Thinking and Working Politically in AMR Surveillance

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DAI is the consortium lead for Fleming Fund Country Grants in Nigeria, Pakistan, Bangladesh, and Indonesia - four countries where overreliance on antibiotic use contributes to the growing threat of antimicrobial resistance (AMR).

Despite each country’s unique AMR and health security challenges, DAI systemically uses the Thinking and Working Politically method – which includes strong political economy analysis, detailed response to the local context, and flexibility in program implementation – to inform daily operations and support a multisectoral One Health approach.

Political Economy Analysis

One tool critical to this method is the Political Economy Analysis (PEA). DAI uses PEA to help operationalize Thinking and Working Politically and inform our implementation strategies. PEAs help provide a better understanding of political and economic dynamics in any setting, including the institutional context needed to sustainably address AMR. PEAs help shape DAI’s implementation strategies by highlighting underlying interests, incentives, historical legacies, social trends, and connecting how these factors effect or impede change. PEAs allow DAI’s teams to make strategic decisions and help investments have a better chance of being sustainable by analysing complex systems of actors, entry points for engagement, and political drivers to effect change.

Conducting a PEA

We apply a flexible framework to conduct a PEA, including the following steps:

• Literature reviews – to gain understanding of the existing literature, identify similar work, review laws and regulations, and identify gaps
• Key informant interview and focus group discussions – to explore and understand local drivers of AMR/AMU and the pathways to change policy and practice
• Stakeholder mapping – to identify entry points for engagement, AMR champions of change
• Policy analysis and budget mapping – to determine policy levers, regulatory impacts, and spending gaps for policy and budget advocacy

The PEA framework and process used under the country grants facilitates stakeholder engagement and provides an opportunity to ensure donor investments have a better chance of being sustained by local counterparts beyond the life of the program.

Thinking and Working Politically, without a PEA

However, it is possible to “think and work politically” even when time does not allow for staff to complete a full PEA. Our team in Bangladesh recently kicked off a six-month programme to examine antibiotic use in hospitals, commercial chicken production, and aquaculture. The team conducted a stakeholder analysis and coordinated with relevant government ministries as well other partners, such as the One Health Poultry Hub, World Health Organization, Food and Agriculture Organization, World Fish, and British Council. By thinking politically, the team was able to leverage, at little to no cost, the expertise of these organizations and develop a multisectoral study design with a One Health approach. These partners will also continue to work with the Bangladesh Country Grant team throughout the implementation of the PPS. By coordinating a political and economic approach across multiple sectors, it creates opportunities for One Health engagement and generates greater AMR/AMU data and information sharing.

In 2020, much of our political insight and advocacy success was due to the understanding we gained while conducting PEAs. Going into 2021, DAI will continue to revisit the PEAs and use the Thinking and Working Politically approach to inform and advance program objectives in Pakistan, Nigeria, Bangladesh, and Indonesia. Our teams will regularly use the PEAs to integrate political analysis into everyday work and help make strategic programmatic decisions. Our continued focus on political analysis will help our programmes deliver strong One Health coordination, evidence-based policymaking, and improve global health security worldwide.

Case Studies

In Nigeria, the team worked directly with the Nigeria CDC and other AMR coordinating bodies to develop and publish a One Health AMR/AMU Governance Manual. This set the groundwork for how sectors will coordinate and collaborate around One Health. It provides information on communication channels across different sectors and a term of reference for government structures.

In Indonesia, the team used PEA to understand the complex ecosystem of government actors. The process highlighted the importance of incorporating government counterparts from the beginning of program implementation to ensure all activities align with national priorities and so that sustainability is prioritized.