Achievement

Antimicrobial Resistance Awareness and Mitigation Programme (AMARAM) is a community-based programme implemented in Alappuzha District to generare public awareness on the issue of Antimocorbial Resistance.  The Programme has been selected at the 10th National Summit on Innovation and Inclusivity as a Best Practice Shaping India’s Health Future.

Antimicrobial medicines are the cornerstone of modern medicine. The emergence and spread of drug-resistant pathogens threatens our ability to treat common infections and to perform life-saving procedures including cancer chemotherapy and caesarean section, hip replacements, organ transplantation and other surgeries.  In addition, drug-resistant infections impact the health of animals and plants, reduce productivity in farms, and threaten food security.

AMR has significant costs for both health systems and national economies overall. For example, it creates need for more expensive and intensive care, affects productivity of patients or their caregivers through prolonged hospital stays, and harms agricultural productivity.  

AMR is a problem for all countries at all income levels. Its spread does not recognize country borders. Contributing factors include lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals; poor infection and disease prevention and control in homes, healthcare facilities and farms; poor access to quality and affordable vaccines, diagnostics and medicines; lack of awareness and knowledge; and lack of enforcement of relevant legislation. People living in low-resource settings and vulnerable populations are especially impacted by both the drivers and consequences of AMR.

Kerala Health has iniated series of policy interventions to contain the problem in tis root.  Kerala Anti Microbial Resistance Strategic Action Plan is a One Health Response andone of its first in the country that considerably reduced the abuse of anbtibiotics.  nPROUD (New Programme for Removal of Unused Drugs) is another initiative by the Kerala Health to dispose expired antibiotic drugs scientifically.  AMRITH (Anti Microbial Resistance Intervention for Total Health) is another initiative to enforce regulations to control Over The Counter (OTC) sale of antibiotics (sale/ purcace of antibiotics with out an active prescription by a registered medical practitioner)

AMARAM works in coordination of multiple departments and the support of Local Self Government Institutions to ensure interventions across different sectors.

Through localized interventions, AMARAM envisions and implements activities for AMR control in the district. In the first phase, the programme was implemented in 12 Grama Panchayats, selecting one panchayat from each health block, namely, Veeyapuram, Mararikulam South, Ezhupunna, Panavally, Muhamma, Ambalappuzha South, Thakazhi, Vallikunnam, Chettikulangara, Devikulangara, Neelamperoor, and Mannar with the aim of developing Antimicrobial Smart Hospitals and Antimicrobial Literate Panchayats.

AMARAM project was inaugurated at Muhamma Grama Panchayat on 23 November 2024 by Shri P. Prasad, the then Minister for Agriculture. The project was implemented by Medical Officers as implementing officers using funds allocated by Local Self Government Institutions for communicable disease prevention.

To effectively address AMR, the programme included measures to prevent misuse of medicines, strengthen infection prevention and control in hospitals, prevent zoonotic and communicable diseases under the One Health concept, and establish systems that ensure hygiene and healthy practices. Community-based awareness programmes conducted according to the AMR awareness activity calendar played a major role in laying the foundation of AMARAM.

Various initiatives were carried out, including:

• Training and strengthening systems for infection prevention and control in hospitals
• Awareness on hand hygiene, scientific handwashing, food and environmental hygiene, and disease prevention practices
• Training healthcare workers on proper use of personal protective equipment
• Behaviour change communication aimed at infection prevention
• Classes on rational antibiotic use and the importance of avoiding self-medication
• Awareness on hygienic newborn care and palliative patient care
• Awareness activities among vulnerable populations such as coastal communities and SC/ST Unnathis
• Interdepartmental awareness programmes
• IEC activities linked to the PROUD programme for safe disposal of unused medicines
• Training for Haritha Karma Sena members and One Health volunteers
• Awareness programmes for pharmacists, lab technicians, nursing officers, and One Health mentors
• School awareness campaigns and competitions

Around 23 district-level AMR awareness posters were developed and disseminated. Health institutions that successfully implemented the first phase of AMARAM – including Women and Children Hospital Alappuzha; Community Health Centres in Muhamma and Mannar; and Family Health Centres in Thakazhi, Ezhupunna, Veeyapuram, Cherthala South, Mararikulam North, Thuravoor South, and Chettikulangara – were honoured by Shri Rajan Khobragade, Additional Chief Secretary, Health Department.

In the initial phase, emphasis was given to training, awareness activities, and strengthening infection prevention measures. Later, behaviour change among the public was assessed through questionnaires. According to the survey, more than 68% of participants had over 85% awareness about AMR, while only 4% had awareness levels below 50%.

In post-intervention evaluation, hospitals achieved 100% compliance with prescribed standards, while local self-government sectors achieved 90%. As part of the second phase of AMARAM, intensified awareness programmes and hospital-based interventions were conducted to ensure antibiotic literacy.

Among the five panchayats in the state declared as Antibiotic Literate Panchayats, four are from Alappuzha—Panavally, Veeyapuram, Chettikulangara, and Thakazhi—reflecting the success of the AMARAM project. Along with General Hospital Alappuzha, Women and Children Hospital, and Chengannur District Hospital, Family Health Centres such as Panavally, Veeyapuram, Thakazhi, Chettikulangara, Thaikkattussery, Thottappally, Chingoli, Kandalloor, and Arattupuzha, as well as Muthukulam Community Health Centre and Fisheries Hospital Pallana, were declared Antibiotic Smart Institutions.

Efforts are on across the district to transform 100 percent of hospitals into Antibiotic Smart Hospitals in the coming years.