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

AMR的原因和影响是多因素的，不限于生物，环境，临床或社会经济领域，因此需要跨学科的方法。拟议项目旨在利用多方法和跨学科的“同一健康”研究方法，揭示坦桑尼亚卫生系统和生猪生产部门中AMR的隐性和显性驱动因素。首先，我们将根据文献和政策文件审查以及在人类和动物卫生系统关键地点的参与者观察进行需求评估。第二，我们将进行利益相关者分析，其中将涉及全面绘制参与与适当使用抗菌药物有关的政策过程的行为者范围，包括正式和非正式部门行为者。第三，一旦确定了解决需求评估所指出的关键问题的政治上可行的干预措施，我们将对针对医疗保健和/或兽医系统关键部分的干预措施进行试点测试。第四，我们将向政策制定者展示调查结果，并调查新信息如何影响他们对政策实施的支持或反对。总体预期成果将成为政策建议的成本效益和证据基础，这与坦桑尼亚的人类和动物卫生系统有关。通过与坦桑尼亚的主要政策参与者--包括国家抗生素耐药性协调委员会、技术工作组、秘书处和抗生素耐药性协调中心--合作，我们将提供证据，为实施国家抗生素耐药性行动计划的战略提供信息，并为其他资源有限的国家树立榜样。政策简报以及卫生和兽医系统在抗生素耐药性的贡献和持久性方面的综合证据将是一项关键产出。我们预计，从这项研究中产生的信息将用于加强抗菌药物的分配和使用系统。

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.