Antimicrobial resistance control efforts in Africa: a survey of the role of Civil Society Organisations

ABSTRACT

Background: Antimicrobial resistance (AMR) is a growing public health threat in Africa. AMR prevention and control requires coordination across multiple sectors of government and civil society partners.

Objectives: To assess the current role, needs, and capacities of CSOs working in AMR in Africa.

Methods: We conducted an online survey of 35 CSOs working in 37 countries across Africa. The survey asked about priorities for AMR, current AMR-specific activities, monitoring practices, training needs, and preferences for sharing information on AMR. Further data were gathered on the main roles of the organisations, the length of time engaged in and budget spent on AMR-related activities, and their involvement in the development and implementation of National Action Plans (NAPs). Results were assessed against The Africa Centres for Disease Control and Prevention (Africa CDC) Framework for Antimicrobial Resistance (2018–2023).

Results: CSOs with AMR-related activities are working in all four areas of Africa CDC’s Framework: improving surveillance, delaying emergence, limiting transmission, and mitigating harm from infections caused by AMR microorganisms. Engagement with the four objectives is mainly through advocacy, followed by accountability and service delivery. There were limited monitoring activities reported by CSOs, with only seven (20%) providing an example metric used to monitor their activities related to AMR, and 27 (80%) CSOs reporting having no AMR-related strategy. Half the CSOs reported engaging with the development and implementation of NAPs; however, only three CSOs are aligning their work with these national strategies.

Conclusion: CSOs across Africa are supporting AMR prevention and control, however, there is potential for more engagement. Africa CDC and other government agencies should support the training of CSOs in strategies to control AMR. Tailored training programmes can build knowledge of AMR, capacity for monitoring processes, and facilitate further identification of CSOs’ contribution to the AMR Framework and alignment with NAPs and regional strategies.

KEYWORDS:

• Antimicrobial resistance
• Civil Society Organisations
• Africa
• regional strategy
• national action plans

Responsible Editor

Stig Wall, Umeå University, Sweden

Responsible Editor

Stig Wall, Umeå University, Sweden

Acknowledgments

We would like to thank the CSO Champions for their time, help, and advice. Further we would like to thank all CSO participants.

Author contributions

The overall supervision of the research design and process was shared by VJRDV, JKV, and CS. YHA supported the design of the research and the survey design and dissemination. TK, TM, and VC provided insight and feedback in the design and development of the survey and the analysis. JLF was responsible for the overall research design implementation, analysis, and writing the final manuscript. All authors inputted on the final manuscript.

Disclosure statement

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the USA Centers for Disease Control and Prevention.

Ethics and consent

All participants were required to sign an informed consent form before participating in the study. The context, rationale and objectives of the study were explained prior to the survey and participation was voluntary. Each participant was informed that he or she had the opportunity to withdraw from the study at any time without being compelled to justify oneself. Data were stored in a password-secured file. The study was assessed and approved by the science office at the Africa CDC as a public health program activity and not human subjects research.

Paper context

This research was conducted to assess and highlight the important role that CSOs can play in controlling and preventing of antimicrobial resistance. To our knowledge, there is no recognised approach to explore and monitor the role of CSOs in the global action on AMR. This study aims to contribute to that aim.

Supplementary material

Supplemental data for this article can be accessed here.

Notes

¹ Tripartite survey levels for assessment (2018). Level 1 Providing and facilitating activities in parts of the country(ies) to raise awareness about risks of antimicrobial resistance and actions that can be taken to address it Level 2 Providing small-scale antimicrobial resistance awareness campaigns, targeting some but not all relevant stakeholders Level 3 Providing nationwide, government-supported antimicrobial resistance awareness campaigns, targeting all or the majority of relevant stakeholders, based on stakeholder analysis, utilising targeted messaging accordingly within sectors Level 4 Providing targeted, nationwide government-supported activities implemented to change behaviour of key stakeholders within sectors, with monitoring undertaken over the last 2–5 years

² In the Graphs 1–4 [SM4], comparing the number of activities taking place across the sectors needs to be taken with caution as there were more CSOs working in the human sector – human sector represented by 20 CSOs, animal sector by 10 CSOs, environmental sector by 5 CSOs. Instead, the number of activities (sizes of bubbles) within the same sector can be compared. One limitation is that the overlap of activity choices, in the survey, for animal and food production reduces the ability to distinguish the CSOs’ specific focus.

³ If all 35 CSOs were to provide a metric for all four objectives.

Additional information

Funding

The initial CSO Workshop was funded by the Africa CDC.