Tackling antimicrobial resistance in sub-Saharan Africa: challenges and opportunities for implementing the new people-centered WHO guidelines

ABSTRACT

Introduction

Antimicrobial drugs form an essential component of medical treatment in human and animal health. Resistance associated with their use has posed a global public health threat. Multiple efforts have been made at the global level directed by the World Health Organization and associated partners to develop policies aimed at combatting antimicrobial resistance.

Areas covered

Whilst the Global Action Plan on antimicrobial resistance and people-centered framework aim to guide countries in implementing successful antimicrobial resistance policies, their adoption and success depend on different implementation contexts. Therefore, this paper highlights the challenges and opportunities for implementing the World Health Organization’s people-centered approach in sub-Saharan Africa, whilst recognizing antimicrobial resistance as a multifaceted problem rooted in ‘complex systems.’

Expert opinion

The people-centered approach provides a solid framework for combating antimicrobial resistance. Countries should build sustainable national action plans, adopt the One Health approach, limit over-the-counter antibiotic consumption, and educate communities on rational antibiotic use. They should also promote inter-country collaborations and innovative solutions, strengthen drug regulatory capacities, invest in infection control, water sanitation, hygiene, diagnostics, and surveillance tools, and promote vaccine uptake to prevent drug-resistant infections.

KEYWORDS:

• Antimicrobial resistance
• sub-Saharan Africa
• complex Systems
• World Health Organization
• people-centered approach

Article highlights

• Sub-Saharan Africa Countries are disproportionally affected by antimicrobial resistance.

• The heavy burden of AMR in LMICs bears a contribution from unstable health systems characterized by limited diagnostic facilities, lack of appropriate functioning drug regulatory mechanisms, and poor disease control and surveillance systems.

• Critical gaps exist in sub-Saharan Africa in adoption of global AMR policies and development and implementation of local national action plans.

• The newly released WHO people centered approach for addressing AMR needs to be adapted to local contexts while considering the complexity of AMR and the local implementation context.

• Contextual implementation determinants need to be considered when adopting the people centered approach for successful implementation in sub-Saharan Africa.

• Successful adaptation and implementation of the WHO people centered approach for addressing AMR requires investments in both the outer setting (communities), and inner setting (hospitals).

• Countries need to utilize ‘systems thinking’ in order predict potential implementation challenges, and offer pragmatic solutions for addressing antimicrobial resistance in the WHO African region.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.