Thailand's national strategic plan on antimicrobial resistance: progress and challenges

Abstract

Antimicrobial resistance is a serious threat that affects all countries. The Global Action Plan on antimicrobial resistance and the United Nations Political Declaration on antimicrobial resistance set standards for countries to resolve antimicrobial resistance challenges under the One Health approach. We assess progress and challenges in implementing Thailand’s national strategic plan on antimicrobial resistance 2017–2022, discuss interim outcomes and share lessons learnt. Major progress includes: establishing a national governance mechanism that leads high-impact policy on antimicrobial resistance and consolidates actions and multisectoral collaboration; creating a monitoring system and platform to track implementation of the strategic plan; and converting strategies of the strategic plan into actions such as controlling the distribution and use of antimicrobials in humans and animals. Interim results indicate that antimicrobial consumption in animals has nearly halved (exceeding the national goal of a 30% reduction) whereas other goals have not yet reached their targets. We have learnt that elevating antimicrobial resistance to high-level visibility and establishing a national governance mechanism is an important first step, and a monitoring and evaluation system should be developed in parallel with implementation. Securing funds is crucial. Policy coherence is needed to avoid duplication of actions. Highly ambitious goals, although yet to be achieved, can advance actions beyond expectations. Political commitment and collaboration across different sectors will continue to play important roles but might not be sustained without a well-designed governance structure to support long-term actions to address antimicrobial resistance.

Antimicrobial Resistance and Community Pharmacists’ Perspective in Thailand: A Mixed Methods Survey Using Appreciative Inquiry Theory

“…The second is a process to move antibiotic groups into a restricted level, which requires a prescription. Re-classification of certain preserved antibiotic hospital and community settings and the prescribing and dispensing of antimicrobials are recommendations [ 27 ].…”

“…Although the ASU programme has been well established in a hospital setting with remarkable success [ 14 , 26 , 27 ], the survey reveals that the ASU in community settings has not been significantly implemented yet. Less implementation, lack of regulation and enforcement capacity due to lack of up-to-date legislation can cause uncontrolled and easy access to antibiotics.…”

“…Less implementation, lack of regulation and enforcement capacity due to lack of up-to-date legislation can cause uncontrolled and easy access to antibiotics. Unauthorised and unregulated supply chains, including inappropriate prescription practices, contribute to self-medication and a growth of AMR [ 27 , 68 ]. The majority of participants agreed that Good Pharmacy Practice (GPP) in the community should be used for regulating quality of community pharmacists’ services, including ASU practice.…”

“…The programme promoted rational antibiotic prescribing by providing financial incentives to recognise appropriate prescribing behaviour by healthcare providers in the hospital settings. The NSP-AMR 2017–2021 has had remarkable success in changing prescribers’ behaviour [ 14 , 26 , 27 ]. Following its success at the hospital level, the ASU programme was then piloted among community pharmacists with a focus on screening for pharyngitis, a common upper respiratory tract infection, in 2017 [ 28 ].…”

“AMR Dialogues”: a public engagement initiative to shape policies and solutions on antimicrobial resistance (AMR) in Thailand

“…In 2016, the Thailand National Strategic Plan on AMR (NSP- AMR), a 5-year plan from 2017 to 2021, was endorsed by the Cabinet as the first national plan to address the problem of AMR in Thailand 19 – 22 . The NSP-AMR comprises of six strategies.…”