Building equity in digital global health: the case of antimicrobial resistance in low- and lower-middle-income countries

The project which commenced in 2021 has now progressed significantly and a number of public health institutions in the states of Himachal Pradesh and Bihar have been included in its purview. The microbiology testing processes have been digitized, processes of analysis of the infection patterns in the hospitals is being regularly carried out by the microbiologists, and we have also been studying prescription slips to analyze the patterns of prescriptions of antibiotics being given to patients. We have made assessment of the diagnostics *infrastructure in all these hospitals and also carried out feasibility of using Point of Care testing technologies to try and get testing facilities more accessible to the rural poor. Since our research showed infeasibility of available machines to be put into clinical practice, we have worked with our research partner PGIMER to make microbiology labs in 2 sub-distirct hospitals operational and digitized. In this way, we have operationalized the systems thinking research approach by analyzing the interconnections between the subsystems of surveillance, prescribing and diagnostics.

EquityAMR will take an interdisciplinary approach from informatics, global health, microbiology, implementation science and critical social science to develop and implement enabling digital technologies for tackling the global crisis of Antimicrobial Resistance (AMR). The research will build and apply an “equity lens” to understand the world of AMR policy, gaps that occur in practice, and how digitization can bridge these gaps. Two domains of WHO policy will be addressed - strengthening knowledge and evidence base and building more responsible prescribing of antibiotics. Digitization will be applied in 3 domains: i) strengthen surveillance by making the AMR problem in underserved populations visible at required levels of granularity for policy makers to take action; ii) integrating diagnostics information with surveillance; and, iii) integrating prescribing practices with surveillance. Taken together, these initiatives will help build and apply an equity perspective, and produce insights of relevance for science, policy and practice about how digitization can enable achieving SDG3 “Good health and well-being”. The project will be implemented through high-quality and equitable partnership of IFI and SHE at UiO, KI in Sweden, Indian educational institutions (PGIMER, RDGMC) and R&D partners HISP India, Doctors for You, SCTIMST and HISP Sri Lanka. Empirically, the project will be implemented in 3 Indian states and 2 Sri Lankan provinces. Five interventions are planned across all sites: i) analysis of policy-practice gaps; ii) understanding prescribing practices of antibiotics; iii) testing feasibility of low cost point of care diagnostic tools; iv) designing, developing and implementing digital interventions for strengthening surveillance and integrating diagnostics and prescribing information; v) evaluating efficacy of interventions to bridge policy-practice gaps, and contribute to bringing more equity through improved surveillance, diagnosis and prescribing.