Why in News
- National Action Plan on Antimicrobial Resistance (NAP-AMR 2.0) for period 2025-29 was recently released, during period when Antimicrobial Resistance (AMR) has been impacting human health, veterinary sectors, aquaculture, agriculture, waste systems, and entire food chain.
- Concern was highlighted that AMR has been crossing hospital boundaries and has been moving through soil, water, livestock, markets, and food systems, establishing One Health challenge.
Understanding Antimicrobial Resistance and Its Scope
What is Antimicrobial Resistance (AMR)?
- Antimicrobial Resistance represents threat to human health where microorganisms develop ability to resist antimicrobial drugs, making infections increasingly difficult to treat.
- Antibiotic residues, resistant organisms and environmental discharge connect multiple sectors—hospitals, agriculture, aquaculture, veterinary practice, waste management and food systems—in powerful and interconnected ways.
One Health Dimension of AMR
One Health framework recognizes that AMR does not remain confined to hospitals but moves through:
- Soil and water systems
- Livestock and animal populations
- Markets and commercial establishments
- Food systems and food chains
- Waste management infrastructure
This interconnected nature makes AMR true One Health challenge requiring coordinated action across human health, animal health and environmental sectors.
Evolution of India’s Approach: From NAP-AMR 1.0 to NAP-AMR 2.0
- First National Action Plan on AMR launched in 2017 represented significant step forward in India’s antimicrobial resistance management. Key achievements of first plan included:
- Brought AMR into national consciousness and public policy discourse
- Encouraged multi-sectoral participation across various governmental and private domains
- Improved laboratory networks for diagnostic capabilities
- Expanded national surveillance systems for tracking resistance patterns
- Supported antimicrobial stewardship initiatives across healthcare sector
- Placed AMR firmly within One Health framework, recognizing critical links between human health, animal health and environment
- Implementation challenges persisted:
- Only Kerala, Madhya Pradesh, Delhi, Andhra Pradesh, Gujarat, Sikkim, Punjab developed State Action Plans
- Only few States advanced into meaningful execution
- Many States depended on fragmented sectoral activities
- State-wide One Health structures did not take shape in most regions
Reason for Slow Uptake
- Determinants of AMR fall under State jurisdiction, including:
- Health administration
- Hospital functioning
- Pharmacy regulation
- Veterinary oversight
- Agricultural antibiotic practices
- Food-chain monitoring
- Waste governance
- National guidance was insufficient for full implementation because operational levers sit with States.
India’s Public Health Experience as Reference Point
Successful Models of Centre-State Coordination
India’s broader public health experience demonstrates that real progress happens only when Centre and States work within structured, mutually accountable system. Two prominent examples illustrate this principle:
National Tuberculosis Elimination Programme
Achievements of TB programme arise from:
- Regular joint reviews between Centre and States
- Shared monitoring missions across jurisdictions
- Clearly defined roles across different levels of government
- Sustained coordination mechanisms
National Health Mission (NHM)
Following similar principles, National Health Mission achieves results through:
- Coordinated planning at national and State levels
- Dedicated funding signals that prioritize health objectives
- Periodic performance assessments and accountability measures
- Enabling States to turn national priorities into on-ground action
These examples provide template for what NAP-AMR 2.0 should aspire to achieve.
Key Features of NAP-AMR 2.0 (2025-29)
NAP-AMR 2.0 represents more mature and implementation-oriented framework when compared with first plan. Plan moves beyond broad intent and outlines clearer timelines, responsibilities and resource planning structures.
Stronger Implementation Orientation
- New plan has moved beyond broad intent and has outlined clearer timelines, defined responsibilities, and resource planning frameworks.
Recognition of Private Sector Role
- Acknowledgement that private sector delivers significant share of health care and veterinary services; hence participation has been emphasised.
Stronger Scientific Base
- Enhanced stress on innovation, including:
- Rapid diagnostics
- Point-of-care tools
- Alternatives to antibiotics
- Improved environmental monitoring mechanisms
Deepened One Health Focus
- Strengthening attention on food-system pathways, waste management, and environmental contamination.
- Moving towards integrated surveillance across human, veterinary, agricultural, and environmental sectors to enable harmonised national approach.
