African Leadership for Anti-Microbial Resistance Action
Anti-Microbial Resistance (AMR) is a pandemic we must not ignore.
What is AMR?
Anti-Microbial Resistance (AMR) is becoming an increasingly significant challenge in the global health sector. AMR occurs when bacteria, viruses, fungi and parasites no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death.
In 2019, sub-Saharan Africa had the highest number of AMR-attributed deaths (23.5 per 100,000) and, without intervention, by 2050 sub-Saharan Africa is expected to bear the highest burden of the predicted 10 million annual deaths.
Amref, in partnership with GSK, is implementing the African Leadership for AMR Action initiative. It aims to create a localised multi-stakeholder AMR Action Group in and for the Africa Region to support national and local-level AMR programmes.
Phase One of this initiative, the exploratory phase, launched in Lusaka, Zambia in December 2023. In this phase we aimed to:
- Conduct a situation analysis to understand the status of AMR action across Africa;
- Create an advocacy/messaging framework to support countries;
- Explore sustainability mechanisms for the delivery phase; and
- Explore setting up a regional Action Group with key regional stakeholders.
Banner image © Amref Health Africa
Right image: Stakeholders at the High-Level AMR Roundtable, CPHIA, Lusaka, Zambia © Amref Health Africa
Phase One findings
The situation analysis identified stakeholders working in the AMR space, their areas of focus aligned with the World Health Organisation’s Global Action Plan (GAP) objectives, and opportunities to contribute to AMR mitigation and response efforts in national and regional AMR plans.
As part of this situation analysis, we conducted deep-dive research in Zambia, Kenya, Ethiopia, Burkina Faso, and Cameroon. This revealed the presence of relevant state actors and intergovernmental bodies, as well as regional NGOs addressing AMR. Key gaps identified included:
Limited multisectoral collaboration
The One Health approach was limitedly adopted at national and devolved levels. Other vital sectors, such as finance, technology, and communication, have yet to develop and implement policies supporting antimicrobial stewardship (AMS), leaving multisectoral collaboration and commitment gaps. Civil Society Organisations (CSOs) have also largely been excluded from the AMR discourse.
Low AMR knowledge
There was low AMR knowledge among community members, healthcare providers, policymakers, and CSOs. Over 50% of households had low knowledge levels.
Poor Anti-Microbial Stewardship (AMS)
Poor antimicrobial stewardship led to misuse and overuse of antimicrobials. Many respondents didn't complete antibiotic courses, lacked veterinary oversight for animals, and gave animals antimicrobials without prescriptions.
Insufficient investment in workforce education and training on AMR
For example, only 19% and 28% of Zambian and Ethiopian health workers, respectively, received continuous professional AMR training. Approximately 42% of human health care providers, 40% of animal health workers and over 90% of environment workers lack sufficient knowledge on AMR, highlighting an urgent need for targeted, sustainable training.
Weak regulation and enforcement
There is inconsistent, underdeveloped regulation and limited self-regulation among professionals and community actors. Around 25% of health workers do not follow infection prevention and control (IPC) protocols, and 53% are unaware of regional and national AMR policies.
A regional advocacy and messaging framework was developed based on findings from the situation analysis. This provided targeted messaging for each stakeholder group to address any misconceptions and advocacy channels to deploy messaging and effectively engage them in AMR action.
Sustainability mechanisms were explored through the development of investment cases, based on data gathered from the situation analysis. The cases serve as a template tool which can be adapted and adopted by countries for country-level investment into cost-effective AMR measures.
A regional Action Group was explored with key regional stakeholders to identify and understand how best to improve co-ordination across the region for addressing the AMR burden.
These achievements set the foundation for a second phase, launched in March 2025, which focusses on addressing key gaps and improving co-ordination for sustained impact.
Phase Two
This phase is an 18-month programme running from March 2025 to August 2026, which is being implemented in Kenya and Zambia. These countries were selected following their extensive engagement in Phase One, which uncovered substantive One Health opportunities to leverage in order to scale AMR response efforts. They also ensure a regionally representative spread covering East and Southern Africa.
This phase aims to strengthen leadership and local ownership for AMR action in the African region through enhanced workforce capacity building, community engagement and multisectoral action.
Project activities include:
- Strengthening workforce capacity in AMR across One Health sectors for effective Anti-Microbial Stewardship and cross-sectoral collaboration.
- Collaboration with One Health subject matter experts (SMEs) to develop AMR training packages for integration into health workforce training programmes.
- Conducting continuous training for the in-service One Health workforce at national and devolved levels.
- Targeted sensitisation sessions w for professionals across animal health, human health, and environmental sectors.
- Integration of AMR education and awareness interventions into community health programmes to promote responsible antimicrobial use.
- Collaboration with One Health subject matter experts and community health divisions to develop AMR training packages for integration into community health workforce training programmes
- Sensitisation sessions to improve CHW and CSO knowledge of AMR, covering topics such as the responsible use of antibiotics, the risks of misuse for human and animal health, and the principles of infection prevention and control.
- Collaboration with Africa CDC and national governments on awareness creation on AMR at a regional level through campaigns by CHWs, CSOs, and on key media platforms.
- Establishment and enhancement of multisectoral coordination at national and regional levels to drive cohesive and sustainable AMR mitigation efforts.
- Supporting One Health joint review meetings at national and subnational levels
- Strengthening a regional co-ordinated mechanism that is locally-owned
- Supporting AMR knowledge exchange forums at the sub-national, national, and regional levels through virtual forums, symposia, conferences, and documentation.
With thanks to GSK for its continued support for the African Leadership for AMR Action initiative, and their ongoing partnership.
