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Policy  –  Develop and implement plan

Assess the situation

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.

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 serves 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 the MEASURE focus area for more information on:

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 to 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 developing effective programs and interventions.

Selected Resources

Resource Description
Sample checklist of National Action Plan development support tools (PDF) This checklist is developed by the WHO for countries to assist 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 This guide by SIAPS offers 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.
Worldwide country situation analysis: response to antimicrobial resistance This WHO report summarizes the findings of the organization’s initial country situation analysis that was carried out between 2013 and 2014. The report analyses the feedback from surveys that were distributed to member states, in order to assess the extent to which countries have undertaken the necessary steps to develop comprehensive policies on antimicrobial resistance. A summary of the report is also available in French.
Joint External Evaluation Tool (JEE Tool): International Health Regulations (2005) WHO and Global Health Security Agenda (GHSA) tool to measure progress towards capacity building for preventing, detecting, and responding to infectious disease threats, including antimicrobial resistance. The evaluation tool is designed for use at the country level and suggests indicators. It has been tested in a number of GHSA-affiliated countries (examples can be accessed on the same page).
National level assessment tool (IPCAT2) and IPCAT2 instruction booklet National level assessment tool (IPCAT2) of infection prevention and control status, and IPCAT2 instruction manual. Excel-based tool from WHO. Both located under “Related Documents” (this is a support tool for implementation of the WHO Guidelines on Core Components of Infection Prevention and Control Programmes).
Making health policy This e-book 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.
TDR: Implementation research toolkit Toolkit designed to help identify system bottlenecks and stakeholders to be involved, formulate appropriate research questions, conduct the research and develop a plan for implementing the study results. Although it is not focusing solely on antibiotic resistance, it provides a template on how issues related to resistance could be addressed.

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