Understanding the landscape for driving antimicrobial stewardship implementation at scale in South Africa.
9 affiliations
- 1Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
- 2Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
- 3National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.
- 4Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
- 5Department of Paediatrics, University of Pretoria, Pretoria, South Africa.
- 6Digital Medication Management, Netcare Group Ltd, Johannesburg, South Africa.
- 7Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.
- 8Department of Pharmacology, University of Pretoria, Pretoria, South Africa.
- 9Division of Family Medicine, Department of Family, Community and Emergency Care, University of Cape Town, Cape Town, South Africa.
Abstract
Background
Antimicrobial stewardship (AMS) programmes are essential for responding to antimicrobial resistance, yet implementation at scale remains challenging everywhere, including in South Africa. This study explored the landscape for driving AMS implementation, identified barriers and enablers and identified priorities for subsequent multi-facility interventions.Methods
Phase 1 of a prospective, multi-phased mixed-methods study used participatory action research informed by the Breakthrough Series methodology and Theory U. Health professionals from public and private sectors participated in workshops in Cape Town and Johannesburg. Activities included mapping individual AMS journeys, identifying barriers and enablers at individual, institutional/facility and national/provincial levels, conducting a SWOT analysis and prioritizing potential AMS implementation projects. Data were analysed using descriptive content analysis.Results
Participants identified substantial enabling factors alongside persistent barriers. Key enablers included mentorship, multidisciplinary collaboration, management support, functional AMS and infection prevention structures, guidelines, diagnostics, national policies and professional society advocacy. Barriers included professional isolation, weak interprofessional relationships, limited funding and staffing, inadequate training, weak governance, poor data use, fragmented public-private and inter-provincial systems, and inconsistent policy implementation. Strengths were identified as being existing programmes and collaboration, weaknesses as resource and education gaps, opportunities as cross-sector collaboration and technology and threats as limited political support and economic constraints. Eight priority AMS areas were identified as collaborative projects for implementation across multiple healthcare settings.Conclusion
South Africa has important existing assets for AMS implementation, although these are unevenly distributed and inconsistently used. Strengthening leadership and collaboration, leveraging existing structures and implementing context-specific countermeasures may support at-scale AMS implementation.
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BibTeX
@article{bergh2026understanding,
title = {{Understanding the landscape for driving antimicrobial stewardship implementation at scale in South Africa.}},
author = {Dena Van Den Bergh and Esmita Charani and Candice Bonaconsa and Adrian Brink and Nicolette Du Plessis and Angeliki Messina and Malcolm Miller and Natalie Schellack and Hafsah Tootla and Klaus B Von Pressentin and Marc Mendelson},
journal = {JAC-antimicrobial resistance},
year = {2026},
month = oct,
doi = {10.1093/jacamr/dlag232},
url = {https://europepmc.org/article/MED/42923216},
note = {CC BY},
}
RIS
TY - JOUR
TI - Understanding the landscape for driving antimicrobial stewardship implementation at scale in South Africa.
AU - Dena Van Den Bergh
AU - Esmita Charani
AU - Candice Bonaconsa
AU - Adrian Brink
AU - Nicolette Du Plessis
AU - Angeliki Messina
AU - Malcolm Miller
AU - Natalie Schellack
AU - Hafsah Tootla
AU - Klaus B Von Pressentin
AU - Marc Mendelson
PY - 2026
DA - 2026/10/22
JO - JAC-antimicrobial resistance
DO - 10.1093/jacamr/dlag232
UR - https://europepmc.org/article/MED/42923216
AB - Background Antimicrobial stewardship (AMS) programmes are essential for responding to antimicrobial resistance, yet implementation at scale remains challenging everywhere, including in South Africa. This study explored the landscape for driving AMS implementation, identified barriers and enablers and identified priorities for subsequent multi-facility interventions.Methods Phase 1 of a prospective, multi-phased mixed-methods study used participatory action research informed by the Breakthrough Series methodology and Theory U. Health professionals from public and private sectors participated in workshops in Cape Town and Johannesburg. Activities included mapping individual AMS journeys, identifying barriers and enablers at individual, institutional/facility and national/provincial levels, conducting a SWOT analysis and prioritizing potential AMS implementation projects. Data were analysed using descriptive content analysis.Results Participants identified substantial enabling factors alongside persistent barriers. Key enablers included mentorship, multidisciplinary collaboration, management support, functional AMS and infection prevention structures, guidelines, diagnostics, national policies and professional society advocacy. Barriers included professional isolation, weak interprofessional relationships, limited funding and staffing, inadequate training, weak governance, poor data use, fragmented public-private and inter-provincial systems, and inconsistent policy implementation. Strengths were identified as being existing programmes and collaboration, weaknesses as resource and education gaps, opportunities as cross-sector collaboration and technology and threats as limited political support and economic constraints. Eight priority AMS areas were identified as collaborative projects for implementation across multiple healthcare settings.Conclusion South Africa has important existing assets for AMS implementation, although these are unevenly distributed and inconsistently used. Strengthening leadership and collaboration, leveraging existing structures and implementing context-specific countermeasures may support at-scale AMS implementation.
SN - 2632-1823
ER -