Global Health Governance Programme, Usher Institute, University of Edinburgh, Edinburgh, UK; School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
German Institute of Global and Area Studies, Hamburg, Germany; Faculty of Business, Economics and Social Sciences, University of Hamburg, Hamburg, Germany.
Lancet Infect Dis. 2023 Jun;23(6):706-718. doi: 10.1016/S1473-3099(22)00796-4. Epub 2023 Jan 16.
Understanding strategic commitments and policy responses to overcome antimicrobial resistance at the national, regional, and global levels is required to evaluate current progress and direct future planning. National action plans (NAPs) are the primary mechanism for guiding national strategy and action for antimicrobial resistance governance. Although several NAPs have been developed, no comprehensive content analysis of these plans exists. Using a governance framework, we aimed to assess all publicly available NAPs on antimicrobial resistance.
We systematically reviewed the contents of NAPs on antimicrobial resistance from 114 countries, applying a governance framework containing 18 domains and 54 indicators in three integral areas: policy design, implementation tools, and monitoring and evaluation. As well as manually searching NAPs and doing online and literature searches that were relevant to specific indicators from repository inception to June 1, 2022, several data sources were used to generate scores, including the Tripartite Antimicrobial Resistance Country Self-Assessment Survey, the Global Antimicrobial Resistance and Use Surveillance System, the Global Antimicrobial Resistance Research and Development Hub, and various WHO datasets. NAPs were included if the country had also submitted the NAP to the Tripartite Antimicrobial Resistance Country Self-Assessment Survey 2020-21, if the NAP was retrievable through a publicly accessible database or website, and if the NAP was either published in English or eligible for machine translation. Three researchers independently reviewed each NAP and were initially blinded to the evaluations of other researchers. They generated a score using a quantification system for each of 54 indicators. The Cochrane protocol for ensuring reliability was followed. The three researchers were then unblinded and met to resolve any disagreements in scoring to reach a consensus agreement. In each case of discrepancy, consensus was reached between the researchers. We developed criteria to standardise the process of quantifying each indicator. We also weighted and collated relevant national data from various sources to generate composite scores concordant with the key governance areas. We transformed these data to a scale of 0 (worst) to 100 (best), ranked countries on the basis of their mean scores, and used descriptive statistics to analyse global and regional trends.
306 NAPs were identified and 114 were eligible for analysis. Between 2020 and 2021, the mean antimicrobial resistance governance score was 51 (SD 14). Norway had the highest governance score (mean 85 [SD 32]), and the Federated States of Micronesia had the lowest governance score (28 [37]). The highest scoring domain was participation (83 [16]), and the lowest scoring domains were accountability (30 [18]) and feedback mechanism (30 [25]). Domains relating to policy design (55 [13]) and implementation tools (54 [17]) scored similarly, whereas monitoring and evaluation (38 [20]) efforts were lower.
International efforts to control antimicrobial resistance varied considerably between countries. Monitoring and evaluation efforts need improving for continuous understanding of national and international progress. International response might not be commensurate with the scale and severity of antimicrobial resistance.
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为了评估当前进展并指导未来规划，需要了解国家、地区和全球层面克服抗微生物药物耐药性的战略承诺和政策应对措施。国家行动计划（NAP）是指导抗微生物药物耐药性治理的国家战略和行动的主要机制。尽管已经制定了若干 NAP，但目前尚不存在对这些计划的全面内容分析。我们使用治理框架，旨在评估所有公开的抗微生物药物耐药性 NAP。
我们系统地审查了来自 114 个国家的抗微生物药物耐药性 NAP 的内容，应用包含 18 个领域和 54 个指标的治理框架，涵盖政策设计、实施工具以及监测和评估三个整体领域。此外，我们还手动搜索 NAP，并对特定指标的在线和文献进行了搜索，这些搜索从存储库创建开始到 2022 年 6 月 1 日截止。我们使用了多个数据源来生成分数，包括三方抗微生物药物耐药性国家自我评估调查、全球抗微生物药物耐药性和使用监测系统、全球抗微生物药物耐药性研究和发展中心以及世卫组织的各种数据集。如果国家还向三方抗微生物药物耐药性国家自我评估调查 2020-21 提交了 NAP、如果 NAP 可以通过公共数据库或网站检索、并且如果 NAP 以英文发布或可以进行机器翻译，则将 NAP 纳入研究。三名研究人员独立审查了每个 NAP，并最初对其他研究人员的评估情况保持盲态。他们使用量化系统为每个 54 个指标生成了一个分数。遵循了确保可靠性的科克伦协议。然后，三名研究人员解除盲态并开会解决评分方面的任何分歧，以达成共识。在每个存在差异的案例中，研究人员都达成了共识。我们制定了量化每个指标的标准化程序。我们还加权并整合了来自各种来源的相关国家数据，以生成与关键治理领域一致的综合分数。我们将这些数据转换为 0（最差）到 100（最佳）的比例，根据平均分数对国家进行排名，并使用描述性统计数据分析全球和区域趋势。
我们确定了 306 个 NAP，并对 114 个 NAP 进行了分析。在 2020 年至 2021 年期间，抗微生物药物耐药性治理平均得分为 51（SD 14）。挪威的治理得分最高（平均 85 [SD 32]），密克罗尼西亚联邦的治理得分最低（28 [37]）。得分最高的领域是参与（83 [16]），得分最低的领域是问责制（30 [18]）和反馈机制（30 [25]）。与政策设计（55 [13]）和实施工具（54 [17]）相关的领域得分相似，而监测和评估（38 [20]）方面的工作得分较低。
国际社会对抗微生物药物耐药性的控制工作在各国之间存在很大差异。需要加强监测和评估工作，以持续了解国家和国际进展情况。国际应对措施可能与抗微生物药物耐药性的规模和严重程度不相符。
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