Compliance with South Africa's Antimicrobial Resistance National Strategy Framework: are we there yet?

J Chemother. 2021 Feb;33(1):21-31. doi: 10.1080/1120009X.2020.1789389. Epub 2020 Jul 22.


Antimicrobial resistance (AMR) is a growing problem worldwide. South Africa has recently released its Antimicrobial Resistance National Strategy Framework (referred to as the Framework) to instigate antimicrobial stewardship programmes (ASPs). Consequently, there is a need to assess compliance with the Framework.

Methods: Descriptive study design, collecting quantitative data, among pre-selected public healthcare facilities. One healthcare professional from each participating facility, involved in ASPs, was invited to participate.

Results: Overall 26 facilities from 8 provinces participated. Average compliance to the Framework was 59.5% for the 26 facilities, with 38.0% for community health centres, 66.9% for referral hospitals and 73.5% for national central hospitals. For 7 facilities compliance was <50% while 5 facilities were >80% compliant.

Conclusion: Although some facilities complied well with the Framework, overall compliance was sub-optimal. With the introduction of universal healthcare in South Africa, coupled with growing AMR rates, ongoing initiatives to actively implement the Framework should be targeted at non-compliant facilities.

Keywords: South Africa; antimicrobial resistance; antimicrobial stewardship; compliance; framework; healthcare centres; hospitals.

MeSH terms

  • Ambulatory Care Facilities / statistics & numerical data
  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship / organization & administration*
  • Antimicrobial Stewardship / standards
  • Antimicrobial Stewardship / statistics & numerical data*
  • Drug Resistance, Bacterial
  • Guideline Adherence / statistics & numerical data*
  • Hospitals / statistics & numerical data
  • Humans
  • Practice Guidelines as Topic / standards*
  • South Africa


  • Anti-Bacterial Agents