Once policies are adopted, they need to be implemented. Here you find guidance and resources to assist the process.
Implementation is probably the most challenging part of the policy process. In many cases, lack of policy implementation is a result of disproportion between the ambition of the policy and the resources and capacity available to actually implement it. Therefore, a proper resource analysis and planned budget allocation is key, as described in the previous section. Implementation should be built on existing structures, policies, and programs where available.
Want to connect with others working to implement national action plans?
The AMR-NAP discussion forum is a free and open online resource run by the WHO AMR Secretariat for those developing and implementing national action plans on antibiotic resistance. Join here.
Annual target plans
One way of increasing the likeliness of actual implementation is to set up annual target plans. Such target plans helps 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. More information on indicators can be found in Evaluate progress.
Annual targets in the White House National Action Plan for Combating Antibiotic-resistant Bacteria
In their National Action Plan from 2015, the US government set up five larger general goals to address antibiotic resistance. These have several attached objectives, each containing 1-year, 3-year and 5-year milestones that define clear targets. An example is Objective 5.3 that was written in the following way:
“Develop a mechanism for international communication of critical events that may signify new resistance trends with global public and animal health implications.
Within one year:
- CDC will work with TATFAR partners to develop a common U.S.-E.U. system for sharing and analyzing bacterial resistance patterns for pathogens identified as urgent and serious threats in Table 1.
- HHS/OGA, USDA, FDA and CDC will work with TATFAR partners to address TATFAR Recommendation #18, which calls for the formation of an international working group to identify key knowledge gaps about transmission of drug-resistant bacteria in animals and the use of antibiotics in animal agriculture.
Within three years:
- CDC will work with WHO and other partners to develop a secure website for real-time sharing of international surveillance data on antimicrobial resistance in order to facilitate early warning and notification of significant events to WHO, regional and international disease surveillance networks (e.g., European Centre for Disease Prevention and Control), and IHR. These efforts will make use of data-sharing practices developed by the U.S. and TATFAR (see above). Steps include developing terms of reference, assessing IT requirements, and identifying mechanisms for validating and sharing information.
- CDC will deploy the website in partnership with the international community and will help test, monitor, evaluate, and improve its utility.
- USDA will identify next steps in addressing knowledge gaps about development and spread of antibiotic resistance in animals, based on the conclusions of the work group formed in fulfillment of TATFAR Recommendation #18 (see above).
Within five years:
- CDC and other U.S. agencies will help ensure access to – and full participation by – public health authorities in all WHO member countries.
- USDA will engage TATFAR and other regional partners in sharing information about drug-resistance trends with implications for animal health.”
Even though indicators are not clearly stated, the milestones provide targets to be fulfilled. The full plan can be found here.
- Elements of a national action plan, which covers some possible policy areas (such as surveillance, and infection prevention) to include in the plan and support tools for their implementation.
- Examples from the field: More about how different countries and regions have worked to develop and implement plans.
|Turning plans into action for antimicrobial resistance (AMR), Working Paper 2.0: Implementation and coordination||Paper developed by WHO with practical guidance on implementation of national action plans on antimicrobial resistance, with a specific focus on LMICs. For coordination committees and others working at country level. Points out importance of building on existing plans and initiatives in relevant areas (such as IPC, immunization, and laboratory strengthening programmes).|
|Building Coalitions for Containing Antimicrobial Resistance: A Guide||Guide by SIAPS that offers guidance on how to 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 “Implement the Action Plan” describes some tools and strategies for managing technical and logistical issues to effectively implement a plan. An older version is available in Spanish and French.|
|Guidelines on Implementation of the Antimicrobial Strategy in South Africa: One Health Approach & Governance||Example of an implementation plan. ‘How to’, step-by-step guide for South African healthcare and veterinary workforce to enact the national strategy, addressing the governance framework at different levels of the health system.|
|Country progress in the implementation of the global action plan on antimicrobial resistance: WHO, FAO and OIE global tripartite database||Database. A global open-access tripartite antimicrobial resistance database developed by WHO, FAO and OIE. Baseline information of country status regarding implementation of national action plans based on country self-assessments.|
|Tackling antimicrobial resistance (AMR) together. Working Paper 5.0: Enhancing the focus on gender and equity||Working paper from WHO to assist countries towards better considering gender and equity in work on antibiotic resistance; informing the implementation of strategies in national action plans.|