Operationalization of Antimicrobial Resistance Governance in Low- and Middle-Income Countries: A Scoping Review

Abstract

There is an inadequate understanding of how antimicrobial resistance (AMR) governance initiatives have been operationalized in low- and middle income countries (LMICs). This scoping review examines peer-reviewed literature on this topic. We searched EMBASE, CAB Abstracts, Scopus, CINAHL, Web of Science, PubMed, and Hinari databases for articles on AMR governance within and across human, animal, environment, and plant health from 2000 to 2024. We screened articles for inclusion and used thematic analysis to synthesize information from included articles. We identified 50 articles, which suggest that AMR governance in LMICs is predominantly shaped by the Global Action Plan. National Action Plans are the most widely adopted AMR governance tool, but with little contextualization and uneven implementation progress. Although the One Health (OH) approach is central to AMR containment, complex coordination and power hierarchies across a diverse range of global, regional, and country-specific AMR stakeholders with distinct roles, capacities, and interests, undermine its use, and contribute to inequities in containment responses. Strengthening AMR governance in LMICs requires institutional and political commitment, just and equitable involvement of OH stakeholders, and the mainstreaming of AMR containment into existing structures to leverage existing resources, skills and institutional capacity while contextualizing responses to local needs.