Summary of NAP Implementation Review

Summary of NAP Implementation Review
Country Name : Indonesia

Chair : Harry Parathon (Chair of ARCC MoH)
Rapporteur : Erie Gusnellyanti (MoH, Pharm. Service)
Participants:
1. Benyamin Sihombing (WHO Indonesia)
2. Nani H. Widodo (MoH, Referral Health Service)
3. Dyah Armi Riana (MoH, NIHRD)
4. Nanang Yunarto (MoH, NIHRD)
5. Yurike Elisa Dewi (MoA, Animal Health)
6. Joan Aprilla Arland (NADFC, Distribution Inspection)
7. Hanny Musytika (NADFC, Standardization)
1. National AMR surveillance system & Governance (1)
Indicators &
Actions/successes Challenges/issues Recommendation
Phase
1.1 -NAP In • National Action Plan on AMR • The multisectoral committee • To establish National
line with GAP- Indonesia 2017-2019 has has not established yet Focal Point as the
AMR/ already in place since May • Budget allocation of MoA has multisectoral committee
2017, developed by not specifically for AMR, it is for AMR control
Governance
multisectoral collaboration, in- included in other program • To implement the NAP
line with GAP AMR One • Ministry of Environment does AMR supported by
Phase 2 Health approach, supported by not have any program or adequate budget for each
Program WHO, FAO, dan OIE activity related to AMR yet sector.
Installation (http://www.who.int/antimicro
- National AMR bial-resistance/national-action-
committee plans/library/en/)
established and • Budget on AMR related
NAP-AMR program has already allocated
underway for human health (MoH) and
animal sector (MoA).
• Ministry of Defense has pilot
project for monitoring AMR in
army hospitals
Indicators &
Phase
3.1. National • 18 surveillance sites in referral • National reference laboratory • To designate of the
human AMR hospitals coordinated by MoH for AMR surveillance has not national reference
surveillance ARCC established yet laboratory (NRL) for
• National External Quality AMR surveillance
Assurance (EQA) for AMR • To involve EQA in
Phase 2 surveillance has not National AMR
Initial established yet surveillance system to
Implementation • Lack of clinical assure the outcome quality
microbiologist and
microbiology lab in hospitals
3.2 Laboratory • 20 Medical Laboratory Centers • NRL and NSCC for AMR • To designate the National
capacity located in provincial level. surveillance have not Reference Laboratory
strengthening • The AMR surveillance on established yet (NRL) for AMR
livestocks conducted by National surveillance as the most
Veterinary Product Assay important part of the
Phase 1 Laboratory National AMR
Exploration and • 8 Regional Disease Investigation surveillance system
Adoption Centers for surveillance
- No national including AMR Veterinary
network Research Center in Bogor
developed • Referral hospital’s laboratories
have the capacity to detect and
report AMR
• NIHRD Laboratory has passed
EQAS for AMR examination
Indicators &
Phase
3.3 Early • One of the Early Warning • AMR's Early Warning • To develop a multicenter
warning system System tools available in animal System has not been surveillance system to
husbandry and animal health developed yet, still on provide Early Warning
sector is the rapid reporting disease based System of emerging
Phase 1
system for animal diseases • Early Warning System for resistance on the national
Exploration and through i-SIKHNAS. This AMR surveillance system in scale
Adoption system has been well developed human health has not
No system in for reporting disease incidence established yet.
place from the field level to the central
level.
• The reported incidence of
veterinary disease was carried
out in an initial response at the
field level through the Animal
Health Center
Indicators &
Phase
7.2 National • Surveillance for the sale, • Data collection from the • To explore the options and
surveillance of distributor and use of provinces is hard to be develop the supply chain to
(AMU) and antibiotics has been done conducted obtain data from the provinces
although not yet integrated • The implementation need to • To establish joint risk analysis
sales at
yet. be strengthen on surveillance by NCC
national level • No NCC for surveillance • To finalize the guideline of
• Surveys for antibiotic sales
in the were based on antibiotic controlling on AMU at
veterinary import data and antibiotic livestock.
sector production data, while the
correlation survey between
Phase 3 sales data and usage data has
Initial not been conducted
comprehensively.
Implementation
- Some
capacity/data
generated from
sales and AMU
Indicators &
Phase
7.6 National • Ministry of Environment has • AMR is not the high level • To include the indicator on
surveillance of already involved, but the main priority of the AMR surveillance and
AR and AMR program has not established Ministry of Environment monitoring in the environment
yet. • The contamination data in • To decide which pathway will
in wastewater
the soil and water resource be chosen to conduct the AMR
