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

一个健康CE-AMR挑战集群是一个雄心勃勃的12个月的项目，汇集了社会人类学，社区参与，卫生经济学，发展的前瞻性艺术，政策制定，全球卫生的前瞻性设计，公共卫生流行病学，健康传播，实验寄生虫学，兽医学，环境科学和动物学领域的专家。我们的目标是调查社区参与（CE）在解决全球抗菌素耐药性（AMR）威胁方面的潜力，特别是在低收入和中等收入国家（LMIC）的背景下。抗生素耐药性是一项重大挑战，在中低收入国家尤其严重，包括我们的重点国家（尼泊尔、印度、越南、孟加拉国和加纳），这是由于多种因素造成的，包括人口增长、卫生基础设施有限以及在没有医疗建议或处方的情况下获得抗菌药物。我们对开发“一个健康”方法特别感兴趣，该方法理解通过探索人类和动物健康、农业和环境来全面解决AMR的必要性。该小组将综合六个组成项目内的经验教训。我们将探索这些项目中的最佳实践，通过在每个国家的项目团队和更广泛的利益相关者之间合作解决关键的研究问题。我们的学习成果将被综合成一本手册，其中将包括：（a）关于在全球南方特定社区内剖析支撑抗菌剂使用需求方的驱动因素的指导;（B）确定相关社区利益攸关方的方法流程，以及关于考虑性别和交叉性复杂性的指导;（c）一套行为目标（个人和社区实施的将影响抗生素耐药性的具体做法），涵盖一个健康范围，特别关注公共卫生，动物生产和WASH部门;（d）围绕将CE嵌入现有卫生、兽医、农业、WASH和其他系统的最佳实践;以及（e）确定和影响国家和国际利益相关者的方法过程。我们将与代表重要部门的非学术利益相关者广泛接触，这些部门在国家范围内从一个健康的角度解决AMR问题。他们将包括卫生、农业（包括畜牧业和渔业）和环境部门的代表，以及地方和国家决策者和发展伙伴。通过每个国家的两个研讨会，我们将合作开发全球-南方主导的研究项目，这些项目将根据每个环境中发挥作用的特定社会和政治背景进行通报-我们将强调开发CE方法的重要性，这些方法可以在现有的国家系统中很好地工作，因此，将是可持续的，适合大规模交付。我们预计将出现新的国家网络，重点是通过社区参与从一个健康的角度来解决AMR。在我们正在开展工作的一些环境中（如孟加拉国和尼泊尔），这种网络已经在发展，我们预计，通过这种有重点的合作，这些网络将得到加强。在其他情况下，这些网络将成为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。本项目的总体目标是帮助降低对抗菌药物的需求，并确保中低收入国家良好使用必要的抗菌药物。虽然这个项目本身无法解决这些问题，但通过汇集多个研究人员和利益相关者网络的专业知识，我们希望朝着这一目标迈进。在整个项目中，我们将与政策制定者、发展伙伴和学者保持联系，以强调行政长官在解决抗生素耐药性问题上的潜力。

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.