RBA INITIATIVE AMR BAJAJI CAMPAIGN
Taking into consideration the difficulty of reaching a large audience directly in the COVID19 situation, RBA Initiative under the funding support from the South Center wanted to reach the public at large with key AMR messages while keeping minimal physical gatherings of people. It is in this regard that the RBA Initiative conducted a Bajaji campaign in Dodoma-Tanzania. Three wheeled motorcycles are commonly known as “bajaji” in Tanzania and “Tuk Tuk” in the other parts of the World. This campaign used the three wheeled motorcycle ‘’bajaji’ ’to transfer the AMR messages to the public through the advert with key AMR messages in Kiswahili language placed behind the Bajaji.
“Bajaji” are widely used as a means of public transport in many urban settings of Tanzania. This was an amazing opportunity to build AMR awareness among the public in Dodoma. Being visually unavoidable the message reached different people, from those who sat inside the “bajaji” (they saw the message on the ‘bajaji’ in front), pedestrians, people at the public transport stations and including those with private means of transport. Furthermore, Bajaji drivers received AMR training and distributed AMR flyers to their passengers and the general public through an organized cavalcade around the city of Dodoma. The training covered the general concept of AMR so that the drivers could understand and disseminate the messages. The drivers were designated as ambassadors to spread AMR messages, distribute AMR fliers during and after the campaign and educate the community about AMR. The training also included journalists from various media outlets, policymakers, and other guests. RBA Initiative also used edutainment, with a special AMR Kiswahili song performed during the training. The link to the bajaj campaign photos https://www.rbainitiative.or.tz/gallery.php?gallery=bajaj
One of the bajaji drivers, Mr. Haule Gwasa, said, “”As a bajaji driver, I have learnt that it is not appropriate to use medicines without seeking advice from the healthcare providers. I used to go directly to buy medicines, including antibiotics, from the small drug outlets, but through the knowledge I have received, I will now be going to the hospital and seeing the doctor before buying medicines. I will also be an ambassador to the fellow drivers, passengers and the general public.’’
The pre-campaign survey asking participants if they had ever heard of antimicrobial resistance revealed in the pre-survey, 62.7% of respondents had never heard of AMR and after two weeks of the Bajaji campaign, this was reduced to 44%.
Additionally, bajaji drivers distributed 600 flyers to 600 members of the public in various streets. The RBA Initiative received positive feedback from the public through phone calls on the desire to learn more about AMR. In addition, a large number of people were reached by the bajaji campaign and read the two key AMR messages that were put behind the bajaji.
Working with other stakeholders, RBA-Initiative is adapting this methodology for use in other parts of Tanzania. However, with technical assistance from RBA Initiative, this methodology has already been adapted in Tanzania’s Kilimanjaro and Mwanza regions. The skilled bajaji drivers can and will be valuable human resources for the ongoing and upcoming AMR campaigns. Everyone can play a part in combating antimicrobial resistance, as this campaign serves as a helpful reminder. Utilizing three-wheeled motorcycles is a successful way to involve the public and increase AMR awareness while adjusting to the local context. As it looks to the opportunity to adapt this methodology on other forms of public transportation, the RBA Initiative is looking for financial support.
The Liverpool Antimicrobial Resistance Citizens’ Jury
This Citizen Jury project forms the basis of the consultation stage of phase 1 of a multi-year programme of work to develop a better information and data sharing model for Antibiotic Guardianship.
The first consultation was delivered using the deliberative method of a Citizen Jury. The jury (wherein people are recruited to broadly reflect the demographics of a particular catchment area) were asked to hear and weigh the evidence, discuss together, and use their values to assess trade-offs and make judgements regarding their remit. The evidence came from a range of expert witnesses who had been briefed to create presentations that provide the jury with a fair balance of relevant information. Over two weeks, jurors encountered and engaged with a series of frameworks to assess the challenge(s) at hand, learnt from presenters, and worked collaboratively with one another to assess the benefits and trade-offs of proposed solutions. They made informed recommendations regarding the legal, ethical, and regulatory aspects of the proposed undertaking.