from has not available yet. surveillance
manufacture • The regulation on AMR • To identify the focal point of
and surveillance in the environment sector
human/animal/ environment has not
fish use and included AMR yet
disposal in • There is no focal point to
conduct AMR surveillance
institutions and
in environment
the home
Phase 1
Exploration and
Adoption
- No/weak
national policy
and guidelines
for surveillance
of AR/AMR in
waste and
environment
2. Awareness raising & Research and Innovation
Indicators &
Phase
2.1 - Awareness • Public awareness campaigns • Monitoring of the public • To continue and expand the
through the Community awareness impact need to be public awareness campaign
campaigns to Movement on Smart Use of developed. to all the community level,
the public Medicines (GeMa CerMat) involving more health
program, prioritized in AMR professionals and other
and prudent use of antibiotics stakeholders
Phase 4 • Nationwide dissemination of • To develop monitoring and
information and educational evaluation methodology to
Full Operation material for increasing public measure the impact of
Nationwide, awareness and knowledge, public awareness campaigns
through printed, electronic, on AMR
government-led and social media
antibiotic • Public awareness has been
implemented to farmers,
awareness veterinary medicine
campaign association, feed production
association, and student of
targeting specific faculty of veterinary medicine
groups (e.g. through stadium generale.
• Antibiotic awareness week
doctors, nurses, has been done routinely
pharmacists, support by MoH with WHO,
some hospitals and pharmacist
farmers, association and MoA with
veterinarians) FAO and university.
2. Awareness raising & Research and Innovation (2)
Indicators &
Phase
2.2 Education • Workshops, training and • The curriculum review need • To maintain compulsory
technical assistance for health to be completed ARCP training as part of
and training professionals at primary • The antimicrobial/antibiotic continuing education
strategies for health cares and hospitals prescribing by health program for health
• Optimizing the role of professionals is still high professionals
professionals pharmacists as the agent of • To update and revise pre-
change to raise awareness and service training curricula for
educate the community different health professional
Phase 3 education programs to
• Health professionals team
Initial from referral hospitals has include AMR/AMS in core
Implementation been trained curricula
- AMR in some • To continue and expand the
• AMR topic has been education program and CPD
pre-service integrated on every scientific
training and/or for health professionals
seminar of professional
some special associations
courses • ARCP is mandatory
implemented for hospital
accreditation
Indicators &
Phase
7.4 AMR • Public awareness has been • CPD on AMR for • To advocate academia to
awareness implemented to farmers, veterinary still need to include AMR subject into
generation & veterinary medicine association, be improved curriculum in faculty and
education in feed production association, and CPD of veterinarian and
the animal student of faculty of veterinary farming professionals
sector medicine through studium
Phase 3 generale. Antibiotic awareness
weekday has been done routinely
- Awareness
programmes support by FAO and university.
developed
and piloted
- AMR in
some pre-
service
veterinary
training
and/or some
special
courses
Indicators &
Phase
7.7 AMR • Government Regulation (82/2001, • Antibiotics disposal • To develop antibiotic
awareness 101) quality of standardization on mechanism for disposal mechanism for
generation & water resources, hazardous and households need to be households in coordination
education in toxic substance developed with MoH and Pharmacist
the • Controlling AMR not yet included Association.
environmental
sector
Phase 1
Exploration and
Adoption
- No policies or
targeted
communication
strategies on
AMR in waste
or only planned
(for antibiotic
manufacturers,
hospitals,
wastewater
treatment
institutions,
farmers (linked
to 7.4)
Indicators &
Phase
6.1 Research & • NIHRD-MoH focuses on • Indonesia has not decided to • To develop greater
vaccine development under join global AMR R&D yet. coherence on policy among
development vaccine consortium and • The research funding and policy NIHRD and laboratory
and innovation antimalaria which consist of has not developed yet. network of MoH
the government, industry, • To provide technical and
on AMR and academic financial resources for
prevention and • NIHRD has included the research on AMR
AMR R&D on the roadmap
containment • Some hospital laboratories
Phase 2 conduct surveillance
Program
Installation
- Policies planned
and existing
structure has a
plan to foster
research and
innovation on
AMR
3. Rational use of antimicrobials and surveillance of use/sale:
