Unified Community System for AMR in Tanzania

Unified Community System improves AMR interventions by providing routinized community level data utilizing existing community structures.

Dr. Esther Mtumbuka, Country Director of CHAI Tanzania will lead the solution in collaboration with the Ministry of Health's ICT unit where UCS is housed.

Antimicrobial Resistance (AMR) related deaths are undeniably on the rise in Tanzania, due to the inappropriate and irrational use of antimicrobial agents. Unfortunately, Tanzania lacks a proper system to collect and analyze information related to AMR, such as access, use, and quality of antimicrobial agents from the community to higher levels. This hinders the proper planning of interventions to address problems at the respective community level, which this project aims to resolve.

Globally, in 2019, AMR was responsible for over 4 million deaths, and in Tanzania, it was associated with 54,000 deaths. It's a harsh reality that AMR is associated with poverty and low socioeconomic status, which means the majority of Tanzanians are at risk of developing AMR due to inappropriate use and a lack of knowledge about antimicrobial agents. However, with adequate data, proper AMR educational awareness campaigns can be done to help minimize the risk and save lives.

The target audience for this solution are Tanzanian societies who live in low socioeconomic status, and are at high risk of infectious diseases and inappropriate use of antimicrobial agents, which can lead to antimicrobial resistance (AMR) and even death. A recent survey conducted in 2022 shows that only 10% of Tanzanians have had or currently have health insurance coverage, while 90% have limited access to proper healthcare services. This lack of access results in self-prescription of antimicrobials with little or no knowledge of the appropriate and good quality ones.

To tackle the issue of antimicrobial resistance (AMR), Community Health Workers (CHWs) will be assisted by CHAI country teams and MOH members in visiting households in vulnerable communities. Community leaders will also be involved in these visits. The CHWs will administer questionnaires embedded in the AMR module in the UCS, collecting data on knowledge and education on AMR and antimicrobial use (AMU). The results obtained from the questionnaires will be utilized to better plan interventions to support these communities.

As we develop the solution, we plan to involve the community to gather requirements and their input for the development of the solution, as well as establish a baseline situation.

The UCS is an information system that aims to improve health service delivery at the grassroots level. With the additional AMR module, the solution will be able to capture all data related to AMR and AMU across one health spectrum. This system helps identify and enroll patients across multiple community health services. It is specifically tailored for community health workers (CHWs) and consolidates data for various community interventions, including HIV, malaria, family planning, tuberculosis (TB), leprosy, reproductive, maternal, newborn, child, and adolescent health, and gender-based violence support. By doing so, the UCS with AMR module enhances referrals and linkages from community-based services to formal health care delivery, which in turn improves the performance monitoring of community health services and workforce for better health outcomes as a public good.

This solution aims to address the issue of Antimicrobial Resistance (AMR) and Antimicrobial Use (AMU) in low socio-economic communities at risk. The solution will focus on providing insights into how big the problem of AMR and AMU is in these communities that will help plan interventions for educating people about better ways of using antibiotics. 

The activities that will enable the success of this solution include a preparatory stage, which involves setting up an AMR module and identifying key community personnel such as Community Health Workers (CHWs), veterinary staff, and AMR champions to support data collection. Having champions in community health intervention has been impactful with evidence from cancer, HIV, and TB interventions.

The next stage involves orientation, deployment, advocacy, and monitoring activities. This stage will generate skilled data collectors and an informed community to produce quality, accurate, reliable, and timely data. When analyzed, this data will provide appropriate information for current and future interventions to combat AMR. The data will help identify hotspots for AMR and AMU, inappropriate access, and low-quality drugs. From this data  interventions will eventually be targeted to contribute to the increase in proper use of antimicrobial agents.

The aim of this project is to promote the proper use of antimicrobial agents. To achieve this, the project team will integrate an AMR module into the existing UCS and pilot it in seven regions. The pilot will specifically assess, collect, and analyze AMR data from the community. The results from the pilot are expected to improve awareness and knowledge of AMU and AMR in the one-health spectrum, and reduce the misuse of antimicrobial agents in humans.

This pilot will inform a transformational phase that will scale up to eight regions per year, reaching twenty-six regions by the end of year three of project implementation. There will be monthly, quarterly, semi-annual, and annual monitoring to ensure that the project reaches its intended impact and adjusts accordingly.

Additionally, the project will engage the Tanzania Medical Device and Drug Authority to incorporate AMR into the pharmacovigilance reporting system of adverse drug reaction (ADR) form.

Possible barriers:

1. Financial barrier - this may arise due to fluctuations in global and local markets. To mitigate this, we will agree on working rates that will be used in our proposed budgets.

2. Technical barrier - staff turnover during the project life cycle may hinder our progress. To mitigate this, we will have a planned approach to recruit new staff as and when required. We will also encourage task shifting and sharing to mitigate staff turnover.

3. Infrastructure barrier - natural disasters such as roadblocks, power outages, and river over flooding through rainfall may cause delays in the completion of our tasks. To mitigate this, we will have comprehensive strategies in place to accomplish our work plans which allow flexibility of change and readjustment of activities timeline from the start of the project, if need be to include extension from funder.

4. Cultural barrier - local residents may hesitate to provide us with full information due to cultural barriers. To mitigate this, we will conduct prior sensitization of such communities on the project we are working on. This will be achieved by involving community leaders and local authorities in the project.

We are applying to the trinity challenge to secure funding to contribute in

increasing proper use of antimicrobial agents in community population through developing a surveillance system to track AMR and AMU in community by in cooperating AMR module in the existing unified community system. By doing so we are supporting the government to have better plans for combating community AMR related death.

In the event of infrastructural barriers as explained above, we request that the trinity challenge to accommodate flexibility where extension is need or called for.

We would like to collaborate with Johns Hopkins Bloomberg School of Public Health to get the benefit of tapping into their cutting edge social behavior change communication using mHealth approach to custom AMR knowledge awareness campaigns.