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Policy  –  Develop and implement plan

Engage stakeholders

Ensuring a true engagement of all relevant stakeholders is essential for an antibiotic resistance policy to be successful and to ensure a sustained effort.

Leadership and oversight of a national action plan should be established early to carry the policy through the development and implementation process.

As antibiotic resistance is a complex issue, broad political buy-in is needed for a national action plan to be effective, politically anchored and financially secure. It should be determined which one or more ministries will spearhead a country’s work on antibiotic resistance. Ministries that could be included are for example health, agriculture, finance, education/research, trade and environment.

Form a multisectoral coordinating group

It is recommended to establish a multisectoral coordination group to lead the development and implementation of the plan. The role of the coordinating group should be established and their political mandate agreed upon. A national focal point should be identified in animal health, human health and plant health.

Conduct a stakeholder analysis

A stakeholder analysis is conducted in order to identify and assess the importance of different stakeholders. In a field as complex and multisectoral as antibiotic resistance, a clear picture of the policy landscape and its actors as well as other key players can serve as a foundation for the rest of the policy process. A thorough stakeholder analysis allows identification of key players; prediction of whether they might support or block the implementation of reforms; and possibility to develop strategies to promote supportive actions and decrease opposing actions before major reforms are decided upon and implemented.

Form a national stakeholder platform

A larger multi-stakeholder platform or coalition can be formed for wider engagement and consultation throughout the development and implementation of the national action plan. In addition to human health, all relevant sectors such as animal health, plant production, and environmental health should be included so they feel ownership in the plan. This group can bring together policy makers, regulatory authorities, academicians, health care professionals, veterinarians, microbiologists, pharmacists, industry, civil society, professional societies, funding organizations, and media amongst others. The platform can be brought together as needed to inform of progress and to solicit input.

Ghana National Platform on Antimicrobial Resistance

When Ghana identified the worrying situation of increasing antibiotic resistance and decided to work towards the development and implementation of a national policy on antimicrobial resistance, they used a multi-stakeholder approach to form a National Platform on Antimicrobial Resistance (NPAR). The Ministry of Health spearheaded the development of the NPAR that brought together a multidisciplinary group with representatives from all relevant sectors including physicians, veterinary medicine, agriculture, pharmacies and regulatory agencies as well as civil society organizations and non-governmental organizations. Read more about the Ghana national policy development under Examples from the field.

Identify and engage champions

Engaging influential individuals, that are on the forefront regarding a specific issue, to promote change is an innovative and evidence-based advocacy strategy. These champions, or opinion leaders, can act as gatekeepers, help change social norms, and accelerate behavior change. In many cases, a public health champion is an influential political leader, health care provider, or other authority figure who uses his or her expertise and professional contacts to facilitate the application of evidence into national policy. A champion can work as a broker between stakeholders and therefore, it is important that champion(s) have a good and influential relationship with the different government departments, and civil society.

Selected Resources

Resource Description
Tackling Antimicrobial Resistance (AMR) together. Working Paper 1.0: Multisectoral coordination Tools, tactics, lessons. Document on multisectoral coordination issued by WHO to support policymakers involved in developing National Action Plans on antimicrobial resistance. Includes tools, tactics and lessons learned gathered from countries including Ethiopia, Kenya, Philippines and Thailand.
Sample terms of reference for a national multisectoral coordinating group, for a national focal point and for a technical working group (PDF) Template. This is a supporting document developed by WHO, FAO and OIE to accompany the manual for developing national action plans (this page also provides additional supporting material important for the national action plan development process plus the TOR document in several languages including Spanish and French).
Building Coalitions for Containing Antimicrobial Resistance: A Guide Guide by SIAPS for how to identify key stakeholders for addressing drug resistance, mobilize their support, formulate and implement a plan and subsequently evaluate outcomes. Also provides a number of templates and sample interview forms that can be adapted for different local contexts. The chapter “Mobilize support” details how to identify stakeholders, organize a working group, and define the key issues. An older version is available in Spanish and French.
Stakeholder Analysis Guidelines (PDF) Guide from WHO that provides a framework for conducting a stakeholder analysis covering the steps from initial planning to the identification of stakeholders and the development and use of relevant tools.
Multidisciplinary and multisectoral coalitions as catalysts for action against antimicrobial resistance: Implementation experiences at national and regional levels Journal article describing how building coalitions can amplify stakeholder efforts to carry out antibiotic resistance prevention and control strategies. Presents an approach to help local stakeholders kick-start a coalition-building process with examples from Ethiopia, Namibia, Zambia.

More from "Develop and implement plan"

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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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Joshi MP, Chintu C, Mpundu M, Kibuule D, Hazemba O, Andualem T, et al. Multidisciplinary and multisectoral coalitions as catalysts for action against antimicrobial resistance: Implementation experiences at national and regional levels. Global Public Health [Internet]. 2018 [cited 2018 Nov 29];13(12):1781–95. Available from: https://doi.org/10.1080/17441692.2018.1449230
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World Health Organization - WHO. Tackling Antimicrobial Resistance Together: Working paper 1.0: Multisectoral coordination [Internet]. 2018 [cited 2018 Nov 29]. Available from: http://www.who.int/antimicrobial-resistance/publications/workingpaper1multisectoralcoordinationAMR/en/
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World Health Organization - WHO. Sample terms of reference for a national multisectoral coordinating group, for a national focal point and for a technical working group [Internet]. World Health Organization - WHO; 2016 [cited 2016 Mar 3]. Available from: http://www.who.int/drugresistance/action-plans/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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GHNDP. Antimicrobial Resistance Project - Ghana [Internet]. Available from: http://www.ghndp.org/antimicrobialresistance/
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FHI 360. Engaging Innovative Advocates as Public Health Champions [Internet]. FHI 360. [cited 2015 Apr 22]. Available from: http://www.fhi360.org/resource/engaging-innovative-advocates-public-health-champions
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HealthKnowledge. Identifying and managing internal and external stakeholder interests [Internet]. Health Knowledge. 2010 [cited 2015 Apr 22]. Available from: http://www.healthknowledge.org.uk/public-health-textbook/organisation-management/5b-understanding-ofs/managing-internal-external-stakeholders
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Schmeer K. Stakeholder Analysis Guidelines [Internet]. WHO, Workforce alliance; 1999. Available from: http://www.who.int/workforcealliance/knowledge/toolkit/33.pdf?ua=1