Boston University College of Engineering, Department of Biomedical Engineering, Boston, USA.
Boston University Institute for Health System Innovation & Policy, Boston, USA.
J Glob Health. 2020 Dec;10(2):020414. doi: 10.7189/jogh.10.020414.
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.
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.
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.
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.
世界卫生组织（WHO）的抗菌药物耐药全球行动计划（GAP）提供了一项全球战略，以对抗抗菌药物耐药性。具体国情国家行动计划（NAP）将 GAP 转化为反映当地优先事项的内容。然而，各国将 GAP 转化为 NAP 的过程以及由此产生的一致性情况并不为人所知。本文的目的是评估八个选定的低收入和中低收入国家（LMICs）的 NAP 与 GAP 及彼此之间的一致性情况，以确定以兽医部门为重点的最佳实践。
使用 WHO GAP 和 WHO 制定 NAP 手册，我们对阿富汗、孟加拉国、埃塞俄比亚、加纳、尼泊尔、尼日利亚、巴基斯坦和乌干达的政策内容进行了评估。如果 NAP 包含≥80%的建议，则被认为与 GAP 一致。运营和监测与评估（M&E）计划被评估为具体、可衡量、可分配和有时限（或 SMAT）。抗菌药物使用减少的融资、目标和立法以及药品质量保证机制使用构建的框架进行评估。然后使用评分系统对各国进行排名，以确定最佳实践。
所有 NAP 均包含 GAP 建议的≥80%。虽然尼泊尔的 NAP 具有战略性，但其余 NAP 均为操作性且统一的 SMAT；阿富汗除外。M&E 计划并非全部 SMAT。只有加纳和乌干达的 NAP 包含详细的成本核算和资金来源，只有尼泊尔的 NAP 包含抗菌药物使用减少的定量目标，只有孟加拉国的 NAP 包含立法。加纳和乌干达的药品质量保证机制最为健全。
所有 NAP 均与 GAP 一致。然而，在监测和评估方面存在差距，这降低了各国的问责能力和实施必要纠正措施的能力。大多数 NAP 缺乏抗菌药物使用减少的融资计划和目标。评估的 NAP 中大多数国家的抗菌药物质量保证策略有限。一种可以让各国对其 NAP 进行基准测试的机制，可以确定具体的限制和最佳实践领域。
