Antimicrobial resistance national level dialogue and action in Ghana: setting and sustaining the agenda and outcomes

Abstract Background Antimicrobial resistance (AMR) has gained national and international attention. The design and launch of national policy on antimicrobial use and resistance and action plan marked a milestone in Ghana’s commitment to control AMR. These strategies are some outcomes of getting and sustaining AMR issues prominence on government’s agenda. Understanding the agenda setting processes, policy actors involved and policy change is important as this provides insights on how and why policy actors defined and framed AMR issues to sustain its prominence despite the changing priorities of government agenda. Objective To examine the processes of setting and sustaining AMR issues on government agenda, the policy actors involved and resulting outcomes. Methods A qualitative study was conducted and data collected through interviewing twenty-four respondents and reviewing technical working group meeting reports and health sector documents. Data was analysed drawing on Kingdon’s agenda setting framework. Result Members of a multisectoral technical working group (AMR platform) formed in 2011 constantly built consensus on AMR problem definition, solutions and actively engaged decision makers to mobilise support and interest. The AMR platform members sustained AMR attention and prominence on government’s agenda through the following multisectoral coordination mechanisms: (1) institutionalising AMR platform activities (2) gathering evidence, sharing findings, and supporting research (3) creating awareness and training (4) gaining and maintaining political support. The activities of the AMR platform contributed to three remarkable outcomes and these are (1) maintained network of AMR Champions, (2) design of a national policy on antimicrobial use and resistance in Ghana (1st edition) and national action plan (2017–2021), and (3) Ghana’s hosting of the second Global call to action on AMR. Conclusion The AMR platform members as influencers concentrated their efforts to move and sustain AMR issues on government agenda. The identified multisectoral coordination mechanisms collectively contributed to agenda setting processes and policy change. The AMR platform engagements are ongoing and it is important the momentum is maintained. As multisectoral coordination and activities are vital especially for AMR ‘One Health’ approach, we hope this paper presents lessons for better understanding of how and why multisectoral groups influence national level agenda setting processes.

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Targets for the reduction of antibiotic use in humans in the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) partner countries

Eurosurveillance ◽

10.2807/1560-7917.es.2019.24.28.1800339 ◽

2019 ◽

Vol 24 (28) ◽

Cited By ~ 3

Author(s):

Fabio D’Atri ◽

Jacqueline Arthur ◽

Hege Salvesen Blix ◽

Lauri A Hicks ◽

Diamantis Plachouras ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Action Plan ◽

Antibiotic Use ◽

The United States ◽

Human Medicine ◽

Antimicrobial Use ◽

Focal Points ◽

Antimicrobial Consumption ◽

Inappropriate Use ◽

And Control

Unnecessary and inappropriate use of antibiotics in human healthcare is a major driver for the development and spread of antimicrobial resistance; many countries are implementing measures to limit the overuse and misuse of antibiotics e.g. through the establishment of antimicrobial use reduction targets. We performed a review of antimicrobial use reduction goals in human medicine in Transatlantic Taskforce on Antimicrobial Resistance partner countries. On 31 March 2017, the European Centre for Disease Prevention and Control sent a questionnaire to National Focal Points for Antimicrobial Consumption and the National Focal Points for Antimicrobial Resistance in 28 European Union countries, Iceland and Norway. The same questionnaire was sent to the TATFAR implementers in Canada and the United States. Thirty of 32 countries replied. Only nine countries indicated that they have established targets to reduce antimicrobial use in humans. Twenty-one countries replied that no target had been established. However, 17 of these 21 countries indicated that work to establish such targets is currently underway, often in the context of developing a national action plan against antimicrobial resistance. The reported targets varied greatly between countries and can be a useful resource for countries willing to engage in the reduction of antibiotic use in humans.

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25.H. Workshop: Challenges in tackling antimicrobial resistance: economic and policy responses

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1199 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

◽

Keyword(s):

