Antimicrobial Resistance (AMR) is a global public health threat which impacts progress in  healthcare, food safety, nutrition security and the attainment of several UN Sustainable Development Goals.  It is a leading cause of death around the world, with the highest burdens in low-resource settings. The World Health Organization (WHO) identified AMR as one the 10 global health issues to track in 2021.

From August 2021-April 2022, eSHIFT worked alongside the Nepal National Public Health Laboratory (NPHL), the Foundation for Innovative Diagnostics (FIND, Blue Frontier and the Software for Health Foundation (S4HF) to design, develop and release the AMR One Health Surveillance Platform in Nepal with the goal of strengthening Nepal’s ability to capture high-quality AMR data.  

The project was supported by a Fleming Fund country grant to FIND. 

What we and our partners did

The national AMR network of Nepal currently includes 21 laboratories tracking both human and animal pathogens and is expanding yearly. This network is expected to generate comparable, representative, high quality data on priority drug-bug combinations to enable timely detection and track emergence and outbreak of drug resistance.

The primary obstacle the NPHL faces in leveraging more advanced analytical tools to track AMR is data management.  Each of the 21 laboratories uses different software systems with varied data entry practices and spreadsheet outputs resulting in a significant burden on the two NPHL data managers to make the data compatible. This manual data cleansing is time consuming, inefficient and not scalable. 

As part of the AMR One Health Surveillance Platform implementation, a bespoke desktop application, Open Data XLS transformer (ODX), was developed to automatically correct data inconsistencies in spreadsheet extracts from laboratory information systems.  Users can configure the tool to address their common data and spelling variations, enabling automated standardisation of surveillance data, and minimising the manual effort required for data cleaning. The tool also reports unrecognised columns and data errors, allowing data managers to quickly understand the quality of their data.

Platform features and capabilities 

The accelerated delivery timeline of the Nepal AMR One Health Surveillance Platform was only possible because of AoS Health, a collaboration between eSHIFT, Blue Frontier and the Software for Health Foundation. AoS Health is an orchestrated suite of tools and services capable of data collection, interoperability between internal and existing client systems, as well as data analytics and warehousing. All elements of the platform come together in a ready-to-use hardware (Pandora), thereby abstracting the technological complexities and empowering national health system leaders and healthcare providers to build best-in-class data management systems quickly.  

The AoS Health Platform has been deployed in 5 countries. It is being developed using an action-research approach with the end goal of establishing it as a global good and a reference architecture for digital health deployments. eSHIFT’s long-term vision is that innovations made during AoS Health projects, like ODX in Nepal, become available to all countries using the platform as part of an ongoing maintenance and sustainability program. By removing traditional barriers to implementation through innovations like the AoS Health Platform we strive to develop sustainable and resilient health systems, and empower our country partners to leverage ongoing developments in digital health.