AMRwise

AMRwise is a phone based digital platform designed to empower communities on the widespread misuse of antibiotics and enable them to get informed decisions on their health. 

Dr. Ramya Ananthakrishnan- Director Resource Group for Education and Advocacy for Community Health. 

By 2050 India is expected to have two million deaths every year due to AMR (WHO 2022). In addition to death and disability AMR results in longer hospital stays and financial hardship for those affected.  WHO has developed the AWARE framework wherein antibiotics are classified into Access (first or second choice of antibiotics), Watch (only indicated for specific syndromes) and Reserve (to be used for life threatening or drug resistant conditions.  It also advises that 60% of total antibiotic consumption in a country should be from the “Access” group but in India about 59% of total antibiotic consumption was from the “Watch” group in 2022. Almost every person hospitalised in India for fever is treated with antibiotics. Secondly, many Indians self-medicate (Global Health Matters 2022). Awareness and education on AMR have become a national priority. The solution aligns with the first Strategic priority of the India’s National Action Plan on AMR for “Information, Education and Training” for the public and other stakeholders involved in antibiotic use. The proposed three states Tamil Nadu, Bihar and Jharkhand have increased rates of over-the-counter prescription sales while Bihar and Jharkhand having increased rates of the “Watch” antibiotics (Shafi et al 2022).

Our solution has been developed to serve the communities in the States of Tamil Nadu, Bihar and Jharkhand. Pharmacists and community leaders specifically women would be the main target groups. Our solution will be designed with the inputs of community health workers and aligns with India’s National Action Plan on AMR. The audio capsules would be designed to suit the different audiences and empower them to take informed decisions on AMR use. Pharmacists are strategically placed to influence and reduce the over-the-counter sale of drugs. Community leaders and women are key influencers in the community, sensitising them would influence them to seek timely medical care, adhere to treatment plans and adopt healthier behaviours. This can lead to better health outcomes for families and communities

AMRwise will disseminate accurate and up to date information about antibiotic resistance. This will help build awareness on the causes, consequences and implications of antibiotic resistance. It will help empower individuals to make informed decisions about their health. The interactive features will motivate individuals to make behaviour changes and reduce the spread of antibiotic resistance. It would also encourage the adherence to prescribed medication and promote appropriate antibiotic use, adherence to treatment guidelines and to take preventive measures such as vaccination and infection control. 

The solution will be able to reach out to populations in resource limited and overcome education and cultural barriers.  It can help facilitate community engagement and collaboration. The knowledge flow will follow a cascade impact. The women leaders who are trained as AMR Champions will be incentivized to make other community members listen to the AMR modules.

Over the next one year our goal is to implement AMRwise in one third of selected districts of the states of Tamil Nadu, Bihar and Jharkhand. The interactive mobile platform will gather data on health seeking behavior, antibiotic use and treatment adherence. At the end of three years this data will be given to the State Health Department to form policy guidelines on AMR and also to scale up the intervention across other States in India. 

We will use the following Indicators to measure progress at the end of the three-year period.

Goal level:

50% of IVRS users report decreased use of antibiotics/ use of over-the-counter prescriptions.

60% of pharmacies give AMR information to people who seek over the counter sale of drugs.

Outcome Level:

 80% of IVRS community users have correct knowledge on AMR.

80% of pharmacists who have had access to IVRS have correct knowledge on AMR.

Output level.

# of audio modules on AMR

# of IVRS community users

# of IVRS pharmacist users

# of IVRS community users who completed 50% of the audio capsules

# of IVRS pharmacist users who completed 50% of the audio capsules

# of IVRS community users who completed 100% of the audio capsules

# of IVRS pharmacist users who completed 100% of the audio capsules

# of Community meetings held by AMR champions

 (Data metrics from “Saadike Vaa Penne” project implemented by REACH)

# of unique users: 1934

# of community members who completed 50% of the audio capsules: 156

# of community members who completed 100% of the audio capsules: 410

Financial

Developing a robust IVRS platform would require significant upfront investment in engaging an agency with an IVRS platform and software development. Also scaling up would require funding support.

Solution: Seeking the support of funding agencies.

Technical

 Creating AMR audio capsules designed to suit different age groups and cultural contexts would require consultations with different teams. The technical content also has to be translated using the correct local terms so as to deliver appropriate meaning.

Solution: Hire local teams for developing content in local languages

Cultural

 The technical content should be developed keeping in mind the cultural sensitivities and language which is offensive or inappropriate should be avoided.

Solution: Hire local teams for developing content in local languages

Community Empowerment

 Communities which are empowered in AMR may begin to question the prescriptions given by the local health care providers and over the counter sale of medication may decrease. This may lead to local protests to the solution being rolled out in communities.

Solution: Design messages on the judicious use of antibiotics for the overall good of the community.

Change in behavior is one of the most important factors needed to prevent AMR in India. Often awareness and education on AMR do not necessarily result in behavior change. The use of behavior changes strategies using technology and the use of incentives can overcome resistance and promote healthy behavior. The Trinity Challenge award would provide funding which is essential to support awareness on AMR and address the challenges posed by unnecessary use of antibiotics. 

1. Institute of Global Health Innovation- to give us technical support in building the platform.
2. Google- to help us to develop a scalable model to be used by the Government of India.