Policy Design, Implementation and Governance of Antimicrobial Resistance

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 40247

Special Issue Editors


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Guest Editor
Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
Interests: role of contextual drivers and power relations of policy actors' behavior and decision-making in shaping AMR policy in Asia; mapping social network of policy makers; AMR governance and challenges in ASEAN region; implementation challenges of AMR-National Action Plan in Asia

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Guest Editor
BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
Interests: Impact of microcredit-based development interventions on health and well-being; gender and health; health equity; human resources for health; universal health coverage

Special Issue Information

Dear Colleagues,

In recent years, antimicrobial resistance (AMR) has emerged as one of the major global health threats. The misuse and abuse of antimicrobials in veterinary and human medicine practices have been described as major contributing factors. In turn, human activities have been shown to contribute to the evolution and spread of AMR in the environment. To address these challenges, the Global Action Plan on AMR was launched at the World Health Assembly in 2015, focusing global attention on the need to design multisectoral national AMR action plans. A review of the evidence for AMR policies highlighted that robust evidence is limited and context-specific, identifying a critical dearth of studies from Asia and concluding that an understanding of the political and economic context is essential for an effective intervention development. Research in this area will identify lessons learnt and best practices to inform AMR policy design and implementation mechanisms. Furthemore, it will improve our understanding of how policymakers’ perceptions of AMR drive their behavior and selection of policy options aimed at appropriate use of antimicrobials and its impact on policies and responses for AMR use.

We welcome contributions based on all aspects related to antimicrobial resistance, which may include original research, review articles, case series, and opinion papers.

Dr. Helena Legido-Quigley
Prof. Dr. Syed Masud Ahmed
Guest Editors

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Keywords

  • Antimicrobial resistance
  • Antimicrobial resistance governance
  • AMR National Action Plan implementation, AMR

Published Papers (10 papers)

