Perspectives on the Regional Strategy for Implementation of National Action Plans on Antimicrobial Resistance in the WHO African Region

Abstract

Background: The WHO Regional Office for Africa developed a Member States (MS)-endorsed regional strategy to fast-track the implementation of MS' national action plans (NAP) on Antimicrobial resistance (AMR). This study explored the perspectives of AMR's national focal points in MS on the implementation of the priority interventions of the regional strategy in their countries. Methods: An online survey consisting of ratings and discussions covering the implementation of the six priority interventions was conducted. Sums of the scores per priority intervention were obtained, and their percentage to the total possible scores were calculated to categorize the implementation as inadequate (0-25%), basic (26-50%), intermediate (51-75%), or advanced (76-100%). Results: Thirty-six of the forty-seven national AMR focal points responded to the survey between 12 November 2023 and 8 January 2024. The implementations were rated as 37-62% (basic-to-intermediate), with the multisectoral coordination and collaboration committee receiving the highest overall rating (62%, 421/684), while the promotion of sustainable investment for the NAP on AMR received the least overall rating (37%, 257/700). The focal points mainly recommended awareness campaigns, capacity building, and regulations and guidelines to improve the implementation of the AMR strategy. Conclusions: The survey revealed a need to enhance awareness campaigns, support the establishment and functioning of AMR evaluation and monitoring systems, and build the capacity of AMR staff with cost-benefit analysis and budgeting skills. It also showed the necessity to improve awareness and conduct education on AMR, streamline evidence generation through One Health Surveillance systems, integrate initiatives to reduce hospital-acquired infections in the antimicrobial stewardship programs, and enhance regulations and guidelines to optimize the use of antimicrobials.

Keywords: AMR awareness campaigns; WHO Regional Office for Africa; antimicrobial resistance; antimicrobial stewardship; national action plan; one health; regional AMR strategy.

Figure 1

WHO/AFRO member states with an AMR multisectoral collaboration and coordination committee.

Figure 2

Ratings of the various aspects of the AMR strategy by the WHO AMR focal points.

Figure 3

Education and awareness on AMR: (a) Proportion of countries with communications and education and awareness campaign strategy on AMR; (b) Countries that have implemented the campaign strategy on AMR; (c) Availability of educational and awareness campaigns targeting secondary and tertiary learning institutions; (d) Representation of professional bodies and institutions of higher learning in the AMR coordination committee and AMR technical working groups.

Figure 4

(a) Availability of active hospital-based antimicrobial stewardship programs; (b) Proportion of countries that have integrated AWaRe categorization of antibiotics into National Essential Medicines list or treatment guidelines; (c) Proportion of countries with standalone hospital-based antimicrobial stewardship programs.