medicines will be strengthened through the use of
laboratory systems to monitor quality assays and
pharmacovigilance reporting systems monitored by the
Medicines Control Council, which will also include
veterinary medicines.
The strategy framework aims to institutionalize AMS, not
only through the adoption of national core standards, but by
incorporating AMS activities into job descriptions,
performance appraisals and continuing professional
education activities. The national development of an
integrated information technology system to link pharmacy,
laboratory and clinical information is similarly vital in this
regard. An audit of patient information systems at primary
care level revealed that only 22 out of 37 systems in all nine
provinces were functional and operational, but could be
scaled up (unpublished observations). A similar audit is
underway at hospital level.
A series of antimicrobial stewardship interventions are
being put in place as part of the strategy framework (Table 3).
Central to these is the AMS ward round, which has been
shown to reduce antibiotic prescribing in South Africa,
without affecting patient safety (17). Coupled with
dedicated antibiotic prescription charts, these activities
focus attention on antimicrobial prescribing and is an
effective means of transferring skills to trainees. Information
on appropriate prescribing in the form of the South African
Essential Medicines List and Standard Treatment Guidelines
has been augmented by an algorithmic clinical guideline on
appropriate antimicrobial prescribing (18).
Enhance infection prevention and control (IPC)
Prevention of infection through wide-reaching vaccination
programmes and improvements in water and sanitation are
important prevention strategies to reduce AMR. South
Africa's extended programme of immunization will be
augmented by increased coverage of influenza vaccination,
which has been shown elsewhere to reduce influenzaassociated
antibiotic prescribing (19) and by fast-tracking
expanded immunization of pneumococcal conjugate
vaccination in high-risk adults. In the context of South Africa,
this includes HIV-infected adults.
A key enabler to effective IPC includes sufficient, suitably
qualified, and competent IPC practitioners (IPCPs) with
defined core competencies. Human resource planning to
meet international norms for IPCPs in South Africa is a
required component of the strategy framework. Although
MONITORING, SURVEILLANCE AND NATIONAL PLANS
AMR CONTROL 2015 59
Figure 3: Antimicrobial Resistance National Strategy Framework Commitments