National Action Plan Research Articles

Exploring pharmacists’ understanding and use of antifungals at a tertiary hospital in England - an interview study

Abstract Introduction Antimicrobial resistance (AMR) is an emerging crisis worldwide. If continued, it is estimated AMR could cause over 10 million deaths annually by 20501. Antifungals are critical in the treatment and prophylaxis of fungal infections, especially invasive fungal infections which can be life-threatening. The national and international antimicrobial stewardship action plan focus primarily on the use of antibacterials. Antifungals have not yet been a focus for stewardship programmes. The appropriate use and understanding surrounding antifungals remain a challenge among healthcare professionals, including pharmacists but there is scarce empirical evidence to demonstrate this problem. Aim To explore pharmacists’ understanding and use of antifungals at a tertiary hospital in England. Methods A qualitative study utilising a constructivist approach involving one-to-one online semi-structured interview based on the Critical Incident Technique2 was conducted. Pharmacists working in the tertiary hospital were purposively sampled and recruited to participate in the study. Following informed consent, participants took part in a semi-structured interview via Microsoft Teams with a researcher. Interviews explored 1) the general purpose of using antifungals and 2) system factors and decisions taken when managing a routine and unusual or challenging case using antifungals. The interviews were audio-recorded and then transcribed verbatim. Transcripts were analysed using reflexive thematic analysis3. The study was registered with the tertiary hospital where participants were recruited from. This study was registered with Oxford University Hospitals NHS Foundation Trust (ref no. 8482) and received ethical approval from the University of Reading School of Chemistry, Food and Nutritional Sciences and Pharmacy internal ethics review committee (study no: 46/2023). Results Nine participants took part in the study. Interviews took an average of 29 minutes (range 15-55 minutes). Participants worked in different specialties including oncology, haematology, paediatrics, and respiratory care. Three themes were generated through the analysis. Theme 1: Diagnosing and managing fungal infections is complex. Limited and/or lack of reliable and timely diagnostic testing makes diagnosing fungal infections difficult. Consequently, patients were sometimes prescribed empiric antifungals to avoid treatment delay. Treatment was then reviewed once test results were available. Patient-related issues such as comorbidities and drug-drug interactions contribute to complex treatment plans. Theme 2: Antifungal stewardship involved a multidisciplinary approach. Pooling together expertise amongst healthcare professionals was imperative in decision-making. Pharmacists were often key antifungal stewards and medication experts despite working with uncertainty. Theme 3: Expressed need to upskill on antifungal stewardship. Participants were aware of gaps in their experience and knowledge when managing complex fungal infections. They want to be more confident in their role. Discussion/conclusions To our knowledge, this is the first study investigating hospital pharmacists’ understanding and use of antifungals in England. Our study showed that pharmacists navigate uncertainties when using antifungals. Pharmacists were viewed as antifungal stewards and medication experts in a multidisciplinary team but pharmacists were themselves aware that they need more exposure to a wider range of scenarios to enhance their confidence. Our findings suggest a need for reliable diagnostic-driven approaches and education and training initiatives for pharmacists to steward antifungals. Our participants worked in one tertiary hospital representing the culture and work practice specific to the hospital. It would be interesting to explore experiences of pharmacists working in other hospitals.

Healthcare workers' views on antibiotic prescribing and stewardship during the COVID-19 pandemic at an NHS Foundation Trust in England: a cross-sectional survey