Specifically in this project the jury considered patients in hospital with confirmed Urinary Tract Infections (UTI) who were prescribed different drug regimens by their healthcare practitioners. They were then asked questions based on the scenario to help the team understand the public perceptions of information and data access to enable new drugs to be tested, treatments to be optimised and to improve care.
The whole process was facilitated by a third party and was overseen by an independent panel whose purpose was to ensure fairness in the information provided to the jury. They worked with the jury to provide a safe space to express opinions and concerns. The jury produce a final report complete with recommendations for the next stages of the project and this was presented back to the project team, which we accepted in its entirety.
Citizen AMR Champions & AMR Awareness
Delivery of the event stimulated conversations on social media (Twitter, LinkedIn) about AMR, raising the profile locally and nationally. Follower count on social channels increased significantly, and impression counts were in the top quartile of similar posts. Additionally, the event raised the importance of meaningful Public Involvement in Research across the research and development community.
The 18 members of the jury received significant education in a broad range of topics related to AMR, drug development and legal and ethical considerations of data usage. Consequentially they are extremely enthusiastic to champion Guardianship more broadly, with one juror explaining how this experience “has changed my life for the better”.
All materials, slides and presentations for the event were produced by leading experts in their field, were assessed by an oversight panel to remove any bias and written for a lay audience. Distillation of the results have been published in a series of reports and all raw data is available. A dedicated webpage is hosted by UoL to hold all assets, which are accessible licence free.
Understanding Public Perception
The key output was gaining insights into what the public thought about:
It is these insights which will be built into the ongoing work and will enable the co-development of a framework that will support a community to become Antibiotic Guardians.
The Citizen Jury project forms the basis of the consultation stage of phase 1 of a multi-year programme of work to develop a better information and data sharing model for Antibiotic Guardianship. The learnings from public perceptions are currently being worked into the initial programme design. Changes have already been made in terms of the ways of working, the level and types of outreach work, and an emphasis on explaining process as well as outcomes. The Jury told us that this latter point was something that helped with the building of trust and displaying of trustworthiness. The public involvement section of the programme is to be significantly expanded to enable repeated involvement of the public in further iterations of the design and implementation processes.
Nationally and internationally, we have been developing an expansive network to ensure that the knowledge gained from this exercise is reused and starts to form the foundations of a better way of involving the public at the heart of system design.
However, some of the recommendations of the jury have already been acted upon and are folded into not just the initial plans for this programme, but also more widely as a set of best practices for similar projects in Liverpool with an aspiration to use health data.
Seriously Resistant Campaign Implementation in Sunderland and County Durham 2021
Seriously is a public facing campaign initially developed by Magpie and Leeds CCG in 2016. Through its campaign content, Seriously aims to educate the public on appropriate use of antibiotics and the issue of antibiotic resistance, reduce misuse of the treatment and encourage individuals to consider the alternatives and effective self-care.
In 2021 Sunderland and County Durham Medicines Optimisation teams implemented the campaign as the two areas were amongst the highest prescribers of antibiotics per patient population in the country, despite ongoing reductions over the past few years. It was hoped that with the support of this campaign we could reduce this by engaging patients and the public as well as prescribers and community pharmacies in the key messages. Patient influence and requests for antibiotics has been highlighted by the prescribers in the local area as key influencer of high antimicrobial prescribing.
Implementation locally built on the existing materials and new resources were developed to encourage public engagement, including new posters and animations. The campaign followed three streams of work; school engagement in an online event, primary care engagement working directly with GPs and Pharmacies to promote messages to patients and a direct public facing educational social media campaign, promoting the campaign messages across County Durham and Sunderland.
