Title: Addressing Gender Disparities In Antimicrobial Resistance (AMR): Empowering Women and Engaging Men in Shinyanga Region, Tanzania.

Abstract

AMR is a rising global and national health challenge that affects millions of people. It alters our ability to treat common infections and sets back the health advancements we have made by decades, as our current drugs become ineffective. This leads to increased morbidity, mortality and underdevelopment in countries. The majority of efforts to respond to AMR in Tanzania are top down and focus on biomedical and technical solutions, such as AMR governance, improved surveillance, diagnostics and AMR stewardship. While these efforts are important, they do not take into consideration the sociocultural gendered norms that shape our everyday realities and affect access and decisions to use medications. As a result, key drivers of AMR such as self medication, inappropriate use of medications and poor sanitation and hygiene practices continue to prevail.

In many communities in Tanzania, gendered power relations within households influence health decision making, access to health care services and the use of antibiotics. Women who are considered caregivers and managers of families’ and communities’ health often have limited decision making power, which leads to inappropriate use of antibiotics and increases the risk of AMR. This project aims to address this gap by co-creating and implementing a gender responsive, community centered AMR intervention in Shinyanga Region, so as to promote equitable household health decision making and responsible use of antibiotics.

Over a 12 month period, the project will train 50 AMR champions and reach about 1,000 community members. The project centers women and girls as AMR champions while actively engaging boys and men as partners and allies in transforming household health decision making dynamics. Using the capacity strengthening and Training of Trainers (ToT) models, the selected AMR champions will be equipped with the knowledge and skills to facilitate peer-led, creative, gender responsive AMR sessions within their existing community social groups, such as Savings and Credit Cooperative Societies (SACCOS) and Village Community Banks (VICOBA). This will create a ripple effect in which knowledge is passed down and sustained within the community. At the same time, structured community dialogue sessions will be conducted with boys and men to reflect and challenge harmful gender norms that affect access to health care and antibiotic use practices. The project also integrates household assessments and infection prevention practices to reduce the need for antibiotics in the first place.

This project is guided by the principles of community engagement, equity and sustainability and is grounded in the One Health approach, gender and power theory and co-creation of locally acceptable behavioral change practices. These frameworks ensure that the proposed intervention addresses individual knowledge gaps as well as the structural and social factors that drive AMR.

This project recommends the integration of gender responsive strategies into AMR policies and interventions for key AMR stakeholders at both sub-national and national levels. The proposed approach is beneficial because it leads to more equitable household health decision making, responsible antibiotic use and reduced infections through better hygiene practices. The project calls for a shift in how we design and implement AMR interventions to recognize that long-term, sustainable change begins at the household level, where everyday health decisions are made.