An analysis of national action plans on antimicrobial resistance in Southeast Asia using a governance framework approach

Abstract Antimicrobial resistance is one of the major challenges of our time. Countries use national action plans as a mechanism to build engagement among stakeholders and coordinate a range of actions across human, animal, and environmental health. However, implementation of recommended policies such as stewardship of antimicrobials, infection prevention and control, and stimulating research and development of novel antimicrobials and alternatives remains inconsistent. Improving the quality of governance within antimicrobial resistance national action plans is an essential step to improving implementation. To date, no systematic approach to governance of national action plans on AMR exists. To address this issue, we aimed to develop the first governance framework to offer guidance for both the development and assessment of national action plans on AMR. We reviewed health system governance framework reviews to inform the basic structure of our framework, international guidance documents from WHO, the Food and Agriculture Organization, the World Organisation for Animal Health, and the European Commission, and sought the input of 25 experts from international organisations, 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. Countries must engage with a cyclical process of continuous design, implementation, monitoring and evaluation to achieve these aims.

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

The Lancet Infectious Diseases ◽

10.1016/s1473-3099(19)30415-3 ◽

2019 ◽

Vol 19 (11) ◽

pp. e371-e384 ◽

Cited By ~ 10

Author(s):

Michael Anderson ◽

Kai Schulze ◽

Alessandro Cassini ◽

Diamantis Plachouras ◽

Elias Mossialos

Keyword(s):

Antimicrobial Resistance ◽

Action Plans ◽

Governance Framework

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A road-map for addressing antimicrobial resistance in low- and middle-income countries: lessons learnt from the public private participation and co-designed antimicrobial stewardship programme in the State of Kerala, India

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-020-00873-9 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Sanjeev Singh ◽

Esmita Charani ◽

Sarada Devi ◽

Anuj Sharma ◽

Fabia Edathadathil ◽

...

Keyword(s):

Public Health ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Infection Prevention ◽

The State ◽

Action Plans ◽

Public And Private ◽

Middle Income ◽

Middle Income Countries ◽

Public Health Threat

Abstract Background The global concern over antimicrobial resistance (AMR) is gathering pace. Low- and middle-income countries (LMICs) are at the epicentre of this growing public health threat and governmental and healthcare organizations are at different stages of implementing action plans to tackle AMR. The South Indian state of Kerala was one of the first in India to implement strategies and prioritize activities to address this public health threat. Strategies Through a committed and collaborative effort from all healthcare related disciplines and its professional societies from both public and private sector, the Kerala Public Private Partnership (PPP) has been able to deliver a state-wide strategy to tackle AMR A multilevel strategic leadership model and a multilevel implementation approach that included developing state-wide antibiotic clinical guidelines, a revision of post-graduate and undergraduate medical curriculum, and a training program covering all general practitioners within the state the PPP proved to be a successful model for ensuring state-wide implementation of an AMR action plan. Collaborative work of multi-professional groups ensured co-design and development of disease based clinical treatment guidelines and state-wide infection prevention policy. Knowledge exchange though international and national platforms in the form of workshops for sharing of best practices is critical to success. Capacity building at both public and private institutions included addressing practical and local solutions to the barriers e.g. good antibiotic prescription practices from primary to tertiary care facility and infection prevention at all levels. Conclusion Through 7 years of stakeholder engagement, lobbying with government, and driving change through co-development and implementation, the PPP successfully delivered an antimicrobial stewardship plan across the state. The roadmap for the implementation of the Kerala PPP strategic AMR plan can provide learning for other states and countries aiming to implement action plans for AMR.

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Exploring gender differences in knowledge and practices related to antibiotic use in Southeast Asia: A scoping review

PLoS ONE ◽

10.1371/journal.pone.0259069 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0259069

Author(s):

Phuc Pham-Duc ◽

Kavitha Sriparamananthan

Keyword(s):

