7 Monitoring

AMS programmes should select the most relevant and feasible metrics to monitor for the specific objectives. For example, one objective of AMS is to ensure access to effective and affordable antimicrobials; an indicator for this objective is the percentage availability of these antimicrobials. This can be reported periodically at regular AMS committee meetings. Another indicator for institutional AMS is the percentage compliance to antimicrobial prescription guidelines.

There is no value in monitoring or auditing without timely feedback to managers and health workers at unit or ward level. Regular feedback promotes best practices and, over time, results in behaviour or system change towards improved quality of care and patient safety, with a goal to reduce AMR.

Changes can be made in response to feedback aiming for a better understanding of patients’ clinical needs and treatment options, and the effects of those changes can themselves be monitored and fed back to assess whether interventions are effective, and where further improvements are indicated. In this way, individual prescribers also learn by using the feedback and are engaged in the overall process.

Impact indicators help in the setting up of governance structures, policies and strategic elements such as the national surveillance systems and processes for the AMS strategy framework. Impact indicators for AMR strategy and implementation include percentage reductions in:

• key resistant organisms
• national consumption of antimicrobials linked to key resistant organisms
• maternal mortality from infectious diseases
• neonatal mortality from infectious diseases.

Figure 10 gives an overview of the steps involved in implementing AMS in LMICs.

Figure 10 Step-wise implementation of AMS in LMICs.

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Implementing AMS in LMICs is a cycle that begins with defining specific aims that are well-defined, realistic and related to ASP objectives. The next step is to assess current performance and barriers to reach aims. Then you decide on an intervention strategy, based on science. To do this, you must include core components and design a feasible programme that is tailored to local requirements. The final step is to evaluate the AMS using proper techniques and plans for sustainability; this feeds into the first step of defining specific aims.

Figure 10 Step-wise implementation of AMS in LMICs.