2021 TRIPARTITE COUNTRY SELF-ASSESSMENT SURVEY (TRACSS): WHO AFRICAN

REGION RESULTS OVERVIEW FOR HUMAN HEALTH SECTOR

Over the past 5 years, the WHO African Region (AFRO) Member States (MS) have participated in the annual Tripartite
AMR Country Self-assessment Survey (TrACSS) as part of global monitoring efforts on the implementation of National
Action Plans (NAPs), and in addressing AMR, in the context of a One Health approach. Forty-one (87%) MS in the
region responded to the 2021 TrACSS round, the highest of all five years; this is a summary of results 2021 TrACSS for
the human health sector.
Key highlights from the 2021 TrACSS

• The 2021 TrACSS responses show that 35 (85%)
of the responding countries have National Action
Plans (NAPs) developed. However, only 15% of
those are implementing and actively monitoring
their NAPs with monitoring and evaluation in
place.
• 98% of responding countries reported that
COVID-19 negatively impacted NAP development
and implementation. Therefore, COVID-19 could
offer opportunities to address challenges on AMR
threats through implementation of cross-cutting
areas.
• 37% of the responding countries have functional
multisectoral working groups and coordination
mechanisms. More than half (54%) of countries
have established multi-sectoral working groups;
however, these are yet to be functional.
• Human and animal health are the sectors most
actively involved in NAP development. Around
98% of countries responded to having both
sectors involved.
• On raising awareness on AMR, 71% of countries
conduct limited or small-scale antimicrobial
resistance awareness campaigns. Also, over half
of countries (59%) are covering AMR in at least
some pre-and in-service training for human
health workers.
• Overall, there are ongoing data collection
activities for AMR surveillance in human health at
national level. 51% percent of countries are
collecting AMR data nationally. 56% of countries
also reported having National Regulatory
Authority or a National Reference Laboratory
that have issued national guidelines for bacterial
isolation, identification and antibacterial
susceptibility testing based on international
standards.
• 83% of countries reported having laws or
regulations in place on prescription and sale of
antimicrobials for human use. However, 32%
countries have systems for Monitoring
antimicrobial use/ sale in human health at
national and sub-national levels.
• Infection Prevention Control (IPC) in human
health: 56% of countries have IPC programs being
implemented only at select health facilities; of
those, 17% have their national IPC programs
according to WHO IPC core components
guidelines.
• On optimizing antimicrobial use in human health,
almost half of the countries (46%) are
implementing practices for appropriate AM use
in at least some health facilities and have
guidelines for appropriate use of antimicrobials.
• 39% of countries have adopted the WHO AWaRe
(Access Watch Reserve) classification of
antibiotics in their national essential medicines
list. 49% reported knowledge about the AWaRe
classification

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 Moving forward: Regional Recommendations for country action

We recognize the commendable strides made by the WHO African Region Member States in the implementation
of their one health AMR NAPs. However, gaps still exist; thus, requiring both a holistic and targeted cross-cutting
approaches which also leverage ongoing initiatives to strengthen health systems, achieve Universal Health
Coverage and enhance health security including the implementation of COVID-19 response plan.

Implementing AMR NAPs: majority of countries
have developed AMR NAPs, but there is an urgent
need to expedite implementation, through
prioritization based on context and available
resources, costing, funding, and monitoring.
Governments need to map out local funding which
is critical for long term sustainability of
implementation. AMR NAPs should also be linked to
critical priorities and agendas across all sectors
including national health sector plans and budgets.
Multisectoral coordination: there is a need to build
capacity to ensure effective functioning of AMR
multisectoral coordination structures in the spirit of
the One Health approach, with legal tools and clear
lines of authority to the highest level possible to
ensure accountability and strong political leadership,
but low enough to ensure action and transformation
on the ground.
Advancing awareness and education on AMR:
Promote nationwide awareness campaign targeting
the majority of priority stakeholder groups, including
pre-primary to secondary school students. Systemic
and formal inclusion of AMR in pre-service curricula
and in-service continuous professional development
(CPD) is needed to enhance knowledge among key
groups.
Enhancing data quality and use and establish
monitoring systems for AM consumption: Strengthen
capacity for systematic data collection and reporting
using the existing WHO platform such as Global
antimicrobial resistance surveillance system (GLASS),
nationally established linkages leveraging existing
interoperable systems such as the Health Information
System and sustainable financing to ensure robust
AMR/AMC surveillance systems. Strengthen
laboratory diagnostic capacity, including Quality
Management Systems and commodity security that
are essential for the collection of accurate AMR
surveillance data needed to inform policy and action
through development or revision of treatment
guidelines and strengthen antimicrobial stewardship
efforts.
Implementing national IPC programmes/WASH:
strengthen country capacity for nationwide
implementation of infection prevention and control
(IPC) and Water Sanitation and Hygiene (WASH)
programmes. Where necessary, we recommend the
use of existing tools to strengthen IPC core
components at National and Health facility level. This
should also include scaling up of WASH measures in
healthcare facilities, and routine immunization efforts,
which form an integral part of addressing AMR.
Monitoring antimicrobial use: strengthen the national
context-specific stewardship programs to ensure that
regulations guide and prioritize the need to close gaps
in access to essential, quality and effective
antimicrobials. 16 countries have adopted the AWaRe
(Access, Watch and Reserve) classification into their
national EML (Essential Medicines List), hence
targeted support should be provided to accelerate
adoption of AWaRe in countries that are yet to adopt.
In addition, studies on behaviour change need to be
conducted for appropriate antimicrobial use.

WHO African Region Member States 5-Year TrACSS Participation Rates

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 ● 2021 TRACSS REGIONAL OVERVIEW ●

87% (n=41)

66% (n=31)
62% (n=29)
57% (n=27)

40% (n=19)

2016/17 2017/18 2018/19 2019/20 2020/21

Progress across the human health indicators

Multi-sectoral Working Groups AMR National Action Plans (NAPs)

22(54%)
15(37%)
14(34%)

6(15%)
6(15%) 5(12%)
5(12%)
4(10%) 4(10%)

1(2%)

A B C D E
A B C D E

Awareness raising on AMR Training and professional education on AMR

21(51%)
20(49%)

14(34%)

9(22%)
8(20%)

3(7%) 3(7%)
2(5%)
1(2%) 1(2%)

A B C D E A B C D NR

National surveillance system for AMR in National monitoring system for use/sale of
human health antimicrobials in human health

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 ● 2021 TRACSS REGIONAL OVERVIEW ●

14(34%) 18(44%)

12(29%)

8(20%) 10(24%)

6(15%)
4(10%) 5(12%)

2(5%) 2(5%)
1(2%)

A B C D E NR A B C D E

Infection prevention and control (IPC) in

human health care Policies to Optimize AMU in humans

15(37%)
16(39%) 14(34%)

12(29%)

7(17%)

6(15%)
5(12%)
4(10%)

1(2%) 1(2%) 1(2%)

A B C D E NR A B C D NR

For most indicators, levels A-B represent limited capacity and levels C-E nationwide implementation. Countries should be aiming to reach levels C-E.

A B C D E
no limited developed demonstrated sustained
capacity capacity capacity capacity capacity

Resources:
Antimicrobial Resistance in WHO Africa
Antimicrobial Resistance Resource Pack
Global Database for the TrACSS

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