Published: 2021-07-27

Learnings from select Indian public welfare programs to catalyze the implementation of India’s national actional plan on antimicrobial resistance

Jyoti Joshi, Anita Kotwani


Antibiotics are an easy, rapid and quick replacement to improved care within fragmented health systems with poor access and infection control measures in many countries, including India. India announced its national action plan for antimicrobial resistance (NAP-AMR) 2017-2021 but has made limited progress. Successful public welfare programs (Delhi metro rail corporation DMRC, swachh bharat mission (SBM), beti bachao beti padao (B3P) and national green tribunal NGT) were reviewed that had addressed critical national concerns similar to AMR. Valuable lessons from their implementation provide the opportunity to improve the governance and operationalization of the NAP-AMR. Unique features of the four programs identified above include resilient leadership, multi-stakeholder coordination with oversight and accountability of partnerships, innovation in program design and implementation and data-driven real-time monitoring for sustained behavior change. Incorporating these strategies into the program design and implementation of India's NAP-AMR will reinvigorate the program to accelerate the achievement of program targets.



National action plan, Antimicrobial resistance, Public welfare programs, India

Full Text:



Willis LD, Chandler C. Quick fix for care, productivity, hygiene and inequality: reframing the entrenched problem of antibiotic overuse. BMJ Glob Health. 2019;4(4):001590.

Walia K, Ohri VC, Mathai D, Antimicrobial Stewardship Programme of ICMR. Antimicrobial stewardship programme (AMSP) practices in India. Indian J Med Res. 2015;142(2):130-8.

Klein EY, Boeckel TPV, Martinez EM, Pant S, Gandra S, Levin SA, et al. Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci U S A. 2018;115(15): 3463-70.

Update on the Work Plan of the Tripartite Memorandum of Understanding for Antimicrobial Resistance to the Programme Committee. Fact sheet: Food and Agriculture Organization (FAO) at the Hundred and Eighth Session 18-22 May 2020. Available at: nc859en.pdf. Accessed on 13 May 2021.

World Health Organization, Food and Agriculture Organization of the United Nations and World Organization for Animal Health. Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries. 2020.

Wellcome. Fact sheet: The Global Response to AMR: Momentum, success, and critical gaps. Available at: files/wellcome-global-response-amr-report.pdf. Accessed on 20 May 2021.

National Centre for Disease Control. Fact sheet: National Action Plan on Antimicrobial Resistance, India, 2020. Available at: Accessed on 13 May 2021.

Pelfrene E, Botgros R, Cavaleri M. Antimicrobial multidrug resistance in the era of COVID-19: a forgotten plight? Antimicrob Resist Infect Control. 2021;10:21.

Knight GM, Glover RE, McQuaid CF, Olaru ID, Gallandat K, Leclerc QJ, et al. Antimicrobial resistance and COVID-19: intersections and implications. Elife. 2021;10:64139.

Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis. 2020;71(9):2459-68.

Mint. Fact sheet: Maharastra government declares mucormycosis a notifiable disease, 2021. Available at: maharashtra-govt-declares-black-fungus-or-mucormycosis-as-a-notifiable-disease-11621933430574.html. Accessed on 13 May 2021.

Hogan AB, Jewell BL, Sherrard-Smith E, et al. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. Lancet Glob Health. 2020;8(9):1132-41.

Turning plans into action for antimicrobial resistance (AMR). Working paper 2.0: implementation and coordination. Geneva: World Health Organization; 2019 (WHO/WSI/AMR/2019.2). Licence: CC BY-NC-SA 3.0 IGO. Available at: Accessed on 20 May 2021.

National Centre of Disease Control. Fact sheet: State Action Plans on AMR. Available at: Accessed on 13 May 2021.

Kamdar M. Planet India: the turbulent rise of the largest democracy and the future of our world. Scribner Book Company; 2008: 192-229.

Gupta R, Nimesh R, Singal GL, Bhalla P, Prinja S. Effectiveness of India's National Programme to save the girl child: experience of BetiBachaoBetiPadao (B3P) programme from Haryana State. Health Policy Plan. 2018;33(7):870-6.

Dubey V. The national green tribunal in Indian perspective. Forensic Res Criminol Int J. 2019;7(5):255-7.

Dandabathula G, Bhardwaj P, Burra M, Rao PVV, Rao SS. Impact assessment of India's swachh bharat mission-clean India campaign on acute diarrheal disease outbreaks: yes, there is a positive change. J Family Med Prim Care. 2019;8(3):1202-8.

Mann ki Baat. Fact sheet: Aatmanirbhar Bharat Abhiyan, 2020. Available at: https://transforming Available at 13 May 2021.