The Governance and Implementation of the National Action Plan on Antimicrobial Resistance in Tanzania: A Qualitative Study.

Gasto Frumence,Taane G Clark,Mecky I N Matee,Sharadhuli Kimera,Mark Rweyemamu,Bugwesa Z Katale,Emmy Metta,Anne-Sophie Jung,Stephen E Mshana,Leonard E G Mboera,Calvin Sindato,Helena Legido-Quigley,Anna Durrance-Bagale

doi:10.3390/antibiotics10030273

Abstract

Tanzania launched its first National Action Plan (NAP) on antimicrobial resistance (AMR) in 2017 to reduce the burden of AMR in the country and contribute to the global response. We aimed to analyze the implementation of the NAP on AMR in Tanzania using the governance framework. In-depth interviews were conducted with human and animal health practitioners and national-level policy actors. We adapted Chua’s AMR governance framework to analyze the development and implementation of the NAP in Tanzania. Implementation of the NAP has realized several achievements, including: (i) the establishment of a functioning Multi-Sectoral Coordinating Committee for coordinating the implementation of AMR activities; (ii) existence of governance structure; (iii) establishment of human and animal surveillance sites; (iv) creation of AMR awareness in the community and (v) availability of guidelines at the health facility level to ensure AMR stewardship. However, some dimensions of the governance areas, including reporting and feedback mechanisms, accountability, transparency and sustainability of AMR plans, are not effectively implemented. Addressing these challenges should involve strengthening the collaboration of the different sectors involved at different NAP implementation levels by careful planning and coordination, and provision of adequate resources to ensure sustainability.

Highlights

Antimicrobial resistance (AMR) is a global public health threat
In the few sections, we detail our findings according to each governance area
Other strategic objectives are to optimize the use of antimicrobial agents in human and animal health, which has two priority actions; and to develop the economic case for sustainable investment that takes account of the needs of all countries and to increase investment in new medicines, diagnostic tools, vaccines and other interventions, which has one priority action of ensuring sustainability of antimicrobial resistance interventions [11]

Summary

Introduction

Antimicrobial resistance (AMR) is a global public health threat. Several studies have reported the causes of rising AMR, including self-medication [1,2], antibiotic overuse [3], clinicians’ over-prescription, a strong belief by the public in antibiotics, including nonprescription purchases [4], veterinary antibiotic use for prophylaxis and growth promotion [5] and inadequate knowledge on Infection prevention and control (IPC) and antimicrobial use and limited access to veterinary and extension services, paving the way for self-treatment and opportunism by profit-driven non-professional veterinary drug sellers and weak veterinary laws [6]. AMR disproportionally affects low-and middle-income countries (LMICs), characterized by relatively weak health systems [9], which are often without adequate effective tools for the prevention and treatment of drug-resistant infections [10]. Most of these countries have limited access to existing and new quality-assured antimicrobials. Recognizing this threat and in response to the Agenda of the 68th World Health Assembly (WHA) in May 2015, Tanzania launched its National Action Plan (NAP) on Antimicrobial Resistance 2017–2022 [11], to tackle AMR using a one health approach. Despite the fact that the NAP has been in place for more than three years, AMR is still a challenge for human, animal and environmental health in Tanzania [6,12,13]

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Discussion

Conclusion