Understanding the Implementation of Antimicrobial Policies: Lessons from the Hong Kong Strategy and Action Plan

Abstract

In 2017, the Hong Kong Strategy and Action Plan on Antimicrobial Resistance 2017–2022 (HKSAP) was announced with the aim of tackling the growing threat of antimicrobial resistance (AMR) in Hong Kong. However, little is known about how the planned activities have been implemented. In this study, we examine the status of implementation of the HKSAP using the Smith Policy Implementation Process Model. Semi-structured interviews with 17 informants found that important achievements have been made, including launching educational and training activities targeting the public, farmers, and healthcare professionals; upgrading the AMR surveillance system; and strengthening AMR stewardship and infection control. Nevertheless, participants also identified barriers to greater implementation, such as tensions across sectors, ongoing inappropriate drug use and prescription habits, insufficient human and technical resources, as well as a weak accountability framework. Environmental factors such as the COVID-19 pandemic also affected the implementation of HKSAP. Our study indicated that expanding engagement with the public and professionals, creating a collaborative environment for policy implementation, and building a well-functioning monitoring and evaluation system should be areas to focus on in future AMR policies.

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

“…For example, some participants were not familiar with AMRCO and AMRWG, while others were not familiar with the NSAP or the outcomes following its launch, although they are available online. This finding is similar to that in Hong Kong, where they found inadequate levels of engagement with non-government and private sectors [ 23 ]. Before improving public awareness, there is a need to ensure that all relevant stakeholders in the field are properly engaged.…”

A Qualitative Study on the Implementation of the National Action Plan on Antimicrobial Resistance in Singapore

“…The reasons mentioned included the fragmented surveillance efforts in the human health sector, difficulty collecting data from private clinics, and insufficient overall technical support across sectors. Our study participants mentioned the development of a national integrated system across various sectors, much like what has been highlighted in Hong Kong and Thailand [ 18 , 22 ]. However, there were concerns that each sector might have their own areas of focus and concern, resulting in data that might not be interpretable and useful across the One Health spectrum.…”

“…For the latter two sectors, a chapter on how to set up an ASP in veterinary practice has been included in the Prudent Use of Antimicrobials Guidelines, but relevant guidelines for AMU in the primary care setting have been described to be lacking and outdated [ 17 ]. Regionally, the implementation of ASPs in the hospital and primary care setting has been mentioned in Hong Kong and the Philippines, but not with respect to the animal health or environment sectors [ 18 , 21 , 25 , 26 ]. The AMS situation at the global level was similar: it was more established in the human health sector than in the animal health sector, the latter of which has been gaining in prominence in recent years [ 27 ].…”

“…Public awareness campaigns on AMR have been highlighted in other countries in various forms including social media and physical events [ 18 ]. The campaigns highlighted often tied in with the annual WAAW celebrations [ 18 , 19 , 20 , 21 , 35 ].…”

“…Public awareness campaigns on AMR have been highlighted in other countries in various forms including social media and physical events [ 18 ]. The campaigns highlighted often tied in with the annual WAAW celebrations [ 18 , 19 , 20 , 21 , 35 ]. In addition, education for professionals was also discussed to various degrees, and across the countries, there seemed to be more educational efforts exerted toward the human health sector than the animal health sector [ 19 , 20 , 21 ].…”