Abstract Introduction Antimicrobial resistance (AMR) is a rapidly escalating global health challenge, projected to cause 10 million deaths annually by 2050.1 In response, the UK Government developed a five-year national action plan, 'Confronting Antimicrobial Resistance 2024 to 2029,' aimed at optimising antimicrobial use and implementing antimicrobial stewardship.2 The COVID-19 pandemic has significantly impacted the healthcare system, jeopardising public health and causing millions of deaths worldwide. The pandemic has exacerbated AMR due to increased antimicrobial therapy and misuse.3 Aim This study explores healthcare workers’ (HCWs) views towards antibiotic prescribing, AMS and AMR during the COVID-19 pandemic in a UK secondary care setting. Methods This cross-sectional study employed an online questionnaire survey conducted at an NHS Foundation Trust in the East of England, targeting doctors, nurses, and pharmacists. The total eligible participants comprised 5,636 doctors, 2,140 nurses, and 206 pharmacists. Data collection was carried out using Qualtrics XM from 12 June to 13 September 2023. Inclusion criteria required healthcare workers (HCWs) to be adults aged 25 or older, registered with relevant professional bodies, and employed during the pandemic. Data analysis involved both descriptive statistics and qualitative methods to interpret participants’ open-ended responses to the question, “What lessons have been learnt during the COVID-19 pandemic?” This study was registered under ISRCTN number 14825813 and received ethical approval from the University of Hertfordshire Ethics and Health Research Authority (HRA) (REC reference number 22/EM/0161). The Citizens Senate reviewed the study protocol to ensure public and patient involvement. Results A total of 23 HCWs completed the survey, including 12 pharmacists, nine doctors, and two nurses. The survey included an open-text section where respondents shared lessons learned during the COVID-19 pandemic. Among pharmacists, 75% (9 out of 12) identified inappropriate antibiotic use without clinical justification as a significant issue, and 67% (8 out of 12) reported an increase in healthcare-associated infections (HCAIs). Additionally, 83% (10 out of 12) noted the positive impact of technology platforms and antibiotic reviews on implementing effective and sustainable AMS. Among doctors, 89% (8 out of 9) emphasised the need for reliable information dissemination, observing that social media often overshadowed evidence-based guidelines. Additionally, 78% (7 out of 9) stressed the importance of staying informed about resistance patterns and antibiotic prescribing trends. All nurses highlighted the significance of AMR awareness and reported that mental fatigue affected decision-making during the pandemic. Discussion/Conclusion This study highlights the essential role of technology platforms in enhancing antimicrobial stewardship practices and the necessity of disseminating reliable information to counter misinformation. The pandemic highlighted the need for clear guidelines and robust communication strategies to support clinical practices. However, this study has limitations, including a small sample size of 23 participants, which may affect the generalisability of the findings. Future research should include larger, more diverse samples to validate these findings and assess specific AMS interventions. The study also revealed the importance of resilient AMS implementation to optimise antibiotic use and improve patient outcomes. Achieving this requires ongoing AMS education, interdisciplinary collaboration, and adaptive strategies to effectively mitigate antimicrobial resistance.

Antibiotic prescribing in health and justice settings (HJS)-surveillance and opportunities for quality improvement

Abstract Introduction Improving surveillance of antibiotic prescribing and reducing health inequalities in antimicrobial resistance (AMR) are priorities in the new 5 year AMR national action plan (2024-2029)1. People in contact with the justice system are one of the inclusion groups in the CORE20plus5, a national NHE England approach to support reduction of health inequalities.2 Aim This project aimed to collate and analyse all antibiotic prescribing data from English prisons in order to identify opportunities for quality improvement. Method This project analysed antibiotic prescribing data from September 2022 to current date for the first time in HJS from the IT system used in all prisons in England. No ethical approval is required as surveillance is of anonymised data only. Data was broken down by age band (18 and under, 19-49, 50 and over), category of prison, region, ICB, individual prison and antibiotic type. The dashboard allows benchmarking across sites and comparison with primary care, as prisoners in HJS are considered to have similar infections to primary care patients. Results The majority of prescribing is in male prisoners, reflecting the male/female population split. The most frequently prescribed antibiotics are those used for: skin and soft tissue (including acne), respiratory tract, dental and urinary tract infections. A number of focus areas for quality improvement have been identified, including: Broad spectrum antibiotics (Cephalosporins, Co-amoxiclav and Quinolones), target of <10% total antibiotic prescribing in primary care, in HJS, currently 11%. Appropriate quinolone prescribing is a target in all settings due to recent MHRA alert3. Acne prescribing represents a significant proportion of antibiotic prescribing in HJS. Lymecycline 12%, whereas in primary care <3%. Duration of Antibiotic Courses: In primary care there is a medicines optimisation opportunity ambition to achieve 75% prescribing amoxicillin 500mg as 5 day duration. In HJS only 27% is for 5 days. When prescribing 100mg doxycycline for respiratory infections, NICE guidance recommends a 5 day course, but in HJS only 3% is prescribed as a 5 day course. For UTI in female prisons, nitrofurantoin 100mg MR is most commonly prescribed, NICE guidance for UTI in women is for 3 days; 47% in HJS are for 3 days, but 35% are 7 day courses. Discussion and Conclusion This dashboard provides insight into antibiotic prescribing data allowing opportunities for quality improvement opportunities to be identified and antimicrobial stewardship interventions to be evaluated. This work will progress to tackle the focus areas identified. Next steps are to work with antibiotic champions from HJS to co-produce intervention plans, share patient safety messages, trial available resources, rollout interventions and monitor impact via the dashboard. Limitations Indications are not available from the data but extrapolated from the antibiotic prescribed. The dashboard is currently an excel spreadsheet in NHSE. It will be moved to a platform that enables access by individual prisons.