( Community-based) (1)
Indicators &
Phase
4.1 National • The essential medicines list • Not all hospitals have the • To strengthen, maintain and
and National Formulary with capacity to make AMR patterns full implementation of AMS
policy for its restriction for the and the use of antimicrobials programs nationwide
reference of antimicrobials (AMU) • To set clear targets and
control of relevant KPI for hospital
use in healthcare facilities • Prescribing audit mechanism
human use of AMS programs and monitor
• Guideline on Antibiotic Use needed to be developed
performance
has already in place • Guideline on Antibiotic Use need
antimicrobials • To complete policy
• Some hospitals have the to be updated and include more development for AMS in
(AMSP) specific based on diseases, and
capacity to make AMR community setting and
Phase 2 patterns and the use of the implementation need to be initiate implementation with
antimicrobials (AMU) strengthen initial focus to reduce misuse
Program
• Policy on AMR Control and overuse for specific
Installation conditions (e.g. URTI)
Program in Hospitals and
- National AMSP • To advocate initiation of
acreditation have been
AMS program to private
planned and under established sector hospitals
development
• The regulation and policy on • To explore options for
the AMSP for primary health introducing regular
cares is under development prescription audit and
• Trainings, workshops and feedback mechanism for
seminars for health AMS
professionals has included • To update and strengthen the
the AMR topics implementation the guideline
on Antibiotic Use
Indicators &
Phase
4.2 National • The sampling and testing on • The report of sampling and • To analize the complete
Regulatory the antibiotics has already testing is not analyzed report of sampling and
Authorities done particularly on the antibiotics testing and taking follow
(NRA) or Drug • NADFC conducts pre and (still in general) up action to improve drug
Regulatory post market control of quality
Authorities antimicrobial medicines as • To develop the regulatory
(DRA) part of quality assurance cooperation in SEARN
activities.
Phase 5 with • GMP, GDP, GPP control has
recommendation already performed on the
Sustainable production, distribution and
Operation
healthcare facilities
 Competent and
functional • There is a cyber patrol to
NRA/DRA with control the online drug sales
capacity to
ensuring/enforcing
antibiotic quality
standards and
taking measures
against substandard
products and
inspecting
pharmacies.
Indicators &
Phase
4.3 Surveillance • Antimicrobial use (AMU) • Guidelines for surveillance of use • To develop policy for
of AMU and monitoring program in and/or sales of antimicrobials has surveillance of
sales in humans human, including antibiotics not available yet antimicrobial use (AMU),
use in Puskesmas as • The consumption and sales consumption (AMC) and
Phase 3 with indicator of rational use of surveillance need to be developed sales monitoring
assistance for medicine (for two diseases: • To identify national focal
development non-pneumonia ARTI and point/MOH unit who will
Initial acute diarrhea), has be responsible for regular
Implementation regularly reported to MoH AMC monitoring
•Monitoring sales
• To use WHO AMC
of antimicrobials at
national level not monitoring methodology
implemented. develop protocol and
Monitoring of use monitoring system for
limited to few Indonesia including
facilities that are identification of data
not representative
and irregularly sources, collection and
analysis processes.
Indicators &
Phase
4.4 Regulation • Regulation on import, export, • Most of API’s for local • To develop regulatory
production, distribution and production is purchased overseas. cooperation through bilateral
of finished use of finished antibiotic GMP certificate is required to or regional cooperation, for
products and APIs have been issue importation permit. Some example: SEARN
antibiotic established and implemented, DRAs does not provide the • To maintain strict regulatory
products and as the following:
information on GMP certified control of FPPs and APIs for
• Importation of finished
APIs facility for public. all antimicrobials
products and APIs shall be
granted by NADFC by issuing • To strengthen inspection/
Importation Letter Permit enforcement to reduce sales
Phase 5 System. of antimicrobials without
• Exportation of finished prescription
Sustainable
products should be granted by • To extract data regularly
Operation
NADFC by evaluation the from existing quality control
•Regulatory
requirements for the export testing databased to
authority and medicines, verification of the determine rate of
system in place GMP certificate and also substandard / falsified (SF)
and are fully issuing the Exportation Letter for antimicrobials
and effectively Permit System. • To finalize the regulation for
implemented • Production and distribution
