A governance framework for development and assessment of national action plans on antimicrobial resistance

Abstract

Strengthening governance is an essential strategy to tackling antimicrobial resistance (AMR) at all levels; global, national, regional and local. To date, no systematic approach to governance of AMR national action plans (NAPs) exists. To address this, we aimed to develop the first governance framework to offer guidance for both the development and assessment of AMR national action plans (NAPs). We reviewed health system governance framework reviews to inform the basic structure of our framework, international guidance documents from the WHO, FAO, OIE and the EU, and sought the input of over 25 experts from international organizations, government ministries, policy institutes and academic institutions to develop and refine our framework. The framework consists of 18 domains with 52 indicators that are contained within three governance areas: "policy design", "implementation tools", and "monitoring and evaluation". To consider the dynamic nature of AMR, the framework is conceptualized as a cyclical process, which is responsive to the context and allows for continuous improvement and adaptation of AMR NAPs. Key messages • Antimicrobial Resistance (AMR) is one of the most pressing and complex issues today, with multi drug-resistant, extensively drug-resistant, and even pan drug-resistant organisms emerging. • AMR is driven by interrelated dynamics in the human, animal, and environmental health sectors, which makes governance challenging. • Strengthening governance of AMR policies at all levels; global, national, regional and local, is essential to tackling AMR. To date, no comprehensive framework for the governance of AMR National Action Plans (NAPs) has been developed. • To our knowledge, this is the first study that has developed a governance framework for AMR NAPs, based on a systematic review of the literature, international guidance, and over 20 experts from various international organizations, government ministries, policy institutes and academic institutions • The framework is conceptualized as a cyclical process between the three governance areas; policy design, implementation tools, and monitoring and evaluation.

National action to combat AMR: a One-Health approach to assess policy priorities in action plans

“…It may also be used in conjunction with the AMR governance framework to better understand how policies are linked to governance and vice versa. 10 Finally, the methodological approach underpins the creation of a database with a complete library of past and current AMR policies that can be easily queried using the values listed in each categorical variable. Paired with a narrative analysis of 'success' stories of certain countries, policymakers, advisors and stakeholders may use this not only for policy innovation but to learn lessons from other governments, institutions or organisations facing similar problems.…”

“…Other works regarding AMR policies have focused on the way the challenge is framed, 8 the challenges of implementation 9 and on how to better assess the governance dimension of AMR policies. 10 Currently, there are growing insights about AMR policies but a lack of a comprehensive framework for the systematic analysis of AMR policies at the national level.…”

Paving the Way for the Implementation of a Decision Support System for Antibiotic Prescribing in Primary Care in West Africa: Preimplementation and Co-Design Workshop With Physicians

“…The governance system and public health priorities could be important additional factors that need to be studied in West Africa before the implementation of a CDSS. Work has been done in European countries about governance to address AMR [ 52 ], and relevant frameworks for assessing this important factor exist [ 20 , 53 ]. However, the analysis and governance frameworks for antibiotic prescribing often lack the assessment of technological innovation, such as electronic decision support.…”

Country Income Is Only One of the Tiles: The Global Journey of Antimicrobial Resistance among Humans, Animals, and Environment

“…AMR is one of the greatest health challenges of the 21st century [ 1 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. On the one side, the overuse and misuse of antimicrobials are certainly among the major drivers for the development of AMR globally, but on the other side, a lack of laboratory resources or skills to identify the organism and its antimicrobial susceptibility, with unreliable or absent surveillance data on AMR, a lack of perception or accountability of the threat, and a lack of treatment guidelines place certain health care facilities at risk for sustaining the development of AMR.…”