Focus areas for the forward momentum of sub-national action plans on antimicrobial resistance (AMR) - Perspectives from three states in a Low- and middle-income Country

Abstract

Abstract Background Antimicrobial resistance (AMR) is a critical public health threat that could impact healthcare systems and economies. The role of national action plans (NAPs) in containing AMR is well-recognized. India has taken multiple steps, including decentralizing action plans by encouraging states to adopt sub-national or state action plans (SAPs) on AMR. Only four states (Out of 28 States and 8 union territories) have a SAP on AMR. To understand the factors and focus areas needed to formulate such SAPs, we report the perspectives of key One Health stakeholders' from three states in India. Methods Two states and one union territory that did not have SAPs on AMR were chosen. A desktop situational analysis was done to identify key stakeholders involved in AMR work in these states and understand the AMR challenges in these states. Local public health champions were also invited. One-day consultation meetings were conducted at each site. A total of 118 stakeholders participated in the meetings. Seventeen in-depth interviews were also held with participants after the meetings to add further insights. The inputs from the meetings and in-depth interviews was subjected to latent and manifest content analysis to identify themes. Results The meetings and in-depth interviews led to identifying AMR drivers and potential interventional strategies and requirements such as improving awareness with targeted communication strategies, strengthening and expanding surveillance in both human and animal sectors, improving community hygiene, stepping up financing mechanisms, and enhancing governance through multisectoral secretariats. The need to decrease the consumption of antibiotics through a strong foundation of public-private partnerships and the scale-up of stewardship efforts was highlighted. An urgency to integrate AMR strategies into other vertical health programs was noted. Conclusion In large lower and middle-income countries, inspite of the presence of NAPs, various challenges exist in containing AMR in states. The perspectives of the stakeholders highlight the focus areas within the NAPs, the contextual challenges, and the need to urgently formulate these SAPs with tailor-made approaches. Utilizing the expertise of multiple stakeholders in each state to materialize SAPs that incorporate these valuable local insights is likely to optimize forward movement.