A well informed and evidence based national action plan has a higher chance to be successfully implemented and to produce results for the benefit of public health.
A national action plan should be based on local data and tailored to the specific setting depending on factors such as the size, complexity, and resources available. Health policies that are not built upon research evidence and relevant data are less likely to deliver the desired outcome. Moreover, poorly informed decision-making can contribute to, or even worsen, problems related to effectiveness, efficiency, and equity of health systems. A situation analysis can be of great value to assess the current situation and influence relevant stakeholders. It provides an overview of the current antibiotic resistance situation and its drivers, and reviews existing policies, activities, structures, systems and stakeholders serving to inform and build the foundation for a national action plan.
Conduct a situation analysis
In the case of antibiotic resistance, assessing the current situation is of high importance in order to ensure an effective and efficient policy process. A thorough analysis usually combines a review of already existing data with the generation of new data. In some settings, a small scale analysis such as a point prevalence study in a representative hospital in combination with a desk review of existing data may be enough as a starting point for the policy process. A situation analysis can include, but is not limited to, a review of:
- Current antibiotic resistance related activities, structures and stakeholders
- Capacity and structures to conduct surveillance of resistance and monitoring of use
- Rates of resistance and infection
- Antimicrobial use in humans, animals, plants, other environmental settings
- Perceptions and behaviour related to known drivers of AMR
- Status of quality assurance of manufactured and/or imported pharmaceuticals
- Current capacity of country systems to regulate and enforce regulations
- Existence and enforcement of policies and legal frameworks
- Availability of alternatives to antimicrobials, including vaccines and others
Assess and generate data
A first step is to see if any information on the following components already exists. Unfortunately data is sparse in resource-limited settings, so often new data needs to be generated. See Development process of National Action Plans for an example and the MEASURE focus area for more information on:
- Burden of antibiotic resistance
- Antibiotic resistance
- Consumption of antibiotics
- Appropriateness of use
- Quality of antibiotics
- Knowledge, attitudes, beliefs and practices – KABP
GARP situation analyses
The Global Antibiotic Resistance Partnership (GARP) has, in collaboration with a number of specific countries, conducted national situation analyses focusing on antibiotic use and resistance. These can be of inspiration and serve as guidance for similar country-specific assessments. Click on the respective country to access the reports:
Understand barriers and facilitators of change
A successful implementation can be enabled or hindered by policies and guidelines, individual responsiveness or level of organizational support. Brainstorming, interviews, focus groups, observations or surveys can be used to help understand the barriers and facilitators to develop effective programs and interventions.
|Sample checklist of National Action Plan development support tools (PDF)||Checklist developed by the WHO to assist countries with the development of their national action plan or assist with reviewing and updating existing plans (this is a supporting document to accompany the manual for developing national action plans).|
|Building Coalitions for Containing Antimicrobial Resistance: A Guide||Guide by SIAPS that offer guidance on how to identify key stakeholders for addressing drug resistance, mobilize their support, formulate and implement a plan and evaluate outcomes. Also provides a number of templates and sample interview forms that can be adapted for different local contexts. The chapter “Understand the local situation” describes tools and strategies for compiling, analyzing, and presenting information about the local antibiotic resistance situation. An older version is available in Spanish and French.|
|Case Studies for AMR Resource Mobilisation||Country examples. Case studies from Ghana, Nigeria and Nepal (Nigeria & Nepal case studies can be accessed at end of page), commissioned by the WHO. Explores scaling up delivery of activities on antimicrobial resistance through leverage of existing and future programmes and projects. Uses a One Health approach for assessment of entry points. Aims to assist teams involved in implementing AMR National Action Plans.
|Assessment tool for joint One Health country visits in relation to antimicrobial resistance||Assessment tool that outlines indicators for human health, but with a One Health lens. Developed to support ECDC country visits to discuss AMR, but can be used as inspiration also in other contexts. The indicators are intended to be used together with assessment tools for the veterinary and environmental sectors.|
|Joint External Evaluation Tool (JEE Tool): International Health Regulations (2005)||Tool and indicators. WHO and Global Health Security Agenda (GHSA) tool to measure progress on preventing, detecting, and responding to infectious disease threats, including antimicrobial resistance. Designed for use at country level. Carried out in a number countries. Available in English, French, Russian, and Spanish.|
|WASH in Health Care Facilities: UNICEF Scoping Study in Eastern and Southern Africa||Template and indicators. UNICEF ESARO report on WASH in health care facilities in Eastern and Southern Africa. See Annex 2 on SDG core questions for monitoring WASH in health care facilities and Annex 3: Indicators in regional enabling environment survey.|
|Instructions for the national infection prevention and control assessment tool 2 (IPCAT2)||Guidance and tool. Instruction manual for using IPCAT2 assessment tool of infection prevention and control status at national level. A printable version of the tool can be found in Annex 1.
|OIE PVS pathway||Mechanism for improvement of national Veterinary Services. Systematic approach to evaluate, plan, cost and support the strengthening of national Veterinary Services (through PVS trained and certified experts only). Based on methodology of the OIE PVS Tool for the evaluation of performance of veterinary services (PDF 2019) and the PVS Tool for aquatic animal health services (PDF 2013).|
|Making health policy||E-book that explains the process of health policy making and explores key elements for policy development and implementation in both the public and private sector. The first section analyzes contextual factors that affect health policy.|
|PDQ-Evidence for Informed Health Policymaking||Database that provides rapid access to high-quality health systems and public health evidence. It includes systematic reviews, evidence-based policy briefs, primary studies, and structured summaries of that evidence.|