Executive summary
In 2018, the National Multisectoral Coordinating Committee on Antimicrobial Resistance1 in Mali, also referred to as the National Coordinating Committee (NCC), published its national action plan (NAP) on the prevention and containment of antimicrobial resistance (AMR), covering the years 2019–20231. The NAP on AMR is well aligned with the World Health Organization’s (WHO) Global Action Plan on AMR, adopts a One Health approach, and details activities and budgets needed for implementation. Recognizing the importance of governmental appropriation of the plan for its sustainable implementation, the NAP on AMR contains a sixth objective that advocates for developing a legislative and regulatory framework for AMR.
The NAP on AMR was developed by the Ministry of Health and Social Affairs,2 in collaboration with the Ministry of Livestock and Fisheries, the Ministry of Agriculture and the Ministry of the Environment, Sanitation and Sustainable Development; however, it awaits formal approval by the prime minister’s office. Unfortunately, the absence of this high-level political endorsement and the absence of dedicated domestic funding and allocation of human resources has impacted implementation and operationalization of the NAP on AMR. Other factors that have negatively impacted implementation include ongoing cycles of political instability, security issues and the coronavirus disease (COVID-19) pandemic.
Despite these challenges, Mali has made progress in addressing and mitigating AMR. The NCC oversees the country’s AMR activities and coordinates national and regional technical groups (TGs) that align with each of the six primary objectives of the NAP on AMR. The Ministry of Health and Social Affairs recently established a One Health platform to provide a multisectoral framework to detect and respond to disease outbreaks of pandemic potential, including a working group dedicated to AMR (2). Interviews with key AMR experts in the country highlighted the need for hiring permanent staff to support NCC activities. In addition, monitoring and evaluation (M&E) activities across the different levels of governance and coordinating mechanisms are crucially needed to identify priority areas.
Due to limited resources, few AMR awareness activities are currently taking place in Mali. While Mali has participated in World Antimicrobial Awareness Week (WAAW), the need for awareness-raising activities at the community and health care level remains. To advocate for action on AMR, researchers and AMR experts in Mali and other African countries have created the African Association for Research and Control of Antimicrobial Resistance (AAAMR), an illustration of the efforts of scientific experts to advance the AMR agenda on the continent.
Significant progress has been made regarding AMR surveillance. In 2019, with support from WHO and the Korea International Cooperation Agency (KOICA), the Ministry of Health and Social Affairs established a patient- based national AMR surveillance system in five hospitals. Additionally, Mali enrolled in WHO’s Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2018. Since then, the country has participated in the data calls of 2019, 2020 and 2021. More recently, Mali also enrolled in the GLASS IT platform for antimicrobial consumption (GLASS-AMC) (3, 4). However, AMR surveillance solutions are needed in regions with less access to health care outside the area of Bamako, the capital city. Expanding AMR surveillance across the country is necessary to get a better understanding of the AMR situation in the country and to support patient care, as well as to make the economic case for investment in activities and interventions to address AMR.
Mali recently updated its national infection prevention and control (IPC) guidelines based on WHO IPC guidelines. IPC committees have been created in 12 facilities across the country, and IPC guidelines are now implemented in the five facilities selected as AMR surveillance sites (5). Despite this progress, the lack of adequate IPC measures in many hospitals in Mali remains a grave concern; IPC monitoring in health care facilities is needed to identify and address critical gaps that contribute to the high incidence of health care-associated infections (HAIs).
Data on the AMR burden in Mali are scarce; however, results from the AMR surveillance network reported to GLASS indicate significant levels of resistance to Watch3 antibiotics (3). Strengthening and expanding laboratory diagnostics and surveillance capacity are necessary to obtain a better view of the health and economic burden imposed by AMR.
Source: World Health Organization