Most countries have a national action plan – but implementation is lagging. The next phase must focus on costing and budgeting these plans and establishing a clear monitoring and evaluation system. 

Many countries have regulations on antimicrobial sales but – with the exception of a few countries – they are  poorly implemented. We need to improve appropriate antibiotic use in all health care facilities, especially in primary care where most prescriptions happen. Sales of antibiotics need to be monitored systematically. This can be achieved through strengthening stewardship programmes, through education and training and by using digital tools for monitoring. 

Progress in implementing national plans is being slowed by insufficient and unstable financing. While surveillance systems have expanded, data are not used consistently to guide prescribing, procurement or policy decisions. A fully integrated One Health approach is necessary, bringing together human, animal, food and environmental dimensions into a single functioning system with seamless exchange of data and information leading to tangible outcomes. Yet One Health remains fragmented, with environmental surveillance the weakest, and workforce capacity continues to fall short.