Making sense of ‘implementation gaps’ as a governance problem of antimicrobial resistance

Abstract

Abstract Background Antimicrobial resistance (AMR) is a pressing global health issue. National Action Plans on AMR (NAP-AMR) are key to mitigate AMR, however, effective translation of action plans has been a governance challenge worldwide. This study explores the implementation gap in Austria by examining experiences of experts involved in domestic AMR policy. Methods This study was guided by grounded theory. Data were collected through qualitative interviews, a focus group, and participation in AMR symposia. Overall, 13 participants were identified through theoretical sampling. Data collection and analysis took place until theoretical saturation was achieved. Results Experts identified the following central themes affecting AMR mitigation: absence of a binding legal framework, paucity of AMR data, low risk perception among decision makers, lack of funding, and insufficient incentive systems for people dedicated to AMR stewardship. Conclusions The interpretation of these findings suggests policy fragmentation, scattered responsibilities, agenda conformity and a lack of recognition as core features which impede a sustainable and effective AMR-related governance. The results should alert policymakers to sustainable public health interventions in the following areas: a) Institutional responsibilities need to be restructured to prioritize AMR stewardship as a guiding principle. b) Investments are necessary for nationwide implementation of AMR stewardship and surveillance systems. c) Financial and symbolic incentives for people dedicated to AMR mitigation are imperative. Key messages • There is a tension between local efforts to make adjustments to mitigate AMR and the current approach of ‘superimposing’ reforms on existing structures. • Effective measures to address AMR require that priority be given to mitigating AMR.