Chibuike Alagboso and Chinwendu Tabitha Iroegbu (Lead writers)
Antimicrobial Resistance (AMR) is often called a “silent pandemic”, but the numbers are anything but silent. An April 2025 study showed that in 2022 alone, more than 3 million children lost their lives to AMR-related infections. This staggering loss highlights the urgent need for stronger global and regional strategies to protect children from this escalating threat.
The Global Research on Antimicrobial Resistance (GRAM) Project paints a worrying picture of AMR’s global impact. In September 2024, it revealed that more than one million people died from AMR each year between 1990 and 2021, with deaths projected to rise steadily in the coming decades, increasing by almost 70% by 2050. However, the study showed that if access to health care and antibiotics is improved, as many as 92 million lives could be saved between 2025 and 2050.
There is opportunity to reverse these predictions and save more lives if decisive actions are taken. From improved healthcare infrastructure to expanded prevention and control measures, investments in research and development of new antibiotics and improving WASH facilities.
In Nigeria, the problem is compounded by limited diagnostic capacity and entrenched prescription habits. Many frontline health workers, especially in rural areas, are pressured by patients to prescribe antibiotics without proper testing. This often means skipping critical investigations like culture and sensitivity tests.
One important way to reverse this trend is involving more frontline health workers who usually prescribe and sell these medications to patients.
Nigeria’s reality
Evidence shows that antibiotic misuse is both a community and hospital problem with 72.4% of community pharmacies and 89.3% of patent medicine vendors dispensing antibiotics without prescriptions, encouraging self-medication.
“Respondents in a Nigeria Health Watch community poll stated that 50% keep antibiotics at home; about 41% reported reusing leftover medication, while 34.2% said they share or buy antibiotics without any laboratory testing.”
These patterns reflect antibiotic treatments based on observation without definitive diagnosis, worsening the risks of AMR in Nigeria.
Nigeria’s second costed National Action Plan on AMR (NAP AMR 2.0) has allocated over USD 20 million to AMR stewardship-related programming, however, only 45% of activities from the fist plan were implemented by 2021 due to funding gaps and competing priorities. These challenges are likely to deepen, as recent funding cuts will place further strain on the implementation of the plan.
Gatekeeping antimicrobial medications
Optimising the use of antimicrobials is one of the five core strategic objectives of the GRAM by the World Health Organisation (WHO). Stewardship programmes are designed to monitor and promote appropriate and responsible use of antimicrobial use at both national and local levels through effective gatekeeping.
Some of these programmes come as fellowships targeting public health and policy experts as it is important to actively engage frontline health workers who interface with patients when they need healthcare.
Health workers actions, both within health facilities and in communities, can determine whether antimicrobials remain powerful tools or lose their effectiveness. A key contribution lies in how health workers prescribe and administer antimicrobial medications.
Doctors who follow evidence-based guidelines can avoid unnecessary prescriptions, while pharmacists ensure patients safely receive the right medications, at the right dose. They also add an extra layer by tracking medicine supply and consumption patterns, offering valuable data for surveillance. Laboratory scientists provide accurate diagnostic testing to guide treatment choices.
Beyond clinical practice, frontline health workers can safeguard patients by tracking side effects and adverse drug reactions. This real-time pharmacovigilance protects individuals and feed into policy decisions.
However, stewardship is not only about medicines, but also about attitudes. Health workers are trusted voices, making them powerful influencers and advocates. By explaining to patients why antibiotics should not be used for viral illnesses, encouraging adherence to prescribed treatments, or promoting infection prevention behaviours like handwashing, they help shift cultural norms around antibiotic use. Preventing infections reduces the need for antibiotics in the first place. Community health extension workers, because of their proximity to households, are uniquely positioned to spread these messages at the grassroots level, becoming “antimicrobial champions”.
Incorporating data for decision-making
AMR cannot be tackled without robust data, and frontline health workers are central to building this. Every prescription, sample, and patient encounter generates information that helps shape research and development of new defenses.
Doctors linking clinical decisions with microbiological results; nurses recording patient progress, and reporting side effects; and pharmacists monitoring prescription accuracy, auditing antimicrobial consumption and flagging inappropriate use, and samples being processed by laboratory scientists can feed data into national and global systems such as WHO’s global antimicrobial resistance and use surveillance system (GLASS).
Beyond frontline workers
It is important to note that AMR is not a problem for health workers alone, it needs a whole-of-society involvement. A One Health approach is needed, recognising that AMR cuts across human and animal health, agriculture, food security, and economic development.
Everyone, from policymakers to farmers to patients, must play a role in conserving antimicrobial effectiveness. The World Bank estimates that by 2050, drug-resistant infections could push up to 28 million people into extreme poverty, with poor countries bearing the heaviest burden.
To make NAP AMR 2.0 impactful, Nigeria must strengthen stewardship where it matters most. That means embedding AMR training into continuing professional development, equipping health centres with affordable diagnostics, providing tools for patient communication, and creating incentives that reward responsible prescribing.
Policies must also address the financial and social pressures that drive inappropriate antibiotic use, acknowledging the realities faced by health providers.
In 2026, Nigeria will host the 5th Global High-Level Ministerial Conference on Antimicrobial Resistance. This offers an opportunity to galvanise global, regional and local partnerships, attract private sector participation, and position stewardship as a cornerstone of both national health security and economic resilience.