Policy analysis of the drivers of antimicrobial resistance within Tanzania's one-health care systems

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The causes and impacts of AMR are multi-factorial, not confined to biological, environmental, clinical, or social-economic domains, therefore inter-disciplinary approaches are needed. The proposed project aims to uncover the covert and overt drivers of AMR within Tanzania's health system and the pig production sector using a multi-method and interdisciplinary, "One Health" research approach. First, we will conduct a needs assessment based on a literature and policy document review as well participant observations at key sites in the human and animal health systems. Second, we will conduct a stakeholder analysis which will involve comprehensively mapping out the range of actors involved in policy processes relating to appropriate use of antimicrobials, across the One Health spectrum including formal and informal sector actors. Third, once politically feasible interventions addressing key issues indicated by the needs assessment have been identified we will pilot test an intervention targeted at critical segments within healthcare and/or veterinary systems. Fourth, we will present finding to policymakers and investigate how the new information influences their support or opposition for policy implementation. The overall expected outcome will be a cost effective, evidence base for policy recommendations, which are relevant in human and animal health systems in Tanzania. By engaging with key policy actors in Tanzania - including the National AMR Coordinating Committee, the technical working groups, the secretariat and the AMR focal point - we will contribute evidence to inform strategies for implementation of the National AMR Action Plan and serve as a model for other resource limited countries. Policy briefs with synthesised evidence on the role of health and veterinary systems in the contribution and persistence of AMR will be a key output. We anticipate that the information generated from this research will be used in strengthening systems for antimicrobial distribution and use.