Refinement of a scoping tool to tackle antimicrobial resistance via a primary health care approach: insights from Kazakhstan, Sweden, and Thailand.

Abstract

WHO recommends a primary health care (PHC)-oriented health system for delivering high-quality, equitable, and efficient care in all countries. Primary care and the community serve as the frontlines for preventing and managing infections and addressing the rise of antimicrobial resistance (AMR). WHO developed a scoping tool to identify AMR-relevant interventions that can be used to strengthen PHC-oriented health systems and applied it to country reviews in Kazakhstan, Sweden, and Thailand. The objective was to identify AMR interventions in primary care and the community that are context relevant, improve quality of care, and strengthen health systems. These interventions included the integration of AMR-related efforts, antimicrobial stewardship, and infection prevention and control into health system policies, practice, and governance; promotion of appropriate antimicrobial use, including use of routine health data; stronger pre-service education and in-service training and support for the primary care workforce; and ensuring access to essential medicines while enforcing regulations on non-prescription sales of antibiotics. Foundational elements of health systems such as water, sanitation, and hygiene and immunisation programmes were also essential for a comprehensive AMR response. This process highlighted the need to engage with a diverse range of stakeholders and to consider social and contextual differences when designing AMR-relevant interventions. National AMR programmes should collaborate with health-system planners to integrate AMR-related interventions into PHC-oriented health systems, strengthening them to drive progress in countries towards universal health coverage while achieving global targets on AMR.