Developing Community-Led Solutions to Antimicrobial Resistance: Building a One Health Approach in Low and Middle Income Countries

The One Health CE-AMR Challenge Cluster is an ambitious 12 month project, which brings together experts in the fields of Social Anthropology, Community Engagement, Health Economics, Participatory Arts for Development, Policy Development, Participatory Design for Global Health, Public-Health Epidemiology, Health Communications, Experimental Parasitology, Veterinary Science, Environmental Science and Zoology. Our aim is to investigate the potential of community engagement (CE) to address the global threat of antimicrobial resistance (AMR) particularly within the context of low- and middle- income countries (LMICs). AMR is a major challenge, particularly acute in LMICs, including in our focal countries (Nepal, India, Vietnam, Bangladesh and Ghana) due to a combination of factors, including growing populations, limited health infrastructure and the accessibility of antimicrobials without medical advice or prescription. We are especially interested in developing One Health approaches, which understand the need to address AMR holistically through an exploration of human and animal health, agriculture and the environment.

The Cluster will synthesise learning from within six constituent projects. We will explore best practice within these projects by addressing key research questions collaboratively across the project teams and with wider stakeholders within each country. Our learning will be synthesised into a handbook that will include: (a) guidance on unpacking the drivers that underpin the demand side of antimicrobial usage within specific communities in the Global South; (b) a methodological process for identifying relevant community stakeholders, as well as guidance on considering complexities around gender and intersectionality; (c) a set of behavioural objectives (specific practices that individuals and communities implement that will impact on AMR) that span the One Health spectrum, with specific attention to public health, animal production, and the WASH sector; (d) best practices around embedding CE into existing health, veterinary, agricultural, WASH and other systems; and (e) methodological process for identifying and influencing national and international stakeholders.

We will engage extensively with non-academic stakeholders who represent sectors important to addressing AMR from a One Health perspective in the national context. They will include representatives from the health, agriculture (including livestock and fisheries), and environment sectors, as well as local and national policymakers and development partners. Through two workshops per country, we will collaborate in the development of global-south led research projects that are informed by the particular social and political contexts at play in each setting - we will emphasise the importance of developing CE approaches that can work well within existing national systems and that, therefore, will be sustainable and appropriate to deliver at scale.

We anticipate the emergence of new national networks that focus on addressing AMR from a One Health perspective through community engagement. In some settings that we are working in (e.g. Bangladesh and Nepal), such networks are already developing and we anticipate that they will be strengthened through this focussed collaboration. In other settings, these networks will be new and potentially influential players in contributing to national planning to address AMR.

The overall ambition of this project is to contribute to decreasing the demand for antimicrobials and ensuring good usage of necessary antimicrobials in low and middle income countries. Whilst this project alone cannot solve these issues, by bringing together the expertise of multiple researchers and stakeholder networks, we hope to move towards this ambition. Throughout the project, we will liaise with policy makers, development partners and academics to highlight the potential of CE to address AMR.

This research will benefit a wide range of stakeholders, including the research community, national and international policy makers, development partners, and individuals employed to work on the project's constituent parts.

Researchers in Bangladesh, Nepal, India, Vietnam, Ghana and beyond will benefit from our investigation into best practices within community engagement as a core strategy to tackle the implications of antimicrobial resistance from a One Health perspective. Knowledge will be shared with them particularly through the development of an open access handbook detailing best practice.

Policy-makers and development partners in Bangladesh, Nepal, India, Vietnam, Ghana and beyond will benefit from our work through our focus on examining how to embed the community engagement approaches into existing systems and community infrastructures. They will be equipped with information to enable them to make informed choices on how to deliver community engagement in order to address the drivers that underpin the demand side of antimicrobial usage at community level, and potentially addressing other health and development issues in the longer term.

Staff working on the project will build their capability to work across disciplines and in cross-sectoral partnerships, to co-design research proposals, and to build leadership skills. We anticipate building capacity particularly in terms of subject knowledge, which will position individuals and organisations as experts in applying One Health perspectives to addressing AMR through community engagement.

This study will directly benefit Bangladesh, Nepal, India, Vietnam and Ghana, all on the list of least developed countries on the DAC list of ODA countries. We will be synthesising best practice within community engagement to address AMR, supporting the development of innovative context-appropriate research agendas across five LMICs, and enabling the development or emergence of national networks dedicated to addressing AMR through a One Health perspective, utilising community engagement methodologies in those five LMICs. We would expect this learning to be relevant for multiple LMICs that have the required health system and service infrastructure to support community engagement interventions, in which case it could eventually benefit many more countries on the DAC list.