Antimicrobial Stewardship Activities in Public Healthcare Facilities in South Africa: A Baseline for Future Direction.

Brian Godman,Johanna Catharina Meyer,Deirdré Engler,Amanj Kurdi,Natalie Schellack

doi:10.3390/antibiotics10080996

Abstract

Antimicrobial resistance (AMR) is a growing problem worldwide, including South Africa, where an AMR National Strategy Framework was implemented to instigate antimicrobial stewardship programmes (ASPs) and improve antimicrobial prescribing across sectors. To address the need to assess progress, a sequential mixed methodology with an explanatory research design was employed. In Phase 1, a self-administered questionnaire was completed by healthcare professionals (HCPs) from 26 public sector healthcare facilities across South Africa to assess compliance with the Framework. The results were explored in Phase 2 through 10 focus group discussions and two in-depth interviews, including 83 participants. Emerging themes indicated that public healthcare facilities across South Africa are facing many challenges, especially at entry level primary healthcare (PHC) facilities, where antimicrobial stewardship activities and ASPs are not yet fully implemented. Improved diagnostics and surveillance data are a major shortcoming at these facilities. Continuous education for HCPs is deficient, especially for the majority of prescribers at PHC level and health campaigns are nearly non-existent. Involvement and visibility of management at certain facilities is a serious shortfall. Consequently, it is important to call attention to the challenges faced with improving antimicrobial prescribing across countries and address these to reduce AMR, especially in PHC facilities, being the first point of access to healthcare for the vast majority of patients in developing countries.

Highlights

The globe is facing an immense challenge with the spread of resistant antimicrobial pathogens [1], with antimicrobial resistance (AMR) increasing morbidity, mortality and costs [2,3,4,5]
We believe this study appreciably extends our understanding of the current situation in South Africa’s public healthcare sector regarding the Framework to help reduce AMR
Of particular concern is the challenges faced by primary healthcare (PHC) facilities, being the first point of access to the healthcare system for the vast majority of patients in South Africa and wider

Summary

Introduction

The globe is facing an immense challenge with the spread of resistant antimicrobial pathogens [1], with antimicrobial resistance (AMR) increasing morbidity, mortality and costs [2,3,4,5]. Whilst we are aware that improvement in healthcare through increased resources is becoming a priority across countries, including many low- and middle-income countries (LMICs), there is still considerable concern about lack of investment in managing both infectious and non-infectious diseases this is changing [13,14,15,16,17,18,19]. An area of critical importance is to safeguard the use of antimicrobials and to focus on appropriate and targeted antimicrobial use in humans, animals and the environment [20,21] This is the strategy behind the World Health Organizations’ One Health approach [22,23]

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Discussion

Conclusion