Study title

Community engagement approaches that have impacted on health outcomes are often time intensive, small-scale and require high levels of financial and human resources. They can be difficult to sustain and scale-up in low resource settings. Given the reach of health services into communities in low income countries, the health system provides a valuable and potentially sustainable entry point that would allow for scale-up of community engagement interventions. This study explored the process of developing an embedded approach to community engagement taking the global challenge of antibiotic resistance as an example. We undertook detailed formative research through a qualitative study to explore the most appropriate mechanisms through which to embed the intervention within the existing health system and community infrastructure, and via a quantitative survey to understand patterns of knowledge, attitudes and practices regarding antibiotic usage in humans.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,...