Kerala Anti-Microbial Resistance Strategic Action Plan (KARSAP)

The Kerala Anti-Microbial Resistance Strategic Action Plan (KARSAP) is a public health initiative launched by the Government of Kerala to combat the growing threat of antimicrobial resistance (AMR). It is one of the pioneering state-level action plans in India designed in alignment with the National Action Plan on Antimicrobial Resistance (NAP-AMR) and the World Health Organization’s Global Action Plan on Antimicrobial Resistance. KARSAP reflects Kerala’s proactive approach to safeguard healthcare systems against the risks posed by resistant pathogens, ensuring the continued effectiveness of antibiotics and other antimicrobial agents.

Background

Antimicrobial resistance is a major global health concern, arising from the misuse and overuse of antibiotics in humans, animals, and agriculture. Resistant infections lead to longer hospital stays, higher medical costs, and increased mortality.
India, being one of the world’s largest consumers of antibiotics, faces significant challenges related to AMR. Kerala, with its well-established healthcare system, recognised the urgency of addressing the issue and developed a comprehensive state-level strategy to mitigate the risks. The KARSAP framework was officially introduced in 2018, making Kerala the first Indian state to adopt such a policy.

Objectives of KARSAP

KARSAP outlines a multi-sectoral approach to tackle AMR with the following core objectives:

• Surveillance and monitoring: Establishing robust systems for tracking antibiotic use and resistance patterns in human, animal, and environmental health sectors.
• Optimised use of antimicrobials: Promoting rational use of antibiotics through stewardship programmes in hospitals and clinics.
• Infection prevention and control: Strengthening hygiene, sanitation, and infection control practices in healthcare facilities.
• Public awareness and education: Educating communities, healthcare professionals, and farmers about the dangers of antibiotic misuse.
• Research and innovation: Encouraging studies on resistance mechanisms, new treatment options, and alternative therapies.
• One Health approach: Integrating human health, veterinary health, and environmental perspectives in AMR containment strategies.

Key Components and Strategies

KARSAP adopts a structured, evidence-based approach. The major components include:

• Hospital-based antimicrobial stewardship programmes (AMSPs): Monitoring prescriptions, restricting unnecessary antibiotic use, and introducing treatment guidelines.
• Laboratory strengthening: Enhancing diagnostic capacity to detect resistant strains rapidly.
• Integrated surveillance: Establishing networks linking hospitals, veterinary institutions, and environmental monitoring bodies.
• Training and capacity building: Regular training for doctors, nurses, pharmacists, veterinarians, and community health workers.
• Regulation of antibiotic sales: Enforcing stricter rules on over-the-counter antibiotic availability to prevent misuse.
• Community engagement: Campaigns targeting the general public to discourage self-medication and incomplete antibiotic courses.

Achievements and Progress

Since its implementation, KARSAP has made significant progress in several areas:

• Development of state-specific AMR surveillance networks integrating medical colleges and district hospitals.
• Establishment of antimicrobial stewardship committees in government medical institutions.
• Awareness campaigns in schools, communities, and media platforms.
• Pilot programmes in veterinary and aquaculture sectors to monitor antibiotic use in food production.
• Partnerships with national and international organisations to strengthen research and policy development.

Challenges

Despite progress, KARSAP faces several challenges:

• Over-the-counter availability: Antibiotics continue to be easily accessible without prescriptions in many areas.
• Private sector engagement: Ensuring compliance among private hospitals and pharmacies is complex.
• Veterinary sector integration: Monitoring antibiotic use in livestock and aquaculture remains underdeveloped.
• Behavioural change: Sustained public education and cultural shifts in prescribing practices are difficult to achieve.

Significance

KARSAP is a milestone in India’s public health policy for the following reasons:

• It represents the first state-level AMR action plan in the country.
• It operationalises the One Health framework, acknowledging interlinkages between human, animal, and environmental health.
• It sets a model for other states to emulate in developing decentralised strategies against antimicrobial resistance.
• It enhances Kerala’s reputation for proactive healthcare governance and innovation.

Future Prospects

The future trajectory of KARSAP involves scaling up surveillance, strengthening partnerships with the private healthcare sector, and integrating AMR monitoring into environmental and agricultural systems. Expanding stewardship programmes to district-level hospitals and rural clinics will be crucial for comprehensive coverage.
By combining public health measures, regulatory frameworks, and awareness-building, KARSAP is expected to play a critical role in containing antimicrobial resistance in Kerala, contributing to India’s national and global fight against one of the most pressing health challenges of the 21st century.