New ReAct Report: Community engagement and AMR: Insights from the Asia Pacific Region

2024-07-22

As the world grapples with complex health issues like antimicrobial resistance (AMR), there's growing recognition that top-down approaches alone are insufficient.

A new report by ReAct Asia Pacific highlights the critical role of community engagement in addressing these challenges, particularly in low- and middle-income countries. The report is based on a preliminary desktop review of selected literature and interviews with civil society organizations and researchers working on community engagement in health and antimicrobial resistance.

According to the report, community engagement in health is not a new concept. Its roots trace back to 19th-century physician activists like Rudolf Virchow, who promoted the idea of social medicine. The approach gained global prominence with the World Health Organization’s 1978 Alma Ata Declaration, which emphasized primary health care and community participation.

Effective community engagement

Effective community engagement requires understanding local contexts, building trust, and co-creating solutions. Dr. Sushil Baral, Managing Director at HERD International in Nepal, emphasizes this point:

“Identifying local champions and training them helped build trust and local ownership of the co-creation process. This enabled open discussions on power dynamics, mutual learning and identification of local issues.”

Best practices in Asia-Pacific

The report showcases various approaches to community engagement across South and Southeast Asia.

Thailand

In Thailand, the Antibiotic Smart Use (ASU) project demonstrated the power of simplifying complex concepts.

Dr. Nithima Sumpradit, National Focal Point for Thailand’s National Strategic Plan on AMR, explains:

“Antibiotic Smart Use aimed to simplify the complex concept of rational use of medicines by focusing on convincing people to not use antibiotics for 3 common conditions – upper respiratory tract infections, acute diarrhea and simple wounds. This clear message was developed jointly.”

India

In India, organizations like REACH have empowered TB survivors to become “champions,” bridging the gap between service providers and users. Anupama Srinivasan, Assistant Director at REACH, notes:

“TB champions provide peer support, create awareness, do local level advocacy, facilitate feedback from users to providers, and address stigma. Their roles have evolved organically based on their individual strengths and interests.”

Engaging informal healthcare providers

The report also highlights the importance of engaging informal healthcare providers, who often serve as the first point of contact for many communities. Dr. Meenakshi Gautham, Assistant Professor at the London School of Hygiene and Tropical Medicine, observes:

“There is a distinct disconnect between the community and the formal health system in India today. The community relies more on informal providers, ASHAs (community health workers), and local pharmacists for health knowledge and services. Strengthening local health systems and engaging with informal providers is crucial for addressing AMR.”

Measuring impact is a challenge

Measuring the impact of community engagement initiatives remains a challenge. Dr. Sonia Lewycka, who leads the Collective Action Against AMR (Co-ACT) study in Vietnam, points out:

“Beyond the core health outcomes, participatory approaches can build community empowerment, self-efficacy and social capital, though these are harder to measure. Communities often take unanticipated actions through the process.”

The report also underscores the need to address broader systemic issues.

Dr. Yogesh Jain, a founding member of Jan Swasthya Sahyog in India, argues:

“Antimicrobial resistance is a complex issue that is far removed from the realities and understanding of most marginalized communities. Root causes like absence of public health systems and warped healthcare-seeking behaviours need to be addressed. AMR cannot be addressed in isolation – an understanding of microbiology, health systems, socioeconomic factors is essential.”

Leading up to High-Level Meeting on AMR at the UN General Assembly: the power and potential of community engagement

As global health leaders prepare for the High-Level Meeting on AMR at the UN General Assembly this September, the ReAct Asia Pacific report serves as a timely reminder of the power and potential of community engagement. By embracing participatory approaches and co-creating solutions with affected communities, we can develop more effective, sustainable strategies to combat AMR and other pressing health challenges.