Implementing the national action plans on antimicrobial resistance in Jordan: document analysis and policymakers' perspectives.

Background: The World Health Organization (WHO) developed the Global Action Plan (GAP) on Antimicrobial Resistance (AMR) in response to its growing threat to human, animal, and agricultural health. Countries worldwide were encouraged to implement National Action Plans (NAPs) to combat AMR. However, low- and middle-income countries (LMICs) face difficulties in implementing NAPs. This study aimed to investigate the implementation of AMR policy in Jordan and assess progress under its NAP. Methods: Using the Implementation Research (IR) framework, this study involved documentary analysis of five policy documents and 17 semi-structured interviews with policymakers. Guided by the IR framework's three phases (proof of concept, proof of implementation, informing scale-up), document analysis was conducted deductively, while the interviews were analysed inductively and deductively using thematic analysis supported by NVivo. Results: Three key themes emerged: implementation challenges, strategy design, and outcome evaluation. Problem identification and context analysis showed that while Jordan's NAP aligns with the WHO's GAP, poor intersectoral coordination, limited stakeholder engagement, and weak enforcement hinder implementation. Participants noted unclear roles for policymakers, creating accountability gaps and inefficiencies. Implementation strategies showed that AMR interventions focus on hospitals, with little attention to other sectors (community pharmacy and primary care). Differences between public and private hospitals led to inconsistent enforcement, while unenforced community pharmacy regulation allowed for unregulated access to antibiotics. Monitoring and evaluating AMR interventions remain key gaps, with a lack of standardised frameworks, fragmented surveillance data, and insufficient monitoring capacity. Conclusion: Although aligned with WHO's GAP, AMR policy implementation in Jordan is hindered by systemic barriers: weak enforcement, limited stakeholder engagement, and fragmented accountability. A focus on hospitals left other settings with limited action or reinforcement. The findings highlighted the need for cross-sector coordination and robust monitoring. While context-specific, these insights may inform AMR governance in comparable settings.