1.4 Monitoring for accountability

As key stakeholders begin to take collective action, monitoring for accountability adds another important dimension to communicating about AMR. Monitoring for accountability is not just a role for governments; it can also engage key stakeholders from industry to civil society.

Effectively monitoring processes and outcomes provides the necessary feedback loops to optimise approaches for maximum impact and resource efficiency. Such monitoring can not only hold stakeholders accountable to commitments made and outcomes, but also ensure sustainability of these actions.

Data becomes actionable when it allows for comparisons and trend analysis, flags outliers in performance, or benchmarks against standards. Such approaches enable data analysis to serve as a trigger for policy action. Change can result from continuous quality improvement, ‘carrot or stick’ enforcement, and/or effective governance structures.

This process of monitoring for accountability can be conceptualised in several stages, such as the 3Cs:

• collecting data
• comprehending these findings
• compelling policy-makers with the findings.

By supporting institutions that enable the 3Cs, monitoring for accountability can serve the critical function of benchmarking progress towards the future vision laid out by the IACG’s recommendations (2018). These institutions might be governmental or non-governmental:each will have its own strengths and limitations, but collectively, these might comprise a global watch of actions against the spread of AMR.

India is an example at the national level because it has successfully integrated environmental standards into its NAP, which will serve as a basis for monitoring and accountability (WHO, 2017a). Environmental concerns are highlighted in three of the six overarching priorities, which include environment-specific interventions and target outputs. Reducing the environmental spread of AMR is one of four goals in the NAP strategic priority (‘reduce the incidence of infection through effective infection prevention and control’).

Groups like the Delhi-based Centre for Science and the Environment played a key role in advancing environmental concerns into NAPs on AMR.

Industry has taken initial steps towards collective action on this as well. In 2018, an international private sector coalition published a progress report noting that, of the 36% of companies contacted that responded (AMR Industry Alliance, 2018):

• all were reviewing operations of suppliers to reduce environmental discharge
• a majority were improving oversight or setting standards into supplier contracts
• nearly 40% were increasing public transparency of their findings regarding these suppliers.