Medicosnext
Dr. Ritu Amatya
She is a clinical microbiologist and a public health professional who served as a lead for the Fleming Fund Country Grant for Nepal from December 2021 to February 2026.
Ms Usha Tandukar
She is a Senior Drug Administrator in the Quality Standard and Regulation Division of the Ministry of Health and Population, Nepal. She serves as the Member Secretary of the National Technical Working Committee on AMR (NTWC-AMR). She holds a Master’s degree in Industrial Pharmacy from Kathmandu University and is an executive member of Women in Science and Technology (WIST). She is registered with the Nepal Pharmacy Council and is a Life Member of the Nepal Pharmaceutical Association (NPA).
The National Public Health Laboratory (NPHL) now coordinates a national network of 26 sentinel laboratories.
Antibiograms are produced, reports are submitted, and databases are updated; but the connection to day-to-day decision-making can be weak.
A hospital antibiogram, for instance, is only useful if clinicians actually refer to it when prescribing. Similarly, national data should inform treatment guidelines, procurement decisions, and stewardship efforts in a way that is visible and practical.
In the end, the value of surveillance lies not in the amount of data collected, but in the difference it makes. Each report, each antibiogram, and each dataset has the potential to shape better decisions, and ultimately, better outcomes for patients.
Antimicrobial resistance (AMR) is often discussed as a clinical problem, but at its core, it is also a problem of visibility. When reliable and timely data are lacking, resistance patterns remain hidden, decisions become uncertain, and responses are often delayed or misdirected. Recognizing this, Nepal’s National Action Plan on AMR (2024–2028) places strong emphasis on strengthening surveillance and research across human health, animal health, food systems, and the environment, within a One Health framework.
If awareness helps us understand the problem, surveillance helps us see it clearly. It gives shape to what clinicians experience every day but cannot always quantify. Which organisms are becoming resistant? What drugs are losing effectiveness? Are patterns changing across regions or over time? These are not academic questions, but they directly influence how patients are treated.
Why Surveillance Matters in Practice
For clinicians, surveillance is not something that exists only in reports or national databases. It quietly shapes everyday decisions. Each time an antibiotic is prescribed empirically, there is an underlying assumption about what is likely to work. Sometimes this assumption is based on experience, sometimes on outdated knowledge, and sometimes on necessity.
When local data is available and trusted, these decisions become more confident and more precise. Treatment aligns better with actual resistance patterns, unnecessary use of broad-spectrum antibiotics can be reduced, and patient outcomes improve. Where such data is weak or fragmented, the opposite happens: clinicians tend to prescribe defensively, often opting for broader coverage “just to be safe,” which in turn fuels the very problem we are trying to control.
In this sense, strengthening surveillance is not just about improving laboratories or reporting systems. It is about supporting better clinical care.
Where Nepal Stands Today
Nepal has made meaningful progress in building the foundations of AMR surveillance. The National Public Health Laboratory (NPHL) now coordinates a national network of 26 sentinel laboratories. These laboratories contribute data on key bacterial pathogens isolated from clinical samples, allowing the generation of antibiograms that reflect resistance patterns across different settings.
At the same time, Nepal’s participation in the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) has helped align national efforts with global standards. Laboratories are increasingly adopting standardized methods, and reporting has become more structured.
Beyond human health, surveillance is gradually expanding. In the veterinary sector, both active and passive AMR surveillance activities are underway. Efforts in food and environmental sectors are still developing but gaining momentum. Notably, joint surveillance initiatives, such as studies on ESBL-producing E. coli across humans, poultry, and the environment, are beginning to reflect a true One Health approach. Monitoring of antimicrobial consumption and use has also started in both human and animal health sectors.
Yet, as with many systems in transition, gaps remain. Data still comes disproportionately from a limited number of sites, with relatively less input from peripheral facilities and the private sector. Laboratory capacity varies, and cross-sector integration is still evolving. Perhaps most importantly, the feedback loop between data generation and clinical use is not yet as strong as it needs to be.
