Benchmarking national action plans on antimicrobial resistance in eight selected LMICs: Focus on the veterinary sector strategies

BACKGROUND: The WHO Global Action Plan on antimicrobial resistance (GAP) provides a global strategy for combating antimicrobial resistance. Context-specific national action plans (NAP) translate GAP to reflect local priorities. However, the process by which countries translate GAP into NAPs, and the resultant concordance, is not well-known. The aim of the paper is to evaluate the NAPs of eight selected low- and lower-middle income countries (LMICs) against GAP and each other to identify best practices with a focus on the veterinary sector. METHODS: Using the WHO GAP, and the WHO Manual for designing NAPs, we performed a policy content evaluation for: Afghanistan, Bangladesh, Ethiopia, Ghana, Nepal, Nigeria, Pakistan and Uganda. NAPs were assessed as concordant with GAP if they contained ≥80% of the recommendations. Operational and monitoring and evaluation (M&E) plans were assessed as: Specific, Measurable, Assignable, and Time-bound (or SMAT). Financing, targets and legislation for antimicrobial use reduction, and medicine quality assurance mechanisms were assessed using a constructed framework. Countries were then ranked using a scoring system to identify best practices. RESULTS: All NAPs contained ≥80% of GAP’s recommendations. Whereas Nepal’s NAP was strategic, the rest were operational and uniformly SMAT; except Afghanistan’s. The M&E plans were not all SMAT. Detailed costing and funding sources were included for only Ghana and Uganda. Quantitative target for antimicrobial use reduction was found only in Nepal’s NAP and legislation only for Bangladesh. Ghana’s and Uganda’s medicine quality assurance mechanisms were the most robust. CONCLUSIONS: All NAPs were concordant with GAP. However, gaps exist in relation to M&E, diminishing the countries’ capacity to be accountable and implement corrective action if necessary. Most lacked financing plans and targets for antimicrobial use reduction. The antimicrobial quality assurances strategies are limited in most of the NAPs assessed. A mechanism by which countries can benchmark their NAP would allow identification of specific limitations and areas of best practice.