A users’ approach to assessing evaluation tools for integrated surveillance of AMU and AMR - the updated CoEvalAMR methodology

Regular evaluation of any surveillance is needed to ensure system effectiveness. In an international research network, called CoEvalAMR, we have developed guidelines for evaluation of integrated surveillance of antimicrobial use (AMU) and antimicrobial resistance (AMR). Different evaluation tools have been assessed using a methodology developed with a focus on the user’s experience in a country case format. The original methodology consisted of a brief description of the case study, followed by an assessment of 11 functional aspects and eight content themes and a SWOT-like analysis. Based on the first round of cases, we have updated the methodology to increase the evaluation coverage and standardisation. The update was based on 1) a brainstorm with CoEvalAMR network members, 2) results of a questionnaire with 23 expected tool users, and 3) a comparison with the SISOT framework developed by the Tripartite (FAO/WHO/OIE). Tool users prefer easy-to-use tools addressing many issues in a way which can be communicated straightforwardly to decision-makers and stakeholders. However, no tool can do this, and each tool has its advantages and limitations. This makes it important to reiterate that the choice of tool depends upon the specific evaluation purpose and that adequate resources, time and training are needed before an evaluation will provide a useful output. Our updated methodology can be used by tool users to share experience regarding different tools, and hereby assisting others in identifying the most suited tool for their purposes.