04 ANTIMICROBIAL RESISTANCE

A functional system is in place for the national response to prevent and combat antimicrobial resistance (AMR) with a One Health approach, including:

Multisectoral work spanning human, animal, agriculture, food safety and environmental aspects, which comprises of developing and implementing a national action plan to combat AMR consistent with the Global action plan on antimicrobial microbial resistance.
Surveillance capacity for AMR and antimicrobial consumption at the national level in accordance with internationally agreed systems such as the WHO Global antimicrobial resistance surveillance system (GLASS), the WOAH Global database on use of antimicrobial agents in animals, and the FAO Antimicrobial resistance monitoring (InFARM) system and IT platform.
Prevention of AMR emergence and transmission in healthcare facilities, food production and the community, through infection prevention and control (IPC) measures.
Ensuring appropriate use of antimicrobials, including assuring quality of available medicines, conservation of existing treatments and access to appropriate antimicrobials when needed, while reducing inappropriate use.
Increasing awareness and engaging the community in activities related to combating AMR in humans and animals, with focus on outreach approach for farmers and rural communities.

The JEE tool reviews the country’s self-assessed response to the annual global monitoring survey on AMR (Tracking AMR Country Self-assessment Survey (TrACSS)).

IMPACT:

Decisive and comprehensive action to prevent the emergence and reduce the spread of AMR. Countries will, in line with the Global action plan on AMR, increase awareness of AMR risks and how to respond to them, such as:

Strengthening surveillance and laboratory capacity;
Enhancing IPC measures in relevant sectors;
Ensuring uninterrupted access to essential antimicrobials of assured quality;
Regulating and promoting the appropriate use of antimicrobials in human medicine, animal health, agriculture, food production and other
fields as appropriate; and
Supporting initiatives to foster the development and appropriate use of new antimicrobial agents, vaccines and diagnostic tools.

MONITORING AND EVALUATION:

(1) A multisectoral national action plan to combat AMR has been produced and made public. (2) Implementation of the AMR national action plan
and sector-specific plans, with monitoring and yearly reporting on progress (including reporting to the international level) in place.

Benchmark 4.1

Effective multisectoral coordination for AMR

Objective To develop and implement a multisectoral national action plan on AMR

01 NO CAPACITY

No national action plan for AMR and no formal multisectoral governance or coordination mechanism on AMR.

02 LIMITED CAPACITY

Establish a national AMR focal point to serve as a coordinating office for AMR within the health ministry or other relevant ministry. *
Identify key stakeholders and AMR leads across relevant ministries and sectors to establish a national multisectoral AMR coordination committee. *
Initiate joint development of a national multisectoral AMR action plan (AMR NAP) based on situational analysis, to identify major risks for occurrence and transmission and include a review of relevant existing regulations and policies. *
Identify programmes and priority activities to be included in the AMR NAP, aligned with the AMR Global Action Plan and for development or scale up. *
Involve AMR experts in the development of national health policies, strategies and plans (NHPSPs) to strengthen health system capacities to manage and integrate AMR activities. *
Advocate for political commitment to call for and support active participation of all relevant ministries in the national multisectoral AMR coordination committee. *
Identification of AMR focal points within and by relevant sectors.

03 DEVELOPED CAPACITY

Develop ToRs for a multisectoral coordination committee, with defined lines of accountability, funding for committee activities and regular meetings (at least four per year) to review AMR NAP implementation. *
Complete the development of the multisectoral AMR NAP with prioritized activities to address AMR in line with the AMR Global Action Plan. *
Submit the AMR NAP for official endorsement through relevant governance mechanisms (e.g. office of the head of state, cabinets, and health and agriculture ministries). *
Train staff from relevant ministries and sectors on leadership skills for effective multisectoral collaboration and coordination needed to develop, implement and monitor joint plans and activities. *
Solicit the national government’s official endorsement of AMR NAP. *
Enhance internal health sector coordination between stakeholders for AMR, universal health coverage (UHC), primary health care (PHC) and health emergencies.
Assess existing capacities for awareness, training, surveillance, infection prevention and control (IPC), and stewardship of antibiotic use in and by relevant sectors.
Assess existing data and information systems for collecting recommended indicators in national sector-specific plans.
Active contribution from civil society partners, academic and research institutions, and other relevant professional organizations in the development and implementation of the national AMR NAP.

