Combating antimicrobial resistance in Africa: a strategic roadmap for surveillance, stewardship, and research

Africa stands at a pivotal moment in public health: the continent faces a high and growing burden of infectious diseases driven in part by antimicrobial resistance (AMR) yet remains underrepresented in global clinical research and surveillance initiatives. Despite advances in technology, infrastructure and human capital in some regions, persistent gaps in laboratory capacity, epidemiologic surveillance, data systems, governance, funding and clinical research impede timely detection, containment and evidence-based management of drug-resistant infections. This review synthesizes the current landscape of AMR surveillance and clinical research capacity across African countries, highlighting the major structural and often over-looked barriers and also exemplary local initiatives that demonstrate scalable progress. We argue that linking strengthened AMR surveillance with concerted investment in clinical research, laboratory networks, antimicrobial stewardship, data governance and policy reforms will enable a shift from reactive responses to proactive, system-wide AMR prevention and containment strategies. Drawing on published literature, policy documents and regional case studies, this review proposed a practical, phased roadmap for integrated surveillance-led healthcare reform tailored to African contexts and realities, with concrete recommendations. It also defined actionable priorities and framework to accelerate AMR detection, research, and containment across Africa, ultimately reducing the burden of drug-resistant infections and strengthening health system resilience in Africa.