The political economy of gender mainstreaming in energy access in Sierra Leone

Abstract In 2017, the Economic Community of West African States launched its Policy for Gender Mainstreaming in Energy Access with each member state tasked to create a National Action Plan (NAP). This study explores the case of Sierra Leone, to understand how stakeholders have influenced the NAP process, and what that might mean for implementation. Using the Actor-Objective-Context framework with interview data from key gender and energy actors. We find elements that make Sierra Leone’s NAP unique; such as addressing systematic barriers, explicitly promoting solar energy and heavily relying on civil society. The study finds that a policy focus on gender reflects both a push from international donor organisations and the national efforts of civil society. Sierra Leone’s NAP reflects the tension between the high priority of gender politics at the national and international level and more immediate interest from the Ministry of Energy and government actors on economic development. It affirms the uneasy co-existence of the liberal and liberating view of women in international development with some evidence that the liberal view prevails. Still, despite the government focus on economic development, poor engagement with the private sector and cultural barriers are likely to hamper the inclusion of women into the energy industry.

An Analysis of Real Estate Market Responses towards Climate Resilient Policies in Malaysia and Indonesia

As global warming increases climate-related disasters, countries must address its impact on real estate. Malaysia’s National Policy on Climate Change, Green Building Index, and National Urbanisation Policy, along with Indonesia’s National Action Plan on Climate Change, Climate Resilience and Adaptation Strategy, and Disaster Management Law, highlight climate resilience in real estate. This study examines these policies and their effects on the real estate markets in Malaysia and Indonesia using qualitative methods. The findings reveal that property values in both countries have increased due to a growing emphasis on sustainability and durability in the market.

An antimicrobial resistance gene situationer in the backyard swine industry of a Philippine City

Antimicrobial resistance (AMR) as a result of antimicrobial overuse and misuse in agriculture is a growing concern, especially in the predominant but poorly regulated backyard or smallholder swine farms of the Philippines. A city-scale surveillance of antimicrobial resistance genes (ARGs) was conducted through selected backyard swine farms to obtain a comprehensive understanding of the AMR situation in the backyard sector of Davao City, Philippines. The ARGs encoding resistance to four antimicrobial classes (β-lactams: blaCTX−M, blaOXA, blaSHV, blaTEM, mecA; quinolones: qnrS and qnr-A2; macrolides: ermA and ermB; tetracycline: tetM) were quantified in swine feces via real-time PCR, and point maps were generated to visualize the ARG geographic distribution. The ARGs bla-TEM, ermB, qnrS, and tetM were detected in all farms at relatively intermediate to high levels, consistently representing the four most used antimicrobial classes in Philippine farms. All the investigated ARGs were present in some local barangay units, indicating potential emergence of AMR hotspots. A 0.5 quantile regression analysis identified specific backyard farm attributes associated with ARG occurrence and diversity, which may influence the ecological spread of the ARGs. These findings provide support for evidence-based guidelines to reinforce a One Health framework for the Philippine National Action Plan to Combat AMR.

