FAO Assessment Tool for Laboratories and AMR Surveillance Systems (FAO-ATLASS)
What is FAO-ATLASS?
FAO-ATLASS is a tool for assessing and defining targets to improve national AMR surveillance systems in the food and agriculture sectors. It is composed of two modules: the surveillance module, and the laboratory module. The structure of the tool is based on five main areas of an AMR surveillance system: governance, data production network (laboratories), data collection and analysis, communication, and sustainability. The module is currently available in English, Spanish, Russian, and Portuguese (laboratory module).
(The five areas)
The tool was first piloted in 2016, and up to date, 60 countries and 270 laboratories hosted FAO-ATLASS assessment missions. FAO is closely working with the World Organisation for Animal Health (WOAH) and World Health Organization (WHO) to coordinate country-level assessments across sectors under a One Health approach.
To make the best use of the information produced, and facilitate implementation of FAO-ATLASS, FAO has initiated the development of an IT solution (web/mobile based application) for digital deployment. The digitalized ATLASS tool will enable the transmission of the data generated from the different FAO-ATLASS questionnaires into a centralized database where the information can be managed and analyzed through interactive dashboards to identify gaps for improvement at national, regional, and global levels.
OUTPUTS
- Mapping of national AMR surveillance systems in the food and agriculture sectors, including organization of AMR surveillance and laboratory networks and analytical capacities
- Baseline assessment of the development and implementation of AMR surveillance activities, providing a Progressive Improvement Pathway (PIP) of capacities from “1-limited”, 2 “Moderate”, 3 “Developed”, 4 “Demonstrated”, and to “5-sustainable” (figure below). This pathway evaluates laboratories' capabilities to detect AMR and assesses surveillance systems' ability to coordinate the generation and dissemination of reliable information on AMR for decision-making processes, with stage 3 indicating reliable data.
- Summary tables and spider webs to easily summarize strengths and gaps for each laboratory assessed and identification of specific steps for advancement of current stage of capacities, helping countries with prioritizing actions for building reliable national AMR surveillance systems
- Monitoring of progress made through PIP stages obtained in follow up assessments
ASSESSMENT MISSIONS
FAO-ATLASS missions are carried out by assessors trained in the effective use of the tool, to ensure harmonized assessments. The assessment team usually includes two main assessors (one with expertise in laboratory techniques for antimicrobial susceptibility testing, and one with expertise in AMR epidemiology and surveillance), in addition to FAO staff who accompany the team for additional support. FAO-ATLASS missions are up to a weeklong. The recommended approach is to carry out the first assessment mission with external assessors to generate baseline information. For follow-up assessments to track progress, national assessors can do these and are recommended yearly.
The assessment is done through a participatory and multisectoral approach with key representatives and stakeholders from all involved sectors, including human health, to describe the cooperation between all sectors. FAO-ATLASS missions usually consist of:
Step 1. Stakeholder meeting with focal points for national AMR surveillance in food and agriculture sectors, and representatives from other sectors such as human health and environment.
Step 2. Visit and assessment of laboratories.
Step 3. Stakeholder debriefing meeting to share and discuss information gathered through the mission and specific recommendations. These discussions benefit from continuity in stakeholder focal points.
Step 4. Report written by the main assessors in a collaborative approach with the country. Once cleared the report is officially submitted to the national authorities to be used for national and regional discussions on the mission findings and recommendations.
Post-ATLASS missions and workshops may be organized at the country or regional level to gather national authorities and experts to review FAO-ATLASS mission findings and to develop plans for progressive improvement of AMR surveillance in their country and region.
ORGANIZATION OF ATLASS COMMUNITIES
FAO is also building a worldwide community of assessors to serve as a technical resource toward harmonized regional and global surveillance efforts.
The ATLASS assessors, trained in the use of the tool, are either international (affiliated with FAO) or national experts (affiliated with the country) with experience in bacteriology and antimicrobial susceptibility testing, and/or applied epidemiology for AMR surveillance in the field of the food and agriculture sectors.
THE WAY FORWARD
FAO has expanded the scope of implementation of activities under objective no. 2 of the FAO Action Plan on AMR, which centers on strengthening surveillance and research, to provide countries with mechanisms to catalyze the formation of AMR surveillance networks and to report and use their AMR data in alignment with international standards. FAO has developed the International FAO Antimicrobial Resistance Monitoring System (InFARM) that is currently in early stages of implementation at a global level.
An integral element of the InFARM system will be to understand the capacities and needs of countries for progressively strengthening AMR surveillance systems that produce reliable AMR evidence. FAO-ATLASS assessments provide a mechanism to identify the level of reliability of the AMR data that will be hosted in the InFARM IT platform.