Table 4 Strengthening AMR Containment in LMICs: Four Promising Practices Highlighted through the Program’s 13-country Experience

1. Implement capacity level-appropriate actions using the WHO Benchmarks for IHR Capacities as an organizing framework

 • The JEE tool is used to assess country capacity in containing AMR; however, it is the complementary WHO benchmarks tool that offers practical guidance to prioritize specific capacity-appropriate actions that can incrementally augment AMR-related capacities

 • Although the WHO benchmarks tool is primarily designed to use with JEEs to support GHSA and IHR, it provides an organized framework based on existing country capacity levels, and thus can be used more broadly to simplify and prioritize NAP implementation actions. In addition, standardized tools and methods such as IPCAT2, IPCAF, WHO point prevalence survey tool, and AWaRe classification of antimicrobials are used to assess specific areas and focus on the benchmark actions that improve IPC and AMS programs and practices

2. Identify entry points and integrate AMR into other national and global agendas

 • To raise its profile as a national priority, AMR should be promoted as a health security threat that is an essential element of pandemic preparedness

 • Given that AMR has the potential to affect all aspects of clinical care and public health relating to infectious diseases, AMR containment efforts should be mainstreamed into broader agendas such as universal health coverage (UHC) and other national and subnational programs, such as quality improvement (QI)/quality of care (QoC), WASH, and maternal and child health; however, practical examples of countries operationalizing this approach are lacking. If this approach can be successfully scaled up, it can help break the traditional siloed approaches and also address the chronic lack of funding for AMR containment in LMICs

3. Improve governance through multisectoral coordination on AMR

 • The second (2018) and third (2022) editions of the JEE emphasize the importance of MSC in the AMR technical area. Reinforcing governance such as organizational management in MSC bodies and providing policy support in areas including funding improve their function and ability to coordinate AMR containment efforts across sectors. Strengthening MSC governance at subnational and local level is equally important, but stewardship needs to stay at the central level

 • MSC bodies and their technical working groups, if functioning effectively, can catalyze both advocacy and actions against AMR in the spirit of One Health. However, attention should be paid to make sure that MSC efforts go beyond just meetings and lead to practical joint actions. Therefore, all relevant ministries and stakeholders should be included in planning and implementing activities to ensure that they coordinate with each other; typically, the human health sector works more actively in AMR containment, while other sectors need targeted engagement

 • MSC bodies and their technical working groups are well-suited to forge integrative collaboration with non-traditional stakeholders such as those working in climate change, which now is being recognized as an AMR threat multiplier

4. Mobilize and diversify funding for AMR containment efforts

 • Regular mapping of players and programs in various sectors can help identify opportunities for collaboration and funding for AMR-related actions. Additionally, integrating AMR and NAP activities into government program agendas and budgets helps diversify funding, resulting in more sustainable resources that are not donor-based

 • MSC bodies must advocate for support from in-country decision- and policy-makers and politicians who are crucial for securing longer-term funding. Preparing a costed operational plan/investment case for AMR containment provides evidence to strengthen this advocacy