Antimicrobial resistance project in Alappuzha emerges as a model initiative

An antimicrobial resistance (AMR) awareness and mitigation programme being implemented across Alappuzha district by the Health department with the active participation of local self-government bodies, has emerged as a model initiative in the country, replicable by other States.

“Amaram’, which was presented at the 10th national summit on Good and Replicable Practices in New Delhi last week, received national attention. Amaram was one of the key interventions launched in Alappuzha district to create community-based awareness and control measures against antimicrobial resistance. Under the initiative, several model interventions were implemented in the health sector as well as in local self-governments, in coordination with multiple departments, grounded in the One Health concept.

The project was initially launched in 12 grama panchayats in Alappuzha. Under Amaram, selected hospitals were to be developed as antibiotic-smart hospitals and selected local bodies as antibiotic-literate panchayats.

Under the Kerala Antimicrobial Resistance Strategic Action Plan (KARSAP), the State has conceptualised how antibiotic-smart hospitals and antibiotic-literate local self-government institutions should be.

Antibiotic-smart hospitals are health-care institutions which implement a pragmatic model of antimicrobial and diagnostic stewardship while ensuring compliance with standard infection prevention and control (IPC) practices.

These hospitals act as a source of continuous ‘information, education, and communication’ (IEC) activities to health-care workers and the public. Community-based campaigns organised according to an AMR awareness activity calendar strengthened the programme’s foundation.

‘An abstract concept’

“Antimiocrobial resistance is a very academic term and an abstract concept and it is very difficult to communicate to people. People are familiar with what an antibiotic is but they get confused when the concept of ‘resistance’ is introduced because it is not the human body, but the bacteria which becomes resistant to antibiotics. Because AMR is a problem that develops in the long term and is invisible, people think that there is no immediate threat. Thus, getting the concept across to the community is tough and it becomes tougher still to get people to change their pill-popping behaviour,” a senior Health official said.

A wide range of activities were implemented, including training to strengthen infection prevention and control systems in hospitals, awareness programmes on hand hygiene, food and environmental sanitation, and disease prevention, as well as large-scale initiatives on neonatal care and palliative patient care.

100% compliance

The first phase prioritised training, awareness, and infection control. Surveys were conducted to assess awareness levels. Post-intervention evaluations showed hospitals achieved 100% compliance with standards, while local self-government bodies achieved 90%. The second phase saw stronger awareness programmes and hospital-based interventions.

Four out of the five antibiotic-literate panchayats in Kerala are from Alappuzha, where 14 hospitals have been designated as antibiotic-smart hospitals. Efforts are on to make all hospitals in the district antibiotic-smart.