Guidelines on Implementation of Antimicrobial Stewardship (AMS) in South Africa: One Health Approach & Governance is intended to act as a blueprint for the steps to be taken by the South African healthcare and veterinary workforce to enact AMS at national, provincial, district and health establishment levels as appropriate, in line with the Strategic Framework and Implementation Plan. The aim is to provide a practical, step-by-step guide that addresses the governance framework at each level of the health system and focuses on the stewardship of antibiotics used to treat bacterial infections other than tuberculosis, addressing gaps in antibiotic stewardship from an overarching national perspective. AMR cannot be tackled by the health sector alone; it requires a coordinated One Health approach that involves human and animal health, the environment, government, and other partners, and is supported by effective governance at all levels. National governance is led by the National Department of Health (NDOH) through the Ministerial Advisory Committee on AMR (MAC-AMR), which provides strategic direction, sets standards, coordinates surveillance and antimicrobial stewardship, and promotes appropriate antimicrobial use, diagnostics, IPC, vaccination, education, and research. The Affordable Medicines Directorate serves as the national focal point and MAC-AMR secretariat. Provincial governance, led by the Provincial Head of Health through the Provincial AMS Committee (PAMSC), translates national standards into local action by coordinating surveillance, stewardship, IPC, training, funding, monitoring, and One Health collaboration. District governance, through the District AMS Committee (DAMSC), coordinates AMR activities across hospitals and primary healthcare facilities, focusing on appropriate prescribing, surveillance, prevention, training, awareness, and collaboration with environmental, veterinary, and municipal services. At the health-establishment level, facilities are the main implementers of AMR interventions, integrating AMS, IPC, surveillance, education, and appropriate antimicrobial use into routine care under the oversight of Hospital AMS Committees (HAMSCs). Monitoring and Evaluation assesses whether AMR strategic objectives are being achieved through national indicators and targets monitored by MAC-AMR. Indicators cover inputs (governance systems), processes (AMS/IPC implementation), outputs (antimicrobial use and resistance), and outcomes/impact (health outcomes and infection-related mortality).
Sudáfrica · 2017-06-01