Table 1.

Ongoing national initiatives in Tanzania to improve antibiotic prescribing and to reduce AMR.

Group	Activities and Achievements	References
Ministry of Health and others—NAP and Guidelines	Tanzania developed and introduced its NAP to reduce AMR in 2017. Frumence et al. (2021) documented several achievements to date following the introduction of the NAP. These included the establishment of a functioning multi-sectoral coordinating committee to help with AMR activities including a governance structure. Additional AMR surveillance sites have recently been introduced alongside educational and other activities encouraging greater awareness of AMR in the community, as well as greater availability of guidelines at health facilities, to improve future prescribing (availability and use of guidelines at health facilities is seen as a crucial first step to improve future prescribing practices). The national STGs were updated and now include the AWaRe classification for antibiotics. The findings of Frumence et al. (2021) contrast the findings of Sangeda et al. (2020). Sangeda et al. (2020) found that whilst there were ongoing AMR surveillance activities in Tanzania, coupled with the implementation of ASPs following the NAP, these activities were still at a low level.	[26,29,30,31,32,33,34]
Ministry of Health and others—ehealth strategy (2013–2018)/star rating system	The adoption of digital technologies and innovative solutions to help improve care delivery increased. This includes greater decentralization. A star rating system was introduced in primary care to improve the quality of care, with funds made available to improve care provision in the public system, especially in disadvantaged rural areas. However, Davis et al. (2022) found that there were still challenges with infrastructure, access, and available resources, including healthcare professionals (HCPs), to effectively tackle AMR in Tanzania.	[35,36,37,38,39]
Medicines, Technologies, and Pharmaceutical Services (MtaPS) program in hospitals	Educational and other programs were undertaken to strengthen ASPs in hospitals—a key element of the 2023 to 2028 NAPs.	[40,41]
Commonwealth Pharmacist Association	Apps have also been developed, including for Tanzania to improve awareness of AMS among HCPs. This includes documenting the indication and duration of the prescription of antimicrobials in patients’ notes to help improve the appropriateness of antibiotic selection.	[42]

NB: AMR = antimicrobial resistance; AMS = antimicrobial stewardship; ASPs = antimicrobial stewardship programs; AWaRe = Access, Watch, and Reserve antibiotics [21,22]; HCPs = healthcare professionals; NAP = national action plan; STGs = standard treatment guidelines.