04 DEMONSTRATED CAPACITY

Identify priority actions (based on risk and feasibility) from the AMR NAP, develop a costed implementation plan with engagement of responsible agencies with established timelines, and begin implementation of actions. *
Identify and map required financial resources to implement and monitor prioritized activities in the multisectoral AMR NAP. *
Develop and implement the multisectoral AMR NAP M&E framework. *
Review AMR NAP implementation progress through regular meetings of the national AMR coordination committee, and provide reports aligned with the annual tracking AMR country self-assessment survey (TrACSS). *
Develop capacities to collect, analyse and report on recommended indicators of the national action plan M&E framework and relevant Sustainable Development Goals indicators. *
Train staff in relevant sectors to support implementation of the AMR NAP. *
Build sector-specific capacities to collect, analyse and report on M&E indicators monitored by the AMR coordination committee.

05 SUSTAINABLE CAPACITY

Incorporate prioritized AMR activities into national plans and budgets of relevant programmes and agencies, and allocate adequate funding. *
Regularly evaluate implementation of AMR NAP through M&E, involving relevant sectors and the multisectoral AMR coordination committee, to jointly update plans and submit data on progress to regional and global levels accordingly. *
Dedicate senior level leadership for the AMR multisector coordination committee and empower it to hold partnering sectors accountable for the delivery of clearly specified actions and targets. *
Embed specific AMR relevant interventions in national strategies and associated budgets for health systems strengthening (e.g. PHC and UHC), as well as national pandemic preparedness plans, response strategies and budgets. *
Document and disseminate lessons learned from efforts for effective multisectoral coordination on AMR and the AMR NAP implementation, including addressing inequities associated with gender, disability and social inclusion. *
Develop capacity to monitor and address social and economic inequities with regards to AMR interventions in relevant sectors. *
Embed and promote AMR interventions in relevant, sector-specific national strategies and budgets and include in national and international development financing proposals.

Benchmark 4.2

A surveillance system of AMR is in place

Objective To develop national AMR surveillance systems across sectors (human health, animal health and agriculture) for surveillance of pathogens of concern and to facilitate data sharing and joint analysis for action

01 NO CAPACITY

No or limited capacity for generating, collating and reporting data (e.g. antibiotic susceptibility testing (AST) and accompanying clinical and epidemiological data).

02 LIMITED CAPACITY

Designate a national coordinating centre to oversee the development and functioning of the national AMR surveillance system with epidemiological, information technology (IT) and data management capacities, with a designated a focal point for the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) and other international AMR surveillance networks the country collaborates with. *
Define national AMR surveillance objectives in accordance with AMR national action plan objectives and cost planned activities. *
Complete an assessment of existing laboratory capacities for identifying and performing AST for common bacteria, fungal pathogens and Mycobacterium tuberculosis. *
Designate a national reference laboratory to support AMR surveillance based on an assessment of existing microbiology laboratory capacities in the country. *
Designate, based on the assessment of microbiology lab capacities, laboratories to support the national AMR surveillance and secure laboratory reagents to detect and report on at least some priority AMR pathogens. *
Develop and initiate training programmes for diagnostic stewardship, data collection and reporting on AMR at national and subnational levels. *
Define laboratory standards and capacity requirements for laboratories to participate in the national AMR surveillance, including identifying and performing AST for targeted pathogens. *
Identify all laboratories that can contribute to an integrated AMR surveillance system using a One Health approach, including food monitoring, animal health, environmental and other sectors.
Designate national focal points for the International Food and Agriculture Organization of the United Nations’ (FAO) Antimicrobial Resistance Monitoring System (InFARM) covering AMR surveillance domains in food and agriculture.
Designate national reference laboratories for AMR surveillance based on assessments of existing microbiology capacity.

