Developing the Nigeria One Health National Action Plan on Antimicrobial Resistance (2.0)

Since the launch of Nigeria’s first National Action Plan (NAP 1.0), the country has made significant progress in mitigating antimicrobial resistance (AMR). Antimicrobial Resistance (AMR) occurs when antimicrobials become ineffective and lose their ability to kill or inhibit the growth of pathogens for which they were previously effective. This resistance makes antimicrobial medications, including antibiotics, ineffective and makes treating infections challenging or impossible. This raises the risk of disease spread, and results in serious illness, disability, and death.

Aware of the threat posed by AMR, the World Health Assembly (WHA) approved the Global Action Plan on Antimicrobial Resistance (GAP) in 2015. Among its aims was the requirement that all Member States had national action plans (NAPs) that were in line with GAP’s goals by 2017. Nigeria was 1 of the 100 countries that prepared a NAP by the end of March 2018. Nigeria’s first NAP for AMR was a five-year plan (2017–2022) outlining goals drawn from examining the strengths, weaknesses, risks, and opportunities of the national AMR situation to mitigate the crisis.

Since the introduction of the NAP on AMR, Nigeria has made strides in addressing AMR in several arenas. For example, in education, AMR was introduced in core curricula in some pre-and in-service training and other continuing professional development for human health workers. Numerous Nigerian schools have adopted and implemented core curricula for undergraduate and graduate veterinarians as well as veterinary paraprofessionals to guarantee coverage of AMR and sensible antimicrobial usage in tertiary education and training programs as well.

The country’s AMR status and the level of implementation had to be evaluated after the NAP expired in 2022, and the main conclusions from this assessment would be incorporated into the creation of the subsequent NAP. As a World Health Organization (WHO) Collaborating Centre, the One Health Trust (OHT) aided in conducting the evaluation (situational analysis) of Nigeria’s NAP 1.0. The OHT Africa Team carried out the analysis with support from representatives of the Nigeria Centre for Disease Control, the Federal Ministry of Health, the Federal Ministry of Agriculture and Food Safety, the Federal Ministry of Environment, and the WHO Country Office.

Following completion of the situational analysis, a workshop on the development of the One Health National Action Plan on Antimicrobial Resistance (AMR NAP 2.0) was held in Abuja, the federal capital territory of Nigeria. The workshop attendees included important AMR stakeholders from the nation’s animal, human, and environmental sectors. OHT was invited to provide input regarding the development of the new NAP, having played a major role in the preparation of the country’s situational analysis document. I (Oluwatosin Ajayi, OHT Research Analyst) was privileged to represent the OHT team at the five-day workshop.

OHT’s Dr. Oluwatosin Ajayi at the workshop

The workshop started with a meet and greet session on Tuesday, October 24, 2023. I had a chance to get to know other participants from different sectors including academic researchers from tertiary institutions across the country; directors of pharmaceutical and medical institutes; founders of AMR-related non-governmental organizations; and representatives from the World Health Organization and World Organization for Animal Health. The NAP 2.0 workshop’s goals were then discussed and there was a presentation outlining the NAP development process in other African nations. After that, the attendees were split up into five groups according to NAP priority areas.

Some of the workshop participants

The NAP priority areas were awareness and knowledge of AMR; One Health surveillance on AMR and multidrug-resistant organisms; infection prevention and control, biosecurity, and WASH; antimicrobial stewardship programs; and research, development, and innovation. The fact that everyone was grouped based on their area of expertise made the tasks interesting. The infection prevention and control (IPC) team members, for example, stressed the need for vaccination and good hygiene in limiting exposure to harmful pathogens, which will lessen the need for antimicrobial usage and ultimately reduce the incidence of AMR. Being a Research analyst, I was in the Research group. At the end of day one, each group had to deliberate, review, and provide feedback on the strategic objectives for the NAP priorities.

The task for each group on the second and third days was to develop priority intervention and operational plans for their group. My group had to develop the operational plans for the research priority focus of the NAP. It was an interesting but challenging task, knowing the impact the exercise would have on Nigeria’s health system. The research team consisted of professors from medical backgrounds, environmental health professionals, veterinarians, and biomedical researchers. Everyone expressed their thoughts, discussed their points of view, and contributed by drawing on their experience and expertise during the highly dynamic session.

The research group during the development of the strategic and operational plans

The fourth and fifth days of the training were devoted to creating strategies for monitoring and evaluating the NAP operational plans. With all of the workshop objectives met by the end the fifth and last day, the Nigeria AMR Coordination Committee Chairperson expressed gratitude to all attendees for their hard work, dedication, and contributions to the creation of the new NAP.