A monitoring framework for reinforcing policies against antimicrobial resistance in Europe

Abstract In an attempt to overcome barriers to the effective implementation of policies against antimicrobial resistance (AMR) in the EU Member States, Norway and Iceland, One Health national action plans (NAPs) need to show improvements in both their formulation and their implementation. Research conducted by Tetra Tech, funded by the EU4Health Programme, has identified shortcomings to One Health national policies across all countries, such as limited political focus and awareness of the challenges brought by AMR; lack of operational plans for delivering on the NAPs; and lack of harmonised indicators and inadequate information systems for monitoring the implementation of plans. On this last issue, subsequent reseach by Tetra Tech has supported the design and development of monitoring indicators for reinforcing the expected improvements of NAPs and the implementation of policies aimed at EU Member States in the 2023 “Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health approach”. While drawing on existing data sources at EU and global level, the study has also worked with Member States representatives in identifying indicators for the monitoring framework and proposed new data collection activities at the national level. Key messages • EU countries face common barriers to the effective implementation of One health policies against AMR, and need to reinforce their national action plans. • Stepping up the fight against AMR in the EU requires a strong monitoring framework for following up on EU recommendations.

Setting targets for antibiotic use in general practice in Europe: a scoping review

Abstract Background National Action Plans (NAPs) aim to address antimicrobial resistance (AMR) understanding and awareness but struggle to translate targets into clinically relevant guidance for general practice. This scoping review aims to identify and map antibiotic use targets in European general practice and explore if and how these targets are linked to NAPs. Methods A systematic search strategy was carried out in MEDLINE (OVID), EMBASE and SCOPUS, with additional manual searches. Two research questions were addressed: ‘What are existing targets for antibiotic use in general practice in the 31 European countries?’ and ‘How are these targets linked to the NAPs on AMR?’. The results are presented narratively. Results 77 reports were included, of which 33 focused on national targets and general practice or linking national targets to local areas. Reports describe local strategies or initiatives to achieve targets, such as feedback to prescribers, systems with benchmarks (at local, regional, and national levels) and financial incentives. However, these reports provide aggregated targets for general practice, such as a percentage reduction of antibiotics prescribed. These targets are set in general, for a specific type of antibiotic, for an amount per number of patients, in defined daily doses (DDD) or in items. None of the reports translate national targets into clinically relevant or practical targets for general practitioners (GPs). Conclusions Most European countries have a NAP with national targets. The type of targets and their implementation at the national and local level vary between countries. Translating national targets into daily clinical practice is challenging and often lacks the involvement and input of prescribers (GPs). Key messages • Translating targets into daily clinical practice is challenging and often lacks the involvement and input of prescribers (GPs). • Local strategies, feedback to prescribers, benchmark systems (local, regional, national), and financial incentives drive successful target achievement.

Results of a 5 year Antimicrobial Stewardship program in a North Italian Hospital

Abstract Issue A National Action Plan (PNCAR) to fight antimicrobial resistance has been launched in Italy in 2017, further revised in 2022. In order to reduce inappropriate exposure to antibiotics and infections from multidrug resistant bacteria, a structured system of surveillance and monitoring according to PNCAR standards has been set up in all Italian regions. In the Hospital of Cittadella (District of Padua, Veneto region), special focus has been given to the reduction of antibiotic consumption, in particular quinolones, third generation cephalosporins, carbapenems and macrolides. Description Multidisciplinary meetings have been monthly organized by the hospital Antimicrobial Stewardship Group, with the aim of coordinating the implementation of specific stewardship actions. A quantitative estimate of antibiotic consumption (defined daily dose - DDD - consumption per 100 days of hospitalization) has been provided by the Regional data warehouse from 2019 to 2023 regarding all classes of antibiotics. Results Between 2019 and 2023 a clear decrease in the consumption of quinolones (from 8 to 5,8 DDD, -28%) and carbapenems (from 2,5 to 1,3 DDD, -48%) was observed but, at the same time, an increase in the consumption of third generation cephalosporins (from 9 to 15,7 DDD, +74%) has been reported. This can be explained as a direct consequence of the correct application of therapy guidelines, which in several cases suggest the use of ceftriaxone instead of meropenem. Finally, after an increase in the consumption of macrolides during the first COVID-19 pandemic wave, the consumption of this class of antibiotics has returned to pre-pandemic level. Lessons Constant monitoring of antimicrobial consumption and the identification of warning situations that may need to implement specific actions are the cornerstone of Antimicrobial Stewardship programs. Targets must be defined analyzing data of bacterial resistance rates and infections from multidrug resistant bacteria. Key messages • In Antimicrobial Stewardship programs it is important to adopt constant monitoring of antimicrobial consumption. • Antimicrobial stewardship programs need to be adapted according to the characteristics of each hospital.

