Table 1 Summary of key findings of subnational assessment

Knowledge of national action plan for antimicrobial resistance (NAP-AMR)

• Inadequate grassroot knowledge: health care workers (HCWs) from large healthcare facilities (HCFs) and district health teams (DHTs), and other sector stakeholders in decision-making and oversight positions had knowledge of the NAP-AMR; HCWs from Lower-level health facilities and grassroot stakeholders from other sectors such as farmers had no knowledge of the NAP-AMR

Participation in NAP-AMR development

• Inadequate subnational involvement: subnational stakeholders were not involved in the development and validation of the NAP-AMR; only sector decision-makers and overseers were involved in the dissemination of the NAP-AMR

Access to a copy of the NAP-AMR

• Suboptimal access to the NAP-AMR: all but one HCF had a copy of the NAP-AMR; only one district health office had accessed a copy of the NAP-AMR; Only ten participants had accessed a digital copy of the NAP-AMR

Participation in joint One Health activities

• Suboptimal participation in One Health: only four participants had been involved in regional/district joint One Health activities

NAP-AMR objectives included in work plans

• Suboptimal integration of NAP-AMR objectives: all the seven participating regional referral hospitals had functional committees for IPC and AMS implementation; lower-level health facilities had not incorporated NAP-AMR activities in their workplans; One Health bodies established in two districts with donor-supported activities and meetings

Funding source for AMR activities

• Lack of sustainable funding: All NAP-AMR activities were supported by donor and implementing partners

Achievements

• Suboptimal gains made: NAP-AMR activities included training sessions (such as continuous medical education), and AMR and disease surveillance actions; regular One Health-AMR quarterly meetings in one of the two districts with established One Health bodies

Barriers and challenges

• Lack of funding for NAP-AMR activities

• Lack of follow-up activities beyond the launch and early dissemination initiatives

• One Health meetings have remained at the district center and have not been disseminated to the lower levels

• Lack of access to copies of the NAP-AMR

• Lack of involvement of subnational stakeholders in the development and validation of the NAP-AMR

Recommendations

• Integration of One Health/AMR activities into district/regional systems

• Decentralization of One Health/AMR bodies

• Integration of the national One Health platform into a ‘neutral’ structure such as Office of the Prime Minister

• Develop policies that would facilitate access to secure funding for One Health activities