Upon review of 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.
The plan should contribute to the strategic objectives outlined in the Global Action Plan on Antimicrobial Resistance and reflect its main principles:
- Engagement of the 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 the following plans:
- Strategic Plan – covering the goals or vision, objectives, priorities and interventions
- Operational Plan – could be one plan or several plans that bridge policy to action and address activities, implementation arrangements, time plan, responsible parties, detailed budget and costing. Examples include communication, resource mobilization, surveillance, and AMR stewardship plans for human, animal, plant and environmental health.
- 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.
Goals and objectives
Setting goals and objectives will help the multi-stakeholder coordinating group know where to focus its energy and how to direct its resources. See Implement the 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 improvement. When developing objectives it is important to make them SMART:
- Results Oriented
- Time Limited
A budgeted 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 be 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?
- Resource mobilization: How will plans be financed in the short- and long-term?
- Surveillance: What activities will occur to address surveillance in human, animal, plant and environment health?
- AMR stewardship: What activities will occur to address rational use of antibiotics in human, animal, plant and environment health?
- Risk assessment: How will each plan manage inherent risks that might occur with implementation?
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:
- Food and agriculture
|The antimicrobial resistance national action plan (AMR-NAP) forum||Online 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||Manual developed by the WHO 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||Database. 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||Manual by SIAPS that 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)||Information portal. 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 Tool, a 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
||Report by the Center for Disease Dynamics, Economics and Policy (CDDEP), which discusses specific policies in low and middle income countries to address antimicrobial resistance.|
|The strategic plan for combating antimicrobial resistance in Gulf Cooperation Council States
||Journal article 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)
||Report commissioned by the Swiss Federal Office of Public Health that 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 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||Journal article series on evidence-based health policy-making 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||Manual for health policy analysis focusing 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
|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.