The AMR project sponsored by EPN was implemented in Kenya, Malawi, and Nigeria. In Nigeria, the project commenced in February 2023 intending to optimize the use of antimicrobials and improve antibiotic prescription, dispensing, administration use, and disposal in faith-based health facilities. The project implemented twenty-five facilities across the southwestern, Eastern, and Middle-belt regions of Nigeria with a selection criterion of a minimum bed capacity of fifty.

Stakeholders which include hospital administrators and pharmaceutical directors of the Ministry of Health implementing states were engaged and the project was properly introduced, sighting its objectives, specific outcomes, and their roles and responsibilities. Formation of AMS committees with a minimum number of four consisting of a doctor, nurse, pharmacist, and laboratory technician or scientist were then carried out by the hospital administrators. Furthermore, IPC and DTC committees were also established. The AMS committee was engaged and intimated with their roles and responsibilities as regards the AMR project which included the completion of two courses on the EPN online learning platform, the development of a work plan based on acquired Knowledge, the creation of awareness among pregnant and breastfeeding mothers and step-down training of staff. The IPC committee was also charged with improving infection, prevention, and control measures in their facilities by ensuring standard IPC procedures are being adhered to. The DTC was saddled with the responsibility of developing guidelines for antibiotic use in their facility as well as regular prescription reviews.

A round of formative visits was conducted in all facilities except St. Mary Hospital Okpoga. The AMS, IPC, and DTC were visited with an overview of the project, their roles, and responsibilities. Technical support was also provided for the development of the work plan. The baseline and prescription assessment training were done virtually with AMS committee members in attendance. This was followed by baseline and prescription assessments done simultaneously with formative visits. Financial support was given to the hospitals to support laboratory MCS tests and AMS committee meetings and activities.  A supportive supervisory visit was also conducted to assess the progress of the project, identify challenges, and provide technical assistance. Discussions on sustainability were held with committees and hospital administrations to ensure continued AMS practices after the project ends.

At the end of the project, all facilities have an established AMS, and the IPC committee convenes monthly and carries out activities that improve AMS also implement IPC guidelines. 100% of the facilities are appropriately stocking antibiotics and there exists a marked decrease in expired antibiotics in general. A total of 60 persons have completed the course on Preventing Antimicrobial Resistance and 67 persons have completed the course on Anti-Microbial Stewardship. All facilities received forty copies of the IEC materials developed by CHAN. 100% of facilities conducting AMR and AMS education to prenatal and post-natal mothers including other patient groups. Over 2500 prescriptions assessed at baseline and endline indicated an increase in treatment choices based on rational diagnosis or culture sensitivity test results. 291 antibiotic samples were collected from implementing facilities, with 4.8% found to be substandard or falsified. Results were shared with hospitals and Directors of Pharmaceutical Services and Difam German Institute for Medical Missions, Germany leading to the publication of a suspected fake drug alert by NAFDAC. Sensitivity testing was conducted in all hospitals, with over 7000 tests recorded from March 2023 to December 2023.

Challenges encountered during project implementation included delays due to the general elections, turnover of AMS committee members, poor internet connectivity in rural areas, overwhelming hospital workloads, and insecurity in certain regions.

Lessons learned in the AMR Project include making the activity plans dynamic quickly adapting to changes that came from the national/political activities and leveraging technology to achieve other project goals. The allocation of an extended timeline for activities, with allowance for unforeseen circumstances.

Recommendations for future projects included extending project coverage to more facilities, adapting physical training instead of online courses to overcome connectivity issues, providing communication devices to AMS committee members, and allocating funds to facilities in need of financial support to sustain projects.