Postgraduate Dissertations


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Five years of National Action Plans on Antimicrobial Resistance: What impact on surveillance?

Firdaousse Ouknider


Thesis submitted as a part of the Master of Philosophy Degree in International Community Health, Faculty of Medicine, Department of Health and Society, University of Oslo, May 2022






Antimicrobial resistance is described in alarming tones globally. By 2020, dozens of National Action Plans have emanated from the Global Action Plan on AMR, with one of the objectives focusing on improving surveillance and reporting. However, bar self-assessment surveys, little is known about their degree of implementation and effectiveness in producing data. I aimed to provide an answer to the last question by using quantitative proxies extracted from the GLASS database that I contrasted to a qualitative analysis of sixty national action plans from the six WHO regions. I then tried to explain the challenges that face the implementation of these documents via semi-structured interviews with experts in the field of AMR.


The results show good overall alignment with GAP objectives of surveillance, reporting and international collaboration that does not translate to data. Most countries are not sharing quality data on WHO’s Global Antimicrobial Surveillance System, in a trend that crosses income and geographical lines. In most cases, poor reporting is the direct result of substandard data collection, but it is also explained by poor impetus to volunteer labor-intensive data, hence the need for WHO to make a use-case to countries to incentivize data sharing. Our results also indicate a battery of challenges that face NAP implementation related to political will, policy environment, financing, buy-in, socio-cultural dynamics, regulation, and One Health application, among other issues. Reducing AMR starts with understanding these problems and considering the various drivers that move it; factors that are indivisible from other drivers of health and country development.