Empowering Communities to Combat Antimicrobial Resistance 

When disease-causing microbes develop resistance to antimicrobial medicines, this phenomenon leads to infections that are harder to treat, causing prolonged hospital stays, an upsurge in hospital costs, and an increase in mortality rates. Widespread and unmonitored use of antimicrobials over time leads to Antimicrobial Resistance (AMR) that has emerged as a major threat, with significant implications to global health, economics, and security.

In Nepal, AMR is fueled by easily available drugs and antimicrobials at local pharmacies and rampant self-medication without consultation with qualified health workers. In 2019 alone, the World Health Organization (WHO) reported that AMR was directly responsible for 6,400 deaths and contributed to 23,200 more, ranking it among the top three causes of death in Nepal. Many people are often unaware of the rational use of antimicrobials, how AMR develops, or how to control its spread. It is crucial to address the lack of knowledge and public awareness of this serious issue.

A Participatory Approach to Address AMR

The community plays a crucial role in addressing the drivers of AMR, but awareness around AMR and its prevention remains poor. A recent survey in Kapilvastu District by HERD International showed that two-thirds of households were completely unaware antibiotics and other antimicrobials. Local government counterparts professed awareness of antimicrobials and their use, but their understanding of AMR was limited.

To address this knowledge gap, a participatory action research project was implemented in Kapilvastu to test how community engagement contributes to address the drivers of AMR. This research focused on the Community Dialogue Approach (CDA), a community-driven model that actively engages the local populations and stakeholders in discussions on AMR and emphasizes collaborative decision-making to tackle local challenges. This approach aims to provide context-specific, localized, and culturally appropriate solutions to the problems. The CDA also aims to address the root causes of AMR in a localized manner by encouraging community ownership of planned interventions and promoting inclusivity and long-term sustainability.

A key component of the CDA is the “One Health” concept, bringing together the human health, animal health, and environment sectors to collaboratively combat AMR. One Health establishes that the engagement of a single sector is insufficient, thus integration is necessary for more effective action against AMR. To ensure a coordinated response, HERD International engaged stakeholders from federal, provincial levels, as well as municipal representatives and community leaders, from the outset of the action research.

Developing Champions of AMR Awareness

As part of the CDA, HERD International provided training to 98 facilitators from Kapilvastu Municipality on conducting community sessions for raising AMR awareness. Despite limited initial knowledge, these facilitators were enthusiastic and eager to learn. Using their new-found knowledge, they conducted awareness sessions for eight months in their communities. By the end of the project, these facilitators emerged as dedicated AMR Awareness Champions, advocating for AMR prevention and educating their communities on the importance of fighting AMR threats. Empowered by the training and experiences, some facilitators even approached their local ward offices to request budget allocations to continue the CDA beyond the research period.

Mainstreaming CDA at Local Level

After CDA sessions were completed in Kapilvastu Municipality, community members, including facilitators and participants demanded that the continuation of the program was essential for long term solutions to AMR. From the beginning, HERD International had sensitized municipal representatives – such as the mayor, deputy mayor, ward chairs, and One Health stakeholders – to AMR. They were actively involved in every phase of the CDA process, from planning and training to monitoring and evaluation. HERD International also conducted multiple meetings and programs to share AMR-related findings, and progress and outcomes of the CDA. This continuous engagement with municipal stakeholders paved the way for mainstreaming CDA into municipal plans and maintain the program as demanded by the constituents.

By co-creating the initiative with the local government, the project ensured shared ownership and alignment with local priorities. Along with facilitators at community level, HERD International trained health workers on CDA, who served as supervisors in the CDA implementation process and were also sensitized to the growing impact of AMR and the urgent need to address this issue.

Continuous discussions and consultations with municipal elected officials and One Health actors, coupled with capacity-building activities and periodic reviews, resulted in increased ownership of CDA at the municipal level. As a result, Kapilvastu Municipality committed to allocate a portion of their municipal budget to sustain this initiative. Additionally, ward chairs from all 12 ward offices within the municipality committed to allocate a portion of their respective budgets to continue the CDA initiative, demonstrating strong local ownership and long-term support for AMR prevention. This commitment has already been translated into action, with the municipality and six wards to run CDA sessions from March 2025.