Mind the governance gap: a one health scoping review of national AMR performance indicators

Despite several initiatives to benchmark national action in responding to antimicrobial resistance (AMR), no comprehensive inventory exists of indicators used across these efforts. We present a scoping review that maps and synthesises existing indicators used to assess national performance in addressing AMR. We conducted a review of academic and grey literature to identify quantitative and qualitative indicators used to assess national AMR performance across animal, environmental, and human health sectors. The academic search was conducted across MEDLINE, EMBASE, and Global Health. The grey literature search was conducted across multilateral organisations (e.g., WHO, FAO, WOAH, UNEP, OECD) and think-tanks. We categorised indicators into a thematic framework spanning 19 subdomains within three overarching domains: Governance & Leadership, Action Areas, and Monitoring & Evaluation. From 184 academic studies, we identified 2311 indicators, and 1406 from 48 grey literature sources. In total, 2101 were in human health, 675 in animal health, 232 in environmental health, and 709 were multisectoral. Within the three overarching domains, 281 were Governance & Leadership, 1907 were Action Areas, and 1671 were Monitoring & Evaluation indicators. When grouping indicators by subdomain, Surveillance & Laboratory (1427), Stewardship (765), and Prevention & Control (365) accounted for the largest volumes, followed by Social Determinants (232), Reporting (141), and Workforce (140), in contrast to Accountability (22), Transparency (22), and Equity (29). This comprehensive scoping review provides a One Health inventory of 3717 indicators used to assess national performance in responding to AMR. While revealing robust Surveillance & Laboratory, Prevention & Control, and Stewardship metrics, we identify critical gaps in Accountability, Transparency, and Equity. These measures comprise the Governance & Leadership domain, which is essential for policy implementation.