03 DEVELOPED CAPACITY

Establish an external quality assessment programme for the national reference laboratory and ensure that it can conduct confirmatory or additional testing. *
Provide adequate equipment, procurement, maintenance and supplies for laboratories supporting AMR surveillance and notification of AMR events. *
Develop a national surveillance protocol including surveillance targets, laboratory standards, priority specimens, pathogens and drug– bug combinations, sampling strategy, defined datasets, metrics, data production, analysis and reporting, quality management and M&E. *
Identify functional AMR surveillance sites in the health sector and in foods production chains to ensure national or subnational representativeness. *
Train sufficient staff to collect, analyse and report AMR data. *
Initiate AMR surveillance at pilot or representative regional and referral hospitals.
Define sectoral AMR surveillance objectives and develop a sectoral AMR surveillance strategy aligned with national AMR surveillance.
Define standards and capacity requirements for laboratories to participate in sectoral AMR surveillance.
Develop steps to strengthen laboratory capacities for identifying and performing AST for targeted pathogens.

04 DEMONSTRATED CAPACITY

Establish a national AMR surveillance system including SOPs, protocols and databases for surveillance data, a system for reporting to ministries of health and agriculture, and a mechanism to analyse data and report back to facilities and WHO. *
Establish an external quality assessment programme for all laboratories generating data for AMR surveillance, to evaluate and provide feedback on capacities to identify and perform AST for targeted pathogens. *
Collect population-based denominators, such as those recommended by GLASS. *
Perform AMR data analyses and disseminate regular reports from the AMR surveillance national coordinating centre. *
Establish mechanisms for AMR surveillance, data sharing and joint review across sectors. *
Establish capacities to perform and analyse molecular tests for AMR, at least within the national reference laboratory. *
Conduct SimEx/AAR/IAR (as relevant) to test the functionality of AMR surveillance systems. *
Expand AMR testing and surveillance to include other clinical sites and/or other components of the country’s health system (e.g. private sector).
Develop strong animal, plant health and agricultural practices for AMR surveillance by implementing standards defined by WOAH and FAO, including the Codex Alimentarius.
Regularly evaluate laboratory capacities to identify and perform AST for targeted pathogens.

05 SUSTAINABLE CAPACITY

Enhance monitoring of antibiotic resistance patterns. *
Disseminate reports indicating the proportion of AMR pathogens among specimens or isolates, results from participation in international external quality assessment rounds of the national reference laboratory, and incidence of infections caused by AMR pathogens at sentinel sites (community- and hospital-acquired). *
Use surveillance data to implement policy changes, develop new legislation or update existing legislation, improving facilities and adapting prevention and control strategies. *
Revise and update AMR surveillance strategies, guidelines, operational plans and SOPs based on lessons learned (from M&E) and ensure follow up of the implementation of M&E recommendations. *
Regularly share AMR surveillance data across sectors, analyse relevant AMR data for policy-making and contribute to international surveillance information sharing and risk assessments for AMR. *
Define and allocate a multiyear budget for AMR surveillance. *
Update sector-specific plans and integrated mechanisms based on feedback from AMR surveillance data analysis and results from M&E of the national surveillance system.
Designate international (e.g. FAO/WHO/WOAH) reference laboratories to support relevant sectors conducting regional and global AMR surveillance based on assessments of technical capacities and global collaboration.

Benchmark 4.3

Effective mechanisms are in place to prevent multidrug resistant organisms (MDRO)

Objective To strengthen mechanisms for preventing MDRO

01 NO CAPACITY

Priority MDRO pathogens (phenotypes and genotypes) have not been identified by national authorities, and MDRO pathogens are not detected.

02 LIMITED CAPACITY

Perform a situational analysis and document current efforts on MDRO prevention in the country.
Map key stakeholders for MDRO prevention with a One Health approach and involvement from the AMR coordination committee and IPC programme.
Mandate the IPC programme to develop an action plan and lead activities to prevent MDRO in close collaboration and consultation with the AMR coordination committee, the AMR national reference laboratory and other relevant stakeholders.
Integrate MDRO prevention into the country’s overall IPC strategy and programme, ensuring alignment with WHO minimum requirements for IPC with involvement of all relevant stakeholders, and design measures to prevent MDRO in both health facilities and community settings.
Identify, in consultation with the AMR coordination committee, priority AMR types that are associated with common infections and create a list of priority MDRO.
Develop training materials on MDRO prevention including the roles and responsibilities of clinicians, laboratory technicians and other relevant professionals, and integrate into existing IPC and AMR training packages.
Develop surveillance and laboratory capacities to identify groups at risk for MDRO.

