News and Opinions  –  2022

India: State Action Plans on AMR in focus at stakeholder colloquium

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ReAct Asia Pacific in association with World Animal Protection, India, and World Health Organization Country Office for India, co-organized the first edition of an annual “Colloquium on State Action Plans on Antimicrobial Resistance 2022” in New Delhi 14 March.

The size of the country and the federal structure of governance in India makes sub-national action plans necessary for effective antimicrobial resistance containment efforts. However, COVID-19 has been a setback in the formulation and implementation of sub-national action plans on antimicrobial resistance. The meeting aimed to facilitate inter-state discussions on strategies to revitalize State Action Plans on AMR and had participation from 16 regions (States and Union Territories) in India.

Participants of the colloquium in a group photo.
Colloquium on State Action Plans on Antimicrobial Resistance in India, hosted b ReAct Asia Pacific, in association with World Animal Protection India and WHO Country Office for India. Discussing strategies to advance the AMR-agenda, by engaging states and lessons learned from COVID-19. Click for larger photo. Photo: ReAct Asia Pacific.

As of March 2022, the three states Kerala, Madhya Pradesh, and New Delhi in India are the only states with functional State Action Plans on Antimicrobial Resistance (AMR) that are currently at its implementation phase. Representatives from these three states spoke about the challenges they have had after the launch of their action plans and how the situation has been complicated by COVID-19. The other states that were present are at various stages of drafting and launch of their State Action Plans on AMR.

Rajeev Sadanandan, CEO Health Systems Transformation Platform India opened the Colloquium. Photo: ReAct Asia Pacific.

The opening presentations were made by Dr Anuj Sharma, WHO Country Office for India and Mr Rajeev Sadanandan, CEO, Health Systems Transformation Platform and former senior bureaucrat. They highlighted the need for representative data from across India to compel funding and commitment by policymakers at the state government level was also highlighted. They also spoke on how health perception is local and contextualized and the need for guidelines from WHO and other agencies to be reviewed and adapted regionally.

Mr Rajeev Sadanandan said:

State action plans on AMR is a culmination of a lot of different processes, health departments should take lead. Action plans should be decentralized beyond state level.

The need for private-public collaborations and identifying priorities for each state, for action on AMR containment was also discussed. The AMR community in India should be able to benefit the gains made through COVID-19 like increased compliance towards infection control and greater visibility for healthcare issues.

Panel discussions and group discussions

The Colloquium had multiple panel discussions and group discussions. Panel discussions had experts debating on the Progress of State Action Plans in the background of COVID-19 and on the Measures for Behavioral Change and Local Action Plans on AMR.

  • It was commonly agreed that there is inadequate representation from veterinary, fisheries, agriculture and environment department in the formation and implementation mechanism of sub-national action plans.
  • Prominent was the agreement on the need for political support to prioritize antimicrobial resistance.
  • The scenario of inadequate political support can only be changed by convincing policymakers through proposing definitive solutions to antimicrobial resistance and representative data on the impact of the problem.
  • We may also need to correct the language used to communicate about antimicrobial resistance and take away all the technical jargon.

Community level

For actions at the community level, discussions centered on:

  • how involving end-consumers and critically evaluating the translation of efforts on AMR containment from a ground-level perspective is required for obtaining more commitment.
  • Formulating strategies for more impactful work can be done effectively by engaging communities impacted by AMR as part of the solution.
  • We also need to define the positive changes that we expect from various community stakeholder groups and come out with ways to measure them,
Discussion on progress of existing state action plans in India. Photo: ReAct Asia Pacific.

The group discussions attempted to look into detail and brainstorm solutions to the nuances in establishing accountable and well-resourced governance structures in each state for AMR containment, thoughts on how to promote multi-sectoral involvement in State Action Plans, strategize on how the interventions mentioned in State Action Plan can be financed, and analyzing what can be the facilitating measures for effective implementation of State Action Plans.

Communique summarizing action points for the State Government

The different stakeholders facilitated the exchange of experiences and best practices from various states of the country – and provided concrete recommendations to catalyze the development and implementation of the State Action Plan on Containment of Antimicrobial Resistance (SAPCAR) with a One Health approach.

A communique was formulated with all participants listing out immediate and long-term strategies in:

  • administration
  • regulation
  • surveillance
  • capacity building
  • awareness and
  • community ownership.

All the participants of the meeting agreed that it was necessary to adopt a holistic and multidisciplinary approach towards the prevention and containment of antimicrobial resistance to improve public health, animal welfare, food security, sustainable agriculture, and environmental health.

ReAct Asia Pacific’s role as a facilitator

ReAct Asia Pacific has been actively engaging different states in India, for formulating and implementing the state action plans on AMR. Beyond the three states which have already launched their action plans, ReAct Asia Pacific organized start-up meetings in the regions of Puducherry, Telangana and Meghalaya in 2021. This was done to enable local experts to come together and take leadership in formulation of localized action plans, taking into account the unique challenges and resource availability of the region. Together, these regions have a population of close to 43 million.

In the role of a catalyst, ReAct Asia Pacific is aiming to come up with a set of strategies on facilitating and implementing sub-national action plans in resource-limited settings. It may have wider applicability in the Asian context, where country populations are huge and there are significant intra-country systemic differences.


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