Civil Society Organizations (CSOs) have a critical role in shaping the national, regional and global responses to Antimicrobial Resistance (AMR). Supporting CSOs increases accountability of government agencies, intergovernmental organizations and other key stakeholders in AMR.[1]   
 
The South Centre invited civil society organizations from the Antibiotic Resistance Coalition (ARC) and allies to apply for limited monetary funds to support awareness and advocacy activities in developing countries for the World Antimicrobial Awareness Week that took place in November 2020. 
 
Six organizations from the African region were selected based on the proposals' quality and the diverse focus of the proposed activities, including sectors beyond human health:

• Mouvement Universel pour la SUrvie de l'HUManité (MUSUHUM), Benin 
• Ace Africa, Kenya
• Ethiopian Veterinary Association (EVA), Ethiopia 
• Observatoire Malien pour la Qualité et la Sécurité des Soins (OMAQUASS), Mali 
• Zimbabwe Association of Church-Related Hospitals (ZACH), Zimbabwe 
• Institute of Environmental and Public Health, Kabale University, Uganda

Below is a summary of the activities as reported by each organization: 
 
Mouvement Universel pour la SUrvie de l'HUManité (MUSUHUM), Benin 
 
MUSUHUM campaigned on awareness-raising and promoting prevention strategies, particularly hygiene and the responsible use of antibiotics in the population and in health care facilities.
 
MUSUHUM trained over 1000 people in rural areas in home-made disinfectant manufacturing and raised awareness in handwashing and food hygiene. The week-long training sessions took place in churches and schools. As part of the activities, they installed eight sixty-liter handwashing devices and donated 100 liters of liquid soap. Posters and training materials were also produced with messages to promote hand hygiene, keep food clean, avoid infections, and provide information on how antibiotic resistance can affect people´s health and result in infectious diseases that can’t be treated. The campaign aimed to increase hand hygiene across the communities and the health facilities, resulting in the prevention of common infections.   
Ace Africa, Kenya
 
Ace Africa held a raising awareness campaign through a youth football tournament. Some of the objectives of the contest were to: 

1. Promote health and wellbeing education on Antimicrobial Resistance (AMR), COVID-19 prevention and positive health seeking behaviors
2. To promote the spirit of healthy competition among children 
3. Provide community members the opportunity to take part in a fun and healthy leisure activity

The football competition had 9 teams of 360 young people aged 9-25 from fishing communities of Lake Victoria, at risk of HIV/AIDS, with limited access to health and hygiene. All 9 teams took part in the football matches, participants and spectators adhered to COVID-19 prevention measures through temperature checks, social distancing, handwashing and wearing face masks.  
 
Ace held education sessions for children and adults, designed banners and booklets to disseminate information, and used a specialist drama performance. Furthermore, there were features on two local FM radios to spread the message of preventing infections and the adequate use of antimicrobials. 
   
Ethiopian Veterinary Association (EVA), Ethiopia 
 
The Ethiopian Veterinary Association campaigned to enhance the concerted national and global efforts to prevent and contain Antimicrobial Resistance (AMR) in Ethiopia. The objectives of the WAAW-2020 campaign were to: 

1. Brainstorm about careful handling of the common antimicrobials currently in use for veterinary services
2. Create awareness to veterinary service providers (veterinarians and para-veterinarians) regarding the development and worsening impacts of AMR in livestock development 
3. Prioritize key challenges/bottlenecks, identify best practices/experiences, opportunities and recommendations for effective prevention and containment of AMR in Ethiopia 

EVA organized a virtual workshop as well as sector-specific sessions that were held for two days. In collaboration with the Federal Ministry of Agriculture (MoA), EVA produced a joint statement for the media to reach the larger public. Higher officials from the Ministry of Health, Environment, Forest and Climate change Commission (EFCCC) and EVA’s General Manager (GM) also had discussions with media experts regarding the impacts of AMR on the livestock sector, key challenges and future response strategies to ensure the prevention and containment of AMR in Ethiopia effectively. 
 
In collaboration with the Federal One Health partners, EVA produced brochures and posters with crucial information on antimicrobial stewardship distributed to public veterinary institutions, academia, research institutions, and private veterinary input suppliers (imports/distributers) and CSOs. They also sent SMS texts to a total of 4,000 veterinary professionals/institutions and producers with information on the appropriate use of antimicrobials. In the future, EVA hopes to expand the distribution of information to livestock owners and the wider community to increase engagement. 
 
