Antimicrobial resistance (AMR) is one of the most serious threats to global health today. It affects how we treat infections in people, animals, and plants, and it undermines health systems, food production, and livelihoods, especially in low- and middle-income countries (LMICs). While many AMR projects are being implemented around the world, one critical question often remains unanswered: what does “sustainable impact” really mean in AMR work?
This question was the focus of Work Package 1 (WP1) of the ICARS Sustainable Impact and AMR project, led by the One Health and Development Initiative (OHDI) in collaboration with partners and supported by the International Centre for Antimicrobial Resistance Solutions (ICARS).
Why Work Package 1 Was Needed
Although “sustainability” is frequently mentioned in AMR projects, there has been no shared, evidence-based definition of what sustainable impact means across the many sectors involved in AMR, such as human health, animal health, agriculture, the environment, policy, and finance. Different sectors often use the term in different ways, making it difficult to design, assess, and compare AMR interventions over time. WP1 was designed to address this gap by systematically reviewing how sustainable impact is defined and applied across sectors, and by developing a clear, practical definition tailored to AMR interventions, particularly in LMIC settings.
What the WP1 Review Did
WP1 involved a structured literature review using systematic methods guided by PRISMA principles. Over 1,400 academic and grey literature sources were screened, with 53 key studies selected for in-depth analysis. These sources spanned health, agriculture, environmental sustainability, governance, development, and business sectors. The review process was led by Professor Benjamin Emikpe of Kwame Nkrumah University of Science and Technology (KNUST), a key collaborator on the project, working closely with the wider research and implementation team. Using qualitative analysis tools and expert review, the team identified common themes that consistently appeared across sectors when sustainable impact was discussed.
Key Insights from the Review
Despite differences across sectors, the review found strong agreement around several core ideas. Sustainable impact in AMR is not just about short-term results, it is about what lasts after projects end. The most consistently identified elements included:
- Long-term impact beyond project timelines
- Institutional strengthening, so systems can continue to function independently
- Policy integration, ensuring AMR actions are embedded in national frameworks
- Community ownership, including behaviour change and local leadership
- Cost-effectiveness and scalability, so interventions can be sustained and expanded
These findings helped shape a shared definition of sustainable impact for AMR, grounded in evidence and aligned with One Health principles.
Why This Matters for AMR Action
Many AMR initiatives are time-bound and externally funded. When funding ends, activities often stop. WP1 provides a foundation for changing this pattern by offering a common language and conceptual framework that policymakers, funders, implementers, and communities can use to design AMR interventions that are built to last. This definition now serves as the cornerstone for the rest of the ICARS Sustainable Impact and AMR project. It ensures that sustainability is not treated as an afterthought, but as a core design principle.
What Comes Next
The completion of WP1 feeds directly into the next phases of the project to build a conceptual framework for achieving sustainability in AMR interventions, develop a draft of the Resource Guide and Toolkit, and subsequently, pilot, test on real-world AMR projects.
Together, these steps will help translate evidence into action, supporting countries and partners to move from short-term projects to lasting, system-level change in the fight against antimicrobial resistance.
