As most of you know, antimicrobial resistance (AMR) is an escalating global crisis that jeopardizes the progress made in healthcare, agriculture, and sustainable development. In Africa, the specific impact of AMR-related infections on the population varies across countries. However, it is estimated that thousands of people die annually in Africa due to AMR-related infections ( with 27.3 deaths per 100,000 attributed to AMR ). In response to the severity of the situation, the Africa Centres for Disease Control and Prevention (Africa CDC) initiated an ambitious strategy to assist African Union member state countries in mitigating the detrimental effects of resistant pathogens and reducing mortality rates throughout the continent. This article emphasizes the urgent need for an effective AMR National Action Plan in South Sudan, which includes a One Health approach to address the interconnectedness of healthcare, agriculture, and the environment in tackling AMR comprehensively. By highlighting the risks posed by AMR to public health, food security, and national sustainability, we also hope to prompt action from national leaders, policymakers, and stakeholders to allocate resources, strengthen healthcare systems, implement regulations, and foster international cooperation in the fight against AMR.
AMR in South Sudan
South Sudan, a country affected by conflict and health challenges, stands particularly vulnerable to this silent threat. As the youngest country on the African continent, South Sudan has a population of approximately 10.75 million and is one of the countries with the highest poverty rates ( 83.3%), according to the World Bank poverty headcount ratio at national poverty lines. Overall life expectancy at birth is around 55 years. The country also has one of the largest populations of livestock in Africa. 80 % of the population make a living from the sale and consumption of animal products. The covid-19 pandemic further strained the impoverished country’s scarce resources undermining the gains made over the years, making the country even more vulnerable. The urgent need to address antimicrobial resistance within South Sudan cannot be overstated, as it poses significant risks to public health, food security, and overall national sustainability.
Antimicrobial resistance occurs when microorganisms evolve to resist drugs designed to kill them. Overuse and misuse of antibiotics contribute to the emergence of resistant strains which particularly has dire consequences for developing economies like South Sudan. The country faces multiple challenges, including a fragile healthcare system, weak regulatory frameworks, inadequate surveillance systems, limited access to clean water and sanitation, and ongoing conflict. In settings like South Sudan, where healthcare resources are strained, resistant infections result in higher mortality rates, increased healthcare costs, and longer hospital stays. The agricultural and animal sector also faces risks, such as reduced productivity and food insecurity, due to the common use of antimicrobials. Recent AMR situational analysis revealed (limited) data on the AMR burden in the country. There is evidence of cases of multidrug-resistant and rifampicin-resistant TB. Studies also highlight high levels of inappropriate antibiotic use in hospitals and weak capacities for Infection Prevention and Control (IPC) and Water Hygiene and Sanitation (WASH).
The urgent need for an effective AMR National Action Plan
Given the urgent need to address AMR, the development and implementation of a comprehensive and effective National Action Plan for AMR is crucial for countries in Africa as it serves as a roadmap for these countries to tackle this growing issue. Two months ago, Africa CDC, in collaboration with the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) supported a three-week-long activity in South Sudan. The objective was to develop an AMR National Action Plan and operational strategies to mitigate the looming crisis in the country. This initiative aligns with the World Health Organization’s global action plan on AMR, which has prompted many countries worldwide to develop their own AMR national action plans and make an economic case for mobilizing resources and sustainable funding.
It is worth noting that many African countries allocate a relatively low budget to the healthcare sector which severely undermines efforts to control and combat infectious diseases in Africa. This limited funding further underscores the importance of swift action and comprehensive strategies to combat the growing AMR crisis and secure a sustainable future for the nations through a multisectoral One Health approach. The Republic of South Sudan, as a signatory to the International Health Regulations (IHR) 2005, had its implementation of the regulation evaluated through a Joint External Evaluation (JEE) in 2017. The JEE report emphasized the lack of capacity within the country to address AMR and other public health events of international concern. In response, South Sudan, with support from partners, proceeded to develop its National Action Plan for Health Security (NAPHS) (launched in 2020), which incorporated interventions to tackle AMR based on JEE recommendations. To address AMR comprehensively and promote sustainable practices, the country has adopted a One Health approach. This approach emphasizes the collaboration and coordination of efforts across the health, agriculture, and environmental sectors.
The country also recognized the significance of having a dedicated plan specifically targeting AMR. Consequently, the National Action Plan for Antimicrobial Resistance was formulated. This plan assumes a critical role in guiding the implementation and monitoring of AMR activities within the country. It is developed based on the progress made with the National Action Plan for Health Security, ensuring a strategic approach to curbing the spread of AMR and mitigating its impact. This comprehensive plan acknowledges the interconnectedness of different sectors, including agriculture, highlighting the need for integrated interventions. The widespread and improper use of antimicrobials in animal husbandry and crop protection practices increases the likelihood of reduced productivity and food insecurity. With this well-crafted National AMR plan, there is a positive outlook for a significant reduction in the incidence of drug-resistant infections in the country, if national leaders, policy makers, and international partners commit to prioritizing and allocating resources to address AMR in the country.
Conclusion
Addressing antimicrobial resistance in South Sudan requires a collaborative approach. Raising awareness among healthcare professionals, policymakers, and the public is crucial. National leaders and policymakers must now commit to implementing the action plan and allocating resources. Multisectoral collaboration across healthcare, agriculture, and regulatory bodies, along with strong disease surveillance systems, is necessary. Enhancing laboratory capacity and promoting appropriate prescribing practices are important. Robust regulations and collaboration with neighboring countries are needed to control the sale of counterfeit drugs. International cooperation, capacity building, and funding support are clearly also essential. Sharing knowledge and best practices will aid in combating AMR effectively. South Sudan must prioritize the fight against AMR to safeguard public health, secure food production, and foster sustainable development. By raising awareness, strengthening healthcare systems, implementing regulations, and fostering international cooperation, South Sudan can ensure a healthier and more sustainable future.
Acting now is crucial in the face of this urgent threat.
.Picture of the South Sudan team that successfully completed the WHO costing and budgeting tool for NAPs on AMR