Policy text analysis of antimicrobial resistance governance in China: A focus on national-level policies

•Unique policy text analysis unveils China's evolving strategy in tackling antimicrobial resistance (AMR) through a 'One Health' approach.•Central government documents highlight a preference for environment-focused policy instruments.•National Health Commission emerges as a pivotal player in shaping comprehensive AMR stewardship policies.•Findings underscore the importance of inter-sectoral collaboration for maximizing policy impact. To explore the structure and characteristics of China's national policies regarding antimicrobial resistance (AMR) governance. This research constitutes a quantitative content analysis of AMR policies issued by the central government from 2004 to 2023. A systematic search identified 112 policy documents, which were analysed using a three-dimensional framework. This framework included policy objectives, policy instruments (The supply-focused instrument aims to promote rational and prudent antibiotic prescriptions. The demand-focused instrument affects consumer use of antibiotics, either directly or indirectly. The environment-focused instrument provides a favourable and systematic policy environment for the prudent use of antibiotics.) and policy evolvement. Sub-themes under the framework were identified through a deductive process, followed by descriptions of frequency distributions of the sub-themes and categories. The majority of policy documents originated from individual governmental departments, with only 8 (7.14%) being jointly issued. The National Health Commission (NHC) remained the predominant policy maker, issuing 56 (48.21%) policies. A clear preference emerged for utilizing environment-focused policy instruments (69.70%), compared with the demand-focused (18.45%) and supply-focused (11.85%) instruments. 'Optimizing the use of antimicrobial medicines' ranked on top of the policy objectives, with 185 (31.25%) citations extracted across 74 (30.58%) policy documents. In addition to increasing numbers of policies over the three stages (2004–2011, 2012–2015, 2016–2023) of development, the use of various instruments became more comprehensive and balanced in the third stage. AMR governance has become increasingly comprehensive in China, despite a deficit in inter-sectoral collaborations. A whole-of-government approach is required to maximize the value of various policy initiatives.