CONFERENCE REPORT SUMMARY

ReAct-DMDC-SPR Southeast Asia Regional Conference: Dealing with Antimicrobial Resistance and Strategic Plan for Drug System Monitoring & Development

2-4 May 2011 Twin Towers Hotel, Bangkok,

1. The ReAct-DMDC-SPR Southeast Asia Regional Conference: Dealing with Antimicrobial Resistance and Strategic Plan for Drug System Monitoring & Development, was held from 3 to 4 May 2011 at the Twin Towers Hotel, Bangkok, Thailand. The conference was jointly organized and sponsored by ReAct and the Drug System Monitoring and Development Program, Social Pharmacy Research Unit, Chulalongkorn University, Bangkok, Thailand.

2. The goal of the conference was to sustain the dialogue, among key stakeholders, towards a regional agenda for action, including especially national and regional policy platforms on ABR. The objectives were to share and learn from country activities, projects and programs, with a focus on successful initiatives that can be further developed into cross-country or regional programmes.

3. Some 200 Thai and 25 participants from the region (Indonesia, Malaysia, Philippines, Thailand, and Vietnam) attended the conference.

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4. The conference kicked off as a common plenary meeting of all participants in the morning of Day 1. The rest of the conference was organized into two parallel meetings, one of the Thai participants and the second of the regional participants, with a small group of Thai delegates assigned to participate in the regional meeting. Both meetings focused on similar themes of sharing experience, knowledge and initiatives undertaken, with the aim of developing an action plan for the year.

5. The Thai stakeholders’ meeting was organized around the following themes:  Addressing the issue of irrational drug use at the community level.  Addressing the problems of advertising and promotion of health products.  Promoting the rational use of drugs through art media.  Rational use of drugs campaign and safety in using drugs in hospitals: sharing.

2 6. The conference was preceded by two related ReAct-sponsored study visits. The first was that of participants from four , engaged in setting up Antimicrobial Stewardship Program (ASP) activities in the country, visiting three public hospitals in Singapore, which have established the ASP (27-28 April 2011). The second was a study visit of nine participants from Indonesia, Malaysia and Philippines to the Antibiotic Smart Use Project site at Lungkoa Primary Health Center, Muaklek District, Saraburi Province, Thailand on 2 May 2011.

7. Since June 2006, ID Pharmacists have been actively running the Antibiotic Stewardship Program at Singapore General Hospital, auditing the use of vancomycin and carbapenems throughout the hospital. Following decreased consumption of these antibiotics and more appropriate prescribing behaviour, the program expanded in 2008 to include eight more broad- spectrum antibiotics. Clinical microbiologists, infection control officers and ID physicians joined the ASP to provide a more holistic service. Tan Tock Seng Hospital launched their ASP in 2009, which includes guidelines on AB use for patients and a computer system that provides advice on antibiotic prescriptions. This has resulted in a 13 per cent fall in the use of five powerful antibiotics, without any compromise to patient safety. Together with a hand- hygiene programme introduced in 2009, it led to the incidence of drug- resistant bacteria dropping by 36 per cent between January 2009 and December 2010.

8. The success of the ASU interventions at the community level, it was observed, was the result of several strategic approaches. These included sensitivity to local context, personalized messages, real interactive collaboration with local stakeholders, use of local champions and use of tried and tested traditional treatments. The program is now in phase three and has become a dynamic peoples’ project – decentralized and networked.

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9. A press conference was convened to witness the awards ceremony for the winners of the Antibiotic Smart Media Competition. Organised by the Drug System Monitoring and Development Program and Thai Health Promotion Foundation, the competition was opened to primary, secondary and tertiary schools as part of the campaign to promote the smart use of antibiotics. Contestants had submitted posters, writings and videos on the message of “Antibiotic Smart Media: Do not use antibiotics without necessity”. The student contestants were also invited to a “Meet and Greet” event with Thai health experts, with a view to encourage the rational use of antibiotics, exchange experiences as well as to develop thinking skills by sharing through media.

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10. Participants also shared activities and events organized around World Health Day 2011, in Indonesia, Malaysia, Philippines and Thailand, which carried the theme of Antimicrobial resistance: no action today, no cure tomorrow.

11. There were five panel sessions on the themes of 1) ABR-RUD initiatives in the region; 2) Antimicrobial Stewardship program in Singapore and Thailand; 3) Antimicrobial Resistance Control Program in Indonesia; 4) Research and Studies in the region; and 5) Further Initiatives. The meeting also saw a discussion on ‘Artists and new communication approaches for health promotion on ABR’.

12. After two days of presentations and deliberations, participants of the regional meeting put together a ReAct-SEA Regional Plan of Action, which called for the development of projects in the following areas:

 A regional community-level Antibiotic Smart Use Programme  A regional hospital-based Antimicrobial Stewardship Programme

5  A model generic curriculum related to AMR for healthcare professionals  Research in the region on: 1) Differences in health outcomes and costs of hospital and community acquired bacterial infections in relation to ABR; 2) Community dispensing of AB; 3) Country ABR Index; 4) AB use in farm food production  A network of cities around the world/region to champion and collaborate on the smart use of antibiotics

13. Participants agreed to work with ReAct and its partner institutions in the region to further discuss and develop these action-plan ideas towards project development, fund raising and implementation.

14. Participants also agreed that another positive outcome of the meeting was an expanded and strengthened network, which should continue with information-communication sharing, collaboration in regional programmes and projects and other forms of support to local initiatives.