online sale of medicines and
shall comply to current GMP
mechanism that can ensure
and GDP, respectively.
• Pharmacovigilance is security of legally registered
implemented including ADR retail online sale
are reported to NADFC
through e-meso application.
Indicators &
Phase
4.5 Regulation • Law number 419/1949 on • The law and regulations are not • To continue and expand
of pharmacies Prescription Drug and specifically for antibiotics the Community Movement
on over the Ministerial Decree No • Law enforcement and policy on Smart Use of Medicines
counter sale 1331/2002 on Licensed implementation should be (GeMa CerMat) program
and Drug Store regulate improved and pharmacist support to
inappropriate antibiotics as prescription improve the
sale of drugs and cannot be sold implementation of the
antibiotics and OTC regulation by effective
APIs • Sampling and testing on the prescription/inspection/dis
antibiotics sales is already pensing tools for delivery
available as a part of antibiotics in the
Phase 4 inspection of drug community
Full Operation distribution • Develop the monitoring on
• Community Movement on the antibiotics sales in the
•Regulatory
Smart Use of Medicines pharmacies, drugstores.
authority and
program has been trained
system in place
the pharmacists and educate
and inspection
the community on AMR and
implemented
prudent use of antibiotics, to
but limited
raise awareness on the
capacity for
antibiotics sales with
enforcement of
prescription
regulation
• Dissemination of
information to the
community
(Community-based) (7)
Indicators &
Phase
7.1 National AMR • Policies and regulations • Monitoring on the implementation • To provide adequate
on AMU in the live stocks of the regulations cannot be financial and human
containment policy
and animal health sectors implemented optimally because resources for joint
and regulatory have been established constrained number of inspectors implementation of policy
framework for through MoA regulation of veterinary medicines and feed program and guidelines for
control of animal No. 14/2017 and No. quality controllers are still limited AGP
22/2017 that prohibits the • Prescription policy and guideline • To strengthen the
use, and their
use of Antibiotics for for using antibiotics on medicated collaborated mechanism
registration for use Growth Promoter in feed is under development among multi-stakeholders
Phase 3 animal sector. (regulators, academia,
• Started on January 2018, private) for AMR policy
Initial
Implementation
Indonesia has completely
banned the antibiotic use
- Policies and/or
regulatory in animal sector.
frameworks • Supervisor veterinary
implemented but established from central to
limited capacity for district level, supervision
monitoring is also conducted by
registration and
requiring business actors
AMU
in the veterinary
medicines and feeding
sector
• The guidelines have
finalized
(Community-based) (8)
Indicators &
Phase
7.5 A national • No policy related to AMR • AMR is not the priority and main • To advocate the high level
AMR in environment sector task of Ministry of Environtment policy makers in Ministry of
containment Environment
policy and
regulatory
framework to
control release
of AR and AMR
into the
environment
and
management
therein
Phase 1
Exploration and
Adoption
• No national
policy to reduce
antimicrobial
contamination
into environment
• No regulations
controlling AR
emissions
4. IPC and AMR stewardship program (1)
Indicators &
Phase
5.1 AMR • AMR Prevention and Control • No specific national policy/ • To develop specific national
stewardship Program in healthcare settings guidelines on stewardship policy / guidelines on
program in available, including • Monitoring and evaluation stewardship, develop and roll
regulations and guidelines, of AMRS has been done in out training materials.
HCS
committees in healthcare limited sites. • WHO to finalize practical
Phase 3 settings both for referral guidelines on AMR stewardship
Initial
(hospital) and primary in HCS
Implementation
-National (Puskesmas) healthcare, and • To develop the monitoring and
IPC/AMR plan- trained personnel evaluation mechanism on
aligned IPC/AMR • Regulation of healthcare AMRS in HCS.
plans implemented accreditation for hospital and • To integrate the IPC and AMRS
in limited number Puskesmas program in the hospital
of HCS
• Clinical practice guidelines program.
define 1st line, 2nd line
antibiotics
• In larger (tertiary) hospitals,
monitoring of prescription of
broad spectrum Abx by
microbiologist.
• Some classification and
restriction on availability of
some classes of antibiotics.
Depends on (three) level of
HCF.
Indicators &
Phase
5.2 • Accredited hospital should • Monitoring and analysis of • To appoint a dedicated staff and
Surveillance of carry out HAI Surveillance, HAI surveillance has not budget at central level, establish
healthcare and reported the data to the been done yet reporting system, database,
