading.
well-being of all forms of life. Events precipitating
In Zimbabwe there is lack of meaningful surveil-
AMR in microorganisms can therefore have impli-
lance data to help understand resistance patterns,
cations on pathogenicity and therefore plant, ani-
prevalent organisms and guide policy development,
mal and human health. This puts pressure on the
due to constraints in the laboratory testing systems.
ability of human and animal health systems as well
Only 25 percent of the human public health labora-
as agricultural production, particularly as the pace
tories have the necessary staffing, equipment and
of discovery and innovation of more effective anti-
reagents to perform culture and susceptibility testing
microbials has significantly slowed down over the
on human samples, which limits the diagnostic ca-
last three decades.
pabilities of health care professionals treating patients
Zimbabwe has faced serious economic challenges and the availability of antimicrobial resistance data to
over the years, which have affected all aspects of guide clinical practice and policymaking.
life, not least of which is the health sector’s ability
Zimbabwe has an essential medicines list (EML)
to provide health care, and which has resulted in a
that was last updated in 2015, but access to antimi-
shortage of health-care workers and stock outs of
crobials is still limited in many areas, and should be
medicines. The agriculture sector is one of the most
expanded alongside efforts to improve supply chains
important pillars of the Zimbabwean economy, with
and storage. The primary reason for lack of access
the majority of the population dependent directly or
to medicines is lack of finances at the national level
indirectly on agriculture.
and fragmented funding from donors. Widespread
Zimbabwe faces significant and growing resistance unregulated availability of antimicrobials over-the-
in common infections such as TB, malaria, HIV, re- counter (OTC) for use in humans and animals has
spiratory infections, sexually transmitted infections been reported despite regulations that prohibit sale
(STIs), urinary tract infections (UTIs), meningitis and without a valid prescription and the possibility that
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 9a pharmacist may lose their license or be fined for cern about dangers of residues of veterinary medical
contravening these laws. More needs to be done agents in food for consumers. For a wide variety of
to improve incentives for appropriate antibiotic use, infections especially those caused by viruses, and
create disincentives for the overuse of antibiotics some bacteria, effective vaccines are available for
and illegal access to antimicrobials of poor quality prevention. Some vaccination programs are offered
through sound legislation and policy. as a public good depending on their importance to
production system economies and to public health.
The use of antimicrobials in crop production is For others, the adoption of good animal husbandry
less well acknowledged although there is potential and hygienic practices may go a long way in reduc-
in the food horticulture industry. ing infection pressure. While these alternatives to
antimicrobial use (AMU) are being promoted, some
Infectious diseases caused by microbiological
important diseases such as vector-borne rickettsial
agents including bacteria, fungi, protozoa and vi-
(Erlichia of ruminants and dogs) and protozoan (Ba-
ruses in animals inflict significantly important eco-
besiases, Trypanosomiasis, Theileria spp) diseases
nomic and public health impact in animal produc-
could benefit from development of effective, user-
tion systems. The use of antimicrobial agents is
friendly vaccines. Vector-borne diseases therefore
therefore an important aspect of animal healthcare.
still rely on chemical vector control with its environ-
However, because of the constant infection chal-
mental implications or the frequent use of antibiot-
lenge to animals in the environment, overdepen-
ics for some of them. The range of options in the
dence and abuse of antimicrobials have contribut-
prevention of microbial infections can therefore still
ed to the development of AMR, which results from
be explored through research.
selection pressure at genetic level. This tendency is
being exacerbated by the need for repetitive treat- Animal disease surveillance is one of the im-
ment such as occurs in milk producing animals portant tools for intelligence gathering to facilitate
and mass treatments as called for in managing early detection of higher impact endemic and
small stock and aquatic animal infections. In other trans-boundary animal and zoonotic diseases and
instances, the prophylactic and metaphylactic use pests. General and disease specific surveillance is
of antimicrobial medicines, in order to achieve sus- also a useful tool in the generation of evidence for
tainably high productivity levels, are to blame for sanitary safety assurance of traded animal-source
the rising occurrence of AMR, which risks affecting products. Disease specific surveillance programs
the availability of some key antibiotics essential for exist for brucellosis in dairy cattle, salmonellosis in
use in treatment of human disease. breeder poultry flocks and slaughtered cattle and
pigs aimed at infection reduction. Surveillance data
The regulatory oversight on the use of veterinary
could be of additional use in the determination of
medicines suffers from the weak distribution of
emerging risks due to AMU and resistance. This re-
veterinary services particularly in the numbers and
quires laboratory testing capacity and capability for
distribution of veterinarians and veterinary parapro-
the determination of resistance as well as monitor-
fessionals. This defeats the intention of the medi-
ing for residues in animal tissues.
