Sourcing Community Solutions to Antibiotic Resistance in Nepal

该项目将制定、试点测试和评估旨在预防和控制尼泊尔抗生素耐药性的高质量干预措施。将通过参与式数字电影制作干预措施，促进以社区为主导的解决日益严重的抗生素耐药性问题的办法，这将导致社区内的健康教育运动和针对决策者的宣传运动。这将直接支持实现联合国可持续发展目标，特别是可持续发展目标3：“确保健康生活，促进各年龄段所有人的福祉”。在尼泊尔，抗生素可治疗的感染是一个重大的公共卫生负担。最近对尼泊尔常见细菌性疾病抗生素耐药性研究的审查表明，抗生素耐药性对公共卫生的威胁日益严重（Basnyat 2015: 6-10）。事实上，正如世界卫生组织警告的那样，在全球范围内，“如果不采取紧急行动，我们正在走向后抗生素时代，在这个时代，常见的感染和轻微伤害可能再次致命”（世卫组织，2016年）。虽然开发新药至关重要，但如果不改变行为，抗生素耐药性将继续对人口健康构成重大威胁。我们的项目旨在严格评估参与式艺术干预在支持这种行为改变方面的潜力。该项目分为三个阶段。第一阶段将侧重于发展合作制作和参与性电影制作的方法，开展健康教育运动和宣传运动。第二阶段将侧重于在一个城市和一个农村环境中试点测试参与式电影制作、健康教育运动和宣传运动，并评估方法的覆盖面、执行保真度和各种利益攸关方的可接受性。第三阶段将侧重于在扩大规模、评估结果和影响之前完善方法。我们的具体干预措施包括四个阶段：1)共同制作短篇漫画（借鉴“基层漫画促进发展”的方法），确定在个人、家庭和社区各级预防和控制抗生素耐药性的关键障碍，并制定社区主导的解决方案，以克服这些障碍。2)将这些漫画制作成纪录片，既可以作为适合当地的健康教育工具，也可以作为针对地区和国家一级决策者的宣传工具；（三）在地方卫生教育活动中利用纪录片；4)在地区和国家层面开展宣传活动。在人文科学、社会科学和公共卫生的交叉点工作，汇集世界电影和数字文化中心（保罗·库克，PI）、纳菲尔德国际卫生与发展中心（詹姆斯·纽维尔和丽贝卡·金，联合i）和HERD国际（Sushil Baral, Sudeepa Khanal，联合i）的专业知识，并与尼泊尔卫生和人口部合作，这一伙伴关系将试行一种创新办法来处理一个重大的公共卫生问题。利用与社区利益相关者合作制作的参与式艺术方法，我们的目标是探索在滥用抗生素中起作用的强大的社会文化、政治和经济问题，并支持社区主导解决这一问题的发展，从而帮助提高政府主导的运动的有效性，并为其增加重大价值。此外，该项目将帮助建立利用参与性艺术作为公共卫生运动工具的能力，使项目小组的专业知识协同作用，以产生任何合作伙伴都无法单独实现的成果。

This project will develop, pilot test and evaluate a high-quality intervention aimed at preventing and controlling antibiotic resistance in Nepal. Community-led solutions to the growing problem of antibiotic resistance will be promoted through a participatory digital film-making intervention that will lead to a health-education campaign within communities, and to an advocacy campaign targeting policy makers. This will directly support the delivery of the UN's Sustainable Development Goals, in particular SDG 3: 'ensuring healthy lives and promoting well-being for all at all ages'.In Nepal, antibiotic-treatable infections are a significant public health burden. A recent review of studies examining antibiotic resistance to common bacterial diseases in Nepal indicates that antibiotic resistance is a growing threat to public health (Basnyat 2015: 6-10). Indeed globally, as the World Health Organisation warns, "without urgent action we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill" (WHO 2016). Although the development of new medicines is critical, without behaviour change antibiotic resistance will continue to be a major threat to population health. Our project seeks rigorously to evaluate the potential of participatory arts interventions in supporting such behaviour change.The project has three phases. Phase One will focus on the development of methodologies of co-production and participatory film-making, a health-education campaign, and an advocacy campaign. Phase Two will focus on pilot-testing the participatory film-making, health-education campaign and advocacy campaign in one urban and one rural setting, and on evaluating the approach for reach, implementation fidelity, and acceptability to a variety of stakeholders. Phase Three will focus on refining the approach prior to scale-up, evaluation of outcomes and impact. Our specific intervention consists of four stages:1) The co-production of short comics (drawing on the 'grass-roots comics for development' methodology) which identify critical barriers to preventing and controlling antibiotic resistance at the individual, household and community levels, and which develop community-led solutions to overcoming those barriers. 2) The development of these comics into documentary films that can be utilised both as health-education tools, which are appropriately tailored for the locality, and as advocacy tools, which are aimed at policy makers at the district and national levels; 3) The utilisation of the documentary films in a health-education campaign within localities; 4) The delivery of an advocacy campaign at the district and national levels. Working at the intersection of humanities, social sciences and public health, and bringing together the expertise of The Centre for World Cinemas and Digital Cultures (Paul Cooke, PI), the Nuffield Centre for International Health and Development (James Newell and Rebecca King, Co-Is) and HERD International (Sushil Baral, Sudeepa Khanal, Co-Is), and working in collaboration with the Ministry of Health and Population in Nepal, this partnership will pilot an innovative approach to dealing with a significant public-health issue. Drawing on participatory-arts methodologies of co-production with community stakeholders, we aim to explore the powerful socio-cultural, political and economic issues at play in the misuse of antibiotics and support the development of community-led solutions to this issue, thus helping to increase the effectiveness of, and adding significant value to, government-led campaigns. The project will, moreover, help build capacity for the use of participatory arts as a tool for public-health campaigning, synergising the expertise of the project team to produce an outcome that none of the partners could achieve on their own.