Strengthening healthcare systems to prevent antimicrobial resistance in LMICs: it is time to act.

Antimicrobial resistance (AMR) poses a rapidly growing threat to global health, with low- and middle-income countries (LMICs) bearing a disproportionate burden. These LMICs face challenges such as weak health system governance, limited diagnostic capacity, undertrained workforces, and poorly regulated antibiotic markets that drive inappropriate antimicrobial use and accelerate AMR. In settings where over-the-counter antibiotic sales remain widespread and empirical treatment is a routine, AMR undermines treatment effectiveness and increases preventable morbidity and mortality. If left unaddressed, AMR is predicted to result in 10 million deaths per year by 2050. Combating AMR in LMICs requires a comprehensive approach: strengthening healthcare systems, enforcing prescription-only policies, raising public health awareness, and fostering collaboration between governments, non-governmental organisations, and international stakeholders. Priority actions include regulating informal pharmaceutical markets, embedding antimicrobial stewardship within primary care, expanding access to basic diagnostics, and using digital health tools to support prescribers and patients. Drawing on regional LMIC experiences, this viewpoint highlights practical pathways for aligning health system reform with AMR containment.