News and Opinions  –  2017

Ensuring action on the AMR Global Action Plan

2017-10-11

To ensure stakeholders are taking action on the Global Action Plan on Antimicrobial Resistance, the Tripartite (World Health Organization, Food & Agriculture Organization of United Nations and World Organization for Animal Health) organizations have come together to develop a M&E approach to the Global Action Plan on Antimicrobial Resistance. The focus lies on ensuring the implementation of antimicrobial-resistance-related measures and activities and assessing if these actions are having the intended outcomes.

The framework aims to develop a manageable system that generates data to inform decision making on antimicrobial resistance for the next five to ten years. The Monitor & Evaluation (M&E) approach has been through consultation by the WHO Strategic and Technical Advisory Group on antimicrobial resistance (AMR) and a meeting of experts in June 2017 and was then circulated for public consultation.

Members of the ARC Coalition came together for two teleconference calls:

  • first focusing on the M&E approach through the lens of human healthcare delivery
  • then through the lens of animal use of antibiotics and the environment

in order to develop joint responses for the public consultation process.

This was an important opportunity for civil society as the M&E approach represents a key source of accountability across the global health community, ensuring effective M&E of progress towards milestones in tackling antimicrobial resistance.

The teleconference on the human health delivery side helped shape joint input supported by:

The Ecumenical Pharmaceutical Network
– Health Action International
– Health Care Without Harm
– The South Center
– Third World Network
– and ReAct (including ReAct Africa Node, ReAct Asia Pacific, ReAct Europe, ReAct Latin America, and ReAct North America)

Their key conclusions include:

Indicators must be transparent, actionable and focused on behavior change

On the human healthcare, those ARC members participating in the process flagged overarching concerns that to ensure accountability, the M&E framework must include indicators that are transparent, actionable, and focused on changes in behavior, not just attitude or knowledge.

Different timelines for M&E framework and IACG

The feedback highlighted that the M&E framework focuses on a 5-10 year horizon, yet the UN Interagency Coordination Group (IACG) has a report  back in 2018 and many country governments will also need to show near-term gains to sustain the momentum of antimicrobial resistance efforts in their National Action Plans.

Measurement approaches linked to stage of development

The input also discusses designing measurement approaches tiered to the stage of development or level of resources in various country settings. This tiered approach might enable broader participation among lower-resourced countries and provide stepping stones to deeper engagement as local infrastructure and capacity grow.

Look at synergy between indicators and GAP Strategic Objectives

When discussing the alignment of the M&E framework with the five GAP Strategic Objectives members cautioned that most AMR outcomes involve more than one of the GAP Strategic Objectives working in concert, so it would be important to look for the synergy among and the gaps between indicators tied to particular Strategic Objectives.

On the animal use of antibiotics and the environment, several ARC members worked together to provide collective feedback to the Tripartite consultation, including:

– Alliance to Save Our Antibiotics
– Health Care Without Harm
– Sustainable Food Trust
– Centre for Science and Environment
– Food Animal Concerns Trust and
– ReAct (including ReAct Africa Node, ReAct Asia Pacific, ReAct Europe, ReAct Latin America, and ReAct North America)

Their key conclusions include:

”One size fits all” approach will not work

Noting that local context across countries differs considerably, they cautioned over the use of a “one size fits all” approach. In places where veterinarians are in short supply or where there might be indigenous pharmaceutical production facilities, the priority focus on indicators may shift. Applying the same indicators universally may result in disparate impact across countries. While a tiered approach might be useful, those in the workgroup noted:

“we are not suggesting that a tiered approach should enable some countries to delay or even not to commit to targets of eliminating routine preventative use.”

Need to discuss preventative use of antibiotics in food animal production

Both growth promotion and preventative use of antibiotics are key contributors to the non-therapeutic use of antibiotics in food animal production. However, the current M&E document does not discuss curbing or eliminating preventative use of antibiotics. As the experience in the Netherlands suggests, curbing growth promotion alone will not be sufficient. Properly structured indicators can play a useful role in holding stakeholders accountable and triggering much needed regulatory changes. To help ensure accountability, the feedback also called for collecting farm and veterinary prescription data on antibiotic use, sales, and resistance patterns, by livestock species and country.