Who Implementation Handbook For National Action Plans On Antimicrobial Resistance

In 2015 the World Health Assembly endorsed the Global action plan on antimicrobial resistance calling on countries to develop and implement national action plans on antimicrobial resistance (AMR). For most countries, the greatest challenge is not developing a national action plan; rather, it is the implementation of the plan based on evidence-based prioritization of activities, systematic monitoring of progress, and ensuring sustainability of efforts. The purpose of this publication is to to provide a practical, stepwise approach to the implementation of the national action plan on AMR within the human health sector; and to provide a process and collation of existing WHO tools to prioritize, cost, implement, monitor and evaluate national action plan activities. The target audience of the publication are national/subnational stakeholders working on AMR within the human health sector. This includes national health authorities, national multisectoral coordination groups, senior technical experts and policymakers involved in implementing AMR activities at all levels of the health system, and implementation partners to accelerate sustainable implementation and monitoring and evaluation of national action plans on AMR.

This document outlines the concept and content of the WHO people-centred approach to addressing antimicrobial resistance (AMR) in the human health sector. The proposed approach recognizes and aims to address the challenges and health system barriers people face when accessing health services to prevent, diagnose and treat (drug-resistant) infections. It puts people and their needs at the centre of the AMR response and guides policy-makers in taking programmatic and comprehensive actions to mitigate AMR in line with a proposed package of core interventions. These interventions are based on a review of four pillars and two foundational steps that are critical to overcome barriers faced by people and health systems in addressing AMR. The four pillars are: (1) prevention of infections; (2) access to essential health services; (3) timely, accurate diagnosis; and (4) appropriate, quality-assured treatment. The pillars are supported by the two foundational steps: effective governance, awareness and education; and strategic information through surveillance and research. Building and adding on to the objectives of the Global action plan on AMR, the 13 core interventions and accompanying priority actions are designed to address AMR in a programmatic manner that puts people, their needs and equitable access to health services at the centre of the AMR response in the community, in primary care, secondary and tertiary care, and at national and/or subnational level. The development of the people-centred core package of AMR interventions was based on a review of the evidence and multidisciplinary expert opinion, complemented with feedback from a global online consultation and WHO’s strategic and technical advisory group on antimicrobial resistance. As countries develop or revise their national action plans (NAPs) on AMR, the people-centred core package of interventions can support the design and prioritization of actions in the human health sector at the different levels of implementation and integrated with broader health system strengthening and pandemic preparedness and response plans.

In 2015 the World Health Assembly endorsed the Global action plan on antimicrobial resistance (GAP-AMR) calling on countries to develop, implement and monitor national action plans on AMR. In 2019, FAO, WHO and WOAH developed a monitoring and evaluation (M&E) framework for the GAP-AMRto track progress towards the plan’s five global objectives, designed with a One Health perspective and reflecting the cross-sectoral nature of AMR with indicators across human and animal health, plant and food production and the environment. Countries are expected to develop an M&E plan for their NAP, tailored to their context and priorities. This includes developing indicators appropriate to the country’s own circumstances, aligned with the proposed core indicators of the GAP-AMR M&E framework, as far as possible. This country M&E guidance document was developed as a reference for countries to support the development and delivery of AMR NAPs. It provides assistance on how to establish an M&E plan for their AMR NAP, building on existing national reporting systems and recommended indicators from the GAP-AMR M&E framework.

The Guide to implementing the One Health Joint Plan of Action (OH JPA) at national level provides practical guidance on how countries can adopt and adapt the OH JPA to strengthen and support national One Health action. Building on the OH Joint Plan of Action theory of change, this Guide describes three pathways and five key steps to implement the OH JPA at national level: • Pathway 1 – Governance, policy, legislation, financing and advocacy • Pathway 2 – Organizational and institutional development, implementation and sectoral integration • Pathway 3 – Data, evidence, information systems and knowledge exchange. The Guide is a joint publication by the four Quadripartite organizations, the Food and Agriculture Organization of the United Nations (FAO), the United Nations Environment Programme (UNEP), the World Health Organization (WHO), and the World Organisation for Animal Health (WOAH).

Seizing a narrowing policy window in a post-pandemic context, the OECD and the European Observatory on Health Systems and Policies, with support from the European Commission, developed a comprehensive methodology culminating in a handbook on "Strengthening Health Systems: A Practical Handbook for Resilience Testing." Inspired by stress tests in various sectors, this methodology was piloted in Finland, Greece, and Spain throughout 2023.