Antimicrobial resistance (AMR) poses a global crisis that threatens advancements in healthcare and achievement of both, Sustainable Development Goals and Universal Health Coverage, according to a press release from the World Health Organisation (WHO). It influences our ability to provide effective health treatments, impacts food production, and ultimately affects life expectancy.

To address AMR, multiple interventions should be carried out, including reviews on infection prevention control and water, sanitation, and hygiene (IPC-WASH) in human and animal health sectors, as well as developing interventions designed to promote the optimal use of antibiotic agents, or commonly referred as antimicrobial stewardship (AMS).

In Indonesia, improper management of medical waste and limited implementation of infection prevention control measures in healthcare facilities contribute to the rise of AMR. These gaps call for the IPC-WASH and AMS assessments.

The AMR Multi-Partner Trust Fund (MPTF) in Indonesia, which consists of WHO, Food and Agriculture Organization (FAO), and World Organisation for Animal Health (WOAH), conducted these assessments from November 2022 until January 2023. Four pilot districts in Central and East Java were selected to carry out the assessments in 33 primary health centres, 18 hospitals, and 160 poultry farms.

IPC-WASH and AMS results

The assessments revealed several challenges: 

• Limited budgetary support hindered the implementation and monitoring of IPC and WASH in healthcare facilities. 
• There is a shortage of healthcare staff and difficulties in implementing WASH in rural areas, especially hygiene services. In terms of AMS, insufficient financial support for education and infrastructure created gaps in implementation. 
• There are variations in the adherence to written IPC guidelines in poultry farms. IPC implementation in poultry farms, including biosecurity, cleaning and disinfection, and waste management reached up to 77% in Karanganyar, 72% in Boyolali, 68% in Blitar, and 54% in Malang.

These assessments raised awareness among healthcare workers, veterinarians of the Livestock Offices and poultry farmers. They serve as a basis for improvements, allowing participants to plan more effectively.

“Now that we have information about challenges in our healthcare facilities, we can plan for improvements. We plan to disseminate the assessment results to all related staff in the District Health Office, hospitals, and Puskesmas, and provide regular technical assistance to Puskesmas,” said Muhdianto, Head of the Medical Services Department, Blitar District Health Office.

Both assessments emphasized the importance of strong IPC-WASH implementation, as it promotes effective AMS practices in healthcare facilities and poultry farms. This contributes to preventing development and spread of AMR in the food sector, a vital concern for Indonesia.

Proposed action

Recently, the Indonesian AMR MPTF team held a high-level meeting involving national and local governments, where study results were shared, and the team advocated for the strengthening of IPC and WASH measures in pilot areas. The proposed action includes wider dissemination of IPC-WASH and AMS and enhancing the capacity of healthcare workers and officials at the provincial and district levels. Moving forward, the team aims to collaborate with local governments in the pilot districts to strengthen commitment and develop joint planning for further improvements. The experiences gained from these districts will serve as valuable references for other districts to adopt the IPC and AMS strategies in their efforts to effectively combat antimicrobial resistance.