Background

A recent global analysis estimated that in 2019, an estimated 1.27 million deaths were directly attributable to bacterial antimicrobial resistance (AMR), with low- and middle-income countries (LMICs) disproportionately impacted. The WHO Southeast Asia region, including Indonesia, is considered an AMR hotspot.

Antibiotic consumption is one of the key drivers, and antimicrobial stewardship programmes (ASPs) have been shown to improve rational antibiotic use and clinical outcomes in high-income settings. However, context-specific evidence is lacking on the value and effectiveness of current antimicrobial stewardship models in LMICs. In Indonesia, the National Action Plan for AMR since 2017 and the nationwide hospital ASP since 2018 have not yet generated the required sustainable change to contain AMR.

The impact of the COVID-19 pandemic on Indonesian nationwide ASP implementation has not been assessed. There is an urgent need to design well-informed, context-specific AMS interventions at the country, province and facility levels that address the local drivers of inappropriate antibiotic use. To date, Indonesia lacks national and sub-national level data/report assessing the progress of nationwide ASPs implementation.

Aims

This project aims to conduct a nationwide assessment of the current state of implementation of hospital ASPs across all 37 provinces to inform stakeholders on the current stage of AMS implementation, their barriers and enablers, and to estimate the impact of COVID-19 at a local level. Supported by the Ministry of Health and the national AMR control committee, the generated information will be used to learn lessons on the vulnerabilities/resilience of local health systems to deal with shocks like COVID-19, and to inform locally relevant actions and policies.