cines control legislation whose aim is to promote
the rational and safe use of medicines. A large Present veterinary laboratory testing capacity is lim-
range of prescription medicines can therefore be ited by personnel skills and equipment. Culture and
accessed and used by lay personnel and animal sensitivity tests for AMR and a limited range of residue
keepers without the necessary controls to ensure testing can be done, especially in support of animal-
judicious and prudent use. source food exports but no monitoring is carried out
for the local market on a ‘client pays’ basis. There are
Greater reliance on preventive veterinary medicine
currently limited capacities to support a comprehen-
has however been gaining popularity due to the con-
sive residue monitoring programme in animal slaugh-
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 10ter establishments, and to monitor or regulate residue more research to be done including surveillance. In
levels in abattoir waste and their disposal pathways. order to prevent resistance, cultural methods are em-
The confirmatory tests for AMR still take long and ployed to control diseases such as crop rotation, use
could benefit from the development and adaptation of of clean seed and use of resistant varieties.
more rapid detection methods to facilitate rapid and
Environmental monitoring and surveillance for
precise decisions on the choice of medicines remov-
AMR needs to be mainstreamed within a general na-
ing the element of “trial and error”.
tional strategy to scale down the rate of emergence
Widespread unregulated availability of over the of AMR. To do this, a clear understanding is required
counter medicines and informal cross-border impor- of drivers in each sub-sector in relation to safeguards
tation of antimicrobials for use in humans and animals on the lists of essential veterinary and medical anti-
has been reported despite legislation prohibiting sale microbials, especially those intended for specific use
without prescription. Policy, legislation and implemen- in human disease.
tation gaps have allowed the routine inclusion of an-
Access to good water and sanitation facilities
tibiotics in feeds, while weak veterinary capacity has
is lowest in rural areas, where two thirds of the
been blamed for the wide access to antimicrobials by
population resides including a few residential
animal keepers, without the necessary checks. En-
areas in the urban areas. Added to this, hospitals,
forcement of existing legal provisions and incentives
clinics and manufacturing industries have poor
for appropriate antibiotic use, with disincentives for
liquid and solid waste disposal methods and the
the overuse of antibiotics and illegal access to antimi-
capacity to regulate the disposal and treatment of
crobials are required.
clinical waste is limited. As a result, antimicrobials
Chemicals are used in the crop sector as fungicides and antimicrobial residues are likely entering the
or for their bacteriostatic effects. There is need for environment, including drinking water and soil.
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 112.0 EXECUTIVE SUMMARY
The AMR situation analysis that was carried out by the The NAP will also prioritise the building of labora-
multi-sectorial Zimbabwe AMR Core Group indicated tory diagnostic capacity, as this forms the basis for
that the problem of AMR, caused by a combination treatment decisions for human and animal health-
of factors, can be addressed through a roadmap to- care professionals and supports informed decisions
wards slowing down the pace of AMR development about AMU. Laboratory capacity is also needed to
and enhancing sustainable reliance on AMU in public conduct AMR surveillance, which will be incorpo-
health promotion. The following 5 strategic objectives rated into the existing integrated disease surveil-
were identified in Zimbabwe, which align with the lance and response (IDSR) system for humans and
WHO Global Action Plan objectives, in order to ensure notifiable disease surveillance system for animals.
preservation of the available antimicrobials so that in- A combined surveillance reporting system will be
fectious diseases are treatable: created to ensure the One Health approach to un-
derstanding the magnitude, patterns and dynamics
• Raise awareness and educate the population, of AMR. A monitoring system for AMU will be estab-
professionals and policy makers on AMR. lished in the public and private sectors to measure
and monitor the usage of antimicrobials in humans,
• Improve understanding of the AMR burden
animals and crop production, its disposal into the
and antimicrobial use patterns through sur-
environmental, and determine the impact of AMR
veillance.
interventions on reducing use.
• Reduce the need for antimicrobials by improv-
In order to minimize the development of AMR,
ing infection prevention and control, improved
renewed attention will be brought to current infec-
farm practices and biosecurity, water sanita-
tion prevention and control practices to reduce the
tion and hygiene, and immunisation.
spread and transmission of multi-drug resistant or-
• Improve controlled access and optimise the ganisms (MDROs). Surveillance of hospital-acquired
use of antimicrobials in humans and animals infections (HAIs) will support these efforts. Biosecu-
rity measures, and better hygiene and health man-
• Sustainable investment into AMR and re- agement practices for animals will be promoted and
search into alternatives to antimicrobials. strengthened through improved policies, guidelines
and practices, training and capacitation of regulatory
This National Action Plan (NAP) will help to plan the
bodies to improve enforcement and testing mecha-
development and implementation of a comprehen-
nisms. The relevant authorities will focus on appro-
sive national communication and awareness plan to
priate environmental controls, the provision of water,
educate the public, professionals and policy makers on
sanitation and hygiene (WASH) facilities in commu-
ways to prevent infections, treat infections appropriately
nities, health and veterinary facilities, and promotion
and conserve antimicrobials. It will strengthen the edu-
of improved hygiene behaviours.
