Every day, antibiotics save lives—from treating a child with pneumonia to curing infections in livestock. Hence, the term “wonder drug” for antibiotics. Yet, these same life-saving medicines are steadily losing their power.

The World Health Organization’s Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report 2025 warns that one in six infections worldwide no longer responds to at least one antibiotic, showing the rapid decline of effective treatments.

Across the world, the rise of antimicrobial resistance (AMR) is quietly undermining our ability to treat infections that were once easily curable—threatening modern medicine itself.

In Nepal, multidrug resistance (MDR) in common pathogens continues to rise.

• Escherichia coli showed MDR rates of 42% in 2021, increasing to 51% in 2023 (AMR Newsletter 2024, National Public Health Laboratory).
• In 2021, bacterial AMR was associated with 4.71 million deaths globally, with 1.14 million directly attributable to AMR (Murray et al., The Lancet, 2022).

With global attention intensifying, it is clear that protecting antimicrobials cannot be done by the human health sector alone. Human, animal, and environmental health are deeply interconnected—requiring a coordinated approach. Nepal is one of the countries actively embracing this shift, using the One Health framework to strengthen its AMR response.

From Concept to Collaboration

The idea behind One Health is simple yet profound: the health of humans, animals, and the environment are inseparable.

Pathogens cross these boundaries effortlessly, and antibiotic use in one sector affects all others. In Nepal, the One Health concept is evolving into structured, practical action.

To coordinate surveillance, improve data sharing, and align policies, Nepal has established several mechanisms:

• The One Health Steering Committee, bringing together experts from human, animal, and environmental sectors.
• A Joint AMR Surveillance Program, integrating surveillance across hospitals, veterinary centres, and environmental sites—an important step toward institutionalizing One Health.

Addressing AMR requires more than medical expertise; it needs shared data, joint action, and synchronised stewardship across all sectors.

The Role of the Fleming Fund Country Grant Nepal (FFCGN)

Through initiatives supported by FFCGN, multidisciplinary teams across human and animal health laboratories, veterinary centers, and food testing facilities are generating quality-assured data that guide national decision-making.

These efforts are:

• Strengthening laboratory capacity and surveillance systems
• Supporting evidence-based antimicrobial use
• Enhancing infection prevention and control across clinical and veterinary sectors
• Facilitating policy alignment under a unified One Health framework

Together with the Government of Nepal and partner institutions, these initiatives are transforming AMR containment from concept to coordinated, sustainable action.

What One Health Looks Like in Practice

Nepal’s One Health experience shows that success begins with building capacity—from the laboratories that test specimens to the national systems that analyze, share, and apply surveillance data.

Human Health Sector

Hospitals in Nepal’s AMR surveillance network are now generating actionable laboratory data to support evidence-based clinical care.

Key activities include:

• Strengthened Laboratory–Clinician Interface (LCI) through interactive workshops.
• Improved communication between clinicians, nurses, and lab professionals.
• Better specimen collection and faster culture and sensitivity testing.
• Standardized reporting formats to improve clarity and decision-making.

FFCGN has also supported Antimicrobial Use (AMU) Point Prevalence Surveys (PPS), revealing overuse of broad-spectrum Watch and Reserve antibiotics, providing crucial data for guideline development.

Strengthened Infection Prevention and Control (IPC) committees and Antimicrobial Stewardship Programs (AMSPs) rely increasingly on laboratory results to guide action.

At the national level, surveillance data directly influence:

• Treatment guidelines
• Diagnostic standards
• Policy decisions

Animal Health Sector

Poultry farm surveillance across all seven provinces reveals valuable insights into antimicrobial use in food-producing animals.

Findings include:

• Widespread use of antibiotics without veterinary oversight
• Use of banned or high-priority antibiotics such as colistin and fluoroquinolones
• Limited awareness of withdrawal periods
• Weak biosecurity practices at farms

These insights now drive discussions among policymakers, veterinarians, and farmers to promote:

• Vaccination
• Improved housing
• Biosafety measures
• Responsible antibiotic use

Such reforms protect public health and strengthen the sustainability of Nepal’s poultry industry.

Food Sector

AMR surveillance in the food sector provides critical insights into how resistant bacteria travel along the food chain.

