From Policy Commitments to Implementation: A Document-Based Assessment of Bangladesh’s National Antimicrobial Resistance Strategy (2023–2028)
Md Ashik Ahmmed
Abstract
Antimicrobial resistance (AMR) is a major public health challenge requiring coordinated action across human, animal, food-production, and environmental systems. Bangladesh’s National Strategy and Action Plan for Antimicrobial Resistance Containment (2023–2028) establishes a multisectoral policy framework, but assessing implementation requires verifiable evidence beyond formal policy commitments.
Objective: This study assesses Bangladesh’s AMR policy architecture, publicly documented surveillance capacity, cross-sector coordination, and accountability requirements relevant to implementing the national strategy.
Methods: A focused, document-based policy assessment was conducted using Bangladesh’s National Strategy and Action Plan for Antimicrobial Resistance Containment (2023–2028), official antimicrobial resistance surveillance information from the Institute of Epidemiology, Disease Control and Research (IEDCR), and the World Health Organization’s Joint External Evaluation (JEE) for Bangladesh, conducted in July 2024 and published in 2025. The documents were examined thematically across governance, surveillance, infection prevention and control, antimicrobial use, One Health coordination, financing, and monitoring. The study did not involve primary data collection or constitute a systematic review of all published AMR research.
Results: The reviewed sources document a national AMR strategy, an established human-health surveillance programme, and a public surveillance reporting infrastructure. WHO’s 2024 JEE reported AMR-related capacity scores of 4 for multisectoral coordination, 4 for AMR surveillance, 2 for preventing the transmission of multidrug-resistant organisms in healthcare, 3 for optimal antimicrobial use in human health, and 4 for optimal antimicrobial use across human and animal health and agriculture. These scores indicate variation in assessed capacity across the AMR response. The review also identified limitations in the consistency of publicly available surveillance-site descriptions and the availability of clearly traceable, nationally representative indicators for antimicrobial use and implementation progress. The findings do not establish that activities lacking public documentation have not occurred.
Conclusion: Bangladesh’s AMR strategy provides an important policy foundation, but stronger public accountability requires transparent indicators, defined denominators, dated surveillance information, sector-specific monitoring, documented financing, and independent verification. This paper proposes the Commitment-to-Evidence Chain (CEEC) as a practical document-analysis heuristic for tracing policy commitments through institutional ownership, resourcing, delivery, and verification. The framework remains conceptual and requires further testing and validation.
Keywords: antimicrobial resistance; Bangladesh; One Health; health policy; surveillance; antimicrobial stewardship; policy implementation; accountability.