cation curriculum in all educational sectors from pri-
mary to tertiary education, improving the knowledge of Stewardship programs will need to be incorpo-
school children and educating human, animal and en- rated into the hospital medicines therapeutic com-
vironmental health care professionals, both as students mittees (HMTCs) to ensure prudent and appropri-
and postgraduates, to be aware of the threat of AMR ate use of antimicrobials. Measures will need to be
and ways to minimize its development and spread in implemented to ensure consistent and sustained
humans, animals and the environment. access to quality medicines by strengthening pro-
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 12curement systems, supply chains and storage fa- updated EML that reflects the current diseases and
cilities for antimicrobials and ensuring sustained pathogens in humans to improve treatment.
funding for the antimicrobials on the Essential Med-
icines List (EML). Control of quality veterinary medi- Both short-term and long-term research needs
cines will need to be increased and simultaneously to be carried out to understand the links, drivers
strengthened without limiting access to animal keep- and dynamics of AMR development and spread be-
ers through enhanced involvement of veterinarians tween the human, animal, and environmental inter-
in the provision of guidance on antimicrobial use faces and to create innovative diagnostic tools, new
in the field as well as scope of practice for veteri- vaccines, and alternative therapies such as probi-
nary paraprofessionals under veterinary oversight. otics and traditional remedies. Funding for these
Public access to antimicrobials at the point of the types of research activities will be provided by the
pharmacy and veterinary medicine general dealers Government with the support and collaboration of
(VMGDs) is to be controlled through improvements development partners and the private sector.
to regulatory processes. This will ensure prudent
Implementation of this plan requires sustained
use without undermining access to quality antimi-
commitment into years to come and a monitoring
crobials and care.
and evaluation plan will be needed to evaluate its
At the same time, the rational use of antimicro- impact. The plan will be achieved through the “One
bials in health facilities will be improved through Health” approach which embraces an integrated,
functional hospital medicines therapeutic commit- unified effort across sectors, addressing the cross
tees, standard treatment guidelines (STG’s) and an cutting nature of AMR.
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 133.0 GOVERNANCE
3.1 Governance Structure
The AMR governance structure was formed and en- The governance structure was formed after a
dorsed in August 2016 by the Secretary for Health consultative process that involved relevant stake-
and Child Care to allow for coordination, manage- holders from the relevant ministries, civil society
ment and monitoring of AMR activities in the coun- (CSOs), academia and non-governmental orga-
try (See Figure 1 below). The AMR focal point is the nizations (NGOs). Technical working groups that
AMR Coordinator who will work under the Depart- are aligned to the strategic objectives of the Global
ment of Epidemiology and Disease Control (EDC), Action Plan were formed at a multi-sectoral ‘One
the Directorate Laboratory Services (DLS) in the Health’ stakeholder’s forum that was held in June
Ministry of Health and Child Care (MoHCC) and the 2016 (See Figure 1 below).
Division of Livestock and Veterinary Services (DLVS).
Fig 1: Governance structure of the Zimbabwe AMR activities
3.2 Leadership
The Secretary for Health in the MoHCC is the office Irrigation Development and the Ministry of Environ-
that is responsible for leading national AMR activi- ment, Climate & Water. The focal point, the Zimba-
ties. The Core Group shall also report to the Perma- bwe AMR Core Group and the Advisory Committee
nent Secretaries through the advisory committees were all appointed by the Secretary for Health for a
in the Ministry of Agriculture, Mechanisation and period of 5 years.
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 143.2.1 Roles of the appointed positions • The national delegation to the World Organ-
isation of Animal Health (OIE)
AMR Focal Point
• University of Zimbabwe
The functions of the National AMR focal point include:
• Biomedical Research and Training Institute
i. Building sustained partnerships and working
nationally and internationally on containment • Civil society
of AMR;
• National Biotechnology Authority of Zimba-
ii. Leading and coordinating activities of the bwe
AMR National Action Plan;
• Ministry of Finance and Economic Develop-
iii. Facilitating and overseeing implementation of ment
activities through the AMR Core Group;
The roles and responsibilities of the AMR Core
iv. Ensuring regular data collection and informa- Group include:
tion sharing by instituting effective communi-
cation and coordination mechanisms among i. Mobilising resources for the national response
all stakeholders, the members of the Core against AMR. Creating correct and relevant
Group and their constituencies, sectors and messaging on AMR in order to guide education
disciplines and; and awareness programmes on AMR to ensure
that the public and all other relevant stakehold-
v. Coordinating national activities as per the Na- ers are sensitised on AMR issues.
tional Action Plan for the AMR program.
ii. Facilitating the establishment of surveillance
The Zimbabwe AMR Core Group systems to monitor AMR.