director, and District/ • High turn over of IPCN capacity for analysis and
associated
Province Health Office. • Advanced training for IPC feedback
infections • Four indicators should be team/committee need to be • To develop specific technical
(HAI) reported periodically developed guidelines for HAI,
Phase 2 • Ministry has mandate to • Data not reported centrally standardized (including
Program oversee HAI, HCF must because no system in surveillance and AMR related)
Installation report to District and to MOH place • To ensure HAI surveillance
•Few public and • HAI part of accreditation gathers data to inform action /
private facilities
have HAI
(must look at CAUTI, policy on AMR
surveillance but VAP/HAP, BSI, SSI) – 56.5 of • To strengthen lab network,
data not 2859 attached to national reference
centralized at lab for HAI
national level
Indicators &
Phase
5.3 IPC • IPC Program in HCS • Lack of supervision and • To strengthen the monitoring
program in available, including monitoring to private and supervision by District
HCS hospitals, otherwise Health Offices
regulations and guidelines, hospital accreditation has • Dedicated staff at national level
committees in HCS both for been filled up the gap, • Quality improvement
Phase 3 despite the fact that not all programme
referral (hospital) and primary
Initial private hospitals • Strengthen M&E by District
Implementation healthcare
accredited Health Office
- IPC program • Regulations on Healthcare • Small dedicated IPC • Strengthen certification /
and capacity budget accreditation
Accreditation including IPC
building plans • IPCN need to be more
implemented in • IPC program include empowered
selected guidelines, standard and • Behavior change
healthcare
facilities transmission precaution,
education and training, HAI
surveillance, rational use of
antibiotics
• Referral hospitals have
isolation facilities
Indicators &
Phase
5.4 Sanitation • Hand Hygiene already • There is no rensponsible • To include access to hand rub in
& hygiene implemented in Healthcare authority and facility to surveys for hospital hygiene to get
and facilites, (Hospital and manage the medical disposal more complete
primary Health care) in health care facilities. • To appoint dedicated IPC staffs at
vaccination
• Campaign conducted at • Recent surveys – suggest national level to support advocacy
in the there may be a problem, esp’ for improving WASH programme
large scale (WASH
community program) for IPC in the access to handwashing • To conduct detailed survey on
community facilities and soap WASH in HCF and make
Phase 4 • Access to water / sanitation • Water supply to hospitals recommendations
Full Operation – data not availability, but responsibility of Ministry of • To increase dedicated budget for
-Policy or access to basic services Health, responsibility for IPC
campaign to good. waste disposal with Ministry
improve of Environment
• Data on hygiene relatively
sanitation &
good, water & sanitation
hygiene is
less good
implemented at
large scale Institutions
-Data on safely • Campaign conducted at
managed water large scale, data available.
supply or Hand hygiene implemented
sanitation in HCF
services exist • Hospitals have IPC team –
and access has some responsibility for
medium WASH.
Indicators &
Phase
5.5 • PCV has just been N/A • To continue and roll out the
Vaccination introduced through a existing program and expand the
in the demonstration program in PCV vaccination program to
West Lombok and East several provinces with high
community
Lombok district, West Nusa incidence of pneumonia infection
Tenggara Province in early
Phase 2 October 2017.
Program • PCV is given at 2, 3 and 12
Installation months.
- PCV
• Coverage of PCV1 : 0.1%
introduced
(3,372 infants)
(1,459 infants)
(as of 21st January 2018)
• EPI generally > 90%
Indicators Actions/successes Challenges/issues Recommendation
7.3 Biosecurity • Training for small and • Backyard small farmers need • To develop strategies for
(IPC) in the medium sized farms has to be educated awareness campaign to
animal sector been done • There are no audit after the enhance knowledge of small
• The impact of this AGP training scale farmers on biosecurity
ban, requires farmers to • To conduct regular
Phase 4 inspection by government
apply biosecurity.
Full Operation • To audit of the learning of
• Several large-scale farms
•CPD on AMR and veterinarians and farmers
have now been awarded
alternative free AI compartment after training
biosecurity certificates, which are • To ensure the biosecurity
measures and conducted through an audit component is included in the
to the farm, one of the CPD of veterinarian
regular audit of
indicators in the audit is • To ensure funding for
learning carried out biosecurity
the implementation of
biosecurity in the farm.
• Policy and guidelines have
been established.
• Compensation for culling
of ‘at-risk’ animals.
