Antimicrobial stewardship programme in Sri Lanka: insights from early implementation experience (2024-2025)

Bridging the gap between national policy and hospital-level implementation remains a critical challenge for antimicrobial stewardship (AMS) in low- and middle-income countries (LMICs). This health policy outlines the phased rollout of Sri Lanka's centrally mandated National AMS programme (2024). Driven by the Ministry of Health and Sri Lanka College of Microbiologists, the intervention deployed four standardised, low-cost tools: a national institutional framework, a localised WHO AWaRe classification, a dedicated antimicrobial prescription chart, and revised empirical guidelines. To overcome resource constraints, the strategy utilised a 'Training-of-Trainers' model and multisectoral coalitions across all nine provinces. A one-year post-launch structural evaluation demonstrated an implementation rate exceeding 50% across all key performance indicators. Integration of the AWaRe classification achieved the highest uptake (74%), while establishing functional AMS teams and Point prevalence surveys achieved 52%. Sri Lanka's experience demonstrates that centralised governance and pragmatic, low-cost structural tools can institutionalise sustainable AMS frameworks in resource-constrained settings.