Strengthening One Health AMR Surveillance in Africa: From Cross-Sectoral Data to Policy Action.

Antimicrobial resistance (AMR) has emerged as one of the greatest threats to global health, with Africa bearing a disproportionate burden: an estimated 1.05 million deaths were associated with bacterial AMR and approximately 250,000 deaths were directly attributable to AMR in the WHO African Region in 2019 alone. This burden reflects high infectious disease prevalence, limited diagnostic capacity, weak antimicrobial stewardship, and fragmented surveillance systems. Given that resistant pathogens and resistance genes circulate across humans, animals, and the environment, effective surveillance requires a coordinated One Health approach. This narrative review synthesizes published literature (2015-2026) identified through PubMed, Scopus, Web of Science, and Google Scholar to assess the status of One Health AMR surveillance in Africa, examine progress across the human, animal, and environmental sectors, identify major implementation barriers, and propose strategic priorities for strengthening integrated surveillance systems. The evidence reviewed shows that participation in surveillance initiatives such as GLASS has expanded and laboratory capacity has improved in several countries; however, substantial gaps remain in veterinary and environmental surveillance, laboratory infrastructure, data interoperability, governance, workforce capacity, and sustainable financing. Fragmented information systems and limited cross-sectoral collaboration continue to impede timely detection of emerging resistance and evidence-informed policy action. Based on these findings, we recommend prioritizing integrated governance structures, strengthened laboratory networks, interoperable digital surveillance platforms, and sustainable domestic financing as foundational steps, with genomic technologies, wastewater surveillance, and regional collaboration serving as complementary priorities as feasibility and resources allow. Strengthening One Health surveillance will be critical for improving early detection of resistant pathogens, informing antimicrobial stewardship, supporting outbreak preparedness, and reducing the growing health and economic burden of AMR across Africa.