Reimagining AMR action through community voices: Lessons from Jahangirpuri, New Delhi, India

2026-03-26

In Jahangirpuri, an urban resettlement slum in Delhi, women are quietly reshaping how antimicrobial resistance (AMR) is understood and responded to at the grassroots. With support from Ek Jeevan Hamari Prerana, a women led NGO rooted in the community, and in partnership with ReAct Asia Pacific, a small group of women volunteers has recently come together under the Antibiotic Smart Community (ASC) initiative. Their work shows that community engagement in AMR must move beyond isolated awareness campaigns and over the counter focus and instead begin with people’s everyday realities.

The ASC initiative in Jahangirpuri demonstrates that AMR is shaped by a complex mix of social, economic and environmental factors. In this crowded neighbourhood, health decisions are influenced by precarious livelihoods, overcrowded housing, limited access to formal healthcare and entrenched gender roles. Women, often primary caregivers, make choices about medicines within tight budgets and unreliable services. This is not simply about overuse or misuse of antibiotics, but about how poverty, gender and environment intersect to shape behaviour.

From five days of learning to lifelong change

Over five days of training with women from a local literacy group, the Antibiotic Smart Communities initiative introduced AMR through interactive sessions that combined short learning segments, group discussions and role plays. The idea was to avoid starting with technical “drug–bug” language and instead invite women to connect AMR to their everyday experiences of health and care. These five days revealed that while talking about AMR directly can be abstract, discussing WASH (Water, Sanitation and Hygiene) is much more relatable.

Through conversations on cleanliness, handwashing, safe water and sanitation, women could see how improving hygiene prevented infections in the first place. If infections are reduced, the need for antibiotics also goes down, which in turn slows the development of antimicrobial resistance. These discussions helped participants not only understand the link between water, sanitation, and hygiene and AMR but also feel that they could actually do something about it in their own homes.

Addressing rational use and everyday realities

The sessions also focused on the rational use of antibiotics. Women learned the difference between bacterial and viral infections and discussed why antibiotics should only be used when necessary and as prescribed. This basic understanding is important at the community level, where antibiotics are often seen as a “quick fix” for fever, cough or stomach upset, even when they are not needed.

Participants also shared candid perspectives on healthcare access. Many spoke about the behaviour of doctors in hospitals that sometimes discourages them from seeking care in formal facilities. As a result, they often rely on informal providers, pharmacists or “quacks” who dispense medicines on demand. They also described common practices such as using leftover antibiotics from previous illnesses or stopping treatment midway once symptoms improve.

These conversations revealed that antibiotic misuse is not driven by ignorance alone, but by a mix of social and systemic factors. Long waiting times, financial constraints and lack of trust in formal services all influence how people seek care and use medicines. Community engagement must therefore address these realities, not just deliver messages about “taking the full course.”

Women as agents of change

The enthusiasm and active participation of the women throughout the five day training were striking. When informed and empowered, they can heavily influence health practices within their families and communities. Their questions, reflections and role plays made clear that they are not passive recipients of information, but active interpreters and adapters of health messages.

One participant, Lalitha, shared how her learning had already begun to ripple beyond her own household.

“I go to a house as house help, and when I told my employer about these sessions, she said,

‘Whatever you are learning from the session, when you come home, teach me as well.’ This made me feel that my knowledge is valuable, not just for my family, but for others around me.”

Her experience captures how community engagement can spread through informal networks, turning women into trusted health educators both in their homes and workplaces.

From empowerment to everyday practice

The five day engagement also highlighted that conversations about hygiene, infection prevention and responsible antibiotic use can be powerful entry points for understanding AMR. Prevention sits at the heart of the discussion. Longer hospital stays, higher medical costs and even loss of life were described not as abstract statistics, but as real fears that women had already experienced or witnessed in their own families. Painful illnesses also mean lost wages and extra burdens on caregivers, often women themselves.

Seeing AMR in this way helps shift the focus from technical resistance to lived consequences. It also opens the door to One Health thinking. Women began to notice how animal health, dirty water and poor sanitation are all part of the same chain of risk and care. These observations make it easier to connect AMR with broader ideas such as safe housing, cleaner streets and better working conditions

Looking ahead

The experience from Jahangirpuri reinforces that sustainable AMR solutions cannot come solely from the top down. They must be built through grounded, community led efforts that bring nuance and accountability into implementation.

Awareness is not the aim; empowerment is the need of the hour. When women like those in Jahangirpuri are informed, supported and heard, they can translate AMR from a global concern into a local, everyday practice of care, cleanliness and responsible use of medicines.

ReAct’s work continues to advocate for a shift in perspective: from seeing AMR as a biomedical challenge alone to understanding it as a societal issue that demands inclusive, intersectional and context sensitive solutions.