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20 pages, 648 KiB  
Article
A Qualitative Study on the Design and Implementation of the National Action Plan on Antimicrobial Resistance in the Philippines
by Maria Margarita M. Lota, Alvin Qijia Chua, Karen Azupardo, Carlo Lumangaya, Katherine Ann V. Reyes, Sharon Yvette Angelina M. Villanueva, Helena Legido-Quigley and Evalyn A. Roxas
Antibiotics 2022, 11(6), 820; https://doi.org/10.3390/antibiotics11060820 - 17 Jun 2022
Cited by 10 | Viewed by 7863
Abstract
Antimicrobial resistance (AMR) is a global public health threat that warrants urgent attention. Countries developed their national action plans (NAPs) following the launch of the Global Action Plan on AMR in 2015. The development and implementation of NAPs are often complicated due to [...] Read more.
Antimicrobial resistance (AMR) is a global public health threat that warrants urgent attention. Countries developed their national action plans (NAPs) following the launch of the Global Action Plan on AMR in 2015. The development and implementation of NAPs are often complicated due to the multifaceted nature of AMR, and studies analyzing these aspects are lacking. We analyzed the development and implementation of the Philippine NAP on AMR with guidance from an AMR governance framework. We conducted in-depth interviews with 37 participants across the One Health spectrum. The interviews were transcribed verbatim and were analyzed thematically, adopting an interpretative approach. The enabling factors for NAP implementation include (1) a high level of governmental support and involvement of relevant stakeholders, (2) the development of policies to support improved responses in infection prevention and control and antimicrobial stewardship, and (3) better engagement and advocacy by professional associations and civil society groups. The challenges include (1) a lack of resources and regulatory capacity, (2) insufficient impetus for AMR research and surveillance, and (3) limited One Health engagement. Although there has been considerable progress for human health, strengthening the involvement and representation of the animal health and environment sectors in the AMR scene must be undertaken. Developing well-defined roles within policies will be paramount to the strong implementation of AMR strategies. Full article
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20 pages, 307 KiB  
Article
Antimicrobial Resistance Research Collaborations in Asia: Challenges and Opportunities to Equitable Partnerships
by Pami Shrestha, Shiying He and Helena Legido-Quigley
Antibiotics 2022, 11(6), 755; https://doi.org/10.3390/antibiotics11060755 - 01 Jun 2022
Cited by 8 | Viewed by 2623
Abstract
Antimicrobial Resistance is recognized as a major threat to global health security. The WHO Southeast Asia region is dubbed a “global hub for AMR emergence”, as it runs the highest risk for AMR emergence among all WHO regions in Asia. Hence, there is [...] Read more.
Antimicrobial Resistance is recognized as a major threat to global health security. The WHO Southeast Asia region is dubbed a “global hub for AMR emergence”, as it runs the highest risk for AMR emergence among all WHO regions in Asia. Hence, there is a need for Asia-centric, collaborative AMR research aligned with the true needs and priorities of the region. This study aimed to identify and understand the challenges and opportunities for such collaborative endeavors to enhance equitable partnerships. This qualitative study adopted an interpretative approach involving a thematic analysis of 15 semi-structured interviews with AMR experts conducting research in the region. The study identified several factors influencing research collaborations, such as the multi-dimensional nature of AMR, limited or lack of funds, different AMR research priorities in Asian countries, absence of Asia-centric AMR leadership, lack of trust and, unequal power relationships between researchers, and the negative impact of the COVID-19 pandemic in research collaborations. It also identified some opportunities, such as the willingness of researchers to collaborate, the formation of a few networks, and the prioritization by many academics of the One Health paradigm for framing AMR research. Participants reported that the initiation of stronger cross-discipline and cross-country networks, the development of Asia-centric AMR leadership, flexible research agendas with shared priorities, transparent and transferable funds, and support to enhance research capacity in LMICs could assist in developing more equitable collaborative research in Asia. Full article
13 pages, 782 KiB  
Article
The Implementation of National Action Plan (NAP) on Antimicrobial Resistance (AMR) in Bangladesh: Challenges and Lessons Learned from a Cross-Sectional Qualitative Study
by Syed Masud Ahmed, Nahitun Naher, Samiun Nazrin Bente Kamal Tune and Bushra Zarin Islam
Antibiotics 2022, 11(5), 690; https://doi.org/10.3390/antibiotics11050690 - 19 May 2022
Cited by 12 | Viewed by 5029
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 [...] Read more.
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. Full article
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16 pages, 467 KiB  
Article
Understanding the Implementation of Antimicrobial Policies: Lessons from the Hong Kong Strategy and Action Plan
by Mingqi Song, Ziru Deng, Olivia Chan and Karen Ann Grépin
Antibiotics 2022, 11(5), 636; https://doi.org/10.3390/antibiotics11050636 - 10 May 2022
Cited by 4 | Viewed by 3094
Abstract
In 2017, the Hong Kong Strategy and Action Plan on Antimicrobial Resistance 2017–2022 (HKSAP) was announced with the aim of tackling the growing threat of antimicrobial resistance (AMR) in Hong Kong. However, little is known about how the planned activities have been implemented. [...] Read more.
In 2017, the Hong Kong Strategy and Action Plan on Antimicrobial Resistance 2017–2022 (HKSAP) was announced with the aim of tackling the growing threat of antimicrobial resistance (AMR) in Hong Kong. However, little is known about how the planned activities have been implemented. In this study, we examine the status of implementation of the HKSAP using the Smith Policy Implementation Process Model. Semi-structured interviews with 17 informants found that important achievements have been made, including launching educational and training activities targeting the public, farmers, and healthcare professionals; upgrading the AMR surveillance system; and strengthening AMR stewardship and infection control. Nevertheless, participants also identified barriers to greater implementation, such as tensions across sectors, ongoing inappropriate drug use and prescription habits, insufficient human and technical resources, as well as a weak accountability framework. Environmental factors such as the COVID-19 pandemic also affected the implementation of HKSAP. Our study indicated that expanding engagement with the public and professionals, creating a collaborative environment for policy implementation, and building a well-functioning monitoring and evaluation system should be areas to focus on in future AMR policies. Full article
