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Policy  –  Develop a 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) 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 Guidelines 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.
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 (examples can be accessed on the same page). Available in English, French, Russian, Spanish.
National level assessment tool (IPCAT2) and IPCAT2 instruction booklet Toolkit. Facility and national level assessment tools (IPCAT2) of infection prevention and control status, and IPCAT2 instruction manual. Excel-based tool from WHO to support implementation of the WHO Guidelines on Core Components of Infection Prevention and Control Programmes).
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.
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.
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Buse K, Mays N, Walt G. Making health policy. Maidenhead, Berkshire, England; New York: Open University Press; 2012.
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World Health Organization - WHO. Sample checklist of National Action Plan development support tools [Internet]. World Health Organization; 2016 [cited 2016 Mar 3]. Available from: https://www.who.int/antimicrobial-resistance/national-action-plans/supporting-documents-tools/en/
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World Health Organization - WHO. Joint External Evaluation Tool (JEE Tool): International Health Regulations (2005) [Internet]. 2018 [cited 2016 Jan 8]. Available from: https://www.who.int/ihr/publications/WHO_HSE_GCR_2018_2/en/
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World Organization for Animal Health - OIE. OIE PVS Pathway [Internet]. The OIE PVS Pathway. [cited 2016 Mar 22]. Available from: http://www.oie.int/support-to-oie-members/pvs-pathway/
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The Global Antibiotic Resistance Partnership - India National Working Group. Situation Analysis Antibiotic Use and Resistance in India [Internet]. Center for Disease Dynamics, Economics & Policy (CDDEP) and Public Health Foundation of India; 2011 [cited 2014 Oct 2]. Available from: https://cddep.org/publications/situation_analysis_antibiotic_use_and_resistance_india/
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Global Antibiotic Resistance Partnership - GARP, Center for Disease Dynamics, Economics & Policy - CDDEP. Situation Analysis Report on Antimicrobial Resistance in Pakistan: Findings and Recommendations for Antibiotic Use and Resistance [Internet]. 2018 [cited 2018 Aug 8]. Available from: https://cddep.org/publications/garp-pakistan-situation-analysis/
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Global Antibiotic Resistance Partnership - GARP, Center for Disease Dynamics, Economics & Policy - CDDEP. Antibiotic Use and Resistance in Bangladesh: Situation Analysis and Recommendations [Internet]. 2018 [cited 2018 Aug 8]. Available from: https://cddep.org/publications/bangladesh-situation-analysis-amr/
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GARP-Zimbabwe Situation Analysis - Center for Disease Dynamics, Economics & Policy (CDDEP) [Internet]. [cited 2017 Oct 16]. Available from: https://cddep.org/publications/garp-zimbabwe-situation-analysis/
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Global Antibiotic Resistance Partnership-Kenya Working Group. Situation Analysis and recommendations: Antibiotic use and Resistance in Kenya [Internet]. Washington, DC and New Delhi: Center for Disease Dynamics,  Economics & Policy; 2011 [cited 2014 Aug 21]. Available from: http://cddep.org/publications/situation_analysis_and_recommendations_antibiotic_use_and_resistance_kenya
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Global Antibiotic Resistance Partnership - Nepal national working group. Situation Analysis and Recommendations: Antibiotic Use and Resistance in Nepal [Internet]. Washington, DC and New Delhi: Center for Disease Dynamics, Economics & Policy (CDDEP); 2015 [cited 2015 Aug 21]. Available from: http://cddep.org/publications/garp_nepal_situation_analysis
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Global Antibiotic Resistance Partnership - Mozambique working group. Situation Analysis and Recommendations: Antibiotic Use and Resistance in Mozambique [Internet]. Washington, DC and New Delhi: Center for Disease Dynamics, Economics & Policy (CDDEP); 2015 [cited 2015 Aug 21]. Available from: http://cddep.org/publications/garp_mozambique_situation_analysis
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Global Antibiotic Resistance Partnership - Tanzania working group. Situation Analysis and Recommendations: Antibiotic Use and Resistance in Tanzania [Internet]. Washington, DC and New Delhi: Center for Disease Dynamics, Economics & Policy (CDDEP); 2015 [cited 2015 Aug 21]. Available from: http://cddep.org/publications/garp_tanzania_situation_analysis
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