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15. ReAct regional process conclusions:

I. Keep regional process going II. Facilitate process of linkage, cross-learning, research/analysis, education development III. Expand network IV. Facilitate collaborative projects; Describe and make them visible V. Larger regional conference in 2012/13 VI. GOAL: Work toward a regional platform for change in ABR: data, experience, showcase, sharing and learning, engaging those who can act, champions!

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PARTICIPANT LIST

Thailand

Dr. Niyada Kiatying-Angsulee, Chair, Social Pharmacy Research Unit, Faculty of Pharmaceutical Sciences; Director, Social Research Institute; Manager, Drug System Monitoring and Development Program, Chulalongkorn University, Thailand.

Dr.Kumthorn Malathum, Ramathibodi Hospital, Mahidol University, Secretary General, Infectious Disease Association, Secretary General, Infectious Disease Association of Thailand; Chair, Antibiotics Working Team, Faculty of Medicine Ramathibodi Hospital Thailand.

Dr. Nithima Soompradith, Senior Pharmacist, Food and Drug Administration; Assistant Director, International Health Policy Program, Ministry of Public Health, Thailand

Ms. Pornpit Silkavute, Health Systems Research Institute, Ministry of Public Health, Thailand

Dr.Pisonthi Chongtrakul, Faculty of Medicine, Chulalongkorn University, Director of the Antibiotic Smart Use Project, Thailand

Dr. Roungtiva Muenpa, Head of Acute Care Unit, Head of Human Resource System and research Development Unit , Pharmacy Department, Hospital, Thailand.

Yaowapha Shaijarernwana, Head, Drug Information Unit, Department of Pharmacy, Maharat Nakorn Chiang Mai Hospital, Thailand

Dr. Sripetcharat Mekviwattanawong, Department of Medicine, Phra Nang Klao Hospital, Nonthaburi, Thailand

Dr. Patcharasarn Linasmita, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, HRH Princess Maha Chakri Sirindhorn Medical Center, Thailand

Dr.Somying Poomtong, Faculty of Pharmacy, Srinakharinwirot University, THAILAND.

Dr. Sirikiat Liangkobkit, Thai Health Promotion Foundation.

Mr. Panya Chayakam, Veteran Thai artist, working on ecological and wildlife themes in the medium of painting and sculpture.

Dr. Yoel Lubell, MSc Public Health, PhD Health Economics, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.

Mr. Marwaan Macan-Markar, IPS Journalist, Thailand.

Dr Siriwat Tiptaradol, Secretary General, Thai Food and Drug Administration. Ministry of Public Health, Thailand.

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Dr. Purnamawati S. Pujiarto, Clinical Pediatrician, Project Director on Empowering community through promoting RUM and patient safety; World Alliance for Patient Safety; Advisory board, Foundation for Older Persons Care, Indonesia.

Dr. Hari Parathon, Sutomo Hospital, Surabaya, Indonesia.

Dr. Hidayati Mas’ud, Apt., Head, Sub-directorate of Rational Use of Drug

Ms. Zorni Fadia, Chief, Sub-Directorate of Standardization, Directorate of Pharmaceutical Services, Ministry of Health, Indonesia

Dr. Erie Gusnellyanti, SSi., Apt, Head of Section of Standardization of Pharmaceutical Services, Ministry of Health, Indonesia.

Malaysia

Dr. Jaya Balan, Health Advisor, Consumers Association of Penang; Senior Lecturer, Discipline Of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.

Dr. Mohamed Azmi Ahmad Hassali, Senior Lecturer, Discipline Of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.

Dr. Asrul Akmal Shafie, Lecturer, Discipline Of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia. Dr. Claire Italiano, Senior Lecturer, Infectious Diseases, University of Malaya Medical Centre, Malaysia

Ms. Kalyhani Nagappa, USM Pharmacy Student, Community Health Worker, Penang, Malaysia

Ms. Nor Izreen Fazlinda Binti Idris, USM Pharmacy Student and Community Health Worker, Penang, Malaysia

Ms. Vilasini, Registered Nurse, Community Health Worker, Penang, Malaysia.

Nepal

Kadir Alam, Assistant Professor, Department of Pharmacology, Manipal College of Medical Sciences, Pokhara, Nepal.

Philippines

Prof. Dr. Isidro Sia, Department of Pharmacology and Toxicology, College of Medicine, University of the Philippines, Manila, Philippines.

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Vietnam

Ms. Nguyen Thi Thuy Nguyen, Epidemiological Field Laboratory of Bavi, Project, on “Antibiotic resistance a global challenge” - contextualized interventions to improve infection control and antibiotic management in Vietnam and India, Vietnam.

Ms. Do Thi Thuy Nga Coordinator-GARP, Oxford University Clinical Research Unit, NHTD-Bach Mai Hospital, Vietnam

Dr. Heiman Wertheim, Oxford University Clinical Research Unit; GARP Coordinator Vietnam, National Institute of Infectious and Tropical Diseases, Bach Mai Hospital, Vietnam.

Dr. Mattias Erik Larsson, Hanoi Medical University (as representative for Karolinska Institutet, Department of Public Health Science, Division of International Health and Dept. of Infectious Diseases), Vietnam.

WHO Dr Madeleine de Rosas-Valera, Technical Officer for Patient Safety, WHO-WPRO

Dr. Maureen Birmingham, WHO Representative, Thailand.

ReAct

Dr. Mary Murray, Global Network Coordinator, ReAct, Australia.

Mr. Satya Sivaraman, Information and Communications Coordinator, ReAct, India.

Dr. Michael Chai – ReAct SEA Coordinator, Malaysia/Thailand

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