CONSULTANT (AWARE)

1. Purpose

The objective of this consultancy is to develop a mechanism to revise antimicrobials listed in National Essential Medicines List (NEML) of Pakistan and a Pakistan-specific Access, Watch, Reserve (AWaRe) list of antibiotics in NEML based on the antimicrobial resistance (AMR) and antimicrobial use (AMU) trend. The list will be developed and finalized with the involvement of key stakeholders and accompanied by a practical implementation framework for integration into national antimicrobial governance mechanisms, including prescribing, procurement, stewardship, and regulatory controls..

2. Background

AMR is recognized globally and within Pakistan as a critical public health challenge. The WHO’s AWaRe classification categorizes antibiotics based on resistance potential, utilization, and spectrum of activity, aiming to guide appropriate antibiotic use. The AWaRe list in low-and-middle income countries (LMICs) guides evidence-based AMR policies in monitoring antibiotic use, regulating over the counter sales and improve prescription-based access to essential antibiotics.

The National Institute of Health (NIH) is the National AMR focal point and collects and reports AMR data from sentinel sites, reporting to national and global platforms for evidence-based policies. The Drug Regulatory Authority of Pakistan (DRAP) is AMU focal point to regulate and monitor AMU under national drug regulatory legislation in coordinating with provincial stakeholders.

In 2023, DRAP had a consultation with engagement of national experts in the field, and a consultant was engaged to formulate a comprehensive desk review and collect AMR data with the support of NIH from federal and provincial levels, with representation from both the public and private sectors.

WHO Pakistan is providing technical support to NIH and DRAP for AWaRe classification of antibiotics included in NEML and in the systematic development of Pakistan’s first AWaRe list of essential antibiotics with active engagement of stakeholders. The AWaRe list will be used a tool for monitoring antibiotic consumption, defining targets and monitoring the effects of stewardship policies that aim to optimize antibiotic use and curb AMR.

3. Work to be performed.

WHO, DRAP and NIH will develop a core group of key stakeholders to oversee the national adaptation and implementation of the WHO AWaRe classification in Pakistan. The consultant will develop an inception report plan and lead the adaptation process, which will involve a contextual review using WHO’s methodology, followed by a comprehensive action plan with timeline to integrate the adapted list into Pakistan’s health system, through regulatory, prescribing, procurement, and monitoring measures.

The consultant is expected to coordinate with WHO, NIH and DRAP focal points team regularly for the refinement and collection of the required information. The methodology will be in alignment with DRAP, NIH guidance for the tasks and approaches mentioned below and consultant will take the lead in reporting against the deliverable.WHO will facilitate a two-day consultation of Technical Working Group (TWG) of relevant experts (federal/provincial) to support national contextualization of the AWaRe classification and guide its integration into the health system through a tailored implementation plan.

l Deliverable 1.1: Conduct a desk review of current global and national guidelines on AWaRe classification. Prepare an inception report detailing the methodology of national adaptation and implementation, with stakeholder mapping and establishing timelines.

l Deliverable 1.2: Develop a draft AWaRe list adapted to Pakistan’s context using the WHO-recommended methodology and available AMR/AMU data, along with comprehensive technical recommendations and guidance for its integration into the health system.

l Deliverable 1.3: Disseminate the draft list and implementation plan with stakeholders, including DRAP, NIH, and WHO and incorporate their feedback.

Output 2: Finalize AWaRe list through national consultation and prepare a comprehensive report with clear recommendations and guidelines.

l Deliverable 2.1: Conduct an online survey among healthcare professionals across all provinces to get feedback and build consensus on the list.

l Deliverable 2.2: Develop the concept note, agenda and facilitate a two-day Technical Working Group (TWG) consultation with federal and provincial experts, to review the results from survey and review and validate the adapted AWaRe list and incorporate inputs for implementation.

l Deliverable 2.3: Finalize the adapted AWaRe list and finalize the comprehensive implementation plan to integrate into Pakistan’s health system, covering regulatory alignment, prescribing practices, procurement processes, and monitoring mechanisms based on the TWG consultation.

l Deliverable 2.3: Submit a report summarising consultative feedback and recommendations.

4. Technical Supervision

The selected Consultant will work on the supervision of:

Responsible Officer: Team Lead, HSD

Manager: Head of WHO Office

5. Duration: 30 working days spread over two month.

6. Specific requirements

Essential qualifications:

Advanced university degree (Master’s level or above) in public health, health systems, microbiology, infectious diseases, medicines, and/or pharmacy sciences.

Experience required (essential): 7 to 10 years of progressive experience in public health, infectious diseases, clinical microbiology, or clinical pharmacy, with demonstrated involvement in antimicrobial stewardship initiatives.

Experience working with the WHO AWaRe classification system, including its application in hospital or community settings to optimize antibiotic use.

Experience (desirable): Preferably working on patient safety, preferably with work in low- and middle-income countries.

Technical skills and knowledge:

Language requirements:

Excellent command of both English and the local language.

7. Place of assignment: Remote