A Qualitative Study on the Design and Implementation of the National Action Plan on Antimicrobial Resistance in the Philippines

Abstract

Antimicrobial resistance (AMR) is a global public health threat that warrants urgent attention. Countries developed their national action plans (NAPs) following the launch of the Global Action Plan on AMR in 2015. The development and implementation of NAPs are often complicated due to the multifaceted nature of AMR, and studies analyzing these aspects are lacking. We analyzed the development and implementation of the Philippine NAP on AMR with guidance from an AMR governance framework. We conducted in-depth interviews with 37 participants across the One Health spectrum. The interviews were transcribed verbatim and were analyzed thematically, adopting an interpretative approach. The enabling factors for NAP implementation include (1) a high level of governmental support and involvement of relevant stakeholders, (2) the development of policies to support improved responses in infection prevention and control and antimicrobial stewardship, and (3) better engagement and advocacy by professional associations and civil society groups. The challenges include (1) a lack of resources and regulatory capacity, (2) insufficient impetus for AMR research and surveillance, and (3) limited One Health engagement. Although there has been considerable progress for human health, strengthening the involvement and representation of the animal health and environment sectors in the AMR scene must be undertaken. Developing well-defined roles within policies will be paramount to the strong implementation of AMR strategies.

Health workers’ perspectives on the occurrence and management of antimicrobial resistance at the human-animal-environment interface in Uganda

“…Our study also reveals common factors for the occurrence of AMR including but not limited to selfmedication, under and overdose, wrong medication for the wrong disease, and treatment without diagnosis which ndings are similar to those reported from earlier studies [14][33] [34]. The results are also similar to a study in the eastern Haryana region which revealed cases of over-the-counter antibiotic sales (either without a prescription or by reusing old prescriptions) and farmers who were unaware of the harmful effects of certain types of antibiotics [37].…”

“…In the bid to promote ecological civilization, several countries are adopting the use of antimicrobial agents in livestock production for the promotion of nutritional security [13]. This coupled with the transition to high-protein diets in the LMICs has caused animal production systems to be more intensive and antimicrobial drugdependent [14]. Small-scale farmers use human drugs to treat their animals due to several reasons which can be explored qualitatively to understand the underlying local context.…”

“…The emergence of antimicrobial-resistant bacteria such as ESBL-PE among animals, humans, and the environment have been increasingly recognized [14]. Such existence of AMR in the three components is usually via contact with wastewater, contaminated foods, and food animal residues among others even though country-level data are scanty in Uganda [15].…”

A Qualitative Study on the Policy Process and Development of the National Action Plan on Antimicrobial Resistance in Singapore

“…A review of 78 NAPs from around the world identified that the animal health and environment sectors were largely missing from many NAPs [ 34 ]. This resonates with the findings from other similar AMR studies conducted in Bangladesh, Malaysia, the Philippines, Tanzania, and Thailand [ 24 , 26 , 35 , 36 , 37 ]. In our previous study conducted in Singapore, we reported the need to address AMR in the animal health and environmental sectors as well [ 14 ].…”

A Qualitative Study on the Implementation of the Workplace TB Program in the Philippines: Challenges and Way Forward

“…Although meetings were reportedly regular at the national level, meetings were reportedly seldom done at the lower levels. A local qualitative study on the implementation of another inter-agency program (antimicrobial resistance program) also reported a similar finding on the limited coordination across different levels of implementation and among relevant national agencies [ 17 ]. The former was linked to devolution which fragmented the health system into thousands of units that lacked coordination and varied greatly in resources for health [ 18 ].…”