• Regular budget has been
allocated
5. One health engagement
(National AMR surveillance, use of antimicrobials, and awareness
raising in animal and environmental sectors) (1)
Overarching • Ministry of Health has • Other ministries have not AMR • To start and develop the
AMR established the Committee yet multisectoral AMR
coordination Antimicrobial Resistance • The multisectoral coordination coordination under the
Control Committee mechanism and formal umbrella of GHSA
mechanism is
(ARCC) started from committee has not been • To formalize a committee
existing between 2014 established yet. It is stated in and ensure it fits in with the
all relevant • Some hospitals have NAP but have not set up yet broader one health and
sectors Antimicrobial Resistance • MOH and MOA and other GHSA committees.
Control Committee ministries have different • To involve the Ministry of
Phase 1 (ARCC) or Team for coordinators and there higher finance and foreign affairs
hospital level based on coordination is required. to ensure that they have the
ministerial regulation • No policy that regulate same idea on the domestic
• ARCC for human health multisectoral coordination. situation on AMR and also
is established, every help keep AMR high on the
hospital has to have a regional and global agenda.
ARCC in hospital level
• MOH has developed
presidential instruction
for ministries involved in
GHSA including AMR.
Inclusion and • Relevant stakeholders • Some stakeholders (e.g • To develop the multisector
engagement of all have been involved in the environtment sector) have not AMR Control Committee
relevant sectors in development of NAP include AMR program as the • To develop a multisector
AMR priority. AMR surveillance and
the NAP-AMR
• MoH conducts regular • Plant health not involved. share information regarding
meetings involving • No involvement of food AMR situation among all
Phase 1 relevant stakeholders produces, pharma, feed sectors
producers • To raise awareness among
agriculture sector regarding
AMR by using evidences
• To engage with food
production, WASH
departments, start with
awareness in these sectors
A platform and/or • Ministry of Agriculture • The monitoring of AMU • To develop the multisectoral
mechanism for conducts the monitoring of has not integrated integrated monitoring of
sharing of AMU AMU at the live stocks by multisectoral yet. AMU
sampling • To develop the monitoring
monitoring data
• Ministry of Health conducts and surveillance mechanism
from all relevant the monitoring of AMU at on sales of antimicrobials.
sectors exist primary health cares for that
for regularly reported
Phase 1 • Some universities conduct
studies in hospitals but this is
not reported to MOH.
A platform and/or • Ministry of Agriculture • The monitoring of AMR • To share the monitoring
mechanism for conducts the monitoring of has not integrated data on AMR among sectors
sharing of AMR AMR at the live stocks by the multisectoral yet. and make it compatible for
laboratory in Bogor all sectors.
surveillance data
• Ministry of Health conducts • To finalize the tricycle
from all relevant the monitoring of AMR at project
sectors exist some hospitals in 2013 and
2016
Phase 1 • Tricycle project on AMR
surveillance has already
started
AAW is nationally • AAW is nationally • The AAW activity has not • To coordinate the
coordinated and coordinated and celebrated integrated among multisectors multisectoral activity on
celebrated with with involvement and AAW and develop the same
contributions from all messages for public
involvement and
relevant sectors awareness during AAW
contributions using the materials already
from all relevant available through the
sectors tripartite and adopt for
country level.
Phase 3
A mechanism for • Budget dedicated to • No sharing of resources or • To identify what budget is

co-sharing of human health for AMR joint resources needed for AMR across the
resources for under MoH program. • No focal point, therefore sectors.
• In MoA, activities for calculating the budget for Steps towards:
AMR initiatives in
AMR not put into budget. AMR is hard. • To identify the existing
the country exist. Government budget is resources
available for surveillance • To develop an operational
Phase 1 of residues. plan, and determine
priorities budgeting for
coordination
Other areas of One

Health concerns are
covered.
Phase

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Indicators Actions/successes Challenges/issues Recommendation

Indicators Actions/successes Challenges/issues Recommendation

Indicators Actions/successes Challenges/issues Recommendation

Indicators Actions/successes Challenges/issues Recommendation

A mechanism for • Budget dedicated to • No sharing of resources or • To identify what budget is

Indicators Actions/successes Challenges/issues Recommendation

Other areas of One

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