03 DEVELOPED CAPACITY

Officially circulate the standard definition of MDRO to all health facilities to align prevention activities accordingly.
Improve awareness of priority MDRO at all health facilities (including both public and private sector facilities and laboratories) and in community settings, and provide training on MDRO prevention for relevant officials at national level.
Implement a strategy and action plan to prevent MDRO at national level (embedded in the overall IPC strategy) and develop, endorse and disseminate a standard protocol for containing MDRO outbreaks.
Collaborate with AMR and IPC programmes to apply available evidence to guide MDRO prevention activities and understand effective prevention methods that extend beyond the AMR domain.
Improve health facility capacities to characterize AMR pathogens causing human infections, systematically report to the national level and identify reference laboratories to provide confirmatory testing for exceptional phenotypes.

04 DEMONSTRATED CAPACITY

Implement national strategy and action plan on MDRO prevention at all levels.
Conduct training on MDRO prevention for all relevant health workers at all levels.
Design a mechanism for timely detection, reporting, risk assessment and monitoring of novel, re-emerging and priority MDRO in the country, and strengthen capacities for the national focal point to track and provide support for MDRO incidents.
Establish and use indicators and monitoring systems to regularly assess implementation of the MDRO prevention strategy, action plan and MDRO risk assessment activities at national and facility levels.
Conduct MDRO related research studies to generate local evidence to inform strategies, protocols and action.
Improve IPC strategy implementation in both public and private health facilities to prevent and control MDRO infections in alignment with WHO core components for effective IPC programmes.
Implement systematic monitoring and reporting of AMR infections by the national body responsible, including a framework for early reporting of any unusual antimicrobial susceptibility profile to WHO’s Global Antimicrobial Resistance and Use Surveillance System - Emerging Antimicrobial Resistance Reporting (GLASS-EAR) framework.

05 SUSTAINABLE CAPACITY

Conduct regular M&E for detection, timely notification of priority and novel MDRO within facilities and at the national level.
Enforce adherence to IPC protocols and interventions in all hospitals to prevent and respond to priority MDRO pathogens in a timely manner.
Assess compliance with protocols and put in place mechanisms to strengthen implementation accordingly.
Define indicators and patient populations based on local epidemiology, risk assessment and resource availability to perform surveillance cultures including asymptomatic colonization with MDRO.
Communicate pertinent MDRO data to local referral networks to inform prevention and containment efforts at health facilities.

Benchmark 4.4

Optimize use of antimicrobial medicines in human health

Objective To ensure appropriate use of all antimicrobials in humans

01 NO CAPACITY

No or weak policy and regulations on appropriate use, availability and quality of antimicrobials for human health.

02 LIMITED CAPACITY

Establish and endorse, by the national AMR coordination committee, a national working group (with ToRs) of experts from relevant authorities and designate a national focal point for surveillance and optimal use of antimicrobials. *
Assess the national medicines strategy including regulatory framework, selection on the essential medicines list, supply chain management, stewardship, rational use plans and strategies, and activities focusing on antimicrobial medicines. *
Assess existing mechanisms for monitoring antimicrobial consumption (AMC), define objectives according to aims and targets of the AMR NAP, and identify relevant actors and sources of data. *
Develop methods to collect relevant AMC data including piloting of methods. *
Develop a draft national antimicrobial stewardship (AMS) plan or strategy and national legislation that regulates use, access and quality of antimicrobials. *
Identify AMS training and educational needs of health workforce, both in preservice and in-service education and training. *
Involvement from public and private sector stakeholders in the activities of the dedicated national working group.
Share relevant plans/strategies, training & educational resources and assessment tools for AMS between sectors.