How Can Land Use Management in Traditional Cultural Landscapes Become a Policy Instrument for Soil Organic Carbon Sequestration and Climate Change Mitigation? A Transylvanian Case Study

Changes in land use from high-nature-value grasslands to arable fields reduce the organic carbon stock in soil, increasing atmospheric carbon concentrations. Maintaining grasslands through traditional agricultural techniques can mitigate climate change by transferring atmospheric carbon to the soil. Benefits of soil organic carbon sequestration include improved soil properties and enhanced ecosystem services and biodiversity. With Romania’s ratification of the Paris Agreement, it is crucial to review climate-related agricultural policies and incentivize carbon sequestration practices in organic soils. This paper presents a soil carbon study in Transylvania’s Târnava Mare region, Romania, known for its preserved cultural landscapes. Soil samples were taken at a depth of 60 cm to assess organic carbon pools under grassland and arable land management across three soil classes: Cernisoils, Hidrisoils, and Luvisoils. Several statistical tests were applied to evaluate the most significant drivers of soil organic carbon sequestration including land use, soil class, and soil depth. The results indicate that land management has the largest impact, with grasslands storing 45% more carbon than arable land on average. This finding should be integrated into national climate action plans, prioritizing the preservation of grasslands and sustainable agricultural practices to support soil organic carbon sequestration.

A guide for policy and decision makers on health literacy policies

Abstract Supported by supranational organizations such as the WHO or the European Union, governments across the world have begun to work systematically on developing and implementing action plans, strategies and policies to improve the health literacy of their citizens and the health literacy friendliness/responsiveness of health organizations. In 2023, a first project on evidence-based policies and practices was initiated by the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) and financially supported by the Swiss Ministry of Health. In this project a guide on how health literacy policies can be developed and implemented was developed by an international working group. This guide brings together insights from existing literature on national health literacy strategies, action plans and interventions, including an expert snowball search within the M-POHL network and among other partners, experiences and case examples collected from M-POHL members and other countries. Feedback on the guide was collected in interactive webinars with policy representatives and decision-makers and addressed. The structure of the guide follows an adapted version of the Public Health Action Cycle model, assisting step-by-step action on health literacy policy development: situation analysis; agenda setting; developing policies, strategies and interventions; implementation; evaluation and monitoring. Each phase is described, and best practices and recommendations provided. The guide closes with a checklist for self-assessment which follows the structure of this document. It supports reflection on the state of policies in a country. This innovative guide contributes to supporting evidence-informed policies and practice. This can be of interest to experts and practitioners who have data on challenges relating to the health literacy levels of population groups and who wish to develop or adjust their policies, services and communications accordingly.

Developing a community engagement toolkit for health impact assessment in Ireland

Abstract Background Community involvement is a core principle of Health Impact Assessment (HIA). However, current guidance for HIA published by Ireland’s Institute for Public Health does not include guidelines on community engagement in HIA. As part of the project HIA-IM - ‘Development of a Health Impact Assessment Implementation Model: Enhancing Intersectoral Approaches in Tackling Health Inequalities,’ a Community Engagement Toolkit was created, with the aim of providing guidance for those carrying out HIAs and engaging with community in the process. The project will implement two HIAs, on the Cork City Development Plan (2022-2028) and the national Climate Action Plan (2024). Incorporating the learnings from the first HIA, the Toolkit will be employed in the second HIA of the project. Methods To develop the toolkit, a literature review of community engagement in HIA was conducted, with benefits and challenges, key approaches, and case studies of HIA’s gathered from grey literature and peer reviewed articles. In line with the participatory nature of HIA, a public consultation event was held, which was presented as a case study within the Toolkit. Results Findings from the literature review contend that engaging with community in HIA captures the lived experiences and local circumstances of the community, fostering empowerment and greater health awareness. However, many practitioners find community engagement to be practically challenging, citing factors such as time and resource constraints; with risks of consultation fatigue and raising expectations. Conclusions The review identified tools that have been used to mitigate these challenges and risks to facilitate meaningful community participation. These findings, along with learnings from conducting the first HIA, has informed the content of the Toolkit. Therefore, this Toolkit aims to complement national HIA guidance to centre the community voice in future HIA practice. Key messages • Developing a toolkit to strengthen participatory approaches and community engagement in health impact assessment in Ireland. • Centering the community voice in health impact assessment: the inclusion of lived experiences and local circumstances in health impact assessment practice in Ireland.