The Zimbabwe AMR Core Group is a multi-sectoral iii. Disseminating active and passive surveil-
group comprising of 18 members, an appointed lance data on antimicrobial use (AMU) and in-
Chairperson, Deputy, Coordinator, Secretariat and tegrated laboratory surveillance data to policy
Committee Members. Members of the Core Group makers and other relevant partners.
are from the following organizations:
iv. Enabling research activities on relevant AMR
• Ministry of Health & Child Care issues.
• Ministry of Agriculture, Mechanisation and v. Encouraging rational use of medicines through
Irrigation Development the establishment of antimicrobial steward-
ship programs.
• Ministry of Environment, Climate & Water
vi. Supporting the implementation of infection pre-
• Department of Livestock and Veterinary
vention and control (IPC) and biosecurity mea-
Services
sures to reduce and control the spread of AMR.
• Medicines Control Authority of Zimbabwe
vii. Monitoring implementation of AMR-related
• Food & Agricultural Organization of the activities by other organisations, institutions
United Nations (FAO) and stakeholders.
• World Health Organization (WHO) viii. The AMR Core Group will be accountable for
the process of implementation of this NAP.
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 15The Zimbabwe AMR Advisory Committee vi. Identifying any gaps in the evidence base,
such as those requiring further research or
There is a multisectoral 12-member Advisory Com- surveillance.
mittee made up of policy makers within the three
core ministries, consultants from the University of Five technical working groups (TWG) that are
Zimbabwe, FAO, WHO, CDC and interested private aligned with the strategic objectives of the Global
practitioners from both human and animal health. Action Plan were formed in June 2016, as follows:
This committee has strategic governing responsi-
• Education and Awareness
bilities that include the following:
• Surveillance and Research
i. Providing practical advice and guidance to
the process of carrying out an AMR situational • Infection Prevention & Control and Biosecurity
analysis and the national action plan.
• Antimicrobial Use
ii. Providing advice and guidance in the imple-
mentation, monitoring and evaluation of the • Research and Development
AMR NAP.
The chairperson of each TWG is a member of the
iii. Contributing to improved capacity, includ- Zimbabwe AMR core group. The roles and respon-
ing research advice, practical and scientific sibilities of TWGs include the following:
advice to the Core Group and government on
• Building sustained partnerships and work in
strategies to:
their sector on containment of AMR;
- minimize the incidence of healthcare as-
• Identifying other relevant stakeholders;
sociated infections (HAIs)
• Facilitating and overseeing implementation,
- monitor AMR and reduce its develop-
including monitoring and evaluation (M&E) of
ment and spread
the NAP through the TWG;
- maintain the effectiveness of antimicro-
• Ensuring regular data submission and informa-
bial use (AMU) and optimize antimicrobial
tion sharing to the Core Group by instituting
prescribing in the treatment and preven-
effective communication systems, frameworks
tion of microbial infections
and coordination among all members of the
- take into account the relevant work of TWG.
other expert groups, in the human and vet-
erinary fields when making its recommen-
dations
3.3 Guiding Principles
iv. Assisting the Zimbabwe National AMR
Core group on its scientific priorities and work, The guiding principles that the Zimbabwe NAP will fol-
including horizon-scanning and long-range low are in line with those articulated in the 68th WHA:
planning as well as dealing with immediate
(i) Whole-of-society engagement including a One
risks and opportunities.
Health Approach
v. Reviewing and evaluate the effectiveness of
A knowledge, attitudes and practices survey of the
the on-going work of the AMR core group.
general public and animal and human health pro-
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 16fessionals and a point-prevalence survey carried microbials prescribed by qualified professionals
out in 18 hospitals showed widespread irrational and used appropriately by individuals will ensure
antimicrobial use and varied knowledge of AMR. quality health care provision at low cost.
The whole of society should therefore be engaged
in curbing AMR in the country as each individual (iv) Sustainability
has a role to play, hence education and awareness
Implementation of this NAP will require to be
of AMR will be intensified.
integrated into the work programs of all relevant
(ii) Prevention first ministries to ensure activities will be carried out.
