Purpose of consultancy

Antimicrobial Stewardship (AMS) involves adopting systematic measures to optimize antimicrobial use to decrease the emergence and spread of resistance, optimise patient care, and improve clinical outcomes. Jordan is preparing to implement a Hub and Spoke model (the model) to support the country in improving the appropriate use of antibiotics and to enable optimal access and maximisation of scarce resources.

The purpose of this consultancy is to support Jordan Ministry of Health and WCO, in close coordination with Regional Office in establishing the model.

2. Background

Antimicrobial resistance (AMR) is a global public health crisis, and Low- and middle-income countries (LMICs) face a disproportionate AMR burden. Inappropriate antimicrobial use is among the key drivers of AMR. There are several factors that may lead to inappropriate antimicrobial use—and these include prescriber related factors (e.g. lack of knowledge, lack of confidence in microbiology results, and market incentives), patient related factors (lack of knowledge, unnecessary pressure on prescribers), and health systems factors (unavailability of antimicrobials, poor microbiology facilities and poor infection control practices).

Antimicrobial Stewardship (AMS) involves adopting systematic measures to optimize antimicrobial use to decrease the emergence and spread of resistance. The World Health Organization (WHO) created a practical toolkit for developing Antimicrobial Stewardship Programs (ASPs) in 2019. There is online training available to understand and use the toolkit. This is complemented by another Open WHO Course on WHO policy guidance. In addition, WHO has a structured competency-based modular online training programme for AMS which use clinical situations and case studies. This is perceived to be an effective resource for clinicians who frequently prescribe antimicrobials with knowledge and tools to improve their use of these essential medications in daily clinical practice.

The proposed model: The proposed model is an adapted version of the traditional Hub-and Spoke model in healthcare service delivery and programs. The traditional model involves the establishment of a central facility or hub, complemented by satellite facilities or spokes. Reviews have shown that the hub-and-spoke model is a highly scalable, efficient design in regular medical care provision. In a typical hub-and-spoke network design, the hub offers a full array of services, and spokes offer more limited-service arrays, but complemented by secondary establishments. The Spokes refer patients needing more intensive services to the hub for treatment. Benefits include consistency across operations and policies, increased efficiencies, enhanced quality, and improved agility. In the proposed model, a hospital (the Hub) will be developed as a Centre of Excellence (CoE) for Antimicrobial Stewardship Programs (ASP). Thus, in addition to serving as a Hub for the initial Hub and Spoke model, the CoE will also support establishing new Hubs across country subsequently.

There are three broad phases envisaged in the Consultancy:

Phase One: 2-4 Months 2024

It identifies and prepares a hospital to be developed as CoE (“The Hub”).

This starts with a preliminary assessment for the selected facility, which should ideally be a ‘general’ hospital, with good IPC and bacteriology lab facilities.

3. Work to be performed.

Output 1: Country mission to support the selected Hub to develop a detailed tailored action plan based on the initial AMR/AMC data available to identify responsible staff and specific milestones.

The mission will include consultation meetings with the MOH AMS team and working groups; site visits to AMS sites; and meeting with Hakeem (the national Health Information System) to support the national AMR surveillance team in using data to guide AMS.

3 days mission to Jordan.

Deliverable 1.1: Practical advice, with outline and content of the hospital AMS plan, to bridge the gaps between IPC and AMS based on the assessment outcome.

Deliverable 1.2: Support implementation and monitor AMS programs, including establishing functional multidisciplinary AMS teams in the selected sites/hospital.

Deliverables 1.3: Work with Hakeem to develop an application to analyze data which will help to monitor compliance with guidance and protocols (a simple dashboard with indicators may be helpful).

Deliverable 1.4: Develop mission report with gaps findings and recommendations.

Output 2:

Online coaching sessions every week or every two weeks

In consultations with the national AMS central team, review and revise the national and hospital SOPs for sample collection procedures and laboratories linked to the availability of adequate supplies.

Deliverable 2.1: Develop well-defined national KPIs for AMS that can be measured and monitored over time including utilizing AMC/U and AMR surveillance data and diagnostic and patient information available to inform AMS

Deliverable 2.2: Advise on enhancing the coordination and/or integration of facility committees (e.g., on IPC, drugs, and therapeutics) and AMS committees and teams.

Deliverable 2.3: Build a closer working relationship between clinical staff (at the hospital level) and Hakeem to improve the timeliness of updating drug prescription/use data.

Deliverable 2.4: Provide technical Support to the AMS team to develop, implement, and monitor AMS programs, including establishing functional multidisciplinary AMS teams in each hospital.

Deliverable 2.5: Support the national team to monitor the progress in collaboration with the hospital

4. Qualifications, experience, skills and languages

Educational Qualifications:

Essential: Advanced degree (Master’s degree) in Infectious diseases, medical microbiology or infectious diseases epidemiology and hospital infection control.

Experience:

Essential: 10 years or more clinical of programmatic experience in AMR particularly on antibiotic stewardship. Experience in setting up and managing AMS programs.

Physician with observed current practical experience in AMR and antibiotic stewardship at the hospital level.

Desirable: Experience in WHO AMR missions and meetings at the Global and regional and country level.

Skills/Technical skills and knowledge:

Leadership and mentoring skills to enhance the national capacities for Stewardship, empowering physicians and clinical pharmacists, and generating and utilizing data to help physicians make better empiric antibiotic treatment choices, resulting in better patient outcomes.

Languages and level required:
Expert level in English and Arabic