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Toolbox  –  Policy

National action plans

A national action plan can serve as a core strategy to coordinate and align activities of different stakeholders and in different sectors. It can also provide a legal and political framework for action.

National and local action needed

Even though antibiotic resistance is a global issue, the major part of the work required to address the problem must be done at national and local level. This need for local action is also reflected in the Global Action Plan on Antimicrobial Resistance, which calls for national action plans in all WHO member states.

The Global Action Plan calls for the development of national action plans

The plan urges “all Member States […] to have in place, within two years of the endorsement of the draft action plan by the Health Assembly, national action plans on antimicrobial resistance that are aligned with the global action plan. (…) These national action plans should provide the basis for an assessment of the resource needs, take into account national and regional priorities, and address relevant national and local governance arrangements.

Taking a One Health approach

All use of antibiotics, whether in human or animal medicine, livestock production, in aquaculture or horticulture, drives development and spread of antibiotic resistant bacteria. A strong antibiotic resistance policy should therefore address the issue holistically through a One Health approach.

Primary goals of a national antibiotic resistance action plan should be to:

  • Reduce the need for antibiotics through infection prevention and control practices
  • Ensure access to, and appropriate use of antibiotics
  • Monitor emergence and spread of resistant bacteria
  • Increase understanding and knowledge of the antibiotic resistance problem and how to manage it

For an effective One Health response, national and local policy makers (including regulators) and experts across different sectors must be brought together. Involve them throughout the development, implementation and evaluation stages.

The WHO secretariat has announced that they will assist Member States by:

  • Supporting countries to develop, implement and monitor national plans
  • Leading and coordinating support to countries for assessment and implementation of investment needs, consistent with the principle of sustainability
  • Monitoring development and implementation of action plans by Member States and other partners
  • Publishing progress reports, including assessment of number of countries that have plans in place, their progress in implementation, and the effectiveness of action at regional and global levels

Challenges to overcome

In its “Policy package to combat antimicrobial resistance”, the WHO lists a number of challenges that most countries will have to address when formulating and implementing a national antibiotic resistance policy. Among them are the following:

  • Limited public awareness and government commitment: Limited public awareness makes it difficult to place antibiotic resistance prominently on the policy agenda and limits the support from civil society organizations.
  • Fragmentation of effort: The coordination and cooperation between different stakeholders in efforts to manage antibiotic resistance is often lacking and can be difficult to establish.
  • Perverse incentives for the use of antibiotics: Unregulated marketing of antibiotics, their continued widespread use as growth promoters in livestock, or profit-seeking prescribing to patients contribute to antibiotic resistance. In those cases where legal frameworks exist, they are rarely accompanied by effective sanctions to enforce existing rules.
  • A lack of effective infection prevention and control programs: The absence of effective infection control measures across human and animal sectors can facilitate the spread of bacterial infections, resulting in a higher disease burden and increasing the risk of transmission for drug-resistant pathogens.

How can the Toolbox help you?

The Toolbox provides guidance, resources and country examples to help work to develop and implement national action plans in a strategic and coordinated way. Develop and implement a plan describes a five-step project management process to facilitate development and implementation of a national action plan addressing antibiotic resistance. Elements of a national action plan outlines components that may be included in a plan, and resources to facilitate implementation of these specific components.

Selected Resources

Resource Description
National Action Plans (NAP) Information portal. Landing page of the WHO’s Antimicrobial Resistance National Action Plans overview.
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.
Library of National Action Plans Information portal. This WHO website page collects antimicrobial resistance action plans of different countries.
Antimicrobial resistance: A manual for developing national action plans Manual from WHO that outlines an incremental approach, which countries can adapt to their specific circumstances and available resources.
Antimicrobial resistance strategies and action plans Information portal that gives an overview of the latest antimicrobial resistance strategies and action plans in the European Union, the United States and Canada, provided by the European Centre for Disease Prevention and Control.
Strategic and operational guidance on animal and environmental aspects: National action plans on antimicrobial resistance for developing countries Report discussing responsible antibiotic use in food animal production, surveillance of antibiotic use and antibiotic resistance and addressing the environmental aspect of AMR in resource-limited settings.
SUPPORT Tools for evidence-informed health Policymaking Journal articles. An article series to guide and give tools on evidence-based health policy-making. It consists of 18 guides that explain different steps in the development, implementation and evaluation of evidence-based health policy. Prepared by the SUPPORT project, an EU-funded research project.
LiST: The Lives Saved Tool Tool. The Lives Saved Tool (LiST) is a PC tool that estimates the impact of scaling up health and nutrition interventions on maternal, newborn, and child health.
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LiST: The Lives Saved Tool [Internet]. Johns Hopkins Bloomberg School of Public Health. [cited 2016 Nov 24]. Available from: https://www.livessavedtool.org/
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Centre for Science and Environment. Strategic and operational guidance on animal and environmental aspects: National action plans on antimicrobial resistance for developing countries [Internet]. Centre for Science and Environment; [cited 2017 Feb 23]. Available from: http://www.cseindia.org/userfiles/strategic-and-operational-guidance-final.pdf
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World Health Organization - WHO. Country progress in the implementation of the global action plan on antimicrobial resistance: WHO, FAO and OIE global tripartite database [Internet]. WHO. [cited 2017 May 22]. Available from: http://www.who.int/antimicrobial-resistance/global-action-plan/database/en/
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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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World Health Organization - WHO. National action plans (NAP) [Internet]. Drug resistance. [cited 2016 Mar 1]. Available from: http://www.who.int/drugresistance/action-plans/en/
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World Health Organization - WHO. Global Action Plan on Antimicrobial Resistance [Internet]. Geneva, Switzerland: World Health Organization; 2015 [cited 2016 Jan 11]. Available from: http://apps.who.int/iris/bitstream/10665/193736/1/9789241509763_eng.pdf?ua=1
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European Centre for Disease Prevention and Control - ECDC. Antimicrobial resistance strategies and action plans [Internet]. 2015 [cited 2016 Jan 7]. Available from: http://ecdc.europa.eu/en/healthtopics/Healthcare-associated_infections/guidance-infection-prevention-control/Pages/antimicrobial-resistance-strategies-action-plans.aspx
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Leung E, Weil DE, Raviglione M, Nakatani H, World Health Organization World Health Day Antimicrobial Resistance Technical Working Group. The WHO policy package to combat antimicrobial resistance. Bull World Health Organ [Internet]. 2011 May 1;89(5):390–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21556308
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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