数据驱动的抗菌药物管理的数字监测:印度资源受限背景下的过程视角

Yogita Thakral
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摘要

抗微生物耐药性(AMR)是社会上最紧迫的全球问题之一,迫切需要基于多学科的研究和实践方法来参与这些政策。在过去的二十年里,已经发布了几份全球和国家政策声明,特别强调了加强数字监控系统。然而,这些举措的实施仍然参差不齐,特别是在中低收入国家的公共卫生系统中。本文认为,造成这些系统的次优使用的一个重要原因是,自上而下的实施模式没有充分满足卫生设施工作人员的需求、愿望和能力,而卫生设施人员最终是该系统的最终用户。该论文强调了数字技术在资源有限的医疗机构中的重要性,以促进负责任地使用抗生素。它讨论了通过数字中介的数据驱动政策为中低收入国家的行动建立证据基础的过程。这一过程被概念化为一个三阶段的过程,包括稳定数据输入、产生结果和在地方一级采取行动。该论文认为,需要自下而上的实施模式,强调需要了解用户在日常工作中的实践,并设计数字系统来增加价值,而不是为这些日常实践工作。该论文强调了建设地方能力以制定有效和可持续的抗菌管理(AMS)计划的重要性,通过围绕数字解决方案建立网络,在网络合作伙伴关系中创造价值,发起围绕数据的对话,并提高对数字的认识来制定AMS计划。
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Digital monitoring for data-driven antimicrobial stewardship: a process perspective from resource-constrained contexts in India
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.
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