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Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map

Van Katwyk, S. R.; Grimshaw, J. M.; et al (2019) C2

BACKGROUND: Growing political attention to antimicrobial resistance (AMR) offers a rare opportunity for achieving meaningful action. Many governments have developed national AMR action plans, but most have not yet implemented policy interventions to reduce antimicrobial overuse. A systematic evidenc...e map can support governments in making evidence-informed decisions about implementing programs to reduce AMR, by identifying, describing, and assessing the full range of evaluated government policy options to reduce antimicrobial use in humans. METHODS AND FINDINGS: Seven databases were searched from inception to January 28, 2019, (MEDLINE, CINAHL, EMBASE, PAIS Index, Cochrane Central Register of Controlled Trials, Web of Science, and PubMed). We identified studies that (1) clearly described a government policy intervention aimed at reducing human antimicrobial use, and (2) applied a quantitative design to measure the impact. We found 69 unique evaluations of government policy interventions carried out across 4 of the 6 WHO regions. These evaluations included randomized controlled trials (n = 4), non-randomized controlled trials (n = 3), controlled before-and-after designs (n = 7), interrupted time series designs (n = 25), uncontrolled before-and-after designs (n = 18), descriptive designs (n = 10), and cohort designs (n = 2). From these we identified 17 unique policy options for governments to reduce the human use of antimicrobials. Many studies evaluated public awareness campaigns (n = 17) and antimicrobial guidelines (n = 13); however, others offered different policy options such as professional regulation, restricted reimbursement, pay for performance, and prescription requirements. Identifying these policies can inform the development of future policies and evaluations in different contexts and health systems. Limitations of our study include the possible omission of unpublished initiatives, and that policies not evaluated with respect to antimicrobial use have not been captured in this review. CONCLUSIONS: To our knowledge this is the first study to provide policy makers with synthesized evidence on specific government policy interventions addressing AMR. In the future, governments should ensure that AMR policy interventions are evaluated using rigorous study designs and that study results are published. more

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The Building Blocks of a Circular Economy: USAID’S Local Systems Approach to Reducing Ocean Plastic Pollution

USAID (2022) CC

Ocean plastic pollution has reached crisis level: every minute, more than an entire garbage truck of plastic makes its way into the world’s oceans—roughly 11 million metric tons annually. While plastic waste presents an immediate threat to marine wildlife and ecosystems, this global challenge al... more

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The Asia-Pacific Community Mental Health Development (APCMHD) Project

Asia-Pacific Community Mental Health Development Project (2008) C1

The Asia-Pacific Community Mental Health Development (APCMHD) project has been established in 2005 to explore diverse leading models or approaches to community mental health service delivery in the Asia-Pacific region. The objective is to illustrate and promote best practice in mental health care in... more

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Namibia: Application for Registration of a Medicine

Ministry of Health and Social Services (MOHSS) (2014) C2

Namibia guideline for submission of applications for registration of pharmaceuticals for human use in common technical document format.

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Key points for considering adoption of the WHO Labour Care Guide: Policy Brief

World Health Organization WHO United States Agency for International Development (USAID) (2022) C_WHO

To improve the quality of care during labour and childbirth, facilitate effective implementation of the World Health Organization (WHO) recommendations: Intrapartum care for a positive childbirth experience, published in 2018, and promote a shift towards improving the experience of childbirth, WHO d... more

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Rwanda's Performance in Addressing Social Determinants of Health and Intersectoral Action: A Review against the Five Themes of the Rio Political Declaration

Ministry of Health, Rwanda (2017) C2

To understand the patterns of Rwanda’s achievements in health development, it is important to explore how Rwanda addresses the Social Determinants of Health (SDH) particularly those related to routine conditions in which people are born, live and work. It is in this particular context that a case ... more

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Biodiversity and Health in the Face of Climate Change

Marselle M., Stadler J., Korn H., et al. (2019) CC

The biosphere underlies the whole sustainable development concept, as the layer on which society and the economy rely. Nature and biodiversity fuel the natural cycles and life-support systems of the planet, on which humanity ultimately depends.

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WPA guidance on steps, obstacles and mistakes to avoid in the implementation of community mental health care

Thornicroft G, Alem A, Antunes Dos Santos R, et al. (2010) CC

World Psychiatry. 2010 Jun;9(2):67-77. The main recommendations are presented in relation to: the need for coordinated policies, plans and programmes, the requirement to scale up services for whole populations, the importance of promoting community awareness about mental illness to increase levels ... more

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Implementing comprehensive HIV and STI programmes with transgender people: Practical guidance for collaborative interventions

UNDP, IRGT, UNFPA, UNAIDS, WHO, USAID, PEPFAR, UCSF Center of Excellence for Transgender Health, Johns Hopkins Bloomberg School of Public Health (2016) C1

This publication offers practical advice on implementing HIV and STI programmes for transgender people, with a focus on transgender women, aligned with the 2011 Recommendations and the 2014 Key Populations Consolidated Guidelines. It contains examples of good practice from around the world that may ... more

Wheelchair Service Training Package - Reference Manual for Participants (Basic level)

World Health Organization; USAID; Leadership Managemtn & Governance project (2013) C_WHO

The main purpose of the training package is to develop the minimum skills and knowledge required by personnel involved in wheelchair service delivery. An important aim of the training package is to get it integrated into the regular paramedical/rehabilitation training programs such as physiotherapy,... more

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Kenya Quality Model for Health: A Training Course for the Health Sector

Ministry of Health, Kenya USAID (2014) C1

Empowering Health Workers to Improve Service Delivery. This training program is designed to build the capacity of program managers and health providers in quality management, and improve the provision of high-quality health services. Please download the chapters directly from the website: https://w... more

Republic of South Africa: Antimicrobial Resistance National Strategy Framework 2018 – 2024