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24 pages, 1566 KiB  
Article
Fighting Antimicrobial Resistance: Development and Implementation of the Ghanaian National Action Plan (2017–2021)
by Wolfgang Hein, Leslie Mawuli Aglanu, MacDonnel Mensah-Sekyere, Anne Harant, Johanna Brinkel, Maike Lamshöft, Eva Lorenz, Daniel Eibach and John Amuasi
Antibiotics 2022, 11(5), 613; https://doi.org/10.3390/antibiotics11050613 - 03 May 2022
Cited by 12 | Viewed by 2913
Abstract
In recent years, Ghana has been recognised as a leading player in addressing antimicrobial resistance (AMR) in Africa. However, based on our literature review, we could not ascertain whether the core elements of the national action plan (NAP) were implemented in practice. In [...] Read more.
In recent years, Ghana has been recognised as a leading player in addressing antimicrobial resistance (AMR) in Africa. However, based on our literature review, we could not ascertain whether the core elements of the national action plan (NAP) were implemented in practice. In this paper, we present a qualitative analysis of the development of AMR-related policies in Ghana, including the NAP. We conducted 13 semi-structured expert interviews to obtain at a more thorough understanding of the implementation process for the AMR NAP and to highlight its accomplishments and shortcomings. The results show that AMR policies, as embodied in the NAP, have led to an extended network of cooperation between stakeholders in many political fields. Broadly, limited allocation of financial resources from the government and from international cooperation have been deplored. Furthermore, the opportunity for using the NAP in mainstreaming the response to the threat of AMR has not been seized. To the general public, this remained hidden behind a number of other relevant health topics such as infection prevention, veterinary services and pharmaceutical regulation. As a One Health (OH) challenge, developing countries could integrate AMR NAPs into other health and environmental programmes to improve its implementation in practice. Full article
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26 pages, 11164 KiB  
Article
Antimicrobial Resistance and Environmental Health: A Water Stewardship Framework for Global and National Action
by Rachel A. Kaiser, Lina Taing and Himesh Bhatia
Antibiotics 2022, 11(1), 63; https://doi.org/10.3390/antibiotics11010063 - 05 Jan 2022
Cited by 11 | Viewed by 4214
Abstract
Antimicrobial resistance (AMR) is a global health crisis that affects all life on Earth. In 2015, the World Health Organization developed guidance to combat AMR in accordance with a One Health framework considering human, animal, and environment sectors of planetary health. This study [...] Read more.
Antimicrobial resistance (AMR) is a global health crisis that affects all life on Earth. In 2015, the World Health Organization developed guidance to combat AMR in accordance with a One Health framework considering human, animal, and environment sectors of planetary health. This study reviewed global guidance and 25 National Action Plans to evaluate thematic priorities in One Health AMR approaches using a novel framework that additionally facilitated the identification of water-related stewardship gaps, as water resources are recognized as the primary environmental AMR reservoir and dissemination pathway. This review found that global and national stewardship primarily focuses on mitigating antibiotic use in the human and animal sectors, overlooking environmental drivers, particularly diverse environmental waters. The findings of this study highlight the need to broaden the scope of water-related AMR concerns beyond water, sanitation, and hygiene (WASH) infrastructure for water supply and wastewater treatment, and account for environmental waters in AMR development and dissemination, particularly in low-income countries where half a billion people rely on environmental waters to meet daily needs. Equitably accounting for water environments, supplies, and waste in AMR prevention, mitigation, surveillance, and innovation can significantly enhance the integration of environmental objectives in One Health AMR stewardship. Full article
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17 pages, 247 KiB  
Article
Framing the Drivers of Antimicrobial Resistance in Tanzania
by Anna Durrance-Bagale, Anne-Sophie Jung, Gasto Frumence, Leonard Mboera, Stephen E. Mshana, Calvin Sindato, Taane G. Clark, Mecky Matee and Helena Legido-Quigley
Antibiotics 2021, 10(8), 991; https://doi.org/10.3390/antibiotics10080991 - 16 Aug 2021
Cited by 4 | Viewed by 2497
Abstract
Despite global awareness of the key factors surrounding antimicrobial resistance (AMR), designing and implementing policies to address the critical issues around the drivers of AMR remains complex to put into practice. We identified prevalent narratives and framing used by epistemological communities involved in [...] Read more.
Despite global awareness of the key factors surrounding antimicrobial resistance (AMR), designing and implementing policies to address the critical issues around the drivers of AMR remains complex to put into practice. We identified prevalent narratives and framing used by epistemological communities involved in the response to AMR in Tanzania, interrogated how this framing may inform policymaking, and identified interventions that could be tailored to the groups believed responsible for AMR. We interviewed 114 key informants from three districts and analysed transcripts line by line. Our results suggest that many different groups help drive the spread of AMR in Tanzania and need to be involved in any effective response. Human health is currently perceived as driving the response, while other domains lag behind in their efforts. For AMR programmes to be successful, all sectors need to be involved, including civil society groups, community representatives, and those working in communities (e.g., primary care physicians). However, current plans and programmes largely fail to include these viewpoints. The perceived presence of political will in Tanzania is a significant step towards such a response. Any strategies to tackle AMR need to be tailored to the context-specific realities, taking into account constraints, beliefs, and power dynamics within countries. Full article
