Supporting One Health policies to manage antibiotic resistance in Senegal: a systems analysis using group model building.

Introduction: Antibiotic resistance (ABR) is a growing public health issue in Senegal, driven by interconnected factors across human, animal, and ecosystem health. This study applied a participatory systems approach to map the factors influencing ABR in Senegal and identify possible policy actions from a One Health perspective. Methods: A group model building workshop was held in October 2023 in Dakar with 22 stakeholders from diverse professions and sectors, including human and animal health, environment, agriculture, and food safety. Causal loop diagrams were co-developed to map factors driving ABR and identify intervention points. Results: The 22 participants identified 55 factors and 88 connections between those factors, that together contribute to the emergence and spread of ABR in Senegal. Four feedback loops were identified: (1) demand for antibiotics; (2) misinformation, public perception and alternative treatments; (3) development of context-appropriate regulations; and (4) enforcement of regulations. Participants proposed 36 actions for ABR mitigation, focusing on: laboratory capacity development; healthcare and infection prevention and control; rational use of antimicrobials in human and animal health; and coordination, communication, and research. Actions considered to have the greatest potential to positively transform the system included: investment in laboratory capacity; enforcement of regulations against the illegal sale of medications; and harmonization of data collection procedures across surveillance systems. Discussion: This study highlights the value of participatory systems approaches for mapping key drivers of ABR and identifying potential ABR policy actions. While this work integrates cross-sectoral perspectives and provides some actionable insights for evidence-informed decision making, the findings reflect the perspectives of national-level actors and shows strong alignment with international policy and priorities. ABR policy design should also involve local authorities and populations to ensure effective and context-appropriate action. This study provides new empirical evidence to support the development of ABR policy in Sub-Saharan Africa by highlighting the interrelationships between policy areas and the knock-on effects that sectoral and cross-sectoral interventions can have.