Improved Governance Framework
- Introduction of higher-level national oversight, with intersectoral supervision under NITI Aayog, through Coordination and Monitoring Committee.
- Mandate created for State AMR Cells and State Action Plans, aligned with national framework.
- National dashboard proposed for continuous progress reporting.
Identified Gaps in NAP-AMR 2.0
Absence of Enforcement Mechanism
- Despite emphasis on State-level implementation, fundamental weakness remains unchanged:
- No formal Centre-State AMR platform
- No joint review mechanism
- No statutory requirement for States to notify or implement plans
- No financial pathways, such as NHM-linked incentives, to support sustained commitment
Federal Challenges
- In federal context, AMR determinants lie primarily in State control, making absence of coordinated mechanisms pivotal gap.
- Risk that national plan may remain technical document without strong administrative structure, political engagement, and shared accountability.
Critical Success Factors for NAP-AMR 2.0
Primary Determinant of Success
Success of NAP-AMR 2.0 depends entirely on how effectively national and State systems work together. This is not matter of technical capacity but of institutional design and political commitment.
Key Factors for Effective Implementation
- Political leadership at both national and State levels
- Senior administrative commitment across governance levels
- Multi-departmental engagement beyond health sector
- Structured accountability mechanisms with consequences
- Adequate financial resources aligned with action plan objectives
- Regular monitoring and evaluation systems
- Cross-sector coordination mechanisms at all levels
Opportunity for India
India has opportunity now to build coordinated and accountable Centre-State model for AMR control. If such system is established with institutional mechanisms, legal framework and financial backing, country can:
- Achieve measurable progress in AMR control
- Set international example for federal nations tackling AMR
- Demonstrate effective implementation of One Health approach
- Build sustainable framework for antimicrobial stewardship
Way Forward: Building Coordinated Centre-State Model
To make NAP-AMR 2.0 effective, India needs clear architecture that brings political leadership, senior administrators and sectoral departments from all States into unified system.
Establishment of National-State AMR Council
A National-State AMR Council should be established with following characteristics:
- Chaired by Union Health Minister for political backing and priority
- Guided by NITI Aayog for institutional coordination
- Provides platform for regular review and joint decision-making
- Enables coordinated problem-solving across:
- Human health sector
- Veterinary sector and animal health
- Agriculture and crop production
- Aquaculture and fish farming
- Food systems and supply chains
- Environmental regulation and pollution control
This council would institutionalize regular engagement and accountability.
Formal State Action Plan Preparation and Notification
State engagement would strengthen if:
- Union Government formally requests each State to prepare and notify its AMR Action Plan
- Clear timelines are established for plan development and implementation
- Annual reviews are conducted to assess progress and identify challenges
- High-level communication, especially through Chief Secretaries, shifts administrative attention and resource prioritization
Experience from National Health Mission and tuberculosis programmes demonstrates that such high-level engagement significantly impacts State-level administrative response.
Financial Mechanisms for Sustainability and Incentivization
Financial mechanisms must follow implementation architecture:
- Modest conditional grants under National Health Mission can drive improvements in:
- Surveillance systems
- Antimicrobial stewardship
- Infection control measures
- Laboratory strengthening
- When funding signals priority, States respond with:
- Administrative energy
- Policy focus
- Resource allocation
- Institutional commitment
This creates positive incentive structure for State compliance and performance.
Unified Implementation Framework
Centre and States must work within common implementation framework characterized by:
- Clear delineation of roles and responsibilities
- Shared accountability mechanisms
- Regular performance monitoring
- Coordinated resource mobilization
- Joint problem-solving approaches
Conclusion
- NAP-AMR 2.0 has offered structured scientific and strategic foundation for India’s AMR response; however, success will depend entirely on effectiveness of Centre-State coordination.
- AMR has been driven by real-world practices across entire One Health continuum, and without strong State participation, national strategy cannot translate into national impact.
- India holds significant opportunity to build coordinated and accountable AMR control model, and with sustained cross-sectoral engagement, NAP-AMR 2.0 can become critical turning point in national AMR journey.
UPSC MAINS PYQs
- Can overuse and free availability of antibiotics without Doctor’s prescription, be contributors to the emergence of drug-resistant diseases in India? What are the available mechanisms for monitoring and control? Critically discuss the various issues involved. (2014)
