ESCALATE-PPS is a hospital partnership initiative in Zanzibar (Unguja Island) designed to close a critical gap in the AMR response: routine, facility-level data on antimicrobial use (AMU) that can drive real antimicrobial stewardship (AMS) actions. The project builds practical capacity in district hospitals to run serial Point Prevalence Surveys (PPS), interpret results, and translate findings into low-resource, high-impact AMS interventions aligned with the Zanzibar Action Plan on AMR (ZAP-AMR).

What the project does:

• Training + mentorship:
  Four one-week workshops over two years, combining PPS methodology with bedside and facility-level AMS (WHO Practical Toolkit + AWaRe).
• Train-the-trainer model:
  Establish Facility Trainers (≥3 per hospital) who lead implementation and enable sustainability despite staff turnover.
• Serial measurement for action:
  Repeated PPS cycles in each target hospital to create a baseline, identify prescribing problems, and monitor improvement over time.
• Digital support:
  Continuous e-learning (Moodle) plus remote audit & feedback to keep AMS activities running between workshops.
• South–South exchange:
  Structured learning exchange between Zanzibar and Tanga to share approaches and align strategies across regional AMR initiatives. 

Partners and setting
ESCALATE-PPS is led by the Bernhard Nocht Institute for Tropical Medicine (BNITM) with local implementation coordinated through Health Improvement Project Zanzibar (HIPZ) and in collaboration with the Zanzibar Ministry of Health (AMR focal point / AMS Technical Working Group), targeting newly established district hospitals on Unguja.