Thakral Yogita
The Health Information Systems Programme (HISP) Centre and Department of Informatics, University of Oslo, Oslo, Norway.
Society of Health Information Systems Programme, Health Information Systems Programme (HISP) India, New Delhi, India.
Front Antibiot. 2023 Aug 2;2:1214826. doi: 10.3389/frabi.2023.1214826. eCollection 2023.
Antimicrobial Resistance (AMR) is one of society's most urgent global issues, requiring urgent multidisciplinary-based research and practice approaches to engage with these policies. Several global and national policy statements have been released in the last two decades, particularly emphasising the strengthening of the digital surveillance system. However, implementing these initiatives remains patchy, particularly in the context of public health systems in Low- and Middle-Income Countries. This paper argues that one of the significant reasons contributing to this sub-optimal uptake of these systems is that the top-down implementation models do not adequately cater to the needs, aspirations, and capacities of the health facility staff, who, ultimately, are the end users of the system. The paper highlights the importance of digital technology in healthcare facilities with resource constraints to promote the responsible use of antibiotics. It discusses the process of developing an evidence base for action in low- and middle-income countries (LMICs) through digitally mediated data-driven policy. This process is conceptualised as a three-phase process, which involves stabilising data entry, generating outcomes, and taking action at the local level. The paper argues the need for bottom-up implementation models, which emphasise the need to understand the practices users engage with in their everyday work and design the digital system to add value and not work to these everyday practices. The paper emphasises the importance of building local capacities to develop effective and sustainable antimicrobial stewardship (AMS) programs through enabling networking around digital solutions, creating value in networked partnerships, initiating conversations around data, and raising awareness of the digital to develop AMS programs.
抗菌药物耐药性（AMR）是当今社会最紧迫的全球性问题之一，需要采取基于多学科的紧急研究和实践方法来落实这些政策。在过去二十年里，已经发布了多项全球和国家政策声明，特别强调加强数字监测系统。然而，这些举措的实施情况仍然参差不齐，尤其是在低收入和中等收入国家的公共卫生系统背景下。本文认为，这些系统采用率未达最优的一个重要原因是，自上而下的实施模式没有充分满足卫生机构工作人员的需求、期望和能力，而他们最终是该系统的终端用户。本文强调了数字技术在资源有限的医疗机构中对促进抗生素合理使用的重要性。它讨论了通过数字媒介驱动的数据政策在低收入和中等收入国家（LMICs）建立行动证据基础的过程。这个过程被概念化为一个三阶段过程，包括稳定数据录入、产生结果以及在地方层面采取行动。本文主张采用自下而上的实施模式，这种模式强调需要了解用户在日常工作中的行为，并设计数字系统以增加价值，而不是与这些日常行为相悖。本文强调通过围绕数字解决方案建立网络、在网络伙伴关系中创造价值、发起关于数据的对话以及提高对数字技术的认识来发展抗菌药物管理（AMS）计划，从而建设地方能力以制定有效且可持续的AMS计划的重要性。
