Title : The impact of the one health approach in tackling antimicrobial resistance in Sierra Leone

Background: As the National One Health Coordinator, I view Antimicrobial Resistance (AMR) as a multisectoral challenge that requires coordinated actions across human, animal, and environmental health systems. In Sierra Leone, AMR remains a significant public health threat, driven mainly by irrational antimicrobial use as a consequence of weak enforcement of medicines regulations and poor adherence to National Drug Control Policies–for example, standard treatment guidelines and the essential medicines list. Antibiotic misuse in both animals and humans negatively affects the long-term usefulness of these commodities for humans and animals, while antimicrobial waste contaminates the environment with antimicrobial residues. AMR policies are not effectively guiding prescribers' practices in all health facilities and pharmacies. These interconnected drivers underscore the need for collaborative efforts rather than working in silos. This abstract demonstrates how Sierra Leone has used the One Health approach to combat AMR.

Method: AMR units and stewardship have been institutionalized using the One Health approach. The NPHA and the Ministry of Health have jointly worked to strengthen antimicrobial stewardship in major government hospitals, NPHA leadership, and the AMR Lead in the Surveillance Program, with support from partners such as the WHO and the UK government through the Flemming Fund. As an OH platform, we coordinated core One Health ministries and stakeholders to recommend and appoint AMR Focal Persons across ministries and develop practical tools and policy documents, including the AMR National Action Plan, a joint SOP for AMR and data sharing, and other strategic documents. The platform also coordinates planning for critical AMR activities, commemorates World AMR Awareness Week (WAAW), advocates for functional AMR laboratory infrastructure, and organizes AMR Quarterly Technical Working Group (TWG) meetings.

Results: As a result, Sierra Leone now has a well-coordinated AMR response governance structure, produces quality AMR data from both the human and animal sectors that underpins national policy and decision-making, and has better awareness of AMR and its drivers. This, in turn, enables Sierra Leone to generate and present quality data for global reporting, such as reporting to GLASS. Also, through the National Action Plan (NAP) for Health Security, activities have been established and implemented to support efforts to reduce AMR at both national and subnational levels. The AMR TWG has worked efficiently, communications have been consistent, and resources have been used cost-effectively.

These efforts are already yielding health and economic dividends. Ensuring that all One Health drivers work together to tackle AMR has helped advance progress toward its goal. In 2024, the One Health platform supported the AMR team in facilitating a symposium with actors from all core One Health ministries and stakeholders from partners, universities, and healthcare providers. These activities help highlight the issues around AMR and how to address them.

In my role, I witness daily how One Health strengthens AMR containment: by aligning stewardship efforts in hospitals and veterinary services, improving laboratory systems, advancing WASH and other IPC interventions, and elevating environmental monitoring as a core pillar of AMR prevention. This integrated governance model has helped Sierra Leone shift from fragmented responses to a unified, evidence driven strategy that protects the effectiveness of life saving antimicrobials, safeguards food security, and builds resilience across communities. The One Health approach is not only improving our national AMR response; it is redefining how we protect health in Sierra Leone for generations to come.

Conclusion: Based on these experiences, I conclude that Sierra Leone’s collective efforts to slow AMR development and spread have significantly improved epidemic preparedness and response. Major achievements include a One Health AMR governance structure, a One Health NAP, AMR data generation, cross-sector collaboration, and improved AMR awareness.

Despite these achievements, challenges remain, including siloed sectoral work, dependence on donor funding, limited laboratory capacity, inadequate use of AMR data for decision-making, weak regulation of antimicrobial agents, and limited digital tools for real-time data exchange. However, continued One Health collaboration and advocacy can overcome these limitations and improve outcomes in the fight against AMR.

Rachel Regina Sandi holds a Master’s in Global Public Health degree, and is currently the Deputy National One Health Technical Coordinator in Sierra Leone, leading cross-ministry collaboration to strengthen disease prevention and control, especially zoonotic diseases and AMR. She is a Public Health and Community Specialist Practitioner with over 28 years in the UK’s NHS, focusing on adult nursing, community practice, and public health. She has served as a Specialist Community Nurse, Clinical Lead, and Lead Care Coordinator, and contributed over five years to humanitarian work in Sierra Leone with AEMRN and Serve United. During the COVID-19 pandemic, she advanced health promotion, education, and vaccination in Brent.