Policy-makers and governments are calling for coordination to address the crisis emerging from the ineffectiveness of current antibiotics and stagnated pipeline of new ones – antimicrobial resistance (AMR). Wider contextual drivers and mechanisms are contributing to shifts in governance strategies in healthcare, but are national health system approaches aligned with strategies required to tackle antimicrobial resistance? A review by Birgand, et al. (2018) provides an analysis of governance approaches within healthcare systems including: priority setting, performance monitoring and accountability for AMR prevention in three European countries: England, France and Germany. Advantages and unresolved issues from these different experiences are reported, concluding that mechanisms are needed to support partnerships between healthcare professionals and patients with democratized decision-making and accountability via collaboration. But along with this multi-stakeholder approach to governance, a balance between regulation and persuasion is needed.
The researchers acknowledge, "The global challenge of antimicrobial resistance (AMR) requires coordination across governments, country borders, health and non-health sectors to maintain effectiveness of antimicrobials. Effective governance has emerged as a crucial attribute deemed essential for sustained healthcare system performance and safety. To address AMR, effective governance needs to extend wider than considering just human health, including agriculture and animal health, but the coordination of efforts to manage inappropriate use of antibiotics within human health still requires much work. Approaches to governance to address AMR serve as a test bed for health system governance more widely when thinking about specific and complex public health challenges. The issue of AMR cuts across health conditions, organizations and professionals. It is estimated that around 700,000 people die each year from drug resistant infections and experts predict an alarming increase to 10 million lives each year by 2050. AMR threatens the practice of basic surgical procedures as well as advancements in medicine, as there are now high proportions of AMR in bacteria that cause common infections. A key component of addressing AMR is to prevent healthcare-associated infections; infections that develop as a direct result of medical or surgical treatment or contact in a healthcare setting."
Birgand, et al. (2018) conclude, "We suggest that the characteristics of the English health policy system generally, and also AMR policy field specifically, diverge from those found in France and Germany in some important ways. It is more top down, more managerial and with a strong emphasis on the setting and monitoring of targets and key performance indicators, and the provision of performance data. An implication is that it will not be easy to align governance systems for AMR across the three countries as they reflect the distinctive health policy fields found in each jurisdiction."
Reference: Birgand G, et al. Comparison of governance approaches for the control of antimicrobial resistance: Analysis of three European countries. Antimicrobial Resistance & Infection Control. 2018;7:28.