Archived Results at a glance - Evaluation of the Coordination of Antimicrobial Resistance (AMR) Activities at the Public Health Agency of Canada (PHAC)   

Introduction

• PHAC’s antimicrobial resistance (AMR) activities include coordinating the development of federal and pan-Canadian Frameworks and Action Plans as well as actions in the area of surveillance, stewardship, infection prevention and control, and research and innovation. PHAC is also Canada’s point of contact on various international initiatives.

• Between 2013-2014 and 2017-2018, PHAC spent, on average, $8.5M per year for AMR activities. Most of this funding is dedicated to surveillance systems.

Background

• AMR has been recognized as one of the most serious global health threats facing the world today. Estimates show that, if no action is taken to reduce its spread, by 2050 AMR could lead to 10 million deaths worldwide every year and the annual reduction in global Gross Domestic Product could be as large as the losses resulting from the 2008–2009 global financial crisis.

What the evaluation found

• PHAC has made significant accomplishments to address AMR over the last five years. There is also general agreement among partners and stakeholders that the development of the two Frameworks and the federal Action Plan was a major endeavour that PHAC has successfully coordinated.
• However, progress made to date appears to be slow considering that PHAC committed to establishing a pan-Canadian strategy by mid-2015. PHAC released a pan-Canadian Framework in 2017 with a corresponding Action Plan expected for summer or early fall 2019.
• The evaluation did not find conclusive evidence that Canada has had a sufficient level of leadership and prioritization on the AMR file. Questions remain as to PHAC’s role as a national leader, responsible for raising the profile of the file and mobilizing stakeholders to take coordinated action in the area. Partners’ expectations with respect to PHAC’s role do not align with perceptions within the Agency.
• Many of PHAC’s activities to address AMR have essentially been conducted in a reactive manner. At the time of the evaluation, PHAC did not have the organizational structures, stable resource allocations for some activities, nor did it have a vision in place to address AMR in the longer-term. Notwithstanding, some actions have started to be put in place at the time of the evaluation.
• Canada has to strengthen the operationalization and monitoring of the implementation of an Action Plan, the integration of surveillance systems and the awareness of AMR among all key stakeholders (e.g., general public, doctors, pharmacists, nurses, dentists, medicine sellers).

Recommendations and responses

1. PHAC should clearly articulate its roles, responsibilities and priorities to address AMR within the federal and pan-Canadian landscape.
   Response: PHAC will develop and share statement on PHAC roles and long-term objectives on AMR.
2. PHAC should have open and regular communications with its federal and pan-Canadian partners on its role, responsibilities and priorities in addressing AMR, and on current work and next steps to meet federal and pan-Canadian commitments.
   Response: PHAC will develop and share a stakeholder engagement plan.
3. PHAC should establish the necessary structures to ensure all of its AMR activities, including policy and surveillance, are coordinated efficiently or integrated, where relevant. It should also continue work to establish an AMR program with clear accountability to accomplish its role in addressing AMR.
   Response: PHAC will examine existing activities and desired results vis-à-vis PHAC roles and responsibilities.
4. PHAC should make every effort it can to ensure the timely release of the pan-Canadian Action Plan by summer or early fall of 2019.
   Response: PHAC will review and revise the critical path for the pan-Canadian Action Plan.

About this evaluation

This evaluation examined the design, delivery and coordination of PHAC’s antimicrobial resistance (AMR) activities since 2013-2014. Data collection methods included: Literature review, document and file review, key informant interviews (with 47 internal and external stakeholders) and a review of financial data.

March 2019