Therefore, political commitment and international
Water, sanitation and hygiene (WASH), improved collaboration and support are needed to promote
practices in individuals, among medical and veteri- the technical and financial investment necessary
nary professionals, organisations and at the farm lev- for effective running of the NAP interventions.
els are low cost interventions areas with immediate Government institutions and other relevant sec-
impact to prevent the spread of infections. These are tors will need to commence utilising the available
basic first steps that can be undertaken, followed by resources and build on this to ensure sustainabil-
infection prevention control in hospitals, better bios- ity.
ecurity and good farm practices and routine vaccina-
tion of humans and animals. (v) Incremental targets for implementation
(iii) Access This NAP has a phased approach that can be
achieved in a stepwise manner, considering
Access to information on AMR is key to empower- short-term priority areas in the five strategic ob-
ing individuals and the nation as a whole. Access jectives in order to meet both local needs and
to diagnostic services and access to quality anti- global priorities.
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 174.0 STRATEGIC FRAMEWORK
The Zimbabwe NAP is built on a foundation of re- to optimise responsible use in animals and
search and development and the necessary politi- humans
cal commitment and investment to ensure the sus-
• Investment in research and development which
tainability of the AMR program.
seeks innovative ideas of alternatives to antimi-
The four key pillars of the strategy are: crobials or quicker diagnostic techniques.
• Surveillance of AMR and AMU patterns in ani- Finally, the implementation of the Zimbabwe NAP
mals, humans and crops. depicts a strong inter-sectoral coordinating mecha-
nism as its foundation and has its roof which is
• Prevention, which will reduce the need for antimi- overarching and cross-cutting indicating the need
crobials through effective IPC, farm biosecurity and to raise awareness and educate the public, profes-
good farm practices, WASH and immunisation sionals and policy makers on AMR and responsible
• Rational antimicrobial use, which seeks to im- antimicrobial use. The Coordinating mechanism will
prove controlled access to antimicrobials and ensure that all these strategies are implemented.
Fig 2: Strategic objectives
4.1 Strategic Plan and Strategic Objectives
for AMR in Zimbabwe
4.1.1 Strategic Objective 1 – Education, training key AMR messages reach and resonates with all
and awareness: To raise awareness and educate sectors and corners of the country. In coming up
the population, professionals and policy makers with the training and awareness program for AMR
on AMR both the formal and informal systems of informa-
tion dissemination will be utilized. The formal ap-
Developing and implementing a home-grown train- proach will encompass all the national educational
ing and awareness program is key to ensuring that and training programs, which are well structured in
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 18terms of content and the way they are delivered, mation will be of common importance to human,
which are aimed at developing specific competen- animal and ecosystem health. This multi-sectoral
cies or skills relevant to AMR. Informal approaches initiative encompasses laboratories from the Min-
will also be used to relay key messages in simple istry of Health and Child Care (MoHCC), Ministry
language that is understandable to all individuals of Agriculture, Mechanisation and Irrigation De-
regardless of social, economic or educational sta- velopment (MAMID), the Ministry of Environment,
tus. Zimbabwe is well advanced in terms of having Water and Climate (MEWC), National Biotechnol-
access to modern forms of communication such as ogy Authority, City Health laboratories and private
print, broadcast, audio and electronic communica- laboratories. AMU information is also lacking and
tion media. However, individuals in different parts this new surveillance will include processes for col-
of the country do not all have equal access to these lecting antimicrobial use data.
communication channels. This disparity in access
will be considered when developing the AMR train- Specific objectives for surveillance are to:
ing and awareness strategy and plan.
1. Strengthen diagnostic laboratory capacity to
Specific objectives for education and awareness are: improve healthcare professionals’ ability to
make informed AMU decisions.
1. To improve awareness and understanding of
AMR for the public, professionals and policy 2. Integrate the surveillance for humans, ani-
makers. mals and the environment into a ‘One Health’
integrated surveillance system.
2. To strengthen the knowledge of human, ani-
mal and environment health professionals 3. Establish an AMU monitoring system for anti-
through improved curricula. microbials for human and animal use.
3. To educate farmers and animal keepers on AMR 4. Analyze and report surveillance data to sup-
to support good antimicrobial use practices. port clinical and policy decision making in rel-
evant sectors.
4. To strengthen the knowledge of school chil-
dren on AMR at primary, secondary and ter- 5. Strengthen capacities for generating and ana-
tiary level education. lysing AMR/AMU data to inform policy develop-
ment, better targeting of interventions and man-
The activities to achieve these strategic objectives agement decisions and to monitor progress.
are described in more detail in the operational plan
in section 3. The activities to achieve these strategic objectives
are described in more detail in the operational plan
in section 3.
