The Implementation of National Action Plan (NAP) on Antimicrobial Resistance (AMR) in Bangladesh: Challenges and Lessons Learned from a Cross-Sectional Qualitative Study

Abstract

This study explored the current situation of the National Action Plan (NAP) on Antimicrobial Resistance (AMR) implementation in Bangladesh and examined how different sectors (human, animal, and environment) addressed the AMR problem in policy and practice, as well as associated challenges and barriers to identifying policy lessons and practices. Informed by a rapid review of the available literature and following the World Health Organization (WHO) AMR situation analysis framework, a guideline was developed to conduct in-depth interviews with selected stakeholders from January to December 2021. Data were analysed using an adapted version of Anderson’s governance framework. Findings reveal the absence of required inter-sectoral coordination essential to a multisectoral approach. There was substantial coordination between the human health and livestock/fisheries sectors, but the environment sector was conspicuously absent. The government initiated some hospital-based awareness programs and surveillance activities, yet no national Monitoring and Evaluation (M&E) framework was established for NAP activities. Progress of implementation was slow, constrained by the shortage of a trained health workforce and financial resources, as well as the COVID-19 pandemic. To summarise, five years into the development of the NAP in Bangladesh, its implementation is not up to the level that the urgency of the situation requires. The policy and practice need to be cognisant of this fact and do the needful things to avoid a catastrophe.

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“…Antimicrobial resistance (AMR) is a worldwide threat to human health and progress. To attain the Sustainable Development Goals (SDGs), urgent multi-sectoral action is required [ 1 ]. Nanotechnology is becoming more widely used in medicine; thus, it is not surprising to find these technologies being used to combat the threat of antibiotic resistance.…”

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“…This has been shown to be an issue for AMR strategies in general, with global AMR commitments from 2015 to 2021 remaining heavily focused on research, surveillance, and stewardship rather than the more upstream, preventative measures outlined in the 2015 AMR Global Action Plan . This further speaks to the need for AMR-sensitive approaches and the integration of AMR into wider sustainable development strategies. − A recent study evaluating the implementation of the Bangladesh AMR NAP reported a lack of activities targeting AMR in the environmental sector, a shortage of a dedicated and trained workforce, and insufficient funding . Integrating AMR into wider sustainable development policies may also therefore prove to expedite NAP implementation from an efficiency perspective, through making use of existing funding, resources, and activities targeting the wider sustainable development goals.…”

“…5−7 A recent study evaluating the implementation of the Bangladesh AMR NAP reported a lack of activities targeting AMR in the environmental sector, a shortage of a dedicated and trained workforce, and insufficient funding. 73 Integrating AMR into wider sustainable development policies may also therefore prove to expedite NAP implementation from an efficiency perspective, through making use of existing funding, resources, and activities targeting the wider sustainable development goals. Since its development in the 1990s, the DPSIR framework has been applied to a very wide variety of issues and contexts, as both a conceptual and analytical tool.…”

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“… 127 Additionally, inter-sectoral coordination with a “health in all” approach, and equitable distribution of resources for health and development are essential achieving UHC in face of the challenges of economic inequities, global uncertainty, antimicrobial resistance, and climate change. 75 , 128 In India, campaigns like “Eat right India”, “Fit India”, “Poshan Abhiyan”, integration of digital health technologies through “Ayushman Bharat Digital Mission” and launch of “National Programme on Climate Change & Human Health” provide an opportunity for inter-sectoral coordination.…”