Departments of Health and Agriculture, Forestry and Fisheries for the Republic of South Africa (2014) C_WHO

The National Department of Health and Department of Agriculture, Forestry and Fisheries have collectively engaged to determine the key interventions that will form the basis for this strategy taking into account the recommendations from the WHO and OIE. The development and implementation of a Natio... more

National Guidelines for Health Care Waste Management in Ghana

Ministry of Health and Ministry of Environment Ghana (2019) CC

Ghana's attempt to regulate health care waste management started in 2002 with the development of guidelines on health care waste manage-ment by the Environmental Protection Agency (EPA). In 2006, the Ghana Health Service (GHS) also developed the Health Care Waste Management Policy and Guidelines as ... more

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WHEELCHAIR SERVICE TRAINING PACKAGE Reference Manual for Participants (Intermediate level)

Sarah Frost, Kylie Mines, Jamie Noon, Elsje Scheffler, and Rebecca Jackson Stoeckle WHO; USAID (2013) C_WHO

Following the release of the Wheelchair Service Training Package – Basic level (WSTP-B), WHO in partnership with United States Agency for International Development (USAID) has developed the Wheelchair Service Training Package – Intermediate Level (WSTP-I). WSTP-I is the second part of the WHO w... more

Summary of National Priorities - Malawi

Community Health Roadmap United States Agency for International Development; Bill & Melinda Gates Foundation; The Rockefeller Foundation; World Bank Group; community health acceleration partnership; unicef (2021) CC

Malawi’s first National Community Health Strategy (NCHS, 2017-2022) defines a new community health system in which community health cadres, both formal and non-formal, deliver services of the Essential Health Package, with a focus on child and maternal health. It envisages an integrated approach t... more

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A case study of the Uganda National Minimum Healthcare Package

Kadowa, Isaac Regional Network for Equity in Health in east and southern Africa (EQUINET) (2017) C1

Regional Network for Equity in Health in east and southern Africa (EQUINET): Disussion Paper 110
This report compiles evidence from published, grey literature and key informants on the UNMHCP since its introduction in Uganda’s health system, and findings were further validated during a oneda... more

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Guidance to facilitate monitoring and evaluation for antimicrobial resistance national action plans

Quadripartite: Food and Agriculture Organization of the United Nations FAO; UN Environment Programme UNEP; World Health Organization WHO; World Organisation for Animal Health WAHO (2023) CC

Antimicrobial resistance (AMR) is a global human, animal, plant and environment health threat that needs to be addressed by every country. The impacts of AMR are wide-ranging in terms of human health, animal health, food security and safety, environmental effects on ecosystems and biodiversity, and ...socioeconomic development. Just like the climate crisis, AMR poses a significant threat to the delivery of the 2030 Agenda for Sustainable Development. The response to the AMR crisis has been spearheaded through the global action plan on antimicrobial resistance (GAP-AMR), developed by the World Health Organization (WHO) in 2015, in close collaboration with the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (WOAH), and formally endorsed by the three organizations’ governing bodies and by the Political Declaration of the high-level meeting of the United Nations General Assembly on AMR in 2016. In 2022, the three organizations officially became the Quadripartite by welcoming the United Nations Environment Programme (UNEP) into the alliance “to accelerate coordination strategy on human, animal and ecosystem health”. The aim of the GAP-AMR is to ensure the continuity of successful treatment with effective and safe medicines. Its strategic objectives include: • improving the awareness and understanding of AMR; • strengthening the knowledge and evidence base through surveillance and research; • reducing the incidence of infection through effective sanitation, hygiene and infection prevention measures; optimizing the use of antimicrobial medicines in human and animal health; and • developing the economic case for sustainable investment that takes account of the needs of all countries and increasing investment in new medicines, diagnostic tools, vaccines and other interventions. With the adoption of the GAP-AMR, countries agreed to develop national action plans (NAPs) aligned with the GAP-AMR to mainstream AMR interventions nationally. Individually, the Quadripartite took action to advance AMR interventions in their respective sectors. FAO adopted a resolution on AMR recognizing that it poses an increasingly serious threat to public health and sustainable food production, and developed an AMR action plan to support the resolution’s implementation. For its part, WOAH developed a strategy on AMR aligned with the GAP-AMR, acknowledging the importance of a One Health approach to AMR. Similarly, more recently, UNEP’s governing body, the United Nations Environment Assembly, recognized that AMR is a current and increasing threat and a challenge to global health, food security and the sustainable development of all countries, and welcomed the GAP-AMR and the NAPs developed in accordance with its five overarching strategic objectives more

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Ethiopian Hospital service transformation Guidelines: Chapter 10 Pharmacy Service: Ethiopian Hospital Management Initiative

Federal Democratic Republic of Ethiopia -Ministry of Health (2017) C1

The Ethiopian Hospital Services Transformation Guidelines (EHSTG) build on and expand the Ethiopian Hospital Reform Implementation Guidelines (EHRIG) and are consistent with the Health Sector Transformation Plan (HSTP). The EHSTG, which is consistent with the national focu... more

Multi-Sector Nutrition Education and Communication Strategy (NECS) II 2021-2025

Government of Malawi; Department of Nutrition; HIV and AIDS Ministry of Health (2021) CC2

The Department of Nutrition, HIV and AIDS (DNHA) in Ministry of Health and Population is grateful to all stakeholders who contributed to the development of the Nutrition Education Communication Strategy II. The DNHA acknowledges the financial and technical support from the World Bank and USAID throu... more

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Namibia National WISN Report 2015: A Study of Workforce Estimates for Public Health Facilities in Nambia

Titus, M., Hendricks, R., Ndemueda, J., McQuide, et al Ministry of Health and Social Services, Republic of Namibia (2015) C2