India’s National Action Plan on Antimicrobial Resistance

India launched the National Action Plan on Antimicrobial Resistance (NAP-AMR 2.0) for 2025-29 amid growing concerns about antimicrobial resistance (AMR). AMR threatens human health, animal health, agriculture, aquaculture, and the environment. The plan adopts a One Health approach recognising the interconnectedness of these sectors. It aims to improve coordination between the Centre and States to combat AMR effectively.

Background and Evolution

India’s first National Action Plan on AMR began in 2017. It raised awareness and promoted multi-sectoral efforts. The plan improved surveillance and stewardship but faced challenges in State-level implementation. Only a few States developed formal action plans. Most States continued fragmented sectoral activities without integrated One Health frameworks. This limited progress brought into light the need for stronger Centre-State collaboration.

Challenges in State-Level Implementation

AMR determinants such as health services, veterinary care, agricultural antibiotic use, and waste management are mostly under State control. National guidelines alone cannot ensure uniform action. States vary in their capacity and commitment. There is no mandatory mechanism for States to develop or notify AMR plans. Lack of financial incentives and formal review systems weakens sustained State engagement.

Key Features of NAP-AMR 2.0

The updated plan is more implementation-focused with clear timelines and responsibilities. It emphasises private sector involvement, as it delivers much healthcare and veterinary services. Scientific innovation is prioritised, including rapid diagnostics and alternatives to antibiotics. The plan strengthens One Health integration by linking human, animal, agricultural, and environmental surveillance. NITI Aayog now oversees intersectoral coordination through a dedicated committee.

Governance and Coordination Needs

NAP-AMR 2.0 calls for each State and Union Territory to establish AMR Cells and prepare aligned action plans. However, it lacks a formal Centre-State coordination platform. Experience from health programmes like the National Tuberculosis Elimination Programme shows that joint reviews and shared accountability improve outcomes. A national-State AMR council chaired by the Union Health Minister could provide this structure. High-level communication and conditional funding could incentivise States.

Importance of One Health Approach

AMR is a complex issue crossing human, animal, and environmental sectors. Antibiotic residues and resistant organisms spread through soil, water, livestock, and food systems. Addressing AMR requires integrated surveillance and action across these sectors. The One Health framework ensures comprehensive strategies that consider all transmission pathways and sources of resistance.

Future Directions

For NAP-AMR 2.0 to succeed, India must build a coordinated and accountable Centre-State model. This includes political commitment, administrative follow-through, and dedicated resources. Without strong State participation, national plans risk remaining ineffective. India’s approach could become a global example if it creates a unified system for AMR control.

Questions for UPSC:

1. Point out the significance of the One Health approach in tackling antimicrobial resistance and its implications for public health policy.
2. Critically analyse the role of Centre-State coordination in India’s federal system with reference to the implementation challenges of the National Action Plan on Antimicrobial Resistance.
3. Estimate the impact of private sector participation in healthcare and veterinary services on combating antimicrobial resistance in India.
4. What are the challenges in regulating antibiotic use in agriculture and aquaculture? With suitable examples, explain how integrated policies can address these issues.

Answer Hints:

1. Point out the significance of the One Health approach in tackling antimicrobial resistance and its implications for public health policy.

1. AMR spreads across human health, animal health, agriculture, aquaculture, environment—One Health integrates all sectors.
2. Antibiotic residues and resistant organisms circulate through soil, water, livestock, food chains, and waste systems.
3. One Health ensures surveillance and interventions cover interconnected transmission pathways, preventing isolated efforts.
4. Public health policies adopting One Health promote multisectoral collaboration and comprehensive AMR control strategies.
5. It aligns human, veterinary, agricultural, and environmental regulations, enhancing effectiveness and resource use.
6. Supports innovation in diagnostics, alternatives to antibiotics, and environmental monitoring for holistic AMR management.

2. Critically analyse the role of Centre-State coordination in India’s federal system with reference to the implementation challenges of the National Action Plan on Antimicrobial Resistance.

1. AMR determinants (healthcare, veterinary, agriculture, waste) are primarily under State jurisdiction, limiting national plan reach.
2. First NAP-AMR saw limited State-level adoption; only few States developed and executed formal action plans.
3. Absence of formal Centre-State platform, joint reviews, statutory mandates, and financial incentives weakens implementation.
4. Effective federal coordination requires structured, mutually accountable mechanisms as seen in TB and NHM programmes.
5. NAP-AMR 2.0 introduces NITI Aayog oversight but lacks enforceable Centre-State coordination and funding pathways.
6. Without political engagement and shared accountability, national intent risks remaining a technical document without impact.

3. Estimate the impact of private sector participation in healthcare and veterinary services on combating antimicrobial resistance in India.

1. Private sector delivers a major share of human healthcare and veterinary services in India.
2. Unregulated private antibiotic use contributes to inappropriate prescriptions and AMR emergence.
3. Involving private providers improves stewardship, surveillance, and adherence to guidelines across sectors.
4. Private sector engagement expands reach of diagnostics, infection control, and AMR awareness programs.
5. Collaboration can encourage innovation, rapid diagnostics, and alternatives to antibiotics in diverse settings.
6. Excluding private sector risks large gaps in AMR control efforts, undermining national strategies.

4. What are the challenges in regulating antibiotic use in agriculture and aquaculture? With suitable examples, explain how integrated policies can address these issues.

1. Antibiotic use in agriculture and aquaculture is often unregulated, leading to residues and resistant bacteria entering food chains.
2. Fragmented governance across agriculture, veterinary, environment, and food safety sectors hampers effective regulation.
3. Examples – Excessive antibiotic use in fish farms contaminates water bodies; crop farming may use antibiotics affecting soil microbiota.
4. Integrated policies under One Health ensure coordinated surveillance, stewardship, and enforcement across sectors.
5. Joint guidelines, State-level AMR Cells, and multi-departmental action plans can harmonize efforts and close regulatory gaps.
6. Financial incentives and conditional grants can motivate compliance and strengthen monitoring in agriculture and aquaculture.