Antimicrobial Resistance ◽

Environmental Health ◽

One Health ◽

Action Plan ◽

National Level ◽

World Health ◽

Successful Implementation ◽

Action Plans ◽

Policy Responses ◽

Human Animal

Abstract Antimicrobial resistance (AMR) is driven by inter-related dynamics in the human, animal, and environmental health sectors and one of the most significant and complex current public health issues of our time. Without effective antimicrobials even common infections may become life-threatening and many treatments such as surgical procedures and chemotherapy will not be possible. There is widespread consensus that the response to AMR requires multiple actions, including improving awareness and understanding of AMR, strengthening the knowledge and evidence based through surveillance and research, reducing the incidence of infection through effective sanitation, hygiene and infection prevention measures, optimising the use of antimicrobials in human and animal health and stimulating research and development (R&D) in novel antimicrobials and alternatives. International and national efforts to combat AMR have grown steadily over the last two decades. Two major landmark developments include the launch of the World Health Organisation (WHO) Global Action Plan on AMR in 2015, which asks all countries to develop national action plans by 2017, and the United Nations (UN) General Assembly agreeing a political declaration on AMR in 2016 where countries committed to work at national, regional, and global levels to develop and implement multisectoral national action plans in accordance with the 'One Health' approach. The European Commission also published a One Health action plan against antimicrobial resistance in 2017. However, despite progress at international level, there remains inconsistent progress and implementation of recommended policies to tackle AMR at national level. The UN Interagency Coordination Group on Antimicrobial Resistance (IACG) recently concluded that currently the greatest challenge in AMR is not designing a national action plan but implementing it. The contrasting cultures, behaviours and incentives of each sector and relevant stakeholders is what makes the successful implementation of AMR national action plans so challenging. The purpose of this workshop will be to discuss the evidence and thinking on the different facets of the complex problem of tackling AMR for academics and policy-makers. These discussions will be informed by a forthcoming book jointly published by the European Observatory on Health Systems and Policies and the Organisation for Economic Co-operation and Development titled 'Challenges in Tackling Antimicrobial Resistance: Economic and Policy Responses'. The workshop will focus on five key questions; How can implementation of AMR national action plans be strengthened? What is the evidence on the rise of AMR and its health and economic impact? How can AMR be most effectively addressed in community healthcare settings? How can the discovery of new antibiotics be reinvigorated to replace those rendered ineffective by resistance? Can more use be made of vaccines to tackle AMR? Key messages Antimicrobial resistance is a complex issue which requires actions across the human, animal, environmental health sectors taking a 'One Health' approach. Improving the quality of governance within antimicrobial resistance national action plans is an essential step to strengthening implementation.

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The 'Arc of Prosperity' Revisited: Homelessness Policy Change in North Western Europe

Social Inclusion ◽

10.17645/si.v4i4.675 ◽

2016 ◽

Vol 4 (4) ◽

pp. 108-124 ◽

Cited By ~ 3

Author(s):

Isobel Anderson ◽

Evelyn Dyb ◽

Joe Finnerty

Keyword(s):

Policy Change ◽

Western Europe ◽

National Level ◽

National Policy ◽

Path Dependency ◽

Housing Systems ◽

Continuity And Change ◽

Nation States ◽

Policy Goals ◽

Policy Shifts

This paper compares continuity and change in homelessness policy in Ireland, Scotland and Norway with a particular focus on the period of post-crisis austerity measures (2008–2016). The analytical approach draws on institutional theory and the notion of path dependency, which has rarely been applied to comparative homelessness research. The paper compares welfare and housing systems in the three countries prior to presenting a detailed analysis of the conceptualisation and measurement of homelessness; the institutions which address homelessness; and the evidence of change in the post-2008 period. The analysis demonstrates that challenges remain in comparing the nature of homelessness and policy responses across nation states, even where they have a number of similar characteristics, and despite some EU influence towards homelessness policy convergence. Similarly, national-level homelessness policy change could not be interpreted as entirely a result of the external shock of the 2008 general financial crisis, as existing national policy goals and programmes were also influential. Overall, embedded national frameworks and institutions were resilient, but sufficiently flexible to deliver longer term policy shifts in response to the changing nature of the homelessness problem and national policy goals. Institutionalism and path dependency were found to be useful in developing the comparative analysis of homelessness policy change and could be fruitfully applied in future longitudinal, empirical research across a wider range of countries.

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The effects of Japan’s National Action Plan on Antimicrobial Resistance on antimicrobial use

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2020.11.158 ◽

2021 ◽

Vol 103 ◽

pp. 154-156

Author(s):

Yoshiki Kusama ◽

Shinya Tsuzuki ◽

Yuichi Muraki ◽

Ryuji Koizumi ◽

Masahiro Ishikane ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Action Plan ◽

Antimicrobial Use ◽

National Action Plan

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‘Never let a crisis go to waste’: post-Ebola agenda-setting for health system strengthening in Guinea

BMJ Global Health ◽

10.1136/bmjgh-2019-001925 ◽

2019 ◽

Vol 4 (6) ◽

pp. e001925 ◽

Cited By ~ 1

Author(s):

Delphin Kolie ◽

Alexandre Delamou ◽

Remco van de Pas ◽

Nafissatou Dioubate ◽

Patrice Bouedouno ◽

...

