Indonesia is among the five countries with the highest projected percentage increases in antimicrobial consumption by 2030, with a growing threat of antimicrobial resistance (AMR).[1] In 2016, Indonesia developed a national action plan to respond to this threat in line with the Global Action Plan on AMR (GAP-AMR) endorsed by WHO in 2015.[2] The national plan set forth multisectoral links between Indonesia’s Ministry of Health (MoH), Ministry of Animal Resources and Fisheries, Ministry of Agriculture and Forestry, and WHO, in collaboration with the Food and Agriculture Organization (FAO), the World Organisation for Animal Health (OIE) and the United Nations Environment Programme. The WHO has provided solid support to the development and implementation of this plan in several ways.

First, together with the Indonesian Ministry of Health, the WHO Regional Office for South-East Asia developed and piloted a situation analysis tool to conduct a baseline analysis and inform the implementation, monitoring, and evaluation of progress across the seven focus areas of the GAP-AMR. The situation analysis process consists of guided discussions between the WHO team, the MoH AMR control committee, senior technical leaders of the national health authorities, the veterinary, agriculture and food sector.

Based on recommendations of the situation analysis, a notable achievement recorded following WHO support was the establishment and full operation of Indonesia’s AMR surveillance system. To achieve this, WHO supported Indonesia to enrol in the Global Antimicrobial Resistance Surveillance System (GLASS)[3] in 2017. After enrolling with GLASS, Indonesia received WHO training to develop the strategies to oversee antibiotic use and consumption at different levels. Through this support, Indonesia has established at least twenty surveillance sites within the national surveillance system, sixteen of which regularly provide data to GLASS.  The support also extended to promoting the rational use of antimicrobials. All the national Drug Regulatory Authorities (DRA) now have tools for quality assurance and registration of antibiotics in place. Routine inspection is implemented, with increased capacity building for enforcement of policies and regulation. AMR stewardship (AMS) programme has also been developed and implemented by relevant institutions.

Other areas that WHO supports include nationwide, government-led antibiotic awareness campaign targeting the general public and professionals. Awareness for professionals includes integrating AMR in some preservice training and specialized courses for continuous professional development and regular learning. General public awareness promotion includes using social media to improve population understanding of antimicrobial resistance.  In November 2020, WHO Country Office in  Indonesia collaborated with the Ministry of Agriculture, the Ministry of Environment and Forestry, the Ministry of Maritime and Fisheries, the National Committee of AMR Control, civil society organizations, United Nations Environmental Programme (UNEP), and FAO on an awareness campaign during the World Antibiotic Awareness Week (WAAW). The campaign disseminated information to relevant stakeholders on different topics concerning AMR in Indonesia. More than 800 participants/viewers from hospitals, health centres, farmers, professional associations (human and animal health sectors), environmental sectors, partners, and CSOs attended. Another nationwide campaign conducted was the GeMa CerMat campaign (Gerakan Masyarakat Cerdas Menggunakan Obat), a social media program to raise awareness of the rational use of medicines in the general public, among academics and health workers.

WHO also supports the One-Health engagement of Indonesia’s national plan, which emphasizes the relationships between the health of humans, animals, plants, and the environment. A notable achievement of this support includes the Minister of Agriculture Regulation No 14/2017, which prohibits using antibiotics as livestock growth promoters, and the Directorate General of Livestock and Animal Health Services (DGLAHS)  Regulation No 09160/PK.350/F/12/2019 prohibiting the use of the antibiotic colistin, which is in the WHO list of Highest Critically Important Antimicrobials for Human Medicine – in animals. Also,  11 Indonesian Faculties of Veterinary Medicine are being engaged within Indonesia’s  One-Health framework to improve infection prevention and control in the animal sector in line with international standards.

Although much remains to do, progress shown from the WHO-supported evaluation of Indonesia’s national action plan on AMR control increases optimism that Indonesia can win the battle against AMR.