4.1.2 Strategic Objective 2 – Surveillance:
Improve detection and understanding of the
AMR and antimicrobial use patterns and trends 4.1.3 Strategic Objective 3 – Infection
through surveillance prevention & control, good animal husbandry
Surveillance is important to detect the magnitude of and biosecurity: Reduce the need for
AMR, and help to monitor trends in space and time. antimicrobials by improving IPC, animal
Sound survey designs backed by laboratory testing health and management practices including
are important tools in detecting AMR. Embracing biosecurity, WASH and immunisation
the ‘One Health’ approach will help to gain efficien- Existing biosecurity measures, good farm manage-
cies by reducing duplicative functions on the work ment practices and national IPC programs need to be
of a similar nature for the same end. AMR infor- strengthened. Biosecurity is defined by OIE as “The
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 19implementation of practices that create barriers in or- 4. Strengthen and expand vaccination programs
der to reduce the risk of the introduction and spread of in animals and humans to improve prevention
disease agents”. The three principles of biosecurity are and control of disease, and reduce AMU
segregation, cleaning, and disinfection; where segre- 5. Reduce the transmission of infectious dis-
gation is the creation and maintenance of barriers that eases in communities, health-care centers,
limit the potential opportunities for infected animals veterinary and plant facilities through effective
and contaminated materials to enter an uninfected water, sanitation and hygiene practices, and
site. Improvement in animal health management prac- provision of appropriate facilities.
tices includes farm facilities and movement controls,
documentation of treatment provided to animals, the The activities to achieve these strategic objectives
provision of appropriate care to sick animals and the are described in more detail in the operational plan
prevention of illegal cross border movements. in section 3.
The purpose of IPC in health care as defined by
WHO, is “to prevent the occurrence of health-care 4.1.4 Strategic Objective 4 – Rational use of an-
associated infections (HAIs) in patients, health-care timicrobials: Improve controlled access and op-
workers (HCWs), visitors and other persons associated timise the use of antimicrobials in humans and
with health-care facilities”(WHO 2009). Core compo- animals
nents of an IPC program include IPC management
structures and human resources such as training, pro- The availability of antimicrobials according to the
gram staffing and occupation health support and IPC National Standard Treatment Guidelines (STGs) and
guidelines that describe IPC activities such as hand Essential Medicines List, which are based upon the
hygiene, standard and transmission based precau- current pathogen resistance patterns, is critical to
tions, waste and linen management, environmental patient outcomes. Robust regulatory and medicine
cleaning, disinfection processes and surveillance ac- management systems, including procurement, dis-
tivities. Infections can also be prevented by effective tribution and dispensing systems, are needed to
vaccination programs and by improving water, sanita- support access to safe, effective and affordable anti-
tion and hygiene practices, and availability and acces- microbials and remove incentives for illegal dispens-
sibility at community level. ing and poor quality medicine sales.
Specific objectives for Infection, prevention and con- Access and availability of certain key antimicro-
trol, good animal husbandry and biosecurity are: bials to animal keepers should be maintained and
expanded and the necessary control mechanisms
1. Strengthen the existing biosecurity measures on implemented to prevent irresponsible use. An impor-
hatcheries, farms, aquaculture establishments, tant element will be on-going education and aware-
slaughter houses, and food processing estab- ness of key individuals involved in the distribution
lishments etc., for pathogen risk reduction and administration of antimicrobials in animals. In
2. Improve movement controls of animals and addition, a sound regulatory environment that con-
animal products, and border control mecha- trols and enforces the responsible use of antimicro-
nisms to reduce trans-boundary animal dis- bials in humans, animals and the environment is es-
ease occurrence transmission sential to the effective control of AMR.
3. Track and reduce the burden of health-care as- Specific objectives for rational use of antimicrobials are:
sociated infections (HAIs) through improving IPC
practices in all health care facilities in Zimbabwe 1. Improving access to quality assured antimi-
crobials to animal keepers by increasing ac-
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 20cess points for the sale and provision of anti- which are termed as short to medium-term plans to be
microbials. implemented in the face of the current problem.
2. Strengthening control of antimicrobials and The long-term strategies need stronger collaboration
their use in animal health by farmers and para from local, regional and international research institu-
veterinarians without limiting access. tions as they require vast amounts of resources and time.
3. Implementing sustainable supervision, audit
Short to medium term (1-5 years) investment and
and feedback mechanisms in health facilities
research needs
by having functional medicines therapeutic
committees in health institutions to ensure Local collaboration linking human-animal-environment
appropriate antimicrobial use by prescribers. research activities is required in the following areas:
• Support research on the model of transmis-
4. Ensuring that Standard Treatment Guide-
sion between organisms and the transmis-
lines (STG’s) and the Essential Medicines List
sion of resistant bacteria among different
(EML) reflect the current resistance patterns
reservoirs (human-animal-environment).
and pathogens in humans and animals.
5. Ensuring adequate supplies of quality assured • Conduct research to understand the capacity
essential antimicrobials at various levels of hu- building needs such as human & financial
man and animal health delivery systems. resources.
