Compliance with South Africa’s Antimicrobial Resistance National Strategy Framework: are we there yet?

Abstract

Antimicrobial resistance (AMR) is a growing problem worldwide. South Africa has recently released its Antimicrobial Resistance National Strategy Framework (referred to as the Framework) to instigate antimicrobial stewardship programmes (ASPs). Consequently, there is a need to assess compliance with the Framework. Methods: Descriptive study design, collecting quantitative data, among pre-selected public healthcare facilities. One healthcare professional from each participating facility, involved in ASPs, was invited to participate. Results: Overall 26 facilities from 8 provinces participated. Average compliance to the Framework was 59.5% for the 26 facilities, with 38.0% for community health centres, 66.9% for referral hospitals and 73.5% for national central hospitals. For 7 facilities compliance was <50% while 5 facilities were >80% compliant. Conclusion: Although some facilities complied well with the Framework, overall compliance was sub-optimal. With the introduction of universal healthcare in South Africa, coupled with growing AMR rates, ongoing initiatives to actively implement the Framework should be targeted at non-compliant facilities.

Keywords:

• antimicrobial resistance
• framework
• compliance
• antimicrobial stewardship
• hospitals
• healthcare centres
• South Africa

Acknowledgements

Mr Danie Kruger developed and modified the online questionnaire for this particular research project. Mr Katlego Mokgwabone assisted with the statistical analysis. Mrs Colleen Mitchell provided assistance in editing the manuscript. The South African Medical Research Council Newton Scholarship grant awarded to the third author in February 2017, provided a platform to formulate the research topic, with no monetary support received.

Disclosure statement

The authors report no conflict of interest.

Additional information

Notes on contributors

Deirdré Engler

Deirdré Engler is a lecturer in the Clinical Pharmacy Division of the School of Pharmacy. Her main research interests are in antimicrobial stewardship, pharmacotherapy and medicine utilisation review to enhance the rational use of medicines.

Johanna C. Meyer

Johanna C. Meyer is a registered pharmacist and Professor, specialising in vaccination as an important pillar of antimicrobial stewardship, and the rational use of medicines at all levels of care within the field of public health pharmacy. Her research aims to strengthen healthcare services, improve public health, and contribute towards reaching the sustainable development goal of good health and well-being.

Natalie Schellack

Natalie Schellack is a registered pharmacist, Professor. She holds three degrees, two bachelor degrees (nursing and pharmacy) and a PhD in Pharmacy. Her research interests are centred on the broad area of clinical pharmacy as related to paediatrics, ototoxicity and infectious diseases (e.g. TB and HIV). She is also a rated researcher (C2) as awarded by the National Research Foundation (NRF), furthermore she is the fourth elected member of the South African Antimicrobial Stewardship Programme (SAASP).

Amanj Kurdi

Amanj Kurdi is a lecturer in pharmacoepidemiology and Pharmacy Practice with research interests in Drug Utilisation Research around NCD and infectious diseases as well as adherence/persistence to medications using secondary database analysis and patient level data through applying various statistical and analytical techniques. Also interested in Health service research and evaluating the impacts of health policies and clinical guidelines.

Brian Godman

Brian Godman is a Professor working with health authorities, clinicians and pharmacists across countries and continents to improve the management of patients with infectious diseases. This includes PPS studies in hospitals as well as the instigation of quality improvement programmes including AMS programmes, and in ambulatory care initiatives to reduce inappropriate prescribing and dispensing of antibiotics, which has resulted in multiple publications.