Global analysis of strategies to tackle antimicrobial resistance.

Background: Antimicrobial resistance (AMR) is a global public health issue driven by inappropriate use of antimicrobials resulting in decreased efficacy on the background of an extremely limited pipeline for new antibiotics. We sought to analyse the effectiveness of key policies and strategies in tackling AMR globally and identify gaps in these.

Method: The scope, magnitude, history and drivers of AMR were reviewed using supporting evidence. Our methodology included a literature review and semi-structured survey, whilst the analyses process was guided by an adapted health policy analyses framework.

Results: Six key policies of global, UK and Nigerian origin were identified along with supporting literature. Seven respondents from key organisations were identified and interviewed. Their responses were analysed using framework analyses principles.

Conclusions: Antimicrobial resistance is driven by several factors, ranging from poverty to poor implementation of inadequate policies. The UK AMR strategy is the most comprehensive with room for improvement. Nigeria lacks a specific AMR policy, but has other policies which address health system drivers of AMR. Similarly, the UK's surveillance system is extensive with recent findings corresponding to global findings. Nigeria's surveillance system is focused on detecting and tackling epidemics as indicated by its recent success with Ebola, but there is room for improvement and it could be expanded to cover AMR. Global policies do not add much value to the UK strategy and provide little guidance on how low-income countries, for example Nigeria can fill current gaps in surveillance and policies as key drivers are not fully addressed.