How better education for health professionals can help curb antimicrobial resistance in poorer countries and save lives

Allison Littlejohn.

While the world’s attention is focused on Covid-19, many other serious international health concerns still need urgent attention. Few public health problems are of greater global importance today than Antimicrobial Resistance (AMR).

In 2019 the UN Ad hoc Interagency Coordinating Group on AMR warned that, if no action is taken, drug-resistant diseases could cause 10 million additional deaths each year by 2050 and cause catastrophic damage to the global economy, forcing up to 24 million people into extreme poverty.

Over the past three years I have been the Academic Director of the ‘Tackling AntiMicrobial Resistance’, a project aimed at reducing AMR in low and middle income countries by improving healthcare practice in the use and monitoring of antibiotics. Funded by the Department of Health and Social Care (Fleming Fund 2018–2021) the work is led by Mott Macdonald, a global consultancy organisation delivering infrastructure in low-resource regions, with the Open University.  Through this work we areexploring new forms of professional learning to address this global health challenge.

Our findings signal a call to action to change how professional development programmes are provided for health workers in environments with limited resources. Rather than following a pre-defined professional curriculum, professionals need to learn new knowledge and, in parallel, develop learning strategies to apply this knowledge to their everyday work activities as they adapt to an uncertain and changing landscape.

Our paper examines tensions faced by health professionals as they engaged in AMR surveillance, questioning whether and how professional learning can help address these pressures. Data was gathered through interviews with 23 professionals working in public health systems across 16 countries: Vietnam, Malawi, Cambodia, Philippines, Pakistan, Mali, Tanzania, Ghana, Uganda, Nepal, India, Laos, Kenya, Bhutan, Myanmar, Zimbabwe. Data were analysed using Cultural Historical Activity Theory which helps pinpoint how tensions evolve between following routine forms of practice in novel contexts, transforming established practice into new ways of working.

The article outlines a number of tensions that slow down change. First, professional groups are not always aware of the global threat posed by AMR. Entrenched professional practices are deep-rooted in the identity of professionals and without understanding the urgency for action, it is unlikely that the use of antibiotics will change until this tension is addressed.

Second, although antibiotics are used across the human health, animal health and agriculture sectors, changes in ways of working are not considered across these sectors in a holistic way. AMR surveillance requires trust and openness among professionals, but this trust is not always evident, particularly where people are not working directly with one another, such as doctors and lab professionals.

A third tension is related to the digitalisation of data. Systems in low-to-middle income countries are only now introducing digitalisation. Effective monitoring  of AMR requires data flow across local, national and global systems. Yet these networks are under-developed and professionals have limited conception of how these inter-relate.

Therefore, it is vital that professionals appreciate the urgent need to change established practice, how these practices fit within local, national and global networks and how datafication and digitalisation open up opportunity to work in different ways.

We are currently using these findings to test new ways to support professional learning through an open, online professional programme on Tackling AntiMicrobial Resistance.  This programme of work extends beyond a set curriculum by providing guidance for team leads to support their teams to integrate the knowledge they learn into their everyday work activities, expanding what they learn and how.

Charitonos, K., & Littlejohn, A. (2021). Professional learning in healthcare settings in resource-limited environments: what are the tensions for professionals’ knowing and learning about antimicrobial resistance?. Studies in Continuing Education, 1-18. 

You may also be interested in:

Littlejohn, A., Charitonos, K., & Kaatrakoski, H. (2019, October). The role of professional learning in addressing global challenges: Tensions and innovations associated with AMR. In Frontiers in Education (Vol. 4, p. 112). 

Kaatrakoski, H., Littlejohn, A., & Charitonos, K. (2021). Antimicrobial resistance challenging professional learning in three LMICs. Journal of Workplace Learning.

Photo: Mathias Pastwa via Flickr (CC BY-ND 2.0)