An Antimicrobial Stewardship Programme (ASP) is a hospital initiative to ensure antibiotics are used correctly and only when necessary, helping to prevent drug-resistant infections and keep antibiotics effective for future patients.
Significant barriers to implementing the programmes that were identified included limited access to microbiology services, insufficient resources and staff to perform stewardship activities, hierarchical hospital structures, and lack of collaboration between the different disciplines working in the hospital. The study found that these barriers were most pronounced in hospitals located in districts with the lowest Public Health Development Index and per capita domestic expenditure.
The NASPA Project aimed to assess the state of ASP implementation across Indonesia, identify the challenges healthcare providers face, and offer recommendations for strengthening these programmes in public and private hospitals. The study surveyed hospitals from across 34 provinces in Indonesia and conducted focus group discussions with a diverse subset of hospitals representing public and private hospitals, high to low tiered levels (A–D), and different geographic regions.
Robert Sinto, dr., the study’s first author, explained: ‘Many smaller and remote hospitals lack essential resources like funding, staff, microbiology labs, and IT support to support high-quality data collection.’
The study also highlighted that national ASP guidelines exist and progress has been made. However, Associate Professor Raph Hamers, Head of Clinical Infectious Diseases Research Programme, said: ‘Stronger regulations are needed to make ASPs a priority, set minimum standards, and provide clear evaluation methods.’
Despite many challenges, the study also identified key enablers that could help strengthen ASP implementation across Indonesia’s hospitals. One of the most important factors is strong leadership support.
Another critical enabler is collaboration and training among healthcare workers. Professor Anis Karuniawati, a co-author of the paper and an expert in clinical microbiology at FMUI said: ‘Cross-disciplinary teamwork between pharmacists, clinicians, and infection control staff was shown to improve adherence to ASP protocols and antibiotic use.’
These enablers offer valuable guidance for policymakers, highlighting the need for clear national standards, better funding support, and training to help hospitals overcome existing barriers.
The NASPA study was a collaboration with Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Monash University Indonesia, Directorate of Health Services Quality of Indonesian MoH, Mahidol Oxford Tropical Medicine Research Unit, and Mahidol University. Funding was provided by Wellcome [106680/Z/14/Z].
Read the full study on the Journal of Hospital Infection website: https://www.journalofhospitalinfection.com/article/S0195-6701%2824%2900334-7/fulltext