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Policy  –  Develop and implement plan

Develop and draft the plan

Building on the situation analysis, the multi-stakeholder coordinating group should identify priority elements to address in the national action plan, and lay out how the plan should be implemented, costed, and evaluated.

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. The plan should contribute to the strategic objectives outlined in the Global Action Plan on Antimicrobial Resistance. It should also reflect the main principles identified in the global action plan:

  • Engagement of whole-of-society
  • Prevention first
  • Ensuring access to antibiotics while avoiding excess use
  • Sustainable interventions
  • Gradual targets for implementation

A national action plan is recommended to contain:

  • Strategic Plan – covering the goals and objectives, priorities and interventions
  • Operational Plan – addressing activities, implementation arrangements, time plan, responsible parties, detailed budget and costing
  • M&E Plan – including indicators, targets and timelines, and methods for reporting and data collection

In order to enhance the chances of success and ensure political buy-in from all concerned parties, stakeholders at all levels should be consulted in the drafting process before the policy is finalized.

Develop goals and objectives

Setting goals and objectives will help the multisectorial coordinating group know where to focus its energy and how to direct its resources. See Elements of a national action plan for suggestions of different policy areas that could be covered under a national action plan on antibiotic resistance.

Consider what you want to achieve, and what change can be made that will result in an improvement. When developing objectives it is important to make them SMART:

  • Specific
  • Measureable
  • Achievable
  • Results Oriented
  • Time Limited
Front page of Ghana's Policy Brief on antimicrobial resistance
Figure 1. Policy Brief and recommendations on Antimicrobial resistance (AMR) in Ghana by the Ministry of Health.

Develop an operational plan

A good implementation plan will cover the steps in the process, what actions are needed to be taken, by who and when, as well as what resources are needed and how to measure progress. For the national plan to be successful budget capacity must allocated to all parts of the national action plan and its implementation phase. A thorough mapping of available resources can serve as the foundation for budget allocation. In low- and middle-income settings, external funding such as aid or NGO resources may make up an important part of health sector finance. When existing resources have been analyzed, a financial plan for implementation and necessary capacity building can be made. In order to successfully ensure necessary budget allocation, economic arguments might be the most convincing to the ministry of finance or other responsible government department. A proper cost-analysis of action vs. non-action can be key, especially in low- and middle-income settings. In addition, an operational plan can include:

  • Communication plan: How will the plans be communicated to those directly and indirectly involved with the process?
  • Risk assessment: What are the inherent risks that might occur with implementation?

Develop an M&E plan

For information on monitoring and evaluation through analysis and reporting of quality indicators, see Evaluate progress.

Resources below have been sorted into the following tables:

  • General
  • Food and agriculture

Selected Resources

General

Resource Description
The antimicrobial resistance national action plan (AMR-NAP) forum A free and open online community of practice run by the WHO AMR Secretariat. The primary aim is to enable those developing and implementing national action plans to have access to advice, support and peer-to-peer discussions.
Antimicrobial resistance: A manual for developing national action plans The WHO has developed this manual to assist development of national action plans. See also Sample template of National action plan on antimicrobial resistance (PDF) that gives overview of the most important aspects to be addressed in a plan. Additional tools and templates in other languages can be found under Supporting documents and tools.
Library of National Action Plans This webpage collects antimicrobial resistance action plans of different countries (WHO). It also links to the manual for developing national action plans (described above).
Building Coalitions for Containing Antimicrobial Resistance: A Guide This guide by SIAPS offers guidance on formulating and implementing an action plan. Also provides a number of templates and sample interview forms that can be adapted for different local contexts. The chapter “Formulate a plan” describes tools and strategies for planning the work to contain resistance once a working group has been established. An older version is available in Spanish and French.
Cost effectiveness and strategic planning (WHO-CHOICE) CHOICE provides countries with information on strategic planning with regard to cost-effectiveness and associated costs to facilitate policy-making decisions. The website also provides an overview of the CHOICE project as well as the One health Toola resource to support strategic health planning and cost-assessment in low- and middle-income countries.
Antimicrobial Resistance in the Western Pacific Region: a Review of Surveillance and Health Systems Response
Report by WHO (Western Pacific Regional Office) that provides in-depth situational reviews and technical discussions of surveillance, monitoring of use and the health systems response for addressing antimicrobial resistance in the region.
Policies to Address Antibiotic Resistance in Low- and Middle-Income Countries
A discussion paper by the Center for Disease Dynamics, Economics and Policy (CDDEP), which focuses on specific policies in low and middle income countries to address antimicrobial resistance.
The strategic plan for combating antimicrobial resistance in Gulf Cooperation Council States
A paper outlining the strategic plan against AMR in the Gulf countries, and lays a foundation for work with National Action Plans in the region.
Response to the Antimicrobial Resistance Threat (PDF)
This report commissioned by the Swiss Federal Office of Public Health aims to identify key success factors in addressing antimicrobial resistance and compares national strategies in a number of European countries with responses in comparable health systems.
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.
SUPPORT Tools for evidence-informed health Policymaking This article series on evidence-based health policy-making was prepared by the SUPPORT project, an EU-funded research project. It consists of 18 guides that explain different steps in the development, implementation and evaluation of evidence-based health policy.
Analysing Disrupted Health Sectors – A Modular Manual This manual for health policy analysis focuses on countries on the verge of economic, military or economic crisis. It offers practical guidance to policy analysts working in health systems that face severe challenges and includes tools and templates that can be adapted to respective circumstances. Module 6 (PDF) focuses on health financing and managing expenditure in weak health systems.

