Developing a situation analysis tool to assess containment of antimicrobial resistance in South East Asia

A ntimicrobial resistance (AMR) is no longer defined by national or political boundaries. Isolates of Escherichia coli bearing mcr-1 were first identified in China, but shortly after were found in clinical and animal samples in the US. 2 The World Health Organization and its partners have warned of the global rise of resistance against antibiotics, particularly those of “last resort.” Evidence shows that the main drivers of AMR are antibiotic selection pressure and transmission of resistant microbes. But drivers at the level of policies and systems also contribute. This complexity calls for a comprehensive, holistic, collaborative approach. The 68th World Health Assembly in 2015 adopted the global action plan on AMR (GAP-AMR, box 1), which was expected to translate into national action plans by May 2017. 17 National action plans should include a strategic action plan, based on a “One Health” approach, bringing together multiple sectors to combat resistance in the local context. The One Health approach provides opportunities to integrate multiple disciplines, working locally, nationally, regionally, and globally to tackle the drivers of AMR emergence. To assist member states, WHO, the Food and Agriculture Organization of the United Nations, and the World Organisation for Animal Health have developed a manual and sample templates, as well as a library of existing national action plans. The manual recommends performing a situation analysis before developing a national action plan. Countries differ widely in their capacity to develop a comprehensive, holistic national action plan. Of 133 countries surveyed in the worldwide situation analysis conducted by WHO, very few reported to have a comprehensive, multisectoral national action plan for containment of AMR supported by sustainable financing. Conducting a comprehensive situation analysis is essential for tailoring a national action plan to the setting of a particular member state, which would inform the subsequent steps of the process.