A temperature tipping point in hypoxic zone size

AbstractTemperature increases will have ubiquitous effects on aquatic food webs, from microbes to consumers, and affect the quality and quantity of carbon flows within and between water layers. A decline in the biological pump moving carbon from surface to lower layers is anticipated. We reviewed 37 years of data on hypoxic zone size and water quality in the northern Gulf of Mexico to determine if air and bottom water temperature increases (0.5°C decade−1) are significantly related to variations in its areal size. There was no significant decline in important river water quality in the 24 years since the national Hypoxia Action Plan was developed to reduce its size. Changes in the ratio of km2 hypoxia per 1000 mt nitrate loading from the Mississippi River from 2000 to 2023 reveals a tipping point in the hypoxic zone size that is driven by ocean warming. Biological factors varying with temperature such as ectotherm growth rates, zooplankton grazing, cell sinking rates, and diatom sequestration of Si or N are apparently more important influences on recent hypoxic zone size than variations in physical factors. This tipping point may be common to similarly warmed and eutrophic coastal waters where warming will likely result in diminished oxygen deficiency (< 2 mgO2 L−1). Hypoxia and food web models assuming a stationary equipoise of nutrient loadings, ratios and food webs will be deficient as coastal waters warm further, coastal storm and hurricane frequency increase and land uses in the watershed are altered with climate change.

Penanganan Sampah Laut di Indonesia : A Review

Indonesia produces 33,113,277.69 tons of waste per year, in which 13,455,925.41 tons are unmanaged waste. From these data, it can be seen that Indonesia is still experiencing problems in waste management. Unmanaged waste is at risk of being carried away by river currents that lead to the sea., Not only land-based waste, marine debris must also be adressed. Marine debris could possibly come from activities on land or at sea. Marine debris consists of three categories; macro, meso and micro marine debris. This paper is a narrative-review on how to dealt with marine debris in Indonesia. Several methods have been done by the Indonesian government to dealt with marine debris. In 2018, the Indonesian government issued Presidential regulation number 83 of 2018, concerning the handling of marine debris. Besides that, Indonesian government also formed National Plan of Action (NPOA) and opened itself to foreign investors to invest on that action plan, especially on adressing marine plastic debris. In addition to forming special team and supporting regulations, the complexity of marine debris problems must also be resolved by integrated research on marine debris, and also make changes on Indonesian human resources‘ mentality and mindset.

Antibiotic prescription, dispensing and use in humans and livestock in East Africa: does morality have a role to play?

Antimicrobial resistance (AMR) is a global threat to human and livestock health. Although AMR is driven by use of antimicrobials, it is often attributed to "misuse" and "overuse", particularly for antibiotics. To curb resistance, there has been a global call to embrace new forms of moral personhood that practice "proper" use, including prescription, dispensing and consumption of antimicrobials, especially antibiotics. This paper seeks to reflect on complex questions about how morality has become embedded /embodied in the AMR discourse as presented in the data collected on antimicrobial prescription, dispensing and use in human and livestock health in Tanzania, primarily focusing on antibiotics. This reflection is anchored on Jarrett Zigon's morality framework that is comprised of three dimensions of discourse; the institutional, public, and embodied dispositions. The data we use within this framework are derived from a qualitative study targeting human and animal health care service providers and community members in northern Tanzania. Data were collected through 28 in-depth interviews and ten focus group discussions and analysed through content analysis after translation and transcription. In addition, a review of the Tanzania's National Action Plans on antimicrobial resistance was conducted. Application of the framework demonstrates points of convergence and divergence in the institutional morality discourse articulated by the Tanzania National Action Plans, the public discourse and the embodied dispositions/ lived experiences of human and animal health care service providers and community members. We demonstrate that AMR is not just associated with "inappropriate" behaviour on the part of drug prescribers, dispensers, and users but also with shortcomings in health systems and service delivery. Antibiotic dispensing and use practices that may be associated with the development of AMR should not be viewed in isolation from the broader health context within which they occur.

