As part of the ICARS Sustainable Impact and Antimicrobial Resistance (AMR) project, our team conducted an online survey to better understand how sustainability is currently understood and applied in AMR interventions across low- and middle-income countries (LMICs). The survey gathered responses from 34 participants, representing a diverse cross-section of ICARS-supported project teams working across human health, animal health, environmental health, and broader One Health–related fields. The goal of the survey was to learn directly from AMR project implementers, researchers, and policymakers about what sustainability means in practice, and how it is being operationalized in real-world AMR projects.
Who Responded to the Survey?
Most respondents came from the human health (47%) and animal health (41%) sectors, with smaller representation from environmental health and other disciplines such as social science and finance. While this reflects the current focus of many AMR projects, it also highlighted an important gap that environmental and social dimensions of One Health remain underrepresented in AMR sustainability discussions and project design.
How Do AMR Practitioners Define “Sustainable Impact”?
Encouragingly, respondents broadly aligned with the working definition of sustainable impact developed under Work Package 1 (WP1). Many further described sustainability as creating lasting, positive change, strengthening local systems and institutions, building capacity and ownership, ensuring continuity beyond the life of a project, integrating AMR efforts into policy and practice, and more. Words such as change, lasting, capacity, policy, and funding appeared repeatedly, showing that practitioners think about sustainability as both impact and continuity, not just short-term results.
What Sustainability Strategies Are Being Used?
The survey showed strong uptake of participatory and systems-focused approaches, including Stakeholder mapping (71%), Capacity building (68%), Local co-development of interventions (65%), Policy engagement (59%) and Ownership mechanisms (56%). However, it also revealed clear gaps with fewer projects reported integrating financial sustainability plans (18%), monitoring beyond the project lifecycle (15%), exit or transition strategies (12%), and business-case development (<5%)
In short, many projects do well at engaging people and building capacity but struggle with long-term financing, transition planning, and continuity after funding ends.
What Does “Sustainability” Look Like on the Ground?
When asked how they would recognize sustainability, respondents pointed most strongly to behaviour change (91%), capacity building (85%), community ownership (85%), and institutionalization and legislative integration (>70%). Interestingly, policy uptake alone was seen as a weak indicator of sustainability, suggesting that policy matters most when it is accompanied by real implementation, ownership, and system change.
Monitoring, Evaluation, and Learning (MEL): A Missing Link?
The survey explored whether certain factors, such as experience, sector, or number of sustainability strategies, made projects more likely to use MEL systems.
The answer? Not really. Statistical analysis showed no strong or consistent drivers of MEL use. Even experienced practitioners were not significantly more likely to use structured MEL systems, and sectoral differences were minimal. This points to a broader issue that may indicate that MEL for sustainability is not yet systematically embedded in AMR programming.
Different “Profiles” of Sustainability Thinking
A deeper analysis revealed that AMR practitioners tend to cluster into different sustainability “profiles,” such as capacity and institutionalization–focused approaches, policy- and legislation-driven strategies, behavioural and stakeholder mapping approaches, hybrid models combining behaviour change and financing, and strong policy integration pathways
These profiles show that there is no single pathway to sustainability, but also reinforce the need for a shared framework that helps projects think holistically and consistently about long-term impact.
Why This Survey Matters
The survey findings complement the systematic literature review conducted under WP1, adding real-world perspectives to academic evidence. Together, they highlight both strengths and blind spots in how sustainability is currently approached in AMR interventions. Most importantly, the results reaffirm the value of the Sustainable Impact Framework developed through this project, offering a structured yet flexible way to think about sustainability, the framework helps ensure that long-term impact is intentional, not accidental.
What’s Next?
Insights from this survey are already being used to refine the Sustainable Impact Resource Guide and Toolkit, ensuring they respond directly to the realities faced by AMR project teams. By listening closely to those working on the frontlines of AMR, this project is helping to move sustainability from an abstract idea to a practical, actionable component of AMR programming.
The survey findings summarized here are drawn from the “Survey on Sustainability in AMR Projects” conducted as part of the ICARS Sustainable Impact and AMR project.
