National action plan on antimicrobial resistance in selected Asia-Pacific low- and middle-income countries: Perspectives of One Health stakeholders.

Antimicrobial resistance (AMR) is a One Health problem worldwide, with low and middle-income countries (LMICs) identified as hotspots for AMR development. Countries have created National Action Plans on AMR (NAP-AMR) to address the growing problem; however, studies on the progression of NAP-AMR implementation are scarce. This study explores the current status of the implementation and impact of NAP-AMR in selected LMICs in the Asia-Pacific region through a One Health lens. In total, 102 experts from Bhutan, Nepal, Pakistan, Timor-Leste and Papua New Guinea were enrolled as the study population. Their perspectives on the level of implementation of NAP-AMR were collected via an online questionnaire, and an 80 % response rate was obtained. Participants felt that NAP-AMR implementation was more advanced in human health than in animal or environmental health. Stakeholders perceived to be well informed also tended to be engaged more actively in implementing the responsibilities outlined in the NAP-AMR. Nearly all participants believed that their country needed local antimicrobial prescribing guidelines for humans (94 %) and animals (86 %). Unrestricted access to antimicrobials and poor implementation status of surveillance systems across human, animal and environmental sectors were identified as areas where more progress is needed. Participants' beliefs about the current level of training and awareness related to AMR, as well as current AMR and AMU surveillance, was different from the Quadripartite AMR country self-assessment survey. Further studies need to be conducted to explore the barriers to NAP-AMR implementation in this setting. This study highlights the importance of systematic and transparent monitoring and evaluation frameworks across multiple One Health sectors, to assess progress on implementation of action plans and identify gaps for further investment or intervention. The importance of co-designing monitoring and evaluation frameworks with input from diverse AMR stakeholders across One Health domains was also identified as critical to ensuring the relevance of these frameworks and an equitable approach.