03 DEVELOPED CAPACITY

Establish a national AMC surveillance system to monitor and report national AMC data based on the Access, Watch, Reserve (AWaRe) classification. *
Adopt the AWaRe classification for antibiotics into the national essential medicines list.
Develop protocols and tools for monitoring antimicrobial use 24 (AMU) in hospitals to inform AMS.
Develop or review the national regulatory framework for appropriate access to and use of quality assured antimicrobials in humans, ensuring that economic incentives are accounted for in medicines reimbursement lists. *
Enact legislation and regulations on import, marketing authorization, production, selection, prescribing and sale of antimicrobials. *
Develop or update and disseminate national AMS plan and clinical treatment guidelines that consider the essential medicines list and apply the AWaRe classification for antibiotics.
Implement AMS programmes and practices in designated health facitilies, including training, monitoring, communication and identification of required budget.
Establish systems to ensure AMS elements are included in pre-service and in-service training curricula for health professionals. *
Conduct periodic knowledge, attitude and practice surveys of health professionals to better understand drivers of prescribing and dispensing behaviours. *
Develop materials for sensitizing experts in both public and private health sectors and raise community awareness of appropriate antimicrobial medicine use.
Participate in AMS training programmes implemented in relevant sectors.
Share methods and tools for monitoring AMC for standardization and comparability across the human, animal, agricultural and environmental health sectors.

04 DEMONSTRATED CAPACITY

Monitor and regularly report on AMC disaggregated by health sector and level when possible.
Perform ad hoc surveys on antimicrobial use in hospitals as part of AMS programmes.
Set national targets for improvement, including the target of AWaRe Access group of antibiotics consisting of 60% of total antibiotic consumption and reported globally. *
Consistently update regulatory and legal frameworks for appropriate use and access to affordable quality assured antimicrobials including: enforcement of prescription only antibiotics, regulation of promotional tactics for antimicrobials by pharmaceutical companies, draft/review of the national medicine prescription and access policy for optimizing use by detecting and correcting issues leading to shortages. *
Expand AMS activities to all health facilities, monitor and evaluate stewardship programmes including the analysis of AMR, consumption and usage data, and provide recommendations for strengthening AMS programmes.
Train a sufficient number of health workers, including public health professionals and community health workers at the national and health facility level (including all types of health facilities), on AMS and AMR, as well as AMC and AMU surveillance.
Develop a list of behavioural change targets to ensure responsible and appropriate AMU in health facilities and the community, and design strategies to facilitate behaviour change. *
Develop a system to monitor antibiotic quality and identify substandard and/or falsified medicines. *
Participate in education campaigns for raising community awareness on the appropriate use of antimicrobial medicines.
Produce regular reports on AMC in animal, agricultural and environmental sectors, ensure data sharing is in place across sectors, and share publicly.
Implement regulatory and legal frameworks to ensure that critically important antimicrobials (highest priority and high priority) are used in a prudent manner.

05 SUSTAINABLE CAPACITY

Continue to monitor AMS activities and ensure AMS is a part of all relevant national policies and standards, including curriculum standards for healthcare professionals, accreditation standards for health facilities and national health policies, strategies and plans. *
Maintain the national regulatory framework for appropriate use of affordable, quality assured antimicrobials, including monitoring of prescription only sales of key antibiotics. *
Evaluate routine surveillance for AMC with annual data collection at national and facility levels. *
Monitor and report if national targets for AMC are met and adjust interventions accordingly. *
Conduct monitoring, documentation and reporting on antibiotic quality (e.g. substandard and falsified medicines). *
Capture data on illegal AMC (e.g. street markets, trafficking, internet sales). *
Perform regular surveys on AMU in hospitals and ad hoc surveys on AMU in primary healthcare/community facilities, and report results to all relevant stakeholders.
Participate in international initiatives to support capacity building for optimizing AMU globally and share country experiences in the human health sector relevant international forums and platforms.
Document and disseminate the results and lessons learned from efforts to minimize AMR events by relevant sectors (e.g. livestock, agriculture, food safety, etc.).
Document permeability of AMU between sectors (e.g. human medicines given to animals).

Benchmark 4.5

Optimize use of antimicrobial medicines in animal health and agriculture

Objective To ensure responsible and prudent use of all antimicrobials in animal food production, animal health and agriculture systems

01 NO CAPACITY

No or weak policy and regulations on responsible and prudent use, availability and quality of antimicrobials in the animal health sector and/or agriculture.

