Community dialogues in Bangladesh

Description

We plan to develop and test the “community dialogue” approach for preventing and controlling antibiotic resistance in Bangladesh. The emergence and spread of antibiotic resistance is especially problematic in settings where antibiotics can be bought without a prescription and where they are over-prescribed by health workers and over-used by the public. The World Health Organisation recommends that the general public can help combat antibiotic resistance by preventing infections, using antibiotics only when prescribed by a health professional, completing the full prescription, never using leftover antibiotics and never sharing antibiotics.

The Ministry of Health and Family Welfare has established the Revitalization of Community Health Care Initiative in Bangladesh. They have done so in order to improve access, utilisation and equity of healthcare. This initiative aims to enable community clinics in rural areas to deliver an essential service package to the approximately 6000 people in their catchments areas. So far, around 13,300 community clinics have been built across the country. Members of this research team have already collaborated with MOHFW on developing and evaluating an intervention to improve the quality of essential services provided within the community clinics in Comilla district. A key part of this package was training community health care providers to prescribe antibiotics correctly and this was very successful. Improving provider capacity to prescribe antibiotics correctly is one important component within a range of behavioural issues that impact on the ways in which antibiotics are used. We intend to build on our existing partnership and develop an intervention that improves knowledge and behaviour in relation preventing and controlling antibiotic resistance within communities in Bangladesh, where antibiotics are available not only from community clinics but also from drug stores.

Aim and Objectives

The project has five objectives: 

  1. to conduct research to inform the content of and processes for delivering community dialogues; 
  2. to adapt the community dialogues approach to the setting; 
  3. to pilot-test the approach in the catchment areas of five community clinics; 
  4. to evaluate the feasibility of the pilot intervention in terms of the number of people it reaches, the extent to which it is delivered as intended, and whether or not is it acceptable to a range of stakeholders;
  5. and to engage with key stakeholders, such as policy makers, district health officials, community clinic staff and communities to ensure that the intervention is appropriate.

Methods

The study has two phases: phase one will focus on intervention development – specifically the adaptation of the community dialogue approach to address the prevention and control of antibiotic resistance in communities in Bangladesh; phase two will focus on careful testing, evaluation of reach, fidelity and acceptability, and refinement of the intervention.

Primary Investigator: Rebecca King (r.king@leeds.ac.uk)

Impact

We will ensure that the community dialogues are “embedded” within the infrastructure of the community support groups of the community clinics. This means that they will be delivered through existing mechanisms and will, therefore, be replicable across Bangladesh. This intervention has the potential to a. contribute to a body of urgent action recommended by WHO to prevent a post-antibiotic era, in which common infections and minor injuries will kill; b. build health system capacity in Bangladesh to deliver community-based interventions; and c. empower communities in Bangladesh to build cohesion and social capital, thus enabling them to contribute further to the economic and social welfare of the country. Furthermore, it has the potential to be adapted for implementation in other national health systems that support similar infrastructures, and to be adapted to address other areas of ARM, including behaviours that contribute to resistance to drugs to treat infections caused by parasites (e.g. malaria) and viruses (e.g. HIV).