Operational research on the frontline to fight antimicrobial resistance in Nepal

17 November 2019
Feature story

Is there overprescription of antibiotics happening in my hospital? How well are my clinicians adhering to treatment guidelines for infections? Are there gaps in infection prevention and control at health facilities under my supervision?

These are some of the burning questions faced by frontline health workers and decision makers fighting antimicrobial resistance (AMR) around the world. The  Structured Operational Research and Training IniTiative (SORT IT) is well designed to help answer such practical questions.

ORT IT is a global partnership-based initiative coordinated by TDR, The Special Programme for Research and Training in Tropical Diseases, and implemented with ministries of health and various partners. It supports countries to build sustainable capacity to conduct and publish operational research and use the evidence for informed decision-making to improve public health. The goal is to make countries “data rich, information rich and action rich”.

As of World Antibiotic Awareness Week 2019, 36 operational research studies are already underway in five countries. These studies cover a broad range of topics including improving the quality of AMR surveillance data, understanding antibiotic consumption patterns, preventing infection in health facilities, and addressing AMR in the agriculture and environment sectors using the OneHealth approach. The generated evidence will help us better understand the actual AMR situation at country level, guide control strategies and contribute to health systems strengthening.

“TDR’s approach to operational research is contributing to national efforts to fight AMR by developing the capacity to generate and use data on the emergence, spread and health impact of AMR,” said Jos Vandelaer, WHO Country Representative in Nepal.

TDR has rapidly pushed ahead with this work by using the SORT IT experience built over the last decade through work in areas such as outbreaks and emergencies, tuberculosis, malaria, and maternal and child health. Notably, about 70% of SORT IT publications emerging from such work have reported an impact on policy and practice.

SORT IT uses a “learning by doing” approach and empowers implementers and frontline health workers who often have little or no prior research experience.

SORT IT’s approach to AMR is aligned with the strategic pillars of WHO’s Global Action Plan on AMR which include improving awareness, strengthening knowledge through surveillance and research, reducing the incidence of infection, optimizing the use of antimicrobials, and developing the economic case for sustainable investment.

WHO country offices and national AMR committees have been at the forefront in identifying SORT IT projects that fit with national AMR priorities. TDR has also joined forces with WHO regional offices for Africa, the Americas, Europe, and South-East Asia to compliment the ongoing SORT IT related research with a Small Grants Scheme for operational research to tackle AMR.

“TDR’s collaborative relationship with countries and the complementarity it brings to the One Health approach are valuable contributions to the fight against AMR,” said Hanan Balkhy, WHO Assistant Director General for AMR.

The operational research expertise built through SORT IT has also been recognized by UNICEF, one of TDR’s four co-sponsors. UNICEF focuses on access and stewardship to antibiotics and will publish this week new strategic guidance for tackling AMR in children.

“UNICEF, as a TDR co-sponsor, looks forward to collaborating with TDR and its roster of operational research experts to improve access and rational use of antibiotics in children,” said Debra Jackson, Senior Health Advisor at UNICEF’s Implementation Research and Delivery Science Unit.