Governance of antimicrobial resistance in Central Africa (2015-2025): a systematic review of policies, One Health coordination and funding.

Background: Antimicrobial resistance (AMR) poses a major threat to effective treatment and global health security, with disproportionate impacts in low- and middle-income settings. In Central Africa, health system fragility, limited surveillance capacity and weak multisectoral coordination heighten vulnerability. Despite momentum following the WHO Global Action Plan, the status of AMR governance, One Health coordination and financing in the subregion remains insufficiently characterized. Objectives: To systematically assess AMR governance in Central Africa (2015-2025), focusing on policy frameworks, One Health coordination and financing mechanisms. Methods: We conducted a PRISMA 2020-compliant systematic review registered in PROSPERO (CRD420251082393). Six databases were searched, along with grey literature, including national policy documents, institutional reports and consultations with AMR focal points. Eligible sources addressed AMR policy, coordination, surveillance and funding. Results: Of the 4464 records identified, 27 documents were included (19 peer-reviewed articles, one report, seven national action plans). Evidence was concentrated in Cameroon, with limited data from other countries. National action plans aligned with global standards were identified in six countries, while none were available for Equatorial Guinea or the Republic of Congo. Across the region, governance was characterized by partial policy alignment but weak implementation, limited operationalization of One Health, fragmented surveillance and reliance on external funding. Key constraints included inadequate laboratory capacity, weak stewardship systems and insufficient domestic financing. Conclusion: AMR governance in Central Africa has progressed at the policy level but remains operationally constrained. Bridging the gap between policy and implementation requires strengthened institutionalization of One Health, improved accountability and sustainable domestic investment.