Keyword(s):

Health System ◽

Agenda Setting ◽

Health Workers ◽

National Policy ◽

Health Sector ◽

Problem Definition ◽

Health System Strengthening ◽

Social Crisis ◽

Policy Actors ◽

Policy Window

IntroductionGuinea is a country with a critical deficit and maldistribution of healthcare workers along with a high risk of epidemics' occurrence. However, actors in the health sector have missed opportunities for more than a decade to attract political attention. This article aims to explain why this situation exists and what were the roles of actors in the agenda-setting process of the post-Ebola health system strengthening programme. It also assesses threats and opportunities for this programme's sustainability.MethodsWe used Kingdon’s agenda-setting methodological framework to explain why actors promptly focused on the health sector reform after the Ebola outbreak. We conducted a qualitative explanatory study using a literature review and key informant interviews.ResultsWe found that, in the problem stream, the Ebola epidemic caused considerable fear among national as well as international actors, a social crisis and an economic system failure. This social crisis was entertained by communities’ suspicion of an 'Ebola-business'. In response to these problems, policy actors identified three sets of solutions: the temporary external funds generated by the Ebola response; the availability of experienced health workers in the Ebola control team; and the overproduction of health graduates in the labour market. We also found that the politics agenda was dominated by two major factors: the global health security agenda and the political and financial interests of national policy actors. Although the opening of the policy window has improved human resources, finance and logistics, and infrastructures pillars of the health system, it, however, disproportionally focuses on epidemic preparedness and response. and neglects patients’ financial affordability of essential health services.ConclusionDomestic policy entrepreneurs must realise that agenda-setting of health issues in the Guinean context strongly depends on the construction of the problem definition and how this is influenced by international actors.

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Antimicrobial use in pigs, broilers and veal calves in Belgium

Vlaams Diergeneeskundig Tijdschrift ◽

10.21825/vdt.v83i5.16633 ◽

2014 ◽

Vol 83 (5) ◽

pp. 215-224 ◽

Cited By ~ 18

Author(s):

M. E. Filippitzi ◽

B. Callens ◽

B. Pardon ◽

D. Persoons ◽

J. Dewulf

Keyword(s):

Antimicrobial Resistance ◽

National Level ◽

Rapid Decline ◽

Antimicrobial Use ◽

Antimicrobial Consumption ◽

Veal Calves ◽

Level Data ◽

Veal Calf ◽

Daily Dose ◽

Unit Of Measurement

Given the risks associated with antimicrobial resistance and its link with antimicrobial use, available data on antimicrobial use in the Belgian pig, broiler and veal calf production were compared. Allowing for comparison of the data available from three peer-reviewed scientific articles, the unit of measurement for antimicrobial use was the Treatment Incidence (TI), defined as the number of animals per 1000 treated daily with one ‘defined’ (DDDA) or ‘used daily dose animal’ (UDDA). Moreover, extrapolation of farm-level data to national-level data was attempted according to the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) methodology, to estimate the amount of antimicrobials used in Belgium per species. Although, among the three species, the highest TI was observed in veal calves (TIDDDA=414, TIUDDA=379), based on the extrapolation, it was estimated that most antimicrobials were administered to pigs (159.4 tons). Thus, the most rapid decline in the total use could potentially be achieved by targeting the pig sector. During the process of data collection for comparison and calculation, it became obvious that there is a need for harmonized monitoring programs.

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The Governance and Implementation of the National Action Plan on Antimicrobial Resistance in Tanzania: A Qualitative Study

Antibiotics ◽

10.3390/antibiotics10030273 ◽

2021 ◽

Vol 10 (3) ◽

pp. 273

Author(s):

Gasto Frumence ◽

Leonard E. G. Mboera ◽

Calvin Sindato ◽

Bugwesa Z. Katale ◽

Sharadhuli Kimera ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Action Plan ◽

Animal Health ◽

National Level ◽

Governance Structure ◽

National Action Plan ◽

Governance Framework ◽

Health Practitioners ◽

Facility Level ◽

Depth Interviews

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.

