Containing Antimicrobial Resistance: Kenya’s Systems Approach

View the original blog post on the Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program website.

Antimicrobial resistance (AMR) is a dire problem in Kenya. There are already high levels of resistance to common first-line drugs and rising infections from life-threatening pathogens, including those leading to pneumonia, salmonella, and gonorrhoea.

Just as AMR involves many sectors—human, animal, and environmental health—containing it requires a consultative, comprehensive, and systemic approach. That means first strengthening the institutions, processes, and people who are leading the effort at every level of the health system.

In 2017, Kenya developed a policy and national action plan aimed at reducing the burden of AMR in the country. Under this framework, the USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program has been supporting the government since 2019 to implement an AMR strategy using a systemic approach. The MTaPS team has been working closely with national, county, and health facility managers and health care workers in three key areas, guided by the program’s Global Health Security Agenda mandate:

Boosting multisectoral coordination

In line with the World Health Organization’s (WHO) One Health approach, MTaPS aims to improve coordination among the human, animal, and agricultural sectors and their shared environment. To that end, we helped Kenya’s Ministry of Health (MOH) launch its National Antimicrobial Steering Inter-Agency Committee (NASIC) in 2019, which is aligned with the country’s AMR policy. MTaPS worked with NASIC’s technical working groups to review their terms of reference and is supporting the development of a monitoring and evaluation framework for the national action plan on prevention and containment of AMR.

Implementing antimicrobial stewardship programs

Promoting sound antimicrobial stewardship (AMS) at the point of care helps to keep antimicrobials effective by decreasing inappropriate use.

MTaPS supported the launch of the National Medicines and Therapeutics Committee, which subsequently revised Kenya’s essential medicines list and incorporated AWaRe (Access, Watch, Reserve) antibiotics categorization. The country is the first among low- and middle-income countries to do so. MTaPS collaborated with other partners to support the MOH to develop the first national AMS guidelines, with plans for wide dissemination and support for implementation. We made sure the Kenya AMS 2019 guidelines included the appropriate county and health care facility governance structures.

To institutionalize appropriate medicine use practices at the facility level, MTaPS trained Medicines and Therapeutics Committees and AMS health facility teams from health facilities in Nyeri and Kisumu counties and Gertrude’s Children’s Hospital on rational use, antibiotic stewardship, medicine use evaluations, and antibiotic use audits.

The work on AMS extends to preservice pharmaceutical management, and MTaPS is working with the University of Nairobi School of Pharmacy to reform the preservice curriculum to integrate AMS-related topics. The program also provides ongoing technical assistance to the Pharmaceutical Society of Kenya to develop a AMS training course linked to continuing professional development and relicensure for delivery through the professional association.

Improving infection prevention and control

Kenya has inadequate capacity for implementing infection prevention and control (IPC) interventions, including a weak monitoring, follow-up, feedback, and support system for complying with IPC guidelines and standards. MTaPS worked to build sustainable institutional and human resource capacity. At the national level, we provided technical assistance to the National Infection Prevention and Control Advisory Committee and the MOH Patient and Health Worker Safety Division to review the existing policy for health care workers.

At the county level, we’ve been helping county leadership to establish IPC governance structures and operations in Nyeri and Kisumu counties, but our work reaches frontline health care workers. We’ve also supported 16 health facilities in both counties to implement a continuous quality improvement approach in implementation of their IPC activities. Specifically, MTaPS-supported activities included a baseline assessment, capacity building workshops, establishing IPC committees, supportive supervisory visits, and ongoing professional development.