Turning plans into action: The ‘Smart Choice’ to tackle Antimicrobial Resistance.

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Low- and middle-income countries (LMICs) face limited resources and competing priorities, making it critical to identify which antimicrobial resistance National Action Plan (AMR NAP) interventions to implement first. The Smart Choice Process (SCP) is an evidence-informed and systematic way to turn policy into action.

The SCP is a One Health, multisectoral approach developed by the AMR Policy Accelerator at the Global Strategy Lab, York University, to guide governments in prioritising their AMR NAP interventions. The SCP assesses interventions based on their feasibility, impact, and alignment with local needs across human, animal, and environmental health sectors, and has been piloted in five countries: Malawi, Kenya, Uganda, Zimbabwe, and Zambia.

Supported by the Fleming Fund Regional Grant, the AMROH ESA project (Antimicrobial Resistance and One Health in East and Southern Africa) and in collaboration with the International Livestock Research Institute (ILRI), the SCP is part of a broader initiative focused on improving AMR management and antimicrobial use.

Above: Smart Choice Process Workshop in Zambia (credit: Global Strategy Lab).

With AMR as a major global health threat, common infections are harder and costlier to treat. LMICs are particularly vulnerable, as limited access to healthcare, poor sanitation, and unregulated antimicrobial use accelerate resistance. In response, the World Health Assembly adopted the Global Action Plan (GAP) on AMR in 2015; in 2016, a Political Declaration was adopted by the UN General Assembly, with member states committing to develop multisectoral NAPs.

However, implementation remains limited. Only 24% of countries report having effectively implemented their NAPs, just 10% have dedicated domestic financing, and 51% report that their multisectoral coordination mechanisms are non-functional. With inadequate resources, the challenge of managing numerous complex interventions alongside competing priorities is stark. Systematic evidence-informed prioritisation, focusing on infrastructure and resources, enables countries to demonstrate results and make the most of existing resource investments.

How does it work?

The SCP is a systematic, country-owned, participatory approach that brings together AMR experts from across the One Health sectors. The SCP supports national stakeholders and policymakers in transparently prioritising their NAP AMR interventions by fostering cross-sectoral dialogue and shared ownership. Throughout piloting the SCP, participants reported that the process offers clear and actionable guidance to inform prioritisation and advance strategic NAP implementation planning.

Stakeholders across the OH sectors complete a Prioritisation Scoring Tool, rating NAP interventions against seven indicators − cost, impact, equity, timeline, alignment, root drivers, and transformative potential. Interventions emerging as high-ranked by experts are then mapped onto the Smart Choice decision-making framework, which organises interventions into:

Interventions emerging as high-ranked by experts are then mapped onto the Smart Choice decision-making framework, which organises interventions into

• • Quick wins: interventions that deliver quick impact on a short timeline.
• • Best buys: interventions that achieve strong impact at low cost.
• • Game changers: interventions that tackle root system causes and enable sustainable, long-term improvements.
• • Equity drivers: interventions that ensure underserved populations and areas are not left behind.

Interventions that score highly across two or more of the four categories are identified as ‘Smart Choices’ and form the basis of facilitated multi-sectoral discussions. Over two days, participants work in groups to build consensus on priority interventions, discuss feasibility, and outline implementation considerations. The process integrates both the Smart Choice decision-making framework results and participants’ contextual knowledge, guiding policymakers to balance the factors of feasibility, sustainability, and local contexts.

Advancing AMR action

Sectoral representatives who have participated in the SCP highlight that one of its key strengths lies in convening multisector technical experts and policymakers, ensuring diverse perspectives are represented. The inclusive design fosters trust and shared ownership, while the structured dialogues and associated prioritisation tools help to refine, build on next steps, and guide more strategic resource allocation and coordinated implementation.

Stakeholders have further highlighted that SCP encourages collaboration across ministries and sectors, strengthening both technical and political commitment. They also strongly recommend the workshop to others involved in AMR policy development, emphasising the process’s ability to translate broad ambitions into concrete and actionable steps. By facilitating agreement and cross-sector collaboration, the SCP enables countries to turn national plans into achievable, prioritised outcomes.

What’s next?

After successfully piloting the SCP in five different settings, the AMR Policy Accelerator is moving forward with the development of a ‘training of facilitators’ model to strengthen country-level capacity. This approach aims to equip in-country facilitators with the knowledge and skills needed to lead and manage the prioritisation process in the fight against AMR.

“Strong AMR governance is critical in the fight against AMR. We have previously collaborated with the Global Strategy Lab and the AMR Policy Accelerator through the Fleming Fund Fellowships, and I am delighted we could extend this partnership to AMROH and support five of the eight AMROH countries," said Dr Arshnee Moodley, AMROH Representative. "The SCP is a perfect tool for helping countries prioritise actions where resources are limited and challenges are many. I am incredibly pleased with this collaboration and the valuable support provided to our regional efforts.”

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