Discussion

This policy analysis highlights three cross-cutting stewardship challenges across Africa. First, African NAPs place strong emphasis on facility-based AMS interventions, particularly the establishment of stewardship committees, development of treatment guidelines, and training of healthcare workers within health facilities. While these measures are feasible and aligned with international recommendations, the NAPS placed comparatively limited attention to upstream market regulation and the economic drivers of antimicrobial misuse. Across the NAPs reviewed, weak alignment was observed for actions related to quality-based market authorization and the removal of incentives that encourage inappropriate antimicrobial use. This is notable in Africa where informal and poorly regulated antimicrobial markets are widespread, and access without prescription remains common. ^{Reference Gulumbe and Adesola7} The focus on downstream stewardship within facilities, without parallel strengthening of regulatory and market controls, risks limiting the overall effectiveness of AMS strategies across African countries.

Secondly, stewardship efforts in the reviewed NAPs remain largely concentrated in human and animal health, with minimal integration of plant health and antimicrobial use in crop production. Although the AU Framework for AMR Control explicitly recommends extending stewardship to plant producers and promoting good agricultural practices, most NAPs showed little alignment with this component. References to antimicrobial use in agriculture were largely confined to livestock and aquaculture, while antimicrobial pesticides and their regulation were largely absent. This narrow sectoral focus undermines the implementation of a fully operational OH approach, particularly in African countries with large smallholder farming population and rapidly expanding agricultural input markets. ^{Reference Bosire8} This represents a critical gap in addressing environmental and agricultural pathways of AMR.

Lastly, public engagement and education are core pillars of the AMR response, yet AMS-focused public awareness and preservice training were underutilized across the NAPs examined. While most plans prioritized in-service training for healthcare professionals, fewer included provisions for integrating AMS into preservice curricula or for linking public awareness campaigns directly to responsible antimicrobial use. Where awareness activities were mentioned, they were often framed broadly around AMR rather than explicitly tied to stewardship behaviors among patients, caregivers, farmers, and community members. This emphasis on professional training alone risks reinforcing responsible supply without addressing demand-side drivers of misuse. Given their potential for long-term behavioral change and sustainability, the limited use of preservice education and AMS-focused public engagement represents a missed opportunity within current national strategies of African countries. ^{Reference Etukakpan, Selçuk, Meilianti, Kusynová and Bajis9}

This study forms part of the succession planning within the Ducit Blue Foundation’s One Health Pan-African AMR Internship/Mentorship Programme. It reflects broader efforts to strengthen policy analysis and evidence translation capacity among early-career public health professionals in Africa. Such capacity building is critical for succession planning in Africa, ensuring that tomorrow’s public health workforce have a good grasp of AMR governance, to support the development of effective NAPs, and ensure that AMS strategies are informed by locally generated evidence.

Note that NAPs reflect country sovereignty and context-specific priorities. Alignment with global and regional frameworks may not fully represent national policy intent.