Antimicrobial Stewardship and Surveillance in Mongolia

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1. Purpose of the consultancy

The purpose of this short-term consultancy (STC) is to provide technical assistance to Ministry of Health, Mongolia in introducing and implementing antimicrobial stewardship (AMS) programme including antimicrobial consumption monitoring in selected hospitals and also support building AMR surveillance system and laboratory capacities. The consultant will be asked to develop national and local guidelines and tools on AMS through consultations with selected hospitals and stakeholders, initiate the AMS program in selected hospital and to provide trainings to AMS members and prescribers on improving the use and consumption of antimicrobials. Moreover, the consultant will support developing national AMR surveillance guidelines adapted from regional AMR surveillance document and support capacity building for surveillance and laboratory.

2. Background

Antimicrobial resistance (AMR) is a major threat to global health and security. It endangers decades of progress made in modern medicine and public health. Although inappropriate use of antimicrobials is regarded as one of the main drivers of AMR, monitoring antimicrobial use is underdeveloped in large parts of the world. The World Health Organization (WHO) Regional Committee for the Western Pacific adopted For the Future: Towards the Healthiest and Safest Region (WPR/2020/RDO/001) in 2019 as a vision to guide WHO’s work with Member States on health priorities in the coming years. Health security, including AMR, is one of the four priorities in the vision, which proposes new ways of working to help countries address complex issues relating to health and development.

The second Multi-Sectoral Action Plan on Combating Antimicrobial Resistance (MNAP), 2022-2025, Mongolia was endorsed in May 2022 by the Minister of Health and Minister of Agriculture and Light Industry to provide directions and framework for combating AMR. Antimicrobial stewardship programmes optimize the use of antimicrobials, improve patient outcomes, reduce AMR and health-care-associated infections, and save health-care costs amongst others. Establishment of AMS programme will be regarded as one of requirements for hospital accreditations in Mongolia. For instance, the First Clinical Hospital has developed a guidance for implementing AMS (Antimicrobial Stewardship Programme in Hospitals Manual of Procedures ISBN 978-621-95675-0-3) that can be applied for other clinical hospitals. There is a strong association between AMR and levels of antimicrobial use, implying that a reduction in unnecessary consumption of antimicrobials could affect resistance. In recent years, WHO has supported countries to strengthen the monitoring of antimicrobial consumption (AMC) and to optimize the use of antimicrobials. Ministry of Health, Mongolia has been generating longitudinal national level antimicrobial consumption data, which has visualized decrease in antimicrobial consumption as a whole and especially for intravenous antibiotics.

AMR surveillance is another important component in MNAP, which will enable and enhance antimicrobial stewardship by providing local susceptibility data to inform policy and clinical practice at national and hospital, as well as to early detect drug-resistant pathogens of importance to respond. Mongolia is in the process of forming a national level AMR surveillance system that will contribute to evidence-based national antibiotics guidelines and has submitted a request to enrol the WHO global GLASS-AMR to share surveillance data with WHO.

Ministry of Health, Mongolia will be implementing the AMR Multi-Partner Trust Fund along with relevant ministries and the Quadripartite (World Health Organization, Food and Agriculture Organization of the United Nations, United Nations Environment Programme and World Organisation for Animal Health) from 2023.

Terms of references for the STC include:

In collaboration with the Ministry of Health, Mongolia and WHO Country and Regional Offices, the short-term consultant will undertake following activities: 1. Support the establishment and implementation of antimicrobial stewardship (AMS) in hospital settings including but not limited to:

1.1 Review the existing guidelines, manuals and procedures on AMS in hospital settings. 1.2 Develop the national guidelines and manual of procedures for implementation of AMS program in hospitals. These include organizational structure for AMS implementation. 1.3 Finalize the AMS guidelines, manuals and procedures through a consultative meeting. 1.4 Conduct a training on AMS for committee members from selected tertiary level hospitals through:

1.1.1. Introduction of tools for the point-prevalence (PPS) or medicines/antibiotics use survey and on-going support for survey teams.

1.1.2 Training of trainers and AMS program members on the tools and guidelines. 1.1.3 Facilitation of trainings on AMS programme

1.5 Provide support in monitoring and evaluation of AMS implementations.

2. Provide Technical support on antimicrobial consumption (AMC) monitoring at the national and hospital level through the WPRACSS (Western Pacific Regional Antimicrobial Consumption Surveillance).

3. Support establishment and implementation of AMR surveillance system, including but not limited to: 3.1 Development of policy and guideline document for AMR surveillance system 3.2 Capacity building of laboratories for data management using WHONET and development of antibiogram for selected hospitals as well as AMR outbreak response 3.3 Coordination with NCCD (National Center for Communicable Disease) and other hospitals to receive support on external quality assurance from external partners including WHO-Collaborating Centres. 3.4 Preparation of data submission to WHO GLASS-AMR, including facilitation with GLASS team, capacity building for collection, data management, interpretation and analysis, and feedback to NCCD and hospitals.

