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The Software for Health Foundation, working as part of the AoS Health consortium, have developed the AMR One Health Surveillance System in Nepal, creating a platform where health data from different sectors can be analysed in a singular location. Centralisation of data in a single DHIS2 data model allows for analysis of patterns and trends in antimicrobial resistance (AMR). Data gathered by province in the surveillance system, can be rendered using GIS, making it possible to view where pathogens and resistance have emerged within Nepal. Using historical data, the changing patterns and trends can be observed by location over time. 

Customisation of the ‘Core’ AoS One Health system occurred over four iterations of the One Health Platform, starting with a stakeholder review of the ‘out-of-the-box standard solution and completing with an official soft launch at the end of the sustainability period in April 2022. 

Data is gathered in XLS spreadsheets (by laboratories in different provinces around Nepal) using a diverse range of formats. These spreadsheets required extensive manual reformatting and cleansing in order to standardise them, an activity that is both time consuming and prone to error. To address these issues the Software for Health Foundation developed a desktop application, Open Data XLS transformer (ODX), that automatically corrects and standardises spreadsheets. The users can define their own ‘spell mappings’ in order to correct common spelling mistakes in important reference data, such as pathogen name, antibiotic name, or specimen types. ODX provides a long-term and sustainable solution to the manual reformatting and cleansing of spreadsheet based data. 

This project acts as a model implementation that illustrates how user centred engagement can, through a small number of iterations, result in a fully customised AMR surveillance service that meets a countries specific needs.

Following the initial implementation of the One Health Platform at the end of February 2022, the project entered a 2-month sustainability period. The project transition activities included formal classroom training as well as ‘on the job mentoring’. Sustainability focussed activities are ongoing today, with a focus on maturing the systems and processes, alongside guiding Nepal on a path to self-sufficiency.