An insight into the implementation of the global action plan on antimicrobial resistance in the WHO African region: A roadmap for action

Introduction: The Global Action Plan (GAP) on antimicrobial resistance (AMR) delivers a 'One Health' strategy for the development of the national action plan. It encourages the optimal use of antimicrobials and strengthens the evidence base through surveillance and research. Methods: This study evaluated the current status of implementation of the GAP on AMR in World Health Organization (WHO) African countries via a retrospective, cross-sectional analysis of routinely collected data on AMR. A SWOT analysis was used to identify the strengths, weaknesses, opportunities and threats involved in the GAP implementation. A roadmap for action was proposed. Results: The overall mean GAP performance score across all the countries that were assessed was 32% +/- SD12 (95% CI 27-36%). The mean thematic scores were 59% +/- 12 (53-65%) for multi-sector and One Health collaboration; 50% +/- 22 (42-58%) for developing national AMR action plans; 38% +/- 12 (33-42%) for awareness and training; 18% +/- 13 (13-23%) for surveillance; 33% +/- 13 (29-38%) for infection prevention and control; and 28% +/- 23 (20-37%) for optimal use of antimicrobial medicines in human, animal and plant health. The difference in GAP performance scores between African sub-regions and between income categories was not statistically significant ( P > 0.05). While seven countries exhibited strengths in two themes, 25 countries exhibited weaknesses across all themes. Six threats and six opportunities were identified to inform a practical roadmap for AMR action. Conclusion: The findings from this study indicate that the overall GAP implementation on AMR in the WHO African region is inadequate. Some thematic GAP scores appeared to be relatively good, but on closer inspection, individual indicators revealed a lack of progress and implementation, requiring action. (c) 2021 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.