The social media campaign was a key area that allowed monitoring of public engagement. The team utilised this to run a system of testing messages via organic sharing prior to targeting further with boosted or paid advertising. This allowed the review of posts and adaptation of any messages that received negative feedback, and a guide to posts that had been well received and may perform well when boosted. This gave a reactive campaign that was tailored to the target audience and allowed negative comments to be minimised.
1. Beat it! #GermFest is the educational, family-facing arm of the campaign, part of a long-term aim to build the first educational festival supporting this area of knowledge. Over 100 target schools in high prescribing areas across Sunderland and County Durham were sent an event pack with printed resources and invited to join the event. Of those, 30 primary school classes signed up to take part; views of the event recording have now reached 100.
2. The overall performance of both owned and paid social media was very strong and the content generated varied discussion and debate amongst the public – from the 92 posts the total reach (incl boosted posts) = 208835 and total engagement (incl boosted posts) = 9018. The Education posts, which contained self-care guidance or treatment advice were the best performing overall. This will be a focus for further targeted social media and other digital marketing approaches.
3. Feedback that was gathered following the campaign from various stakeholders indicated that the campaign was useful, but that it could be further developed. A summary of feedback received is included below;
There are a number of plans for further development of the campaign in Sunderland and County Durham, as well as plans to further expand the reach to a regional or national level.
Antibiotic Amnesty: A collaborative project, bringing together organisations across the Midlands, to encourage safe disposal of antibiotics by the public
Antimicrobial resistance (AMR) is a major health threat and there is increasing recognition that contamination of the environment by the unsafe disposal of antibiotics via domestic waste streams is a risk for driving the further development and spread of resistant organisms. Our project promoted the safe disposal of unused and unwanted antibiotics via community pharmacies and encouraged these pharmacy teams to raise awareness of the public about the appropriate use of antibiotics.
We ran an antibiotic amnesty across the NHS England Midlands region and invited community pharmacy teams to participate ,supporting them with a webinar and resources to use. We asked them to engage the public by having ‘amnesty conversations’, highlighting the risks of using leftover antibiotics and encouraging them to return unused or unwanted antibiotics to the pharmacy. The pharmacy teams recorded the number of conversations they had with patients and the number of full or part packs of antibiotics returned over a two-week period (15-30 November 2021). The amnesty ran alongside the Pharmacy Quality Scheme incentive to use the TARGET antibiotic checklist with patients when dispensing prescriptions for antibiotics, and was complementary to the scheme.
The amnesty was advertised to the public via the CCGs involved, GP practices, and participating community pharmacies using social media, website content and posters. A resource pack, including the digital resources in 13 languages, was made available for use across the Midlands. The Local Pharmaceutical Committee and Local Authority also collaborated to advertise the campaign and/or provide communication with pharmacies.
Overall, 239 community pharmacies took part in the amnesty; they held over 7800 amnesty conversations with members of the public and recorded the return of 369 part-packs and 126 full packs of antibiotics. They also used the TARGET antibiotic checklist 4600 times in the two-week period.
Engagement with 7800 members of the public, raising awareness of the importance of the safe disposal of antibiotics:
Raising awareness of the general public about the threat of AMR, appropriate use of antibiotics, and the safe disposal of antibiotics (and medicines in general).
Return and safe disposal of almost 500 packs of antibiotics:
Preventing potentially unsafe disposal of antibiotics, for example down toilets, sinks or in domestic refuse, and subsequent contamination of the environment.
Reducing the likelihood of people saving/sharing antibiotics and the consequences on health and AMR that this may have.
Collaboration with organisations across the local area.
Engagement of 240 community pharmacy teams in additional antimicrobial stewardship work, complementary to other initiatives such as the Pharmacy Quality Scheme.
Education of stakeholders, on the amnesty campaign and local AMR priorities/issues, via educational webinars (live and recorded), with guest speakers from primary and secondary care.
Production of new resources that are available to use by other organisations.
Stronger links with Local Authority, Local Pharmaceutical Committees and other local NHS organisations.
