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Policy  –  Develop a national action plan

Evaluate progress of the national action plan on antimicrobial resistance

Monitoring and evaluation are key components of national action plans on antimicrobial resistance (AMR).

Progress of the national action plan on AMR

In order to ensure that implementation of the national action plan (NAP) occurs as planned, continuous monitoring and evaluation is important. Results should be fed back to government parties and members of the stakeholder platform in a timely manner and in a format that can be interpreted and used by the respective party. Periodic evaluation is important to understand if goals are being accomplished and to identify aspects that may need improvement. Often evaluation is done by measuring indicators, however, in addition, the collection of descriptive data can be helpful to give a comprehensive view of the extent to which changes are occurring.

Develop a monitoring and evaluation plan

The quadripartite organizations (WHO, FAO, WOAH and UNEP) encourages an 8-step process for developing an M&E plan for AMR NAPs:

  • Decide on the M&E audience
  • Define the M&E questions
  • Identify indicators and data sources
  • Decide on roles, responsibilities and governance mechanisms
  • Decide on data collection, analyses and reporting timelines
  • Develop a comprehensive M&E plan
  • Earmark resources to implement the M&E plan
  • Factor in periodic reviews of the M&E plan

Figure 1. Step-by-step process for developing an M&E plan for AMR NAPs. Source: FAO, UNEP, WHO and WOAH.
Plans should be tailored to the country context and priorities and capacity. It is for example important to keep data collection processes simple, feasible and sustainable and build on existing information systems that collect data on relevant indicators or proxy indicators.

Annual target plans

One way of increasing the likeliness of actual implementation is to set up annual target plans. Such target plans help in planning for short and long term goals of the policy and to go from policy into action. Moreover, they can serve as important tools for budget planning and allocation. It is advisable that the annual target plans also include clear and measurable indicators to allow monitoring and evaluation of the process.

Developing indicators

An essential part of the M&E plan is the development of adequate indicators. It is important that indicators represent the progress towards implementing the activity or achieving the outcome. They should be specific, measurable, achievable, relevant and time-bound (SMART). Indicators used to monitor implementation of the antibiotic resistance policy can be divided into different groups:

Indicator Groups for Monitoring and Evaluation:

Indicator type Description Examples
Process indicators Measure implementation of activities and usage of inputs (financial, human or other resources required for the achievement of an output).
  • Working groups formed
  • Training sessions held
  • Launch of public awareness campaign
Output indicators Track delivery of outputs (products or services resulting from the implementation of activities).
  • Number of infection control programs initiated
  • Dosages of antibiotics distributed
Outcome indicators Assess short- to medium-term
intervention results (outcomes – describable or measurable changes that are derived from use of an initiative’s outputs).
  • Incidence of infection in health facilities, farms and communities
  • Number of drug-resistant infections
  • Amount of antibiotic consumption in food animal production
Impact indicators Measure long-term effects.
  • Reduced levels and slower development of resistance
  • Reduced impact of infectious diseases on human and animal health

Data collection

In MEASURE you can find specific tools and resources to support in measuring various aspects of antibiotic resistance and use (such as point prevalence survey protocols and knowledge, attitudes, beliefs and practice questionnaires):

Analyze results

Data collected from monitoring and evaluation efforts should be analyzed by the multisectoral coordinating group and additional key stakeholders.

Results from monitoring indicators (such as process indicators) can inform discussions on future implementation strategies. Results from evaluation indicators (such as output, outcome or impact indicators) can also be used in future resource allocation decisions. Information for both sets are needed, as a failure of impact may be due to a failure in implementation.

Communicate results

It is key to feed back results to partners and stakeholders using communication methods and content tailored to the audience. Public recognition should be made of the contributions and successes of partners involved, as affirmation of hard work provides incentive for continued involvement. Transparent reporting and acknowledgement of positive progress promote confidence in the national action plan.

Selected Resources

Resource Description 
Guidance to facilitate monitoring and evaluation for antimicrobial resistance national action plans Guidance from WHO for countries on how to establish a monitoring and evaluation plan for their national action plan on AMR, building on existing national reporting systems and recommended indicators from the Global Action Plan on AMR M&E framework. Intended for members of the AMR multisectoral coordination committee or working group, persons responsible for M&E and other key actors involved in NAP implementation.
The implementation handbook for national action plans on AMR: Guidance for the human health sector Handbook with indicators from WHO. Provides a practical, stepwise approach to NAP implementation within the human health sector. Chapter 7 details how to monitor and evaluate the NAP, and includes a checklist for M&E. Annex 7 lists human health indicators for M&E of the NAP AMR at the country level.
FAO Antimicrobial Resistance Policy Review and Development Framework Guidance 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.
Building Coalitions for Containing Antimicrobial Resistance: A Guide Guidance by SIAPS offers guidance on how to formulate and implement a plan and evaluate outcomes, including indicators. Also provides a number of templates and sample interview forms that can be adapted for different local contexts. The chapter “Monitor and evaluate” gives an overview of the M&E process with country examples. An older version is available in Spanish and French.
Monitoring and evaluation of the global action plan on antimicrobial resistance: framework and recommended indicators Guidance and indicators. Framework to help obtain and analyze standardized data to assess the success of the global action plan on antimicrobial resistance (GAP) and inform operational and strategic decisions on resistance at both national and global levels. Recommends indicators to be compiled on a national level as well as indicators to be collected on a global level from secondary sources. FAO, OIE, WHO.
Measuring the global response to antimicrobial resistance, 2020–21: a systematic governance analysis of 114 countries Journal article and indicators. This study analyzes country NAPs on AMR from a governance perspective. The appendix pages 3-5 lists indicators analyzed around three main areas: Policy design, implementation tools and M&E.
ECDC, EFSA and EMA Joint Scientific Opinion on a list of outcome indicators as regards surveillance of antimicrobial resistance and antimicrobial consumption in humans and food-producing animals Indicators. Suggestion of outcome indicators with a ‘One Health’ perspective to support assessment of progress made in the implementation of actions against antibiotic resistance in EU Member States. Provides rationale for selection, describes methodology, and provides example of calculation of indicators. Established by European health and food safety agencies. Examples: Human medicine: proportion of Escherichia coli bacteria resistant to third-generation cephalosporins. Veterinary medicine: proportion of E. coli in food-producing animals that are susceptible or resistant to a number of antibiotics.
An analysis of national action plans on antimicrobial resistance in Southeast Asia using a governance framework approach Journal article and indicators. Reviews the content of ten national action plans from countries in Southeast Asia. Uses an antimicrobial resistance governance framework to evaluate policy design, implementation tools, one health engagement, monitoring and evaluation and sustainability.
Evaluating Policy Influence and Advocacy Guidance to support evaluation of policy influence and advocacy from Better Evaluation, a global collaboration aimed at improving evaluation practice.

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