As part of the discussions at the virtual workshops, there were some essential reflections, including the need to strengthen the One Health platform collaboration, the importance of creating strategies to reach more veterinary professionals, and improving diagnostic and treatment procedures to prevent AMR. Also, more assessments on factors contributing to AMR in the various production practices are needed to understand the situation further.  
Observatoire Malien pour la Qualité et la Sécurité des Soins (OMAQUASS), Mali 
 
OMAQUASS launched the campaign theme for 2020 "Zero cases of antibiotic resistance in health structures in Mali." The campaign aimed to contribute to the reduction of the cases of antimicrobial resistance in Mali and increase public knowledge. Apart from launching the campaign, they organized a conference and training sessions for health workers on resistance to commonly used antibiotics. The training included the enhancing capacity for the rational prescription of antimicrobials in 6 health reference centers.
 
OMAQUASS also held a public awareness campaign on tuberculosis and to particularly promote appropriate adherence to treatment. The conference was also promoted through media and radio spots. During the conference, participants also discussed current trends of resistance in the country and critical measures to prevent AMR in animals and the environment. The challenges discussed included the lack of inadequate laboratories and insufficient capacity.  As part of the conference's recommendations, participants identified the need to increase understanding of the country's resistance patterns, promote effective treatment to animals and humans, and the need to include, in the evaluation process for hospitals, the rational prescribing of antimicrobials.     
Zimbabwe Association of Church-Related Hospitals (ZACH), Zimbabwe 
 
ZACH’s campaign consisted of increasing awareness through engaging the media, the public and health professionals. For the press, they held a virtual training session of 24 journalists on AMR's growing threat in Zimbabwe and the world.  The workshop's objective was to raise awareness and encourage the writing of articles on AMR even beyond the WAAW.
 
ZACH engaged two radio stations (Star-FM and POWER-FM) and one television station (ZTV) to run spots on AMR awareness messages. A total of 14 spots were broadcasted on both radio and television during prime time for each station. Over 65 percent of Zimbabwe's population is in the rural areas where radio and television have adequate coverage, even in hard-to-reach areas. Materials were produced on AMR awareness and distributed to hospital facilities and communities of faith. ZACH engaged NETONE, a network provider with approximately 44 percent of Zimbabwe’s subscribers (to send messages on AMR awareness using their SMS platform). In total, ZACH managed to reach over 100,000 subscribers with AMR awareness messages.
 
Institute of Environmental and Public Health, Kabale University, Uganda
 
The campaign by the Institute included a symposium on the need to curb the spread of antimicrobial resistance. The speakers (doctors, pharmacists, and chief lab scientists from the Kabale Referral hospital) talked about infectious diseases, antimicrobial resistance, and its causes and the scientific mechanisms. The audience included students and the general public. Customized t-shirts, pens, and writing pads were distributed to all participants with information on AMR's dangers. The activities related to the World Antimicrobial Awareness Week were held in Kabale, Uganda.
 
A radio program was organized about AMR, including jingles and a radio talk show by a medical practitioner to stop the indiscriminate use of antimicrobials. Fliers were distributed throughout the town and placed at strategic places to disseminate the information that were produced in the local languages and in English.  Participants observed the need to have policies and legislation to regulate better antimicrobials and increase education for the public to better use antimicrobials. 
 
Strengthening support for local CSOs
 
As illustrated by the diversity of activities, awareness campaigns continue to be essential to address AMR. Moreover, at the local level, supporting these organizations provides them with the ability to engage directly with key populations or population areas that may be harder to reach. The organizations designed the information campaigns utilizing different media platforms to reach different age groups and geographical regions. They also used sports events and art to promote AMR information. The materials elaborated by each organization used the local context to help make the messages more accessible. The events held by the organizations helped identify gap areas where efforts can be directed in future campaigns. 
 
The South Centre activities on AMR are supported by a grant from the Fleming Fund.

Author: Mirza Alas is Programme Officer of the Health, Intellectual Property and Biodiversity Programme (HIPB) of the South Centre.