Reaching beyond health to accelerate the fight against AMR in Nepal

Nepal suffers from a high burden of antimicrobial resistance (AMR). In 2019, the country recorded 6400 deaths directly caused by AMR and 23 200 deaths in which AMR was a contributing factor, making it one of the top three causes of deaths in the country.

When Nepal initially developed its National Action Plan (NAP) on AMR in 2016, it was solely within the purview of the Ministry of Health and Population (MoHP). Reiterating the need to address AMR through a coordinated, multisectoral, One Health approach, WHO Country Office (WCO) for Nepal advocated for redrafting of the action plan to ensure engagement of all relevant ministries, academia and development agencies. The revised National Action Plan for AMR, drafted with WHO support, was endorsed by Nepal's Cabinet in 2024.

"By engaging all relevant stakeholders in the drafting phase itself, we were able to generate a sense of ownership of the document among all sectors which proved to be a good practice," said Dr Rajesh Pandav, WHO Representative to Nepal.

While MoHP remains the lead counterpart, WCO Nepal has extended technical collaboration with other ministries, government agencies and national institutions for addressing AMR.

These include collaborations with the environment sector to support survey of antimicrobial residues in wastewater, collaboration with food and agriculture sector for integrated surveillance of AMR through implementation of the ESBL E coli Tricycle Project, engagement with youth groups for awareness raising on AMR, fostering operational research on AMR for Nepalese researchers across different sectors including animal health, food and agriculture, and capacity building of lab personnel. Similarly, each year WCO has been observing World AMR Awareness Week in collaboration with quadripartite parties.

A medical lab technologist processing water samples to detect AMR-causing organisms at the National Public Health Laboratory, Bagmati Province, Nepal. Credit: National Public Health Laboratory

WCO Nepal's support on conducting AMR surveillance has made it possible to assess the status of AMR in Nepal. For example, the National AMR surveillance data from 26 hospitals across Nepal indicates high prevalence of multi-drug resistance among common pathogens like E. coli (51%), Klebsiella spp. (56%) and Acinetobacter species (72%). Resistance to important antimicrobials like carbapenems, third generation cephalosporins is also increasing. Likewise, data on antimicrobial consumption also shows higher consumption of antimicrobial (>60%) from watch group of antimicrobials.

Furthermore, the emphasis on One Health approach in policy documents such as the National Health Policy (2021), National One Health Strategy (2019) show the government's recognition of the importance of multisectoral collaboration to address complex health challenges.

"Through our work on AMR, we have been able to demonstrate the importance of multisectoral collaboration and coordination to tackle important health issue. Learnings from this work have also been applied to other programme areas like NCDs," said Dr Rajesh Pandav, WHO Representative to Nepal.

Furthermore, the identification of working across sectors effectively as one of the goals of the ARG Plan has enhanced WCO Nepal's initiatives on multisectoral collaboration.

Most recently WCO Nepal partnered with a youth organization called NYMAT-Nepal to launch the Youth Against AMR campaign which aims to empower young leaders with the knowledge, skills and tools to drive innovative solutions and build resilient communities in the face of AMR.

As of November 2024, more than 2700 young people have signed up to join the campaign. After completing various AMR-related courses on Open WHO and undergoing orientation from WHO staff, these volunteers will be mobilized to conduct awareness programs on AMR within their communities.

"We are proud to partner with WHO to combat the growing threat of AMR. Together, we are empowering communities, especially youth, to be agents of change and ensure a healthier future for all," said Madhusudan Kaphle, the founder and executive director of NYMAT Nepal.

With continuous engagement and sensitization efforts across sectors, AMR now sits high among the list of priorities for the Government, as evidenced by important policy decisions such as:

• mandatory display of red line in antibiotics packaging;
• prohibition on import, sale, distribution and manufacturing of antibiotics that are not on WHO-recommended list;
• prohibition on the use of antibiotic in poultry feed; and
• minimum service standards (for hospitals) have included antimicrobial stewardship and infection prevention and control programmes.

Following the successful multisectoral engagement on AMR, WCO Nepal has extended collaboration in areas including IHR-JEE, IHR-SPAR, IHR-PVS bridging workshops. Additionally, WCO Nepal is leveraging partnerships with other UN agencies and international/national organizations for addressing resource gaps to address AMR.

WHO will continue to support the Government of Nepal to combat the threat of AMR and protect the health and well-being of the people of Nepal.

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