An Equity-Focused Systematic Analysis of Antimicrobial Resistance National Action Plans in 14 West African Countries.

Abstract

Objectives: Antimicrobial resistance is a growing global health threat that disproportionately affects socially and economically disadvantaged populations. National Action Plans are critical for coordinating national responses, but the extent to which they address equity remains unclear. This study assessed how antimicrobial resistance National Action Plans from 14 West African countries incorporate equity considerations.

Methods: We reviewed antimicrobial resistance National Action Plans from 14 West African countries using a four-domain equity framework: (1) recognition of equity, (2) identification of vulnerable populations, (3) inclusion of equity-oriented interventions and (4) integration of equity into governance and monitoring. We assessed whether National Action Plans acknowledged 16 high-risk groups, including people living with HIV, displaced or mobile populations, children and adolescents, older adults, people with mental health disorders, rural residents, people with chronic illnesses, people living with disabilities, pregnant women, low-income populations, healthcare workers, people with substance use disorders, incarcerated populations, indigenous or minority groups, homeless populations and migrants or seasonal workers.

Results: All National Action Plans adopted a One Health approach, but equity was inconsistently addressed. Most did not explicitly reference equity, and none included equity-related indicators in monitoring frameworks. Healthcare workers and rural populations were the most frequently mentioned groups. Common interventions included hygiene promotion, public awareness campaigns and training of healthcare workers, but these were largely generic and rarely adapted to the specific needs of marginalised populations. Stakeholder engagement was often multisectoral but seldom ensured the participation of disadvantaged groups. Across the region, the lack of disaggregated data and tailored strategies highlights a significant equity gap.

Conclusion: Equity remains insufficiently integrated into antimicrobial resistance governance in West Africa. Future National Action Plans must explicitly identify at-risk populations, include equity indicators and involve affected communities in planning and oversight. Embedding equity is essential to building resilient and people-centred antimicrobial resistance strategies.