Antimicrobial resistance in low and middle income countries driven by governance policy and One Health strategies for effective action

Abstract

Antimicrobial resistance (AMR) causes approximately 1.27 million direct deaths annually and disproportionately affects low- and middle-income countries (LMICs), where limited diagnostics, weak regulation, and constrained financing hinder effective containment. To synthesize evidence on governance, policy, and One Health strategies addressing AMR in LMICs, focusing on feasibility, equity, and public health impact. A scoping review of 85 peer-reviewed and policy sources (2015–2026) was conducted across PubMed, Scopus, Web of Science, Google Scholar, and institutional repositories (WHO, FAO, WOAH, UNEP, OECD, UNGA). Study selection and data extraction were performed independently by two reviewers, with disagreements resolved through consensus. Evidence was thematically synthesized and mapped by feasibility, equity, and outcomes within a One Health framework. Short-term interventions, including prescription-only policies, antimicrobial stewardship, and community campaigns, reduced antibiotic use (7.5–36%) and improved knowledge (15–25%). Medium-term One Health reforms strengthened coordination and surveillance, increasing cross-sector reporting by 45–60% and improving early outbreak detection in 20–25% of sentinel sites, although laboratory capacity remains critically limited in LMICs, particularly in Africa, where only ~ 1% of laboratories perform bacteriology testing. Long-term measures, including veterinary antimicrobial restrictions, environmental monitoring, and research investment, showed sustained reductions in antimicrobial use and improved access (10–20%). AMR is fundamentally a governance and systems challenge. Phased implementation of feasible stewardship interventions can deliver rapid gains, while sustained control requires strengthened multisector governance, integrated surveillance, and equitable innovation. Evidence remains limited by heterogeneity and underrepresentation of locally led initiatives.