Abstract
While antimicrobial resistance (AMR) has rapidly ascended the political agenda in numerous high-income countries, developing effective and sustainable policy responses in low- and middle-income countries (LMIC) is far from straightforward, as AMR could be described as a classic ‘wicked problem’. Effective policy responses to combat AMR in LMIC will require a deeper knowledge of the policy process and its actors at all levels—global, regional and national—and their motivations for supporting or opposing policies to combat AMR. The influence of personal interests and connections between for-profit organisations—such as pharmaceutical companies and food producers—and policy actors in these settings is complex and very rarely addressed. In this paper, the authors describe the role of policy analysis focusing on social constructions, governance and power relations in soliciting a better understanding of support and opposition by key stakeholders for alternative AMR mitigation policies. Owing to the lack of conceptual frameworks on the policy process addressing AMR, we propose an approach to researching policy processes relating to AMR currently tested through our empirical programme of research in Cambodia, Pakistan, Indonesia and Tanzania. This new conceptualisation is based on theories of governance and a social construction framework and describes how the framework is being operationalised in several settings.
Highlights
London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; Saw Swee Hock School of Public Health, National University of Singapore, 119077 Singapore, Singapore
Progress in policy responses for combating antimicrobial resistance (AMR) is being hindered, in part, owing to an Progress in policy responses for combating AMR is being hindered, in part, owing to an insufficient insufficient evidence base for the effectiveness of the myriad policies proposed targeting in turn the evidence base for the effectiveness of the myriad policies proposed targeting in turn the vast array vast array of actors involved across the human health and animal sectors
Substantial resources resources are being sought towards assessing the effectiveness of different interventions to combat are being sought towards assessing the effectiveness of different interventions to combat AMR in AMR in lowand middle-income countries (LMIC), it would be impossible—and unwise in our opinion—to try and evaluate all interventions in a range of LMIC contexts
Summary
To develop our conceptual framework, we relied on seminal papers in three areas: governance, social construction and the policy process in LMICs (8–21). Two of the authors reviewed this literature and identified key concepts on governance and how AMR and target populations of potential interventions are socially constructed, while the other two authors operationalised the conceptual framework into a methodology to apply in a range of countries. In the sections that follow, we summarise how the literature we reviewed shaped our conceptual framework and describe the processes used to operationalise the framework in a range of countries
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