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

One Health CE-AMR挑战组是一个雄心勃勃的12个月项目，汇集了社会人类学、社区参与、卫生经济学、参与式发展艺术、政策制定、全球卫生参与式设计、公共卫生流行病学、健康传播学、实验寄生虫学、兽医科学、环境科学和动物学等领域的专家。我们的目标是调查社区参与(CE)应对抗菌素耐药性(AMR)全球威胁的潜力，特别是在低收入和中等收入国家(LMIC)的背景下。由于人口增长、卫生基础设施有限以及在没有医疗咨询或处方的情况下无法获得抗菌药等多种因素，急性呼吸道感染是一项重大挑战，在包括我们的重点国家(尼泊尔、印度、越南、孟加拉国和加纳)在内的小岛屿发展中国家尤其严峻。我们特别感兴趣的是开发一种健康方法，它理解通过探索人类和动物健康、农业和环境来整体解决AMR的必要性。该专题组将从六个组成项目中综合学习。我们将通过跨项目团队和与每个国家更广泛的利益攸关方合作解决关键研究问题，探索这些项目的最佳做法。我们的学习将被综合成一本手册，其中将包括：(A)关于拆解支撑全球南方特定社区内抗菌剂使用需求方面的驱动因素的指导；(B)确定相关社区利益攸关方的方法过程，以及关于考虑围绕性别和交叉性的复杂性的指导；(C)一套跨越单一健康谱的行为目标(个人和社区实施的将影响AMR的具体做法)，特别关注公共卫生、动物生产和洗涤部门；(D)关于将CE嵌入现有的卫生、兽医、农业、洗涤和其他系统的最佳做法；以及(E)确定和影响国家和国际利益攸关方的方法过程。我们将与非学术利益攸关方广泛接触，这些利益攸关方代表在国家背景下从一个卫生角度解决AMR问题的重要部门。他们将包括来自卫生、农业(包括畜牧和渔业)和环境部门的代表，以及地方和国家政策制定者和发展伙伴。通过每个国家的两个研讨会，我们将合作开发由全球-南南主导的研究项目，这些项目根据每个环境中正在发挥作用的特定社会和政治背景提供信息--我们将强调开发能够在现有国家系统内很好地运作的CE方法的重要性，因此，这种方法将是可持续的，并适合于大规模交付。我们预计将出现新的国家网络，通过社区参与，从一个健康的角度解决AMR问题。在我们正在工作的一些环境中(例如孟加拉国和尼泊尔)，这样的网络已经在发展，我们预计它们将通过这种有重点的合作得到加强。在其他情况下，这些网络将是新的和潜在的有影响力的参与者，为解决AMR的国家规划做出贡献。该项目的总体目标是有助于减少对抗菌剂的需求，并确保在低收入和中等收入国家良好使用必要的抗菌剂。虽然这个项目本身不能解决这些问题，但通过汇集多个研究人员和利益相关者网络的专业知识，我们希望朝着这一雄心迈进。在整个计划过程中，我们会与政策制定者、发展伙伴和学者保持联系，以突出行政长官在处理资产负债表问题上的潜力。

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.