Food and agriculture

Resource Description
CODEX ALIMENTARIUS International Food Standards: Antimicrobial Resistance Global standards for the responsible use of antimicrobials in food-producing animals. The “Code of practice to minimize and contain antimicrobial resistance” (CAC/RCP 61-2005) describes the responsibilities for regulatory authorities, veterinary pharmaceutical industry, wholesalers, retailers, veterinarians and farmers. “Guidelines for Risk Analysis of Foodborne Antimicrobial Resistance” (CAC/GL 77-2011) gives guidance on assessing the risk to human health from foodborne antibiotic resistant bacteria, and determining appropriate management strategies to control those risks. Available in English, French and Spanish.
FAO Antimicrobial Resistance Policy Review and Development Framework Guide from FAO to help decision-makers and technical staff to review, develop and implement national policies on antimicrobial use and resistance in food animal production. Covers both AMR-specific and AMR-relevant policies. The Framework is designed to help countries review and update their national policies and provides examples from countries that facilitate effective national responses to AMR. Developed for governments in Asia and the Pacific.
Guidelines for the prudent use of antimicrobials in veterinary medicine (2015/C 299/04) Example guidelines from the European Commission that provide authorities, farmers and veterinarians with recommendations and examples of possible strategies for prudent use of antimicrobials in veterinary medicine. Lists roles of different actors and possible measures within different animal holding systems. Available in a number of languages, including English, French and Spanish.

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World Health Organization - WHO. Cost effectiveness and strategic planning (WHO-CHOICE) [Internet]. Cost effectiveness and strategic planning (WHO-CHOICE). [cited 2016 Mar 21]. Available from: http://who.int/choice/en/
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World Health Organization - WHO. Antimicrobial Resistance in the Western Pacific Region: a Review of Surveillance and Health Systems Response [Internet]. Geneva, Switzerland: World Health Organization; 2015 [cited 2015 Apr 20]. Available from: https://apps.who.int/iris/handle/10665/208222
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Food and Agriculture Organization of the United Nation - FAO. Antimicrobial Resistance Policy Review and Development Framework [Internet]. 2018 [cited 2019 Jul 1]. Available from: http://www.fao.org/emergencies/resources/documents/resources-detail/en/c/1154167/
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SIAPS. Building Coalitions for Containing Antimicrobial Resistance: A Guide. Submitted to the US Agency for International Development by the Systems for Improved Access to Pharmaceuticals and Services Program. Arlington, VA: Management Sciences for Health. [Internet]. 2017 [cited 2018 Mar 14]. Available from: http://siapsprogram.org/publication/building-coalitions-for-containing-antimicrobial-resistance-a-guide/
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Food and Agriculture Organization of the United Nations - FAO, World Health Organization - WHO. CODEX ALIMENTARIUS International Food Standards - Antimicrobial Resistance [Internet]. FAO; WHO; [cited 2015 Nov 27]. Available from: http://www.fao.org/fao-who-codexalimentarius/thematic-areas/antimicrobial-resistance/en/
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World Health Organization - WHO. Analysing Disrupted Health Sectors - A Modular Manual [Internet]. 2009. Available from: http://www.who.int/hac/techguidance/tools/disrupted_sectors/en/
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The antimicrobial resistance national action plan (AMR-NAP) forum [Internet]. WHO. [cited 2017 Jun 14]. Available from: http://www.who.int/antimicrobial-resistance/national-action-plans/discussion-forum/en/
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Balkhy HH, Assiri AM, Mousa HA, Al-Abri SS, Al-Katheeri H, Alansari H, et al. The strategic plan for combating antimicrobial resistance in Gulf Cooperation Council States. J Infect Public Health. 2016 Aug;9(4):375–85.
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Bernhard Bonk M. Response to the Antimicrobial Resistance Threat - A comparative study of selected national strategies and policies [Internet]. Swiss Federal Office of Public Health; 2015 Sep. Available from: http://www.ndphs.org///documents/4762/PAC_11_side_event__Presentation_Mathias_Bernhard_Bonk.pdf
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UNICEF, UNDP, World Bank, WHO. TDR: Implementation research toolkit [Internet]. World Health Organization - WHO. [cited 2016 Nov 24]. Available from: http://www.who.int/tdr/publications/topics/ir-toolkit/en/
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Ministry of Health Republic of Ghana. Policy Brief: Antimicrobial Resistance (AMR) [Internet]. 2015 [cited 2016 Mar 17]. Available from: http://www.reactgroup.org/wp-content/uploads/2016/10/Ghana-Policy-Brief_Annex-8-Poliy-Brief.pdf
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European Commission. Commission Notice — Guidelines for the prudent use of antimicrobials in veterinary medicine (2015/C 299/04). 2015 Sep 11 [cited 2016 Feb 23];58:7. Available from: http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=uriserv:OJ.C_.2015.299.01.0007.01.ENG&toc=OJ:C:2015:299:FULL
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World Health Organization - WHO. Library of national action plans [Internet]. Drug resistance. 2016 [cited 2016 Mar 1]. Available from: http://www.who.int/drugresistance/action-plans/library/en/
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World Health Organization - WHO, Food and Agriculture Organization of the United Nations - FAO, World Organization for Animal Health - OIE. Antimicrobial resistance: A manual for developing national action plans [Internet]. Geneva, Switzerland: World Health Organization; 2016 [cited 2016 Mar 1]. Available from: http://www.who.int/drugresistance/action-plans/manual/en/
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Oxman A, Hanney S, editors. SUPPORT Tools for evidence-informed health Policymaking (Article Series) [Internet]. Health Research Policy and Systems; 2009. Available from: http://www.health-policy-systems.com/supplements/7/S1
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Gelband H, Delahoy M. Policies to Address Antibiotic Resistance in Low- and Middle-Income Countries [Internet]. The Centre for Disease Dynamic, Economics & Policy; 2014 Sep. Available from: http://cddep.org/publications/policies_address_antibiotic_resistance_low_and_middle_income_countries