Mid-Term Review of Thailand’s Second National Action Plan on Antimicrobial Resistance (NAP-AMR 2) 2023-2027
Mid-Term Review of Thailand’s Second National Action Plan on Antimicrobial Resistance (NAP-AMR 2) 2023-2027
About Project
Antimicrobial resistance (AMR) is a global public health challenge that affects human health, animal health and the environment. It also threatens the national economy through food exports and medical tourism. Thailand’s Second National Action Plan on AMR sets six goals and six strategies under a One Health approach. The Thai Food and Drug Administration (Thai FDA) commissioned the Health Intervention and Technology Assessment Program (HITAP) to conduct a mid-term review. The review assesses progress against the plan’s goals, identifies barriers and facilitators, and provides recommendations for the remainder of the plan and for the development of the third plan.
The review used a qualitative-dominant mixed-methods design that combined three sources of evidence. These were in-depth interviews with senior stakeholders from the human, animal, environmental and governance sectors, quantitative analysis of publicly available data, and a review of policy documents and academic literature. The findings were analysed using the PRISM framework, alongside causal loop diagrams that illustrate the system dynamics behind them. They were then validated with stakeholders in March 2026.
The review found tangible progress in several areas. Antimicrobial use in animals fell by 57.6%, and use in humans has continued to decline. Thailand’s national surveillance system is strong by regional standards, and the country met international benchmarks for AMR system capacity. However, a shared set of structural constraints across all goals has undermined this progress:
- governance mechanisms disrupted by repeated changes of government
- indicators that do not capture real outcomes
- a lack of dedicated budget and specialist workforce
- siloed work across agencies
- a two-tier gap between large institutions and local-level actors
The evidence also shows that incentive-based measures change behaviour more effectively than awareness-raising alone. Examples include pay-for-performance, accreditation-linked requirements and trade standards.
In the short term, the review recommends restoring national coordination, making AMR visible to the public, piloting incentive-based interventions, and aligning agency mandates with resources. For the third national plan, it recommends:
- a permanent, politically independent AMR coordinating body
- workforce reform
- stronger regulatory enforcement
- an evaluation framework built in from the design stage
Thailand already has the knowledge and technical capacity needed to address AMR. What remains is to build governance that is stable and continuous across political cycles.