Laboratories are testing samples from production to retail, guiding improvements in:

• Good Manufacturing Practices (GMP)
• Hygiene and handling
• Residue monitoring

These data inform policies that reduce AMR transmission and ensure consumer safety.

Environmental Sector

Environmental monitoring is now integrated into Nepal’s AMR response.

Testing wastewater from healthcare facilities, farms, and other sites helps identify resistant bacteria circulating in water systems and the wider environment.

Together, these cross-sectoral efforts represent what One Health looks like in practice—a unified, evidence-based national response.

Building Systems: Integration, Digital Transformation, and Governance

Nepal’s One Health progress is not just about data collection; it’s about building systems.

National AMR governance now includes:

• National Steering Committee for AMR (NSC-AMR)
• Sectoral AMR/AMU Technical Working Groups (TWGs)

These bodies ensure regular dialogue, joint learning, and coordinated decision-making across human, animal, food, and environmental sectors.

Digital Transformation

The integration of Laboratory Information Management Systems (LIMS) is modernizing Nepal’s AMR network by:

• Streamlining data entry and reporting
• Improving accuracy
• Reducing manual workload
• Accelerating national and global reporting

This shift allows laboratories to focus more on testing and interpretation, and less on paperwork.

Policy and Governance Framework in Nepal

Nepal has now established several key national frameworks that anchor the One Health approach:

— National Action Plan on AMR (2024–2028)

Formalizes multisectoral coordination and strengthens governance structures.

— National Antimicrobial Treatment Guidelines (2023)

Integrates cumulative antibiograms and WHO AWaRe classification for rational antibiotic use.

— National Essential List of Veterinary Medicines (2023)

Promotes responsible antibiotic use in animals and aligns with One Health principles.

Together, these frameworks provide a strong foundation for integrated AMR containment.

Lessons Learned

Nepal’s One Health experience highlights that effective AMR control depends on:

• Engaged stakeholders from clinicians to farmers
• Strong laboratory–clinician communication
• Direct linkage between evidence and action
• Multisectoral coordination grounded in real-world data

A Shared Responsibility

As we observe World Antimicrobial Awareness Week (WAAW) 2025, it is vital to remember that preserving the power of antibiotics is a collective responsibility.

• Clinicians and pharmacists must prescribe and dispense responsibly.
• Farmers and veterinarians must avoid unnecessary antibiotic use and maintain good hygiene and biosecurity.
• Everyone must avoid self-medication, complete prescribed doses, and practice infection prevention—including hand hygiene.

Nepal’s growing success with the One Health approach demonstrates that collaboration, evidence sharing, and innovation can transform AMR containment from concept to impact.

By building on these foundations, Nepal is helping safeguard antimicrobials for future generations—protecting people, animals, and the environment alike.

References

Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet. 2022 Feb 12;399(10325):629–655. doi:10.1016/S0140-6736(21)02724-0. Epub 2022 Jan 19.
Erratum: The Lancet. 2022 Oct 1;400(10358):1102. doi:10.1016/S0140-6736(21)02653-2.
PMID: 35065702; PMCID: PMC8841637.

Disclaimer

The Fleming Fund Country Grant for Nepal is funded by the UK Department of Health and Social Care’s Fleming Fund by UK International Development. The views expressed in this publication are those of the authors and not necessarily those of the UK Department of Health and Social Care.

Ms. Pavitra Rana

She is a communications professional with over a decade of experience in communication, outreach, and knowledge management in the development sector. Over the years, she has worked on a wide range of issues, including sexual and reproductive health, climate change, open data, data for development, and governance. At FHI 360, she now focuses on antimicrobial resistance (AMR), One Health, and global health security, using storytelling and evidence-based communication to translate complex health information into actionable insight.

Prof. Dr Ritu Amatya

She is a medical doctor (MBBS, MD Microbiology, MPH) with over two decades of experience spanning academia and the development sector. She currently leads the Fleming Fund Country Grant for Nepal (FFCGN), strengthening national capacity to address antimicrobial resistance (AMR) through a One Health approach. Her work integrates scientific expertise and public health insight to bridge evidence with policy and practice for improved health outcomes.