Importance of Antimicrobial Resistance Stewardship Based on a Systemic and Transdisciplinary Approach: <i>The Case of Strategic Planning, Implementation and Surveillance in Senegal</i> .

Abstract Based on a One Health approach, the Senegalese National Action Plan for Antimicrobial Resistance (NAPAMR 2018–2022) was elaborated. Its implementation has improved the International Health Regulations’ (IHR) capacities. However, this plan was not yet evaluated in 2022, making it urgent to analyse the said NAPAMR implementation level through a mixed design study. First, the quantitative component was a cross-sectional, retrospective and evaluative study with a structured closed survey on coverage and implementation indicators. Then, the qualitative component was a case study with a semi-structured opened interview guide in order to identify the implementation’s determining (either facilitating or blocking) factors. Covering the 2018–2022 implementation period (5 years), the implementation was analysed each time by dividing the number of activities effectively implemented by the number planned. It focused on the key sectoral actors in Senegalese AMR control who implemented and evaluated the NAPAMR using Excel 2010 ® and QDA MinerLite1.4.1©2004 software. The approval of the National Ethics Committee for Health Research (NECHR/ CNERS ) was obtained. Findings showed that human, animal and environmental health were represented at 73.9, 8.7 and 4.3%, respectively. Regional level accounted for 2.2%, compared with the sub-regional levels, which were absent from the plan development process. The transdisciplinarity coverage rate was adequate at 45% and effective at 40%, with the overall achievement of NAPAMR activities at 53.6%. Those specific to the laboratory and hygiene were respectively 70.6 and 69.2%. Implementation was delayed overall by 37.3%, and specifically by 75% for coordination, communication and research, with 38.1% of activities rescheduled. Temporal analysis shows an overall decreasing 5-year trend, with better achievements in annual transition (e.g. 23%, Q4 2020). A similar trend has also been noted especially for hygiene, infection prevention and control (54%). Finally, the determining factors for implementation were funding, M&amp;E including research, training, integration and COVID-19 was a major blocking factor. Information © The Authors 2025