4. Provide technical support to the implementation and monitoring of the Multi-sectoral Action Plan on Antimicrobial Resistance in Mongolia 2022-2025 focusing on all relevant areas and advocacy and awareness raising for policy and decision-makers. These also include: 4.1 MPTF (Multi-Partner Trust Funds) AMR, and One Health when necessary. 4.2 Other areas of MNAP related to the rational use of medicines, antibiotics/antimicrobials and surveillance and surveillance and laboratory.

5. Submit a final report, including newly developed tools and guidelines and recommendations and timelines for next actions.

3. Planned timelines (subject to confirmation)

Start date : 1 June 2023 End date: 1 May 2024 Duration: 11 months

4. Work to be performed

Outputs: The consultant is expected to deliver the following products:

Output 1: Provision of guidelines, manuals, and procedures on AMS in hospital settings

Deliverable 1.1 consultancy plan

Deliverable 1.2 situation report on AMS and antimicrobial use in the country and selected hospitals

Deliverable 1.3 guidelines, manuals and procedures for AMS

Output 2: Establishment and capacity building of selected hospitals' AMS team

Deliverable 2.1 development of hospital AMS tools

Deliverable 2.2 training of trainers on AMS using the developed tools and manuals

Deliverable 2.3 Finalization of AMS guidelines, manuals and tools

Deliverable 2.4 Monitoring and evaluation reports of AMS in hospitals

Output 3: Antimicrobial consumption monitoring

Deliverable 3.1 Introduction of WPRACSS in hospitals (consultation and briefing reports)

Deliverable 3.2 Hospitals AMC monitoring submitted to WPRACSS

Output 4: AMR surveillance and laboratory

Deliverable 4.1 Development of national AMR surveillance policy document

Deliverable 4.2 Development of antibiograms for selected hospitals

Deliverable 4.3 Hosting workshop for capacity building of surveillance, laboratory and outbreak response

Deliverable 4.4 Update standard operational procedures for taking samples, processing of samples, culture, susceptibility testing, and analysis and interpretation

Output 5: Consultancy reports

Deliverable 5.1 monthly consultancy reports

Deliverable 5.2 meeting reports with participating countries

Deliverable 5.3 final technical reports with all deliverables

5. Specific requirements

QUALIFICATIONS

Required: University degree in medicine, microbiology, pharmacy and/or relevant public health and clinical fields as an individual consultant

Desirable: Advanced university degree in medicine, microbiology, clinical pharmacy, public health with a training on AMR/AMS/AMC and/or relevant fields

EXPERIENCE

Required: At least 7 years of experience in the area of antimicrobial resistance such as antimicrobial consumption monitoring, clinical pharmacy, clinical practice, microbiology/clinical laboratory and/or other field at national and international level

Desirable:

• National health policies, strategies and plans and One Health/AMR
• Knowledge of AMC (ATC/DDD) methodology and AMS interventions in hospital settings
• Experience in AMR surveillance and/or laboratory
• Experience in managing outbreak of AMR pathogens and/or managing patients infected with AMR pathogens

• Experience in conducting training using adult learning methodologies

  TECHNICAL SKILLS & KNOWLEDGE

• Understanding of health systems and service delivery in resource-limited setting

• Specialized on AMR-related areas such as Antibiotic Stewardship, Surveillance of AMR pathogens, Surveillance of Antibiotic Use/AMC, Point Prevalence Survey, antimicrobial and diagnostic Stewardship, microbiology, etc
• Capacity to plan and conduct operational activities
• Excellent communication, interpersonal and presentation skills
• Outstanding organizational and time-management skills; and

• Proven research skills (desirable in antimicrobial resistance or relevant area)

  LANGUAGES

  Essential: Fluent in English ( writing, reading and speaking) Asset : Russian (writing, reading and speaking)

6. Competencies

• Communicating in a credible and effective way
• Producing results
• Moving forward in a changing environment
• Fostering integration and teamwork
• Knowing and managing yourself

7. Place of Assignment The consultant will work in WHO country office in Ulaanbaatar, Mongolia (onsite). It is planned to work along with a national consultant on AMR who will work at the WHO country office as well.

8. Medical Certificate (Consultants only)

Individual consultants must provide WHO fitness for work form from their physician.

9. Travel

In country travel is expected which will be planned in the country

Additional Information

• This vacancy notice may be used to identify candidates for other similar consultancies at the same level.
• Only candidates under serious consideration will be contacted.
• A written test may be used as a form of screening.
• If your candidature is retained for interview, you will be required to provide, in advance, a scanned copy of the degree(s)/diploma(s)/certificate(s) required for this position. WHO only considers higher educational qualifications obtained from an institution accredited/recognized in the World Higher Education Database (WHED), a list updated by the International Association of Universities (IAU)/United Nations Educational, Scientific and Cultural Organization (UNESCO). The list can be accessed through the link: http://www.whed.net/. Some professional certificates may not appear in the WHED and will require individual review.
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• The purpose of this vacancy is to develop a list of qualified candidates for inclusion in this advertised roster. All applicants will be notified in writing of the outcome of their application (whether successful or unsuccessful) upon conclusion of the selection process. Successful candidates will be placed on the roster and subsequently may be selected for consultancy assignments falling in this area of work or for similar requirements/tasks/deliverables. Inclusion in the Roster does not guarantee selection to a consultant contract. There is no commitment on either side.