Abstract
BackgroundAntimicrobial resistance (AMR) is a growing problem worldwide in need of global coordinated action. With the endorsement of the Global Action Plan (GAP) on AMR in 2015, the 194 member states of the World Health Organization committed to integrating the five objectives and corresponding actions of the GAP into national action plans (NAPs) on AMR. The article analyzes patterns of alignment between existing NAPs and the GAP, bringing to the fore new methodologies for exploring the relationship between globally driven health policies and activities at the national level, taking income, geography and governance factors into account.MethodsThe article investigates the global governance of AMR. Concretely, two proxies are devised to measure vertical and horizontal alignment between the GAP and existing NAPs: (i) a syntactic indicator measuring the degree of verbatim overlap between the GAP and the NAPs; and (ii) a content indicator measuring the extent to which the objectives and corresponding actions outlined in the GAP are addressed in the NAPs. Vertical alignment is measured by the extent to which each NAP overlaps with the GAP. Horizontal alignment is explored by measuring the degree to which NAPs overlap with other NAPs across regions and income groups. In addition, NAP implementation is explored using the Global Database for Antimicrobial Resistance Country Self-Assessment.FindingsWe find strong evidence of vertical alignment, particularly among low-income countries and lower-middle-income countries but weaker evidence of horizontal alignment within regions. In general, we find the NAPs in our sample to be mostly aligned with the GAP’s five overarching objectives while only moderately aligned with the recommended corresponding actions. Furthermore, we see several cases of what can be termed ‘isomorphic mimicry’, characterized by strong alignment in the policies outlined but much lower levels of alignment in terms of actual implemented policies.ConclusionTo strengthen the alignment of national AMR policies, we recommend global governance initiatives based on individualized responsibilities some of which should be legally binding. Our study provides limited evidence of horizontal alignment within regions, which implies that regional governance institutions (e.g., WHO regional offices) should primarily act as mediators between global and local demands to strengthen a global governance regime that minimizes policy fragmentation and mimicry behavior across member states.
Highlights
Antimicrobial resistance (AMR) is a growing problem worldwide in need of global coordinated action
We developed a codebook based on the Global Action Plan (GAP) in which we turned objectives and corresponding actions into Text Search Query Items (TSQIs) that were used to code the content of all national action plans (NAPs) using the NVivo text search query tool
This section presents our analytical findings regarding the current state of national AMR policy alignment, both vertically and horizontally, based on the syntax and content indicators as well as data regarding implementation status derived from the Global Database for Antimicrobial Resistance Country Self-Assessment
Summary
Antimicrobial resistance (AMR) is a growing problem worldwide in need of global coordinated action. The article analyzes patterns of alignment between existing NAPs and the GAP, bringing to the fore new methodologies for exploring the relationship between globally driven health policies and activities at the national level, taking income, geography and governance factors into account. The GAP was endorsed in May 2015 by the WHO’s 194 member states who were urged to develop and have in place national action plans (NAPs) on AMR by 2017 modeled on the guidelines in the GAP. It brings to the fore new methodologies for exploring the relationship between globally driven health policies and activities at the national level, taking income, geography and governance factors into account. Thereby, the article contributes to the global health governance literature by illuminating the important juncture between governance initiatives at the global level and alignment at the national level
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