We are not aware of a similar amnesty project taking place over such a large geographic footprint, having so many community pharmacies participate or record the level of detail on patient/public interactions and medication packs returned as part of the amnesty.
The project is being developed into a One Health approach for future campaigns, with a more comprehensive and organised approach to recruiting community pharmacies using PharmOutcomes platform.
For 2022 we are building on the success of, and lessons learned from, the 2021 campaign to increase public engagement by:
Including pet owners in the campaign. Linnaeus Group veterinary practices in the Midlands are participating in the amnesty for 2022, with other interested groups invited to come on board. In a similar way to community pharmacies, veterinary surgeries are keen to promote antimicrobial stewardship and are required to accept veterinary medicine returns from clients and pet owners and have the facilities to dispose of them safely.
Enlisting the support of a wider group of organisations to advertise the campaign to staff and members of the public, including dental surgeries, local NHS Trusts and local universities, local veterinary practices.
Collaborating with local universities across the Midlands (e.g. Aston, De Montfort) to develop and implement MPharm student projects to gather more detail about returned antibiotics. They are also considering supporting a research project and supporting the detailed review of antibiotics returned to specific pharmacies, to give us more insight and see if there are specific issues we may wish to address.
Trial of patient survey using QR codes linked to a public survey, available in multiple languages, to gather more qualitative information on patient engagement/attitudes/beliefs.
Developing a post-campaign feedback survey for community pharmacy teams to learn more about successes and learnings of the campaign.
Collaborating with Royal Pharmaceutical Society to develop a website to host campaign resources to allow use by other areas.
Liaising with water and wastewater companies to engage in advertising the campaign to the public via social media
Collaborating with interested organisations from outside the UK, e.g. New Zealand, to share plans and resources
Pan-African One-Health Interns (Youth-Led) Spread Awareness of AMR through Innovative Social Media Campaigns
Evidence and data on awareness indicate low levels of knowledge and understanding of AMR amongst the public. We have gathered information from multiple sources including vox pops, stakeholders engagement, key opinion leaders, policymakers and the general public, which resulted in the finding that messaging around AMR, may be lost, and not transferable in the local languages. Africa is the youngest continent, with UN data showing approximately 60% of the population being under 25. This creates a huge opportunity to innovate with the youth, including future prescribers, and dispensers during their pre-service education, creating champions, through their involvement in mitigating AMR and developing innovative campaigns towards shaping the narrative. This is in line with our youth against antimicrobial misuse (YAAM) project, which includes youth productivity and inclusiveness strategy.
As part of our efforts to promote the One-Health approach to addressing antimicrobial resistance, the Ducit Blue Foundation carried out a 3 months AMR One-health Pan-African internship program on “Involving Youth in the Mitigation of Antimicrobial Misuse & Antimicrobial Resistance”, in collaboration with the Food and Agriculture Organization and 5 regional student associations.
Our beneficiaries were 25 One-health undergraduates and recent graduates of 5 professional streams (Human medicine, Veterinary medicine, Pharmacy, Agriculture and Microbiology) from Anglophone and Francophone Sub-Saharan African countries, thus creating an enabling environment for one-Health interprofessional learning on AMR.
The interns were tasked with coming up with innovative approaches to utilize social media to increase awareness of AMR during World Antimicrobial Awareness Week 2021, supported by the South Centre.
Objective of the WAAW public engagement:
A youth-led public engagement across francophone and anglophone countries.
Enhance multidisciplinary One Health solutions for public engagement, create a youth voice as future ambassadors and champions towards curbing AMR, and develop innovative campaigns for WAAW.
Localise the language of AMR for better public and grassroots understanding.
1. Execution of WAAW activities:
We produced a video together with 25 interns on what AMR means in their local languages, which was launched across multiple social media platforms, receiving multiple accolades.
Multidisciplinary intern groups conducted AMR awareness campaigns for different social media strategies and physical engagement in their local communities, such as local primary and secondary schools.
