Background and Objective:
Antimicrobial Resistance (AMR) is a growing global concern inextricably linked to human interactions across multiple sectors, including animal health, agriculture, food production, and the environment. Using a One Health lens, to understand the spread and risk of AMR, will be vital to successfully addressing such a complex issue. International efforts are focussed on designing and implementing policy – but developing and implementing comprehensive monitoring and evaluation frameworks for national strategies remains a challenge. Working with a broad range of stakeholders, we aimed to co-design a pragmatic, adaptable monitoring and evaluation (M&E) framework for Australia’s AMR Strategy.

Methods:
To develop the M&E framework we employed multi-stage, iterative co-design. We undertook a scoping review and interviews with international leaders involved in monitoring national AMR strategies to examine best practice, enablers and barriers. We then engaged an Expert Advisory Group (EAG) with diverse One Health expertise. We undertook a policy analysis of national strategy documents and worked with our EAG to draft program logic models (PLMs) – using backcasting to formulate the inputs, outputs and outcomes required to address AMR. We conducted Delphi surveys (n=15 experts/sector), to get consensus on the importance and feasibility of outcome measures. In early 2023 we will explore the Delphi findings and refine the PLMs in national systems thinking workshops - prioritising what needs to happen next for M&E to be successfully implemented. Workshops will focus on identifying linkages and leverage opportunities between and within sectors.

Results:
This co-design approach (using established public health methods) is providing Australia with a systematic, collaborative, and responsive way to create an M&E framework across multiple One Health sectors.

Conclusion:
Evaluating the impact of national AMR strategies is complex, takes time, and needs to champion the voices of a range of stakeholders. Systems thinking is useful for facilitating this.