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European experience in transition to circular economy

Economic Analysis Theory and Practice ◽

10.24891/ea.19.4.598 ◽

2020 ◽

Vol 19 (4) ◽

pp. 598-617 ◽

Cited By ~ 1

Author(s):

S.V. Ratner

Keyword(s):

European Union ◽

Circular Economy ◽

Raw Materials ◽

Action Plan ◽

National Level ◽

The European Union ◽

Scientific Methods ◽

European Experience ◽

General Scientific ◽

The Eu

Subject. The article considers the concept of circular economy, which has originated relatively recently in the academic literature, and is now increasingly recognized in many countries at the national level. In the European Union, the transition to circular economy is viewed as an opportunity to improve competitiveness of the European Union, protect businesses from resource shortages and fluctuating prices for raw materials and supplies, and a way to increase employment and innovation. Objectives. The aim of the study is to analyze the incentives developed by the European Commission for moving to circular economy, and to assess their effectiveness on the basis of statistical analysis. Methods. I employ general scientific methods of research. Results. The analysis of the EU Action Plan for the Circular Economy enabled to conclude that the results of the recent research in circular economy barriers, eco-innovation, technology and infrastructure were successfully integrated into the framework of this document. Understanding the root causes holding back the circular economy development and the balanced combination of economic and administrative incentives strengthened the Action Plan, and it contributed to the circular economy development in the EU. Conclusions. The measures to stimulate the development of the circular economy proposed in the European Action Plan can be viewed as a prototype for designing similar strategies in other countries, including Russia. Meanwhile, a more detailed analysis of barriers to the circular economy at the level of individual countries and regions is needed.

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Antimicrobial Resistance Nosocomial Strains of Enterobacter spp. in Ukrainian surgical Hospitals: results of multicenter study

International Journal of Antibiotics and Probiotics ◽

10.31405/ijap.4-5.18.04 ◽

2018 ◽

Vol 2 (4) ◽

pp. 39-45

Author(s):

A.G. Salmanov ◽

O.M. Verner

Keyword(s):

Antimicrobial Resistance ◽

Multicenter Study ◽

Antimicrobial Susceptibility ◽

National Level ◽

Surgical Site Infections ◽

Hospital Record ◽

Antimicrobial Susceptibility Test ◽

Local Data ◽

Epidemiologic Surveillance ◽

Medical Institutions

Objective. To determine activity of antimicrobials against Enterobacter spp. isolated from patients hospitalized to surgical departments in different Ukrainian hospitals. Materials and methods. A total of 3991 Enterobacter spp. isolated from patients with surgical site infections in 24 surgical hospitals in 17 Ukrainian regions. The identification and antimicrobial susceptibility of Enterobacter spp. were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing. Interpretative criteria were those suggested by the Clinical and Laboratory Standards Institute (CLSI). Results. The most potent antimicrobials were imipenem, meropenem, cefixime and amikacinum. The high rates of resistance were found to penicillin (46,2%), ampicillin/sulbactam (42,9%), gentamicin (40,4%), ceftazidime (39,4%), ampicillin (38,2%), and cefuroxime (36,3%). Conclusions. (1) Resistance of nosocomial strains of Enterobacter spp. at in patient medical institutions, that are subject to research, is a serious therapeutic and epidemiologic issue. Imipenem, meropenem, cefixime and amikacinum have been the most active to nosocomial strains of Enterobacter spp. (2) Taking into account resent changes and resistance levels of nosocomial strains of Enterobacter spp., which take place in various regions, constant monitoring over resistance to antimicrobials at every in patient medical institution is required. Also, hospital record sheets of antibiotics should be elaborated based upon the local data received. (3) Antibiotics utilization policy in each surgical in patient institution should be determined based in accordance with the local data on resistance to antimicrobials. (4) System of epidemiologic surveillance over antimicrobial resistance should be established on the local, regional, and national level.

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The Role of Government Backbenchers

10.1093/oso/9780198753827.003.0005 ◽

2017 ◽

Author(s):

Meg Russell ◽

Daniel Gover

Keyword(s):

Policy Change ◽

Legislative Process ◽

Role Of Government ◽

Policy Actors ◽

Corporate Manslaughter ◽

Party Cohesion ◽

Government Legislation

This chapter explores how government backbench parliamentarians in both chambers at Westminster influence the content of government legislation and the dynamics of politics. Government backbenchers are often thought to be Westminster’s most influential policy actors, operating through the ‘intraparty mode’. As summarized here, governments have recently become less able to rely on their votes, thanks to declining party cohesion. Yet governments are rarely defeated as a result of rebellious votes. This chapter analyses government backbenchers’ amendments proposed to the 12 case study bills—some of which served purposes other than immediate policy change—and their role as ‘pivotal voters’ in resolving legislative disputes with other (particularly opposition) actors. It also emphasizes their influence on legislation before it is introduced, and the importance of ‘anticipated reactions’. For example, ministers introduced the Corporate Manslaughter Bill only reluctantly, following backbench pressure. Backbenchers hence have subtle, and often hidden, influence in the legislative process.

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