6. Controlling public access to prescription Long term investment and research needs
only antimicrobials at the point of the phar- • Innovative diagnostic tools especially AMR
macy and veterinary medicine general dealers rapid diagnostic tools (RDT’s)
(VMGDs).
• User-friendly and affordable vaccines and
7. Strengthening regulations to ensure appropri- new vaccines
ate use of antimicrobials in animals.
• New medicines, i.e. antibiotics
8. Promoting stewardship and pharmacovigi-
lance in the use of antimicrobials. • Alternative therapies (complementary medi-
cines, probiotics, etc.)
The activities to achieve these strategic objec-
tives are described in more detail in the opera- Specific objectives for Investment, Research &
tional plan in section 3. development are:
1. To ensure sustainable investment in counter-
ing AMR through implementing the NAP.
4.1.5 Strategic Objective 5 – Sustainable
Investment into AMR interventions and 2. Develop innovate modern diagnostics, vac-
research into new antimicrobials and cine and alternative therapy to AM.
alternatives to antimicrobials
The interventions to achieve these strategic objec-
There is a need to develop the economic case for sus- tives are provided in the tables below and described
tainable investment that takes into account the need for in more detail in the operational plan in section 3.
increased investment in new diagnostic tools, vaccines,
medicines and other interventions. The proposed ac-
tivities are divided into short-term (1-2years), medium-
term (2-5 years) and long-term (>5 years) research
strategies. This plan outlines the immediate actions,
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 215.0 OPERATIONAL PLANS
Below are the detailed operational activities, time frames and indicators for monitoring the achievement of the
strategic objectives described above in the strategic plan. Time frames for completion of these activities have been
divided into short term (within the next 2 years), medium term (within the next 5 years) and long term (greater
than 5 years).
5.1 Strategic objective 1 – Education, training and awareness
The four key pillars of the strategy are:
• Surveillance of AMR and AMU patterns in animals, humans and crops.
• Prevention, which will reduce the need for antimicrobials through effective IPC, farm biosecurity and good
farm practices, WASH and immunisation
• Rational antimicrobial use, which seeks to improve controlled access to antimicrobials and to optimise
responsible use in animals and humans
• Investment in research and development which seeks innovative ideas of alternatives to antimicrobials or
quicker diagnostic techniques.
Finally, the implementation of the Zimbabwe NAP depicts a strong inter-sectoral coordinating mechanism as
its foundation and has its roof which is overarching and cross-cutting indicating the need to raise awareness
and educate the public, professionals and policy makers on AMR and responsible antimicrobial use. The
Coordinating mechanism will ensure that all these strategies are implemented.
STRATEGIC OBJECTIVE: To improve awareness and understanding of AMR for the public, professionals and policy
makers
Intervention Activities Responsibility Timeframe
1.1 Develop a 1.1.1 Review existing communication and awareness strategies. TWG 1st year
comprehensive national 1.1.2 Carry out an assessment on existing KAP (knowledge representatives
communication and attitudes and practices) with animal keepers, farmers and veterinary
awareness plan extension workers in rural communities, key-informant interviews.
1.1.3 Utilise results from the existing KAP and additional KAP
including the national AMR situational analysis to inform on gaps
and areas of strengthening.
1.1.4 Draft a national communication and awareness plan to cover
topics including: AMR, AMU, IPC, biosecurity and animal health
management, food security and safety, WASH and hand washing,
stewardship, prescribing and treatment guidelines/practices,
enforcement, waste disposal, surveillance, residues, and testing
methods for humans and animals using various channels.
1.1.5 Pilot draft national communication and awareness plan in
small cohorts.
1.1.6 Adjust national communication and awareness plan based on
the results of pilot study.
1.1.7 Validation meeting to adopt final national communication
and awareness plan.
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 221.2. Roll-out of 1.2.1 Host a stakeholder sensitisation meeting on the approved Fluoroquinolone 1st – 2nd
the national AMR plan (i.e. ministries of health, agriculture, environment, education, AMR core group, year
communication and drug authority, media, enforcement, farmer organizations, MoHCC, TWG’s
awareness plan professional associations, clinicians, nurses, pharmacists), hospital
CEOs/associations, university heads, FAO WHO, OIE, NGOs, faith
based organizations, provincial reps).
1.2.2 Review existing and produce Information, Education and
Communication (IEC) materials.
1.2.3 Training of trainers (in-service training).
1.2.4 Cascading of training to frontline cadres (nurses and
extension staff - veterinary).
1.2.5 Disseminating AMR information as identified in the
communications plan (will include stewardship, IPC, good practices,
animal health management, biosecurity, food safety etc) (channels
include online, newspaper, radio, television, fliers, road shows,
etc.) (target audiences i.e public, students, health professionals,
regulators).
1.2.6 Engage Civil Society Organisations (CSOs) and development
partners to mainstream AMR into programmes.
