Strengthening implementation of antimicrobial resistance national action plans

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.