Maturity Assessment of the Health Information System Using Stages of Continuous Improvement Methodology: Results From Serbia.

Since the health information system (HIS) in public health care services in Serbia was introduced in 2009, it has gradually expanded. However, it is unclear how well the HIS components have developed and the whole system's stage of maturity. In June-September 2021, a maturity assessment of the Serbian HIS was conducted for the first time using the HIS Stages of Continuous Improvement (SOCI) toolkit. The toolkit measures HIS status across 5 HIS domains: leadership and governance, management and workforce, information and communication technology (ICT), standards and interoperability, and data quality and use. The domains were further divided into 13 components and 39 subcomponents whose maturity stage was assessed on a 5-point Likert scale, indicating the level of development: (1) emerging/ad hoc; (2) repeatable; (3) defined; (4) managed; and (5) optimized. The toolkit was applied in a working group of 32 professionals and experts who were engaged in developing the new national eHealth strategy and action plan. The overall maturity score of the Serbian HIS was 1.6, which indicates a low level. The highest baseline score (2) was given to the standards and interoperability domain, and the lowest (1.1) was given to ICT infrastructure. The remaining 3 domains (leadership and governance, Management and Workforce, and Data Quality and Use) were similarly rated (1.7, 1.7, and 1.6, respectively). A baseline assessment of the maturity level of Serbian HIS indicates that the majority of components are between the emerging/ad hoc stage and repeatable, which represent isolated, ad hoc efforts, with some basic processes in place and existing and accessible policies. This exercise provided an opportunity to address identified weaknesses in the upcoming national eHealth strategy.

A prescription audit in the ear, nose and throat outpatient department, in a tertiary care hospital: a descriptive cross-sectional study

Background: Prescription audit is a quality improvement process aimed at enhancing patient care and outcomes by reviewing prescriptions. It provides feedback to healthcare providers, (HCPs) to identify areas for improvement and ensure the quality of prescriptions. This study aims to analyse the prescription patterns and prescribing behaviour of doctors using world health organization (WHO) recommended core prescribing indicators and prescription audit guidelines from national health mission (NHM), India and implement action plan accordingly. Methods: A descriptive observational cross-sectional study was conducted for one month in the ear, nose and throat outpatient department (ENT OPD) of KMC-RI, Hubballi. A total of 96 prescriptions were analysed using WHO-recommended core indicators and additional indicators from a prescription audit template. An action plan was created to enhance prescription quality. Results: All the prescriptions contained complete demographic details of the patients, OPD registration name and date of consultation. Handwriting was legible in all 96 prescriptions with a score of 100%. Two lowest performing attributes were identified using prescription audit tool namely, allergy status and generic name with a score of 7% and 37.9% respectively. The study revealed that average number of drugs encountered was 1.9, the percentage of drugs prescribed by generic name was 37.9%, percentage of encounters with an injection prescribed was 2.08% and percentage of drugs prescribed from NLEM was 37.9%. Conclusions: The prescription audit revealed that most prescriptions adhered to WHO standards. However, improvements are needed in documenting allergy status and prescribing by generic name. An action plan with a defined timeline has been prepared to provide feedback, aiming to enhance prescription quality and ensure better healthcare outcomes.

Perspectives on the Regional Strategy for Implementation of National Action Plans on Antimicrobial Resistance in the WHO African Region.