13 pages, 459 KiB  
Article
Exploring the One Health Perspective in Sweden’s Policies for Containing Antibiotic Resistance
by Jaran Eriksen, Ingeborg Björkman, Marta Röing, Sabiha Y. Essack and Cecilia Stålsby Lundborg
Antibiotics 2021, 10(5), 526; https://doi.org/10.3390/antibiotics10050526 - 03 May 2021
Cited by 8 | Viewed by 3344
Abstract
Antibiotic resistance is considered to be a major threat to global health. The main driver of antibiotic resistance is antibiotic use. Antibiotics are used in humans, animals, and food production and are released into the environment. Therefore, it is imperative to include all [...] Read more.
Antibiotic resistance is considered to be a major threat to global health. The main driver of antibiotic resistance is antibiotic use. Antibiotics are used in humans, animals, and food production and are released into the environment. Therefore, it is imperative to include all relevant sectors in the work to contain antibiotic resistance, i.e., a One Health approach. In this study, we aimed to describe and analyse Sweden’s policies related to containing antibiotic resistance, from a One Health perspective. Twenty-three key policy documents related to containment of antibiotic resistance in Sweden were selected and analysed according to the policy triangle framework. Sweden started early to introduce policies for containing antibiotic resistance from an international perspective. Systematic measures against antibiotic resistance were implemented in the 1980s, strengthened by the creation of Strama in 1995. The policies involve agencies and organisations from human and veterinary medicine, the environment, and food production. All actors have clear responsibilities in the work to contain antibiotic resistance with a focus on international collaboration, research, and innovation. Sweden aims to be a model country in the work to contain antibiotic resistance and has a strategy for achieving this through international cooperation through various fora, such as the EU, the UN system, and OECD. Full article
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16 pages, 893 KiB  
Article
The Governance and Implementation of the National Action Plan on Antimicrobial Resistance in Tanzania: A Qualitative Study
by Gasto Frumence, Leonard E. G. Mboera, Calvin Sindato, Bugwesa Z. Katale, Sharadhuli Kimera, Emmy Metta, Anna Durrance-Bagale, Anne-Sophie Jung, Stephen E. Mshana, Taane G. Clark, Mark Rweyemamu, Helena Legido-Quigley and Mecky I. N. Matee
Antibiotics 2021, 10(3), 273; https://doi.org/10.3390/antibiotics10030273 - 09 Mar 2021
Cited by 27 | Viewed by 4379
Abstract
Tanzania launched its first National Action Plan (NAP) on antimicrobial resistance (AMR) in 2017 to reduce the burden of AMR in the country and contribute to the global response. We aimed to analyze the implementation of the NAP on AMR in Tanzania using [...] Read more.
Tanzania launched its first National Action Plan (NAP) on antimicrobial resistance (AMR) in 2017 to reduce the burden of AMR in the country and contribute to the global response. We aimed to analyze the implementation of the NAP on AMR in Tanzania using the governance framework. In-depth interviews were conducted with human and animal health practitioners and national-level policy actors. We adapted Chua’s AMR governance framework to analyze the development and implementation of the NAP in Tanzania. Implementation of the NAP has realized several achievements, including: (i) the establishment of a functioning Multi-Sectoral Coordinating Committee for coordinating the implementation of AMR activities; (ii) existence of governance structure; (iii) establishment of human and animal surveillance sites; (iv) creation of AMR awareness in the community and (v) availability of guidelines at the health facility level to ensure AMR stewardship. However, some dimensions of the governance areas, including reporting and feedback mechanisms, accountability, transparency and sustainability of AMR plans, are not effectively implemented. Addressing these challenges should involve strengthening the collaboration of the different sectors involved at different NAP implementation levels by careful planning and coordination, and provision of adequate resources to ensure sustainability. Full article
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19 pages, 635 KiB  
Systematic Review
Quality and Utility of Information Captured by Surveillance Systems Relevant to Antimicrobial Resistance (AMR): A Systematic Review
by Mustafa Al-Haboubi, Rebecca E. Glover, Elizabeth Eastmure, Mark Petticrew, Nick Black and Nicholas Mays
Antibiotics 2021, 10(4), 431; https://doi.org/10.3390/antibiotics10040431 - 13 Apr 2021
Cited by 2 | Viewed by 2814
Abstract
Health surveillance systems are considered vital for combatting antimicrobial resistance (AMR); however, the evidence-base on the effectiveness of these systems in providing information that can be used by healthcare professionals, or the acceptability of these systems by users, has not been reviewed. A [...] Read more.
Health surveillance systems are considered vital for combatting antimicrobial resistance (AMR); however, the evidence-base on the effectiveness of these systems in providing information that can be used by healthcare professionals, or the acceptability of these systems by users, has not been reviewed. A systematic review was conducted of a number of databases to synthesise the evidence. The review identified 43 studies that met the inclusion criteria, conducted in 18 countries and used 11 attributes in their assessment of surveillance systems. The majority of systems evaluated were for monitoring the incidence of tuberculosis. The studies found that most surveillance systems were underperforming in key attributes that relate to both effectiveness and acceptability. We identified that two features of systems (ease of use and users’ awareness of systems) were associated with greater acceptability and completeness of systems. We recommend prioritising these for the improvement of existing systems, as well as ensuring consistency in the definition of attributes studied, to allow a more consistent approach in evaluations of surveillance systems, and to facilitate the identification of the attributes that have the greatest impact on the utility of data produced. Full article
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