INTRODUCTION: Antimicrobial resistance (AMR) threatens public health, food safety, and economic stability, with low- and middle-income countries like Rwanda disproportionately affected. AMR leads to resistant infections in humans and animals, increasing morbidity, mortality, and healthcare costs.
METHODS: A qualitative policy evaluation was conducted using a literature and policy review of Rwanda’s National Action Plans (NAP 1: 2020–2024; NAP 2: 2025–2029) and global evidence on AMR control. Four policy options (strengthening surveillance, regulating livestock antimicrobial use, enforcing prescription-only antibiotic sales, and maintaining the status quo) were assessed using criteria including equity, sustainability, efficacy, value for money, and One Health alignment.
RESULTS: Policy evaluation of four alternatives strengthening AMR surveillance, regulating livestock antimicrobial use, enforcing prescription-only antibiotic sales, and maintaining the status quo shows that enhanced surveillance is most equitable, sustainable, and holistic. Livestock regulation ranks highest in efficacy and cost-effectiveness, while doing nothing risks worsening the AMR burden.
CONCLUSION: Rwanda should prioritize establishing a decentralized, multisectoral AMR surveillance system integrating human, animal, and environmental data, supported by livestock antimicrobial regulation and strict enforcement of prescription-only antibiotic sales.