Background: The WHO Regional Office for Africa developed a Member States (MS)-endorsed regional strategy to fast-track the implementation of MS' national action plans (NAP) on Antimicrobial resistance (AMR). This study explored the perspectives of AMR's national focal points in MS on the implementation of the priority interventions of the regional strategy in their countries. Methods: An online survey consisting of ratings and discussions covering the implementation of the six priority interventions was conducted. Sums of the scores per priority intervention were obtained, and their percentage to the total possible scores were calculated to categorize the implementation as inadequate (0-25%), basic (26-50%), intermediate (51-75%), or advanced (76-100%). Results: Thirty-six of the forty-seven national AMR focal points responded to the survey between 12 November 2023 and 8 January 2024. The implementations were rated as 37-62% (basic-to-intermediate), with the multisectoral coordination and collaboration committee receiving the highest overall rating (62%, 421/684), while the promotion of sustainable investment for the NAP on AMR received the least overall rating (37%, 257/700). The focal points mainly recommended awareness campaigns, capacity building, and regulations and guidelines to improve the implementation of the AMR strategy. Conclusions: The survey revealed a need to enhance awareness campaigns, support the establishment and functioning of AMR evaluation and monitoring systems, and build the capacity of AMR staff with cost-benefit analysis and budgeting skills. It also showed the necessity to improve awareness and conduct education on AMR, streamline evidence generation through One Health Surveillance systems, integrate initiatives to reduce hospital-acquired infections in the antimicrobial stewardship programs, and enhance regulations and guidelines to optimize the use of antimicrobials.

Penerapan Metode Case-Based Reasoning pada Website SORTING (Sorong Atasi Stunting) Sebagai Implementasi Smart City (Studi Kasus: Distrik Sorong Timur)

Stunting is one of the issues designated as a national priority issue at this time. Determining this priority issue is to accelerate the level of achievement of national development goals. East Sorong District, Sorong City, Southwest Papua Province is one of the focus location with a high prevalence rate. This study aims to develop an information technology called SORTING (Sorong Atasi Stunting) using the case-based reasoning method. This research produces a system that can be accessed from anywhere and at any time, which can be used by residents, especially mothers, to consult regarding their baby's growth problems. SORTING was developed using the expertise of nutritionists who usually deal with stunting problems. SORTING resulted in several conclusions that the application expert system can diagnose stunting by using the case-based reasoning method as an engineering approach to the knowledge base; The application of the SORTING expert system can provide an overview of stunting including the results of the percentage of diagnoses, factors and recommendations for solutions that must be taken; The application of the SORTING expert system can be used as a second alternative to consult with experts in diagnosing stunting. And it can also be an alarm to continue consulting with experts directly; The application of the SORTING expert system can increase knowledge about stunting. The researchers hope that SORTING can assist the government in the National Action Plan for Stunting Management which emphasizes reducing stunting rates and can help the community recognize stunting diseases early and prevent them.

Temporary Labor Migration from Sri Lanka to Gulf Cooperation Countries: Analyzing Labor Trafficking Amidst the Financial Crisis

Background and Aims: The financial crisis in Sri Lanka (SL) has marked a significant growth in temporary labor migration to Gulf Cooperation Countries (GCC). Temporary labor migration refers to migration from one state to another in pursuit of employment opportunities for a temporary period. The National Policy on Migration for Employment (NPME) and the National Action Plan of SL asserted the importance of developing labor migration policies in response to the country’s severe need for remittances during the financial crisis. A financial crisis occurs when a country's expenditure exceeds its national income, resulting in a shortage of goods and services for its citizens. Along with this understanding, this paper examines how the temporary labor migration from SL to GCC has developed in response to the financial crisis in the country. It argues that reforming labor migration policies solely based on remittance does not appear to be adequate to protect migrants from trafficking. In this setting, the key research question is how labor trafficking has risen amidst the financial crisis in SL. Methodology: In this study, Delphi indicators have been utilized to identify the demarcations of labor trafficking. The data was collected from thirty interviews conducted with family members of labor migrants who migrated to GCC in 2022. Results: The results indicate that shortcomings in the governance of labor migration during the financial crisis in SL have led to an increase in labor trafficking. Conclusion: The paper concludes with the discursive, implementation, and efficacy gaps in the governance of labor migration and suggests a right-based framework to guarantee equitable recruitment procedures.