From Collecting Data to Using It
One of the less visible challenges in surveillance systems is that data often stops at the point of reporting. Antibiograms are produced, reports are submitted, and databases are updated; but the connection to day-to-day decision-making can be weak.
For surveillance to truly make a difference, it needs to become part of clinical thinking. Data should be accessible, understandable, and relevant to those who are making treatment decisions. A hospital antibiogram, for instance, is only useful if clinicians actually refer to it when prescribing. Similarly, national data should inform treatment guidelines, procurement decisions, and stewardship efforts in a way that is visible and practical.
There is also an important link with infection prevention and control. Resistance patterns can highlight where IPC practices may need strengthening, closing another critical loop between data and action.
The Role of the Medical Community
Surveillance is often seen as a technical or laboratory-driven activity, but its success depends heavily on the engagement of the wider medical community.
Clinicians contribute to surveillance in ways that are sometimes underestimated. The decision to send a culture before starting antibiotics, the quality of the sample collected, and the timing of that decision all influence the reliability of surveillance data. When these practices are consistent and thoughtful, the data becomes more representative and useful.
Laboratories, of course, remain central. Maintaining quality requires standard methods, regular quality assurance, and skilled personnel. But equally important is the ability to communicate results clearly and in a clinically meaningful way. Data that is difficult to interpret rarely influences behavior.
Finally, clinicians are the end users of surveillance data. Whether it is consulting an antibiogram before initiating therapy or narrowing antibiotics once culture results are available. These small, everyday actions are what ultimately translate surveillance into impact.
Institutional Support and Coordination
Building a robust surveillance system requires coordinated effort across multiple institutions.
The Ministry of Health and Food Safety, along with NPHL, plays a leading role in setting standards, expanding networks, and ensuring alignment with global systems such as GLASS. As the system matures, strengthening digital platforms for timely reporting and feedback will become increasingly important.
The Department of Drug Administration has a critical role in linking surveillance data to regulatory decisions. Resistance and antimicrobial use trends can inform which antibiotics need tighter control and where policy adjustments are necessary.
Educational and regulatory institutions also have a part to play. The Medical Education Commission can help ensure that future clinicians are comfortable interpreting and using AMR data. Professional councils and associations can reinforce data-driven practice through training, guidance, and peer engagement.
At the same time, greater inclusion of private hospitals and smaller laboratories is essential. Without their participation, national surveillance will continue to reflect only part of the picture.
Looking Beyond Human Health
AMR does not belong to any one sector. Resistant organisms move between humans, animals, food systems, and the environment. Addressing it effectively requires a connected view.
Nepal has already taken important steps in this direction, but integration remains a work in progress. Bringing together data from different sectors, aligning methods, and sharing findings across disciplines will be key to building a truly functional One Health surveillance system.
Looking Ahead
Nepal has established a strong starting point for AMR surveillance. The challenge now is less about creating systems and more about making them work together, consistently and meaningfully.
Expanding coverage, especially in underserved and private sectors, remains important. Strengthening laboratory quality and ensuring consistent standards across sites will improve reliability. Just as crucial is ensuring that data flows back to clinicians and policymakers in a timely and usable form.
Most importantly, there needs to be a cultural shift from seeing surveillance as a reporting requirement to recognizing it as a clinical tool.
Conclusion
AMR cannot be managed effectively without knowing what is happening on the ground. Surveillance provides that insight. It allows us to move from assumption to evidence, from generalized approaches to targeted action.
For Nepal, the next step is clear: expand surveillance to capture more representative data and ensure that the data being generated is actively used. This means bringing surveillance closer to where decisions are made viz at the bedside, in clinics, and within health systems.
In the end, the value of surveillance lies not in the amount of data collected, but in the difference it makes. Each report, each antibiogram, and each dataset has the potential to shape better decisions, and ultimately, better outcomes for patients.
Pillar 2 is, at its heart, about making evidence work. Because in the fight against antimicrobial resistance, informed action begins with informed understanding.