02 LIMITED CAPACITY

Involve public and private stakeholders from animal health and/or agriculture sector in activities of the dedicated national technical working group under the multisectoral AMR coordination committee. *
Map and review existing legislation, regulations and policies for the management of antimicrobial medicines in relevant sectors (livestock, agriculture, food safety, etc.), particularly for nonveterinary medical purposes and use of medically important antimicrobials in food-producing animals. *
Share the most recent WHO list of medically important antimicrobials for human medicine with the animal health and agriculture sectors

03 DEVELOPED CAPACITY

Develop regulations on prescription only sales of antimicrobials for use in animals and for food production, limiting non-prescription use of medically important antimicrobials. *
Develop capacity for enforcement of regulations. *
Develop training package on AMU in animal health and agriculture to promote responsible and prudent use at national, subnational and facility levels.
Establish a training and certification mechanism for veterinarians prescribing antimicrobials for both terrestrial and aquatic animals.

04 DEMONSTRATED CAPACITY

Collaboration between sectors on the development and dissemination of joint evidence-based information, education and communication materials on AMR and misuse or abuse of antimicrobials. *
Develop and disseminate information, education and communications materials to key stakeholders on AMR and misuse or abuse of antimicrobials across the animal health sector and/or agriculture sectors.
Develop and enforce a full national regulatory framework for responsible and prudent use of affordable, quality assured antimicrobials in animals and agriculture. *
Recommend and implement the phasing out the use of antimicrobials for animal growth promotion.
Monitor the sale and use of substandard and/or falsified antimicrobials, and develop corresponding enforcement mechanisms. *

05 SUSTAINABLE CAPACITY

Support the inclusion of relevant information and lessons learned in any annual reports developed by the national AMR coordination committee. *
Participate in international initiatives to build capacities for optimizing AMU globally. *
Document and disseminate the results and lessons learned from efforts to minimize AMR events in relevant sectors (e.g. livestock, agriculture, food safety, etc.)
Develop and promote best practices for reducing AMU in the animal and plant farming and agriculture sectors.
Conduct monitoring, documentation and reporting on antibiotic quality (e.g. substandard and falsified medicines).
Conduct and collaborate operational research on the impact of responsible and prudent AMU in relevant sectors (i.e. animal health, human health, food security, agriculture and the environment). *

* Participation and contribution of other sectors to action.

