Bridging AMR knowledge gaps and improving policy implementation: a perspective on the role of community engagement in Africa.

Antimicrobial resistance (AMR) is an escalating global threat, posing a serious challenge to public health and medical and social advancements. Top-down research methods and policy implementation approaches have fallen short in capturing the complexities of AMR transmission and supporting effective policy implementation, including in diverse and resource-constrained settings. This perspective article suggests that community engagement has the potential to improve AMR outcomes by generating more community-relevant, context-specific AMR knowledge, providing novel data and evidence for action. We further note that locally rooted civil society organizations (CSOs) are essential to fostering relevance, acceptability, and effectiveness of AMR interventions, as well as engendering strong commitment to AMR policy development and implementation. We focus on the role that lived experiences and participatory research approaches, such as citizen science, can play in generating locally grounded AMR knowledge, as well as how community engagement can facilitate trust and a sense of ownership surrounding AMR policies among community members. We also note the potential of community engagement to identify and address equity and cross-sectoral coordination challenges and contribute to more equitable and sustainable AMR policy implementation. Drawing on successful initiatives in Nigeria, Zimbabwe, Malawi, and Kenya, and acknowledging the role of advocacy by CSOs, we demonstrate the potential of community-driven approaches to transform AMR responses and human, animal, and environmental health-related outcomes, and note that to be successful, this community engagement must be genuine, meaningful, inclusive, and transparent.