Governance structure for antimicrobial resistance (AMR) and antimicrobial use (AMU) established with FAO support

17 February 2021, Makeni City – The Food and Agriculture Organization of the United Nations (FAO), in close collaboration with the World Health Organization (WHO) have supported the Government of Sierra Leone to establish a One Health governance structure for Antimicrobial resistance (AMR) and Antimicrobial use (AMU) surveillance in the human and animal health sectors.

AMR poses a significant global health threat to human and animal health. It is estimated that, by 2050, ten million people will die every year due to AMR , unless a global response to this problem is mounted. In response to this threat, the Government of Sierra Leone recognized AMR as a priority agenda, and developed a National Strategic Plan for combating Antimicrobial resistance 2018-2022. To implement the interventions stated in the strategic plan, a strong One Health governance structure/mechanism for coordinating national efforts to combat antimicrobial resistance as outlined in the objective one of the strategic plan has been established. The created governance mechanism comprises of a National Multi-sectoral Coordinating Group (NMCG) and Technical Working Groups (TWGs) with clear Terms of Reference (ToRs) to provide technical oversight during implementation of the strategic plan.

With funding support from the United Kingdom (UK) Department of Health and Social Care (DHSC), under its Fleming Fund (FF), FAO is the lead grantee for the animal health component of the Fleming Fund Sierra Leone Country Grant for AMR, whereas WHO is the lead implementing agency for the public health component of the grant. FAO and WHO supported the Government of Sierra Leone through the Ministry of Health and Sanitation (MOHS), Ministry of Agriculture and Forestry (MAF) and Ministry of Environment (MOE)/Environment Protection Agency (EPA) to strengthen the NMCG, which is expected to oversee and coordinate AMR related activities in all sectors to ensure a systematic, comprehensive approach. Dr Joseph Kanu, the Deputy Program Manager for surveillance and National AMR Focal Person, at the opening ceremony of the workshop, emphasized "the importance of establishing a governance structure for AMR and it’s linkage to the National One Health Platform (NOHP). He said “The governance structure is essential to tackle AMR, with a weak governance structure it will be hard to address the AMR challenges”. He further stated that, “NMCG is expected to lead facilitation and coordination of a national response to the threat of AMR. It should be multisectorial with representation from across all the sectors from human, animal and environmental health”. The NMCG was established in 2017 but had never been formalized. The meeting agreed on the organogram and developed Terms of Reference (ToRs) for the NMCG.

Dr. Germain Bobo, Country Team Leader for FAO's Emergency Centre for Transboundary Animal Diseases (ECTAD) said, “No one person, organization, or sector can address issues at the animal-human-environment interface alone, including AMR. By promoting collaboration across all sectors, a One Health approach can achieve the best health outcomes for people, animals, and plants in a shared environment”. He further highlighted the activities under the animal health component of the Fleming Fund country grant for AMR which includes a situational analysis of AMR/AMU in food animals and development of a national surveillance plan for AMR in animal health.

According to the WHO Infection Prevention and Control (IPC) Lead, Anna Maruta, “The governance structure is essential to tackle AMR, and the scope should be broad enough to address all five strategic objectives of the global action plan, prioritizing activities in a step-wise approach”. She further added that, “the NMCG must be appropriately integrated and have clearly defined roles and responsibilities in the existing health system, public health and disease-specific programmes, animal health and production, the food sector and environmental initiatives”.

The meeting deliberated and agreed on the One Health governance structure for AMR and linked the proposed structure to the existing and operational Sierra Leone structure at the One Health Coordination Committee level and will be supported by a secretariat to be funded by WHO.

Establishment of the Technical Working Groups (TWGs) for AMR/AMU

Below the NMCG, the One Health AMR Technical Committee was established with three TWGs to lead various thematic areas as follows; (i) surveillance and laboratory, (ii) education and research, and (iii) AMR stewardship TWGs. Their ToRs have been developed that outline their roles and responsibilities with membership defined.

The Fleming Fund Country Grant for Sierra Leone focuses on setting the foundations for AMR and AMU surveillance in the human and animal health sectors. The grant will run for 13 months, to further support One Health approach for AMR surveillance, the situational analysis of antibiotic use in food animals in the country and the development of the national surveillance plan for AMR in animal health.