Tools

The Pursuit of Responsible Use of Medicines: Sharing and Learning from Country Experiences. Geneva: World Health Organization; 2012 (https://apps. who.int/iris/handle/10665/75828).
Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/259462).
Implementation manual to prevent and control the spread of carbapenem-resistant organisms at the national and health care facility level. Geneva: World Health Organization; 2019 (https://www.who.int/publications/i/item/WHO-UHC-SDS-2019-6).
Handle antibiotics with care in surgery [infographic]. Geneva: World Health Organization (https://www.who.int/images/default-source/ihs/ipc/
infographic_ssi_tb.jpg?sfvrsn=7eee0a5_5).
The role of infection prevention and control in preventing antibiotics resistance in health care [infographic]. World Health Organization (https://cdn.who.
int/media/docs/default-source/documents/infection-prevention-control09320f4b-309f-4999-8e23-23541eeb60a6.pdf?sfvrsn=1ea132d5_1).
Antimicrobial Resistance: A manual for developing national action plans. Version 1. Geneva: Food and Agriculture Organization of the United Nations, World Organisation for Animal Health and World Health Organization; 2016 (https://www.who.int/publications/i/item/antimicrobial-resistance-a- manual-for-developing-national-action-plans).
National antimicrobial resistance surveillance systems and participation in the Global Antimicrobial Resistance Surveillance System (GLASS): core components checklist and questionnaire. Geneva: World Health Organization; 2016 (https://apps.who.int/iris/handle/10665/251552).
Diagnostic stewardship, A guide to implementation in antimicrobial resistance surveillance sites. Geneva: World Health Organization; 2016 (https:// www.who.int/publications/i/item/WHO-DGO-AMR-2016.3).
Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level. Geneva: World Health Organization; 2016 (https://www.who.int/publications/i/item/9789241549929).
Interim Practical Manual: supporting national implementation of the WHO Guidelines on Core Competencies of Infection Prevention and Control Programmes. Geneva: World Health Organization; 2017 (https://www.who.int/publications/i/item/WHO-HIS-SDS-2017-8).
WHO implementation handbook for national action plans on antimicrobial resistance: guidance for the human health sector. Geneva: World Health Organization; 2022 (https://www.who.int/publications/i/item/9789240041981).
Global Database for Tracking Antimicrobial Resistance (AMR) Country Self- Assessment Survey (TrACSS) [database]. Food and Agriculture Organization of the United Nations, UN Environment Programme, World Health Organization and World Organisation for Animal Health (www. amrcountryprogress.org).
Monitoring and evaluation of the global action plan on antimicrobial resistance. Framework and recommended indicators. Geneva: Food and Agriculture Organization of the United Nations, World Organisation of Animal Health and World Health Organization; 2019 (https://www.who.int/ publications/i/item/monitoring-and-evaluation-of-the-global-action-plan-on-antimicrobial-resistance).
World Organisation for Animal Health. ANIMUSE Global Database on antimicrobial agents intended for use in animals [website]. Paris: World Organisation for Animal Health; 2023 (https://amu.woah.org/amu-system-portal).
OIE Standards, Guidelines and Resolutions on Antimicrobial Resistance and the use of antimicrobial agents. Paris: World Organisation for Animal Health; 2020 (https://www.woah.org/app/uploads/2021/03/book-amr-ang-fnl-lr.pdf).
OIE List of Antimicrobial Agents of Veterinary Importance. Paris: World Organisation for Animal Health; 2021 (https://www.woah.org/app/ uploads/2021/06/a-oie-list-antimicrobials-june2021.pdf).
Global action plan on antimicrobial resistance. Geneva: World Health Organization; 2016 (https://www.who.int/publications/i/item/9789241509763).
U.S. National action plan for combating antibiotic-resistant bacteria [website]. Atlanta: Centers for Disease Control and Prevention; 2021 (https://www. cdc.gov/drugresistance/us-activities/national-action-plan.html#:~:text=The%20U.S.%20National%20Action%20Plan,the%20health%20of%20all%20 Americans).
Executive summary: The selection and use of essential medicines 2021: report of the 23rd WHO Expert Committee on the selection and use of essential medicines. Geneva: World Health Organization; 2021 (https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021.01).
National systems to support drinking-water, sanitation and hygiene: global status report 2019. UN-Water global analysis and assessment of sanitation and drinking-water (GLASS) 2019 report. Geneva: World Health Organization; 2019 (https://www.unwater.org/publications/un-water-glaas-2019- national-systems-support-drinking-water-sanitation-and-hygiene).
WHO guidelines on use of medically important antimicrobials in food-producing animals. Geneva: World Health Organization; 2017 (https://www.who. int/publications/i/item/9789241550130).
Integrated surveillance of antimicrobial resistance in foodborne bacteria: application of a one health approach: guidance from the WHO Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR). Geneva: World Health Organization; 2017 (https://apps.who.int/iris/ handle/10665/255747).
Critically important antimicrobials for human medicine: 6th revision 2018. Geneva: World Health Organization; 2019 (https://www.who.int/ publications/i/item/9789241515528).
GLASS Emerging antimicrobial resistance reporting framework (GLASS-EAR). Geneva: World Health Organization; 2018 (https://www.who.int/ publications/i/item/9789241514590).
GLASS guidance for national reference laboratories. Geneva: World Health Organization; 2020 (https://www.who.int/publications/i/ item/9789240010581).
Global Antimicrobial Resistance Surveillance System (GLASS) Molecular methods for antimicrobial resistance (AMR) diagnostics to enhance the global antimicrobial resistance surveillance system. Geneva: World Health Organization; 2019 (https://www.who.int/publications/i/item/WHO-WSI- AMR-2019.1).
Global Antimicrobial Resistance and Use Surveillance System (GLASS) [website]. Geneva: World Health Organization; 2023 (https://www.who.int/ initiatives/glass).
The International FAO Antimicrobial Resistance Monitoring (InFARM) System (under development) [website]. Rome: Food and Agriculture Organization of the United Nations; 2023 (https://www.fao.org/antimicrobial-resistance/resources/database/infarm/en/).
Simulation exercises [website]. Geneva: World Health Organization; 2023 (https://www.who.int/emergencies/operations/simulation-exercises).
WHO simulation exercise manual: a practical guide and tool for planning, conducting and evaluating simulation exercises for outbreaks and public health emergency preparedness and response. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/handle/10665/254741).
Guidance for after action review (AAR). Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/311537).
Guidance for conducting a country COVID-19 intra-action review. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/ handle/10665/333419)