Combating Antimicrobial Resistance in Singapore: A Qualitative Study Exploring the Policy Context, Challenges, Facilitators, and Proposed Strategies

Abstract

Antimicrobial resistance (AMR) is a global public health threat that warrants urgent attention. However, the multifaceted nature of AMR often complicates the development and implementation of comprehensive policies. In this study, we describe the policy context and explore experts' perspectives on the challenges, facilitators, and strategies for combating AMR in Singapore. We conducted semi-structured interviews with 21 participants. Interviews were transcribed verbatim and were analyzed thematically, adopting an interpretative approach. Participants reported that the Ministry of Health (MOH) has effectively funded AMR control programs and research in all public hospitals. In addition, a preexisting One Health platform, among MOH, Agri-Food & Veterinary Authority (restructured to form the Singapore Food Agency and the Animal & Veterinary Service under NParks in April 2019), National Environment Agency, and Singapore's National Water Agency, was perceived to have facilitated the coordination and formulation of Singapore's AMR strategies. Nonetheless, participants highlighted that the success of AMR strategies is compounded by various challenges such as surveillance in private clinics, resource constraints at community-level health facilities, sub-optimal public awareness, patchy regulation on antimicrobial use in animals, and environmental contamination. This study shows that the process of planning and executing AMR policies is complicated even in a well-resourced country such as Singapore. It has also highlighted the increasing need to address the social, political, cultural, and behavioral aspects influencing AMR. Ultimately, it will be difficult to design policy interventions that cater for the needs of individuals, families, and the community, unless we understand how all these aspects interact and shape the AMR response.

A Qualitative Study on the Design and Implementation of the National Action Plan on Antimicrobial Resistance in the Philippines

“…The increased level of engagement was also observed in the animal health sector, as is evident in the “IAMResponsible” campaign for the animal and agricultural sector, specifically targeting veterinarians, farmers, students, and the general public. This finding is similar across other ASEAN countries and could likely be attributed to the increased awareness and advocacy at the global level through international initiations, such as the WHO’s World Antimicrobial Awareness Week in November annually [ 17 , 27 ]. However, some respondents noted that the level of attention on the issue tends to wane after these campaign activities.…”

“…Insufficient infrastructure to support a national surveillance system has also been reported by other countries [ 29 ]. For example, Thailand highlighted a lack of national policy decisions for the development of a comprehensive surveillance system; Singapore mentioned that, although surveillance in the human health sector was well established, it was mainly limited to the public sector, and it was also lacking in the animal health and environment sectors [ 27 , 31 ]. The antimicrobial usage (AMU) surveillance in the Philippines was also reported to be insufficient.…”

Understanding antimicrobial resistance from the perspective of public policy: a multinational knowledge, attitude, and practice survey to determine global awareness

“…Their qualitative ndings suggested that promoting awareness among policymakers and stakeholders is of critical importance to reduce the burden of AMR. (Singh et al, 2019).…”

Understanding Antimicrobial Resistance from the Perspective of Public Policy: A Multinational Knowledge, Attitude, and Perception Survey to Determine Global Awareness

“…However, a previous case study in Singapore has shown that the progress of AMR initiatives can be compromised regardless of resource allocation and that combating AMR is also complex in high-resource settings such as Singapore. Their findings suggest that promoting awareness among policy-makers and stakeholders is of critical importance to reduce the burden of AMR [ 15 ].…”