The National Action Plan on Antimicrobial Resistance 2021–2026.

This National Action Plan on Antimicrobial Resistance (NAP-AMR) sets out Lesotho’s multi-sectoral response to antimicrobial resistance (AMR) for 2020/21–2025/26, framed within a One Health approach. It is developed under the guidance of a National Multi-Sectoral Steering Committee comprising key ministries (Health, Agriculture and Food Security, Tourism Environment and Culture, Water, Finance) and development partners, and is aligned with the WHO Global Action Plan on AMR, Africa CDC’s AMR Framework 2018–2023, OIE’s AMR Strategy, and relevant national policies and plans. The overarching goal is to reduce morbidity and mortality due to AMR in humans and animals by coordinated interventions across human health, animal health, plant health and the environment. The plan is structured around five strategic objectives mirroring the global action plan: awareness and education; surveillance and research; infection prevention, hygiene and biosecurity; optimization of antimicrobial use; and investment, research and development. Key measures are elaborated through nearly 20 strategic interventions and about 75 key activities, detailed in logical framework matrices. Under Strategic Objective 1, the plan calls for a baseline knowledge, attitudes and practices (KAP) study, a national AMR communication strategy, adaptation and dissemination of IEC materials, advocacy and sensitization of political and community leaders, media engagement, and integration of AMR content into formal and informal curricula and continuing professional education. Strategic Objective 2 focuses on strengthening laboratory capacity for AMR detection, establishing and standardizing quality management systems and SOPs, building a multi-sectoral AMR surveillance and reporting system (including integration into DHIS2 and participation in GLASS), and promoting AMR-related research agendas and operational research across sectors. Strategic Objective 3 addresses infection prevention and control and environmental protection through development of biosecurity guidelines for farms and food establishments, strengthening border controls for transboundary diseases, reviewing and intensifying vaccination programmes, promoting open defecation free communities and improved water access, and developing waste management strategies including sewage pre-treatment at hospitals. Strategic Objective 4 aims to optimize antimicrobial use in human and animal health by reviewing and updating essential medicines lists and standard treatment guidelines (including AWaRe classification), formulating veterinary medicines regulations, incorporating AMR into sectoral policies, reactivating therapeutic and veterinary drug committees, developing AMR stewardship and pharmacovigilance guidelines, establishing a pharmaceutical quality control laboratory, and strengthening district-level AMR coordination. It also foresees capacity building on rational prescribing and dispensing, and post-marketing surveillance through pharmacovigilance committees and tools. Strategic Objective 5 seeks to strengthen the economic and evidence base for sustainable investment by mobilizing resources for AMR and alternative medicines research, conducting expenditure tracking on infections and out-of-pocket spending on antimicrobial use, and fostering multi-sectoral collaboration on research. The plan is costed using an activity-based costing approach, estimating a total requirement of LSL 270,853,622 over five years, with the largest share allocated to hygiene, infection prevention and control. A monitoring and evaluation framework with 39 indicators at impact, outcome and output levels is established, relying on existing information systems and periodic surveys, with mid-term and end-term evaluations and defined national, regional and global reporting channels.