Gender Differences ◽

Antimicrobial Resistance ◽

Southeast Asia ◽

Scoping Review ◽

Antibiotic Use ◽

Educational Interventions ◽

Sociodemographic Factors ◽

Targeted Interventions ◽

Inappropriate Use ◽

Males And Females

Inappropriate use of antibiotics has been one of the main contributors to antimicrobial resistance, particularly in Southeast Asia. Different genders are prone to different antibiotic use practices. The objective of this scoping review is to understand the extent and type of evidence available on gender differences in antibiotic use across Southeast Asia. The search strategy for this scoping review involved PubMed, Semantic Scholar, BioMed Central and ProQuest. Two-level screening was applied to identify the final sample of relevant sources. Thematic content analysis was then conducted on the selected final sources to identify recurring themes related to gender differences in antibiotic use and a narrative account was developed based on the themes. Recommendations for next steps regarding reducing inappropriate antibiotic use and gender considerations that need to be made when developing future interventions were also identified. Research on gender and antibiotic use remains scarce. Studies that discuss gender within the context of antibiotic use often mention differences between males and females in knowledge, attitudes and/or behaviour, however, do not explore reasons for these differences. Gender differences in antibiotic use were generally examined in terms of: (i) knowledge of antibiotic use and antimicrobial resistance and (ii) practices related to antibiotic use. Evidence indicated that differences between males and females in knowledge and practices of antibiotic use varied greatly based on setting. This indicates that gender differences in antibiotic use are greatly contextual and intersect with other sociodemographic factors, particularly education and socioeconomic status. Educational interventions that are targeted to meet the specific needs of males and females and delivered through pharmacists and healthcare professionals were the most common recommendations for reducing inappropriate use of antibiotics in the community. Such targeted interventions require further qualitative research on factors influencing differences in knowledge and practices related to antibiotic use among males and females. In addition, there is also a need to strengthen monitoring and regulation practices to ensure accessibility to affordable, quality antibiotics through trusted sources.

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Benchmarking national action plans on antimicrobial resistance in eight selected LMICs: Focus on the veterinary sector strategies

Journal of Global Health ◽

10.7189/jogh.10.020414 ◽

2020 ◽

Vol 10 (2) ◽

Author(s):

Ebiowei Samuel F Orubu ◽

Indorica Sutradhar ◽

Muhammad H Zaman ◽

Veronika J Wirtz

Keyword(s):

Antimicrobial Resistance ◽

Action Plans

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Genomic basis of antimicrobial resistance in non-toxigenic Clostridium difficile in Southeast Asia

Anaerobe ◽

10.1016/j.anaerobe.2020.102290 ◽

2020 ◽

Vol 66 ◽

pp. 102290

Author(s):

Korakrit Imwattana ◽

Pattarachai Kiratisin ◽

Thomas V. Riley ◽

Daniel R. Knight

Keyword(s):

Clostridium Difficile ◽

Antimicrobial Resistance ◽

Southeast Asia ◽

Genomic Basis

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The global governance of antimicrobial resistance: a cross-country study of alignment between the global action plan and national action plans

Globalization and Health ◽

10.1186/s12992-020-00639-3 ◽

2020 ◽

Vol 16 (1) ◽

Author(s):

Louise Munkholm ◽

Olivier Rubin

Keyword(s):

Antimicrobial Resistance ◽

Global Governance ◽

Action Plan ◽

World Health ◽

Action Plans ◽

Vertical Alignment ◽

Member States ◽

Horizontal Alignment ◽

Global Action ◽

Global Action Plan

Abstract Background Antimicrobial resistance (AMR) is a growing problem worldwide in need of global coordinated action. With the endorsement of the Global Action Plan (GAP) on AMR in 2015, the 194 member states of the World Health Organization committed to integrating the five objectives and corresponding actions of the GAP into national action plans (NAPs) on AMR. The article analyzes patterns of alignment between existing NAPs and the GAP, bringing to the fore new methodologies for exploring the relationship between globally driven health policies and activities at the national level, taking income, geography and governance factors into account. Methods The article investigates the global governance of AMR. Concretely, two proxies are devised to measure vertical and horizontal alignment between the GAP and existing NAPs: (i) a syntactic indicator measuring the degree of verbatim overlap between the GAP and the NAPs; and (ii) a content indicator measuring the extent to which the objectives and corresponding actions outlined in the GAP are addressed in the NAPs. Vertical alignment is measured by the extent to which each NAP overlaps with the GAP. Horizontal alignment is explored by measuring the degree to which NAPs overlap with other NAPs across regions and income groups. In addition, NAP implementation is explored using the Global Database for Antimicrobial Resistance Country Self-Assessment. Findings We find strong evidence of vertical alignment, particularly among low-income countries and lower-middle-income countries but weaker evidence of horizontal alignment within regions. In general, we find the NAPs in our sample to be mostly aligned with the GAP’s five overarching objectives while only moderately aligned with the recommended corresponding actions. Furthermore, we see several cases of what can be termed ‘isomorphic mimicry’, characterized by strong alignment in the policies outlined but much lower levels of alignment in terms of actual implemented policies. Conclusion To strengthen the alignment of national AMR policies, we recommend global governance initiatives based on individualized responsibilities some of which should be legally binding. Our study provides limited evidence of horizontal alignment within regions, which implies that regional governance institutions (e.g., WHO regional offices) should primarily act as mediators between global and local demands to strengthen a global governance regime that minimizes policy fragmentation and mimicry behavior across member states.

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