Policy intervention for antimicrobial resistance mitigation in Nepal: a scoping review of statutory and policy instruments

Antimicrobial resistance (AMR) is an urgent global health threat, and Nepal faces rising challenges across human, animal, and environmental health sectors. Although Nepal has multiple statutory and policy instruments related to medicine, public health, animal health, food safety and environment governance, their collective contribution to, AMR mitigation has not been systematically mapped. This scoping review analyzes Nepal’s AMR related policies and examines their alignment with the WHO Global Action Plan on AMR. Using Arksey and O’Malley’s scoping review framework and Joanna Briggs Institute Population, Concept, Context eligibility criteria, we systematically identified policy instruments from government repositories from 1970 to 2025, including Nepal Law Commission, Ministry of Health and Population, Ministry of Agriculture and Livestock, and Ministry of Forest and Environment. Eligible documents included acts, policies, strategies, that directly or indirectly contributed to AMR control. Data were extracted on awareness, surveillance, responsible use, research, governance, and leadership, and synthesized using the Walt Gilson policy triangle. Nepal’s AMR policy landscape shows a transition from early regulatory statutes focused on drug quality and public safety toward an integrated One Health approach. Older instruments contained limited explicit AMR related provisions but contributed indirectly through pharmaceutical regulation, drug quality assurance, public health protection and governance mechanisms. More explicit commitments to AMR awareness, multisectoral surveillance, stewardship, and research emerged only in recent policies, notably the One Health Strategy 2019, National Health Laboratory Policy 2012, and National Action Plan on AMR 2024–2028. Key policy gaps included weak enforcement of prescription only antibiotics, limited surveillance interoperability, insufficient operational and behavioral research, and unclear leadership roles at different tiers of government. Nepal’s recent policy instruments demonstrate growing alignment with global AMR frameworks, particularly through One Health and multisectoral approaches. However, policy design, implementation readiness, and evidence gaps remain, including limited operational detail on integrated surveillance, expanding antimicrobial stewardship beyond hospitals, institutionalizing targeted AMR communication, investing in operational research, and clarifying provincial/municipal responsibilities are essential to support effective policy implementation. Addressing these areas could strengthen implementation readiness, while further empirical research is needed to assess how the policies are financed, implemented, enforced, and monitored, and whether they influence antimicrobial use and AMR outcomes in practice.