There were 30,800 unique engagements measured across various social media platforms, with the majority centred across 8 anglophone and francophone countries
2. Results from feedback on the WAAW:
76% of the interns were satisfied with WAAW group activities.
88% of the interns believed that the programme and group activities had a One-health component.
An Excerpt: Increased learning during WAAW, including facilitated masterclasses to raise awareness and conducting a pre evaluation survey through Google forms.
3. We also conducted a Life After the Internship/Mentorship Programme survey for our sustainability goals. Some excerpts:
Interns are putting things learnt during the programme into practice for both their studies and work, going on to create awareness on radio shows, including university communities, educating the general public on the impact of AMR and prevention, using local dialect and English.
Participated in AMR outreach awareness activities as part of a student One Health innovation clubs, and was involved in student research into perceptions towards antimicrobial usage.
Worked as a research assistant, supporting the National Action Plan AMR Project, a collaboration between the University of Glasgow, Kilimanjaro Christian Research Institute, and Bugando Medical Center advocating for correct use.
Influenced a local committee to investigate the effluent discharge of a community hospital.
Organised a 4-module course for 1000+ medical and paramedical students on AMR, with positive post-assessment outcomes.
Head of the delegation for the IPSF on a fight against fakes focus session at the 74th World Health Assembly in Switzerland.
In two years of organizing an internship program aimed at involving youth in the mitigation of antimicrobial misuse and antimicrobial resistance, we have successfully collaborated with five (5) African regional partners in the coordination of the internship, delivering six (6) core modules and facilitating project output, monitoring & evaluation, accountability learning, and communications. As a result, successes from the past cohorts have informed the direction of our growth this year (2022).
From the recommendations garnered through feedback given, we will be increasing the duration of the internship/mentorship to build on the gains of the programme and embed the learning towards more sustainable development. Our analysis of our previous cohorts, including the impact survey through our life after internship survey shows that there is a strong need to further increase the public engagement component of the programme, creating solutions providers to bridge the gap in appropriate awareness creation of medical information.
Some examples include:
– Hosting webinars and spaces, and networking with many other organisations both nationally and globally, to spread more awareness of AMR including for policymaking.
– Presented this at the World Health Student’s AMR summit and was the second runner-up out of a pool of 200+ students from all around the world.
– Conducted an advocacy program on AMR for undergraduate students at the University of Nairobi. They were speaking about the role of students in containing AMR.
– All my friends and peers know me for my passion for AMR. I spread the word on social media and also through word-of-mouth. In May 2021, I was also chosen as the head of the delegation for the IPSF on a fight against fakes focus session at the 74th World Health Assembly in Switzerland. I have also mentored numerous students to ignite their passion for AMR.
– I have also been invited to speak at quite a number of events and webinars on different AMR topics.
This led us to include a new module “Media & Communications” in our curriculum to address the gaps identified in previous cohorts on public engagement, as well as a more allocated focus on data analysis and research and behavioural change.
The Media & Communication module will be focused more on the following;
– Solutions Journalism
– Editorials: Social Impact, ensuring visibility
– Media & Communication: Crafting strategies for media engagement, tools and technologies.
Target Beneficiaries: 40 recent graduates of any discipline related to human health, animal health, environmental health, and journalism/ mass communication (this is a new stream to the programme, creating a further unique opportunity for the health teams to work with the media students to proffer solutions).
Project Duration: The total duration of the project will be 12 months.
Outcome: For the 2022 cohort, special emphasis is being placed on encouraging participants to become more strategic in using different media technologies, data-oriented solutions, and engage more in research as a follow-up to become aware of the impending dangers of AMR in a bid to actively innovate solutions around it.
Our goal is to raise nationwide, regional, and global professionals and youth antibiotic guardian champions through education, media engagement, and advocacy towards a culture of stewardship and conscientious, evidence-informed use of antimicrobials.