Strengthening Antimicrobial Resistance (AMR) Related Activities in Kiribati

Background

According to the WHO Global Report on Antimicrobial Resistance (AMR) surveillance 2014, there are high levels of resistance found in all region of the world. There are more infections and more antibiotics prescribed in developing and resource challenged countries. Each location has its unique infections and antibiotic resistance patterns. Without urgent action, common infections and major injuries can once again kill.

Pacific Island Countries are also affected by the same problem related to AMR which has also burden the health care system. Recently, Kiribati had reported an unusual increase of Methicillin-Resistant Staphylococcus Aureus (MRSA) cases in the month January 2017.  A total of 14 cases were reported in January 2017, compared to 7 cases for the whole of 2016. However, it is not clear whether they are community or hospital acquired cases pending detailed investigation.

The above has raised alarming issues and questioned the current clinical and public health practices in Kiribati which call for the need to investigate and outline urgent intervention.

There are many benefits for Kiribati in carrying out AMR project, including improved patient outcomes (from more logical antibiotic prescribing), reduced unnecessary antibiotic prescribing and reduced resistance and incidence of MRSA outbreak and even preventing associated deaths.  These benefits may translate into sufficient resource savings for Kiribati. 

This project will support WHO Regional and Global Action Plan on AMR (2015) and WHO Regional Framework for Action on Access to Essential Medicines in the Western Pacific (2011-2016) that emphasizes rational selection and use of medicines. Furthermore, this project will be used as one of the key reference in developing the Kiribati National Action Plan on AMR.

Purpose/Specific Objective of the Activity

To strengthen activities related to laboratory-based AMR surveillance, MRSA country situation analysis, antibiotic guideline, antimicrobial stewardship and hospital infection prevention in Kiribati

Description of activities to be carried out

In collaboration with WHO and national authorities, the contractor will:

Phase I (June 2017)

1. Review and update Tungaru Hospital Laboratory procedure on reporting and monitoring of antibiotic sensitivities and multi-resistance bacteria pattern
2. Identify the most common bacterial causes of infections in Kiribati and develop an antibiogram  for Kiribati, including calculation of the rates of MRSA and other multi-resistant ‘superbugs’
3. Review and update current antibiotic guideline for Kiribati that is country specific, for the treatment of common infections in both hospital and community based on local laboratory data  
4. Review and update Infection and Prevention Control guideline and policy
5. Update antibiotics and antimicrobials list in the Kiribati Essential Medicine List (EML)

Phase II (August 2017)

1. Establish a system of restriction for a few very expensive, critical antibiotics
2. Train prescribers on rational use and prescribing of antibiotics
3. Provide training to key stakeholders on interventions to contain multi-resistance bacteria and other Infection and Prevention Control activities
4. Submit a technical report to WHO with recommendations for other processes and policies to strengthen AMR stewardship, infection prevention control, rational prescribing, use and control of antibiotics/antimicrobials and laboratory surveillance and MRSA interventions

Method(s) to carry out the activity

The existing Kiribati Essential Medicine List (EML) 2014, Infection & Prevention Control (IPC) policy, Antibiotic Susceptibility Testing (AST) guidelines, External Quality Assessment reports, Antibiotic guideline 2013, previous WHO consultant MRSA assessment findings and other related policy/reports in place at Tungaru Central Hospital and other key public health facilities will be used as reference for training, review and situation analysis; has to meet country needs and in line with current international standards.

Description of the tasks/process involved in carrying out the activity(

(i) The contractor will need undertake this project in two phases and travel to Kiribati twice in order to carry out this activity. He/She will analyze the content of the current standard treatment guideline and other associated policies such as IPC and standard operating procedures and EML 2014 and AST guidelines and AMR data in Tungaru Central Hospital and other key public health facilities.

(ii) The contractor will conduct consultation meetings with key stakeholders in the Ministry of Health & Medical Services (MHMS) during the course of this review:-

• Meet face to face with the Permanent Secretary for Health, MHMS Kiribati
• Meet face to face with the Director Hospital Services, Director Public Health Services, Director Nursing, Chief of Laboratory Services, IPC nurse, Hospital Consultants and Chief Pharmacist at Tungaru Central Hospital.
• Meet with National Drugs & Therapeutics Committee
• Meet with other key MHMS officials, both clinical and public health staffs as when required or recommended.

(iii)  The contractor will also need to meet with other relevant stakeholders when suggested by MHMS.
(iv)  Visit key health facilities and community, while conducting country situation analysis when necessary or when suggested by MHMS.
(v)   Conduct training to prescribers on rational use and prescribing of antibiotics.
(vi)  Conduct training to key stakeholders on interventions to contain HA-MRSA and CA-MRSA and other multi-resistance bacteria.
(vii) The Contractor may need to communicate with the relevant MOH officials via email, telephone in order to obtain other necessary information.
(viii) The deliverables will be communicated to WHO by means of email

Timeline/Duration of assignment

Period of work is from 1st June to 31st August 2017, for a total number of 20 working days. (Phase I & Phase II – 14 days in country and 6 days desktop review)    

Deliverable(s) to be submitted during and after the period of the assignment including manner of delivery and payment

The deliverables will include:

Phase I

1. Draft Kiribati Antibiotic guideline 2017
2. Recommendation for updates to the Kiribati EML
3. Established reporting and monitoring process/procedures and tools for antibiotic sensitivities and resistance pattern in Tungaru Hospital Laboratory
4. CSA report highlighting the findings, short term/immediate and long term actions and interventions of controlling/reducing HA-MRSA and CA-MRSA in Kiribati

Phase II

1. Draft guideline or policy for restricted antibiotics or antimicrobials use in Tonga
2. 10 or more prescribers trained on rational use and prescribing of antibiotics
3. All key stakeholders trained on interventions to contain HA-MRSA and CA-MRSA and other multi-resistance bacteria
4. Final technical report with recommendations for other processes and policies to strengthen AMR stewardship, infection prevention control, rational prescribing, use and control of antibiotics/antimicrobials and laboratory surveillance and MRSA interventions

Payment will be made in the following instalments

      0% - upon acceptance of countersigned contract;

      50% - upon acceptance of agreed work plan;

      25% - upon acceptance and completion of phase I activities and deliverables

      25% - upon acceptance and completion of phase II activities and deliverables

Interested should submit the proposal to wpfjidpsprocurement@who.int by 24 March 2017. Please use Tender Notice No. 55003 as subject to all submissions