1.2.7 Use of champions in influencing AMR activities and attitudes
in all relevant sectors (see champion creation below).
1.2.8 Organise activities for World Antimicrobial Resistance
Awareness Week.
1.2.9 Presentations on AMR during other commemorative days e.g,
world TB day, hand hygiene day, World Veterinary Day, etc.
1.3. Identify and 1.3.1 Establish criteria to select AMR champions and specify role of AMR core group; 2nd year
capacitate opinion the champions. TWGs
leaders to champion
1.3.2 Identification of AMR champions/opinion leaders.
the AMR agenda in all
sectors. 1.3.3 Capacitation of AMR champions and consensus building.
1.4. Advocate on IPC 1.4.1 Hold field days to promote good hygiene practices and MoHCC Ongoing
in human health, sanitary measures.
and good animal
1.4.2 Hold meetings at the community level e.g. women’s groups,
health management
church organisations, farmer groups.
and biosecurity at
community level. 1.4.3 Train Village Health workers in IPC and AMR; and train para
veterinary auxiliaries in biosecurity and AMR.
1.5. Promote 1.5.1 Run education and awareness campaigns. MoHCC and Ongoing
behavioural change relevant
1.5.2 Commemorate hand hygiene days.
and practices that instil authorities
good hygiene in the 1.5.3 Mobilise resources for WASH facilities and activities.
community through
access to effective
water, sanitation and
hygiene facilities.
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 23STRATEGIC OBJECTIVE: To strengthen the knowledge of human, animal, environment health professionals and feed
manufacturers through improved curricula and educate farmers on AMR to support good prescribing practices
Intervention Activities Responsibility Timeframe
1.6 Strengthen curricula 1.6.1 Engage stakeholders and advocate for curricula review and TWG/Core group 1st – 2nd
for human health update. supporting year
professionals (including review panels,
1.6.2 Review and update tertiary educational curricula on AMR,
doctors, nurses, curricula
AMU, IPC, biosecurity, biosafety, WASH, stewardship, prescribing
pharmacists, laboratory committees
and treatment guidelines, enforcement, surveillance, and lab
scientists, health at universities 1st – 2nd
testing for humans and animals.
promotion students, and training year
public health students). 1.6.3 Review and update educational curricula at professional in- institutions in
service training levels for human health to strengthen AMR, AMU, collaboration
IPC, biosecurity, biosafety, WASH, stewardship, prescribing and with MoHCC
treatment guidelines, enforcement, surveillance, and lab testing for
humans and animals.
MoHCC, NBA,
1.6.4 Develop training modules in IPC requirements to reduce
HPA and its
transmission of MDRO to be used for training of health workers at
Councils, Min
pre- service and in-service level.
of Higher
1.6.5 Enforce continuous professional development (CPD) on AMR, and Tertiary
AMU, IPC, biosecurity, biosafety, WASH, stewardship, prescribing Education,
and treatment guidelines, enforcement, surveillance, and lab Vocational
testing for humans and animals Traning Schools
1.6.6 Formalize and strengthen mentoring and supervisory
program for junior doctors in the public sector
1.6.7 Formalize and strengthen mentoring and supervisory
program for junior pharmacists in the public sector
1.6.8 Formalise a training programme for all nurses at primary
health-care (PHC) on selection of antimicrobials for use at the
facilities
1.6.9 Strengthen mentoring and supervisory program for
prescribing nurses in the public sector
1.7. Strengthen curricula 1.7.1 Review and update tertiary educational curricula TWG/Core group
for animal health AMR, AMU, IPC, good animal health management practices supporting
professionals. and biosecurity, WASH, stewardship, prescribing and treatment review panels,
guidelines, enforcement, surveillance and lab testing for humans curricula 1st – 2nd
and animals committees year
at training
1.7.2 Review and update educational curricula at professional
institutions in
in-service training levels for animal health to strengthen AMR, AMU,
collaboration
IPC, good animal health management practices, biosecurity, WASH,
with MoHCC and
stewardship, prescribing and treatment guidelines, enforcement,
MoA, MoHTE
surveillance and lab testing for animals Ongoing
and Vocational
1.7.3 Formalize and strengthen mentoring program for junior Training Schools
veterinarians in the public sector
1.7.4 Design and integrate AMU and AMR into continuous
DVS
professional development of veterinarians
1.7.5 Enforce continuous professional development (CPD)
on AMR, AMU, IPC, good animal health management practices,
biosecurity, WASH, stewardship, prescribing and treatment
guidelines, enforcement, surveillance, and lab testing for animals
DVS
THE ZIMBABWE ONE HEALTH ANTIMICROBIAL RESISTANCE NATIONAL ACTION PLAN, 2017-2021 24You can also read
