Impacts of Health Systems Governance on Antimicrobial Resistance Containment in Kenya and Vietnam

Governance is a critical determinant in the performance of health systems. However, it is still a relatively under-researched concept in health systems. Specifically, limited studies have been conducted on the role of governance in antimicrobial resistance (AMR) containment especially in low- and middle-income countries (LMICs). Through this research, I will lead a team to understand how health systems governance structures, functions and processes affect AMR containment using Kenya and Vietnam as LMIC case studies. Kenya has a decentralized health system while Vietnam has a centralized one. Although Kenya and Vietnam have national action plans (NAPs) for 2017-2022 and 2013-2020 cycles respectively, which define governance structures, functions and processes for AMR containment, implementation is not optimal. Guided by decentred governance theory, we will investigate AMR governance challenges from a One Health Approach combining literature review, non-participant observations, and interviews with national and subnational officers working in human and livestock health, agriculture, and environment sectors. Globally, we will assess governance structures adopted by World Health Organization (WHO) member states as outlined in the available 131 NAPs and compare performance in relation to the Global Antimicrobial Resistance Surveillance System (GLASS). Overall, we will make a methodological contribution and inform post 2022 NAPs implementation.