Mentoring and Supportive Supervision to Enhance Antimicrobial Stewardship in Selected Hospitals Across India: The AMR Smart Hospital Project by the Indian Medical Association

Abstract

Antimicrobial resistance (AMR) is a WHO-designated “silent pandemic”, responsible for an estimated 4.95 million deaths globally in 2019, including 1.27 million deaths directly attributable to AMR, with India alone contributing over one million AMR-associated deaths and nearly 300,000 attributable deaths in the same year. Antimicrobial stewardship (AMS) programmes are critical to containing AMR; however, their implementation in low- and middle-income countries (LMICs) is often constrained by limited resources, inadequate training, and lack of standardized protocols. This project aims to strengthen AMS and infection prevention and control (IPC) practices in Indian hospitals through structured mentorship and supportive supervision, and to establish an “IMA AMR Smart Hospital” certification as a benchmark for excellence.

A longitudinal study will be conducted in 12 hospitals selected by simple random sampling from institutions expressing interest nationwide. Baseline AMS and IPC capacity will be assessed using the WHO Checklist of essential health-care facility core elements for AMS programmes in LMICs, complemented by review of 13 key institutional documents. Following desktop gap analysis, targeted mentorship and supportive supervision will be provided over two months to support context-appropriate implementation and strengthening of AMS and IPC protocols, followed by continuous monitoring and feedback. Final on-site assessments will determine eligibility for “IMA AMR Smart Hospital” certification.

The primary expected outcomes are demonstrable improvements in AMS and IPC practices, enhanced patient safety, and reductions in AMR-related morbidity and mortality in participating hospitals. The certification process is anticipated to incentivize institutional commitment, while the mentored model is expected to generate a scalable, context-sensitive framework that can be replicated across other facilities in India and adapted to similar LMIC settings worldwide. This will represent one of the first nationwide, mentorship-driven AMS strengthening and certification initiatives in an LMIC context.