Applied Platform Technologies for Community AMR Surveillance

As AMR digital trendsetters, eSHIFT has developed a low-cost, scalable solution countering AMR in low-income regions. The 'AoS.Health/AMR' platform supports the One Health strategy, by fostering cross-sector collaboration, informed decision-making, connected diagnostics results, and puts community engagement at the heart of scalable digital AMR solutions.

eSHIFT Partner Network’s board president Mr Steven Uggowitzer, who is also Fleming Fund’s Expert Advisory Group’s AMR digital lead, and Mr John Farrow, MPH, will present.

AMR, potentially the next global health crisis on par with or surpassing COVID-19, threatens to render antibiotics ineffective and is expected to result in 10 million deaths annually by 2050. This crisis is exacerbated by a dual gap in education on proper antibiotic use and in comprehensive, actionable data for policy-making. AMR data, crucial for informed decisions and effective interventions, remains fragmented across different sectors and levels of healthcare, often hindered by reliance on outdated, often even paper-based systems, and the absence of unified data platforms.

Our initiative seeks to bridge these gaps by leveraging digital innovations to aggregate and analyse AMR data from diverse sources, thereby enhancing the effectiveness of national action plans and fostering a culture of responsible antibiotic use. By integrating an interactive and engaging digital platform, we aim to involve healthcare workers and communities directly, transforming AMR data collection into a participatory and educational process. This approach not only targets the immediate need for improved data accessibility and quality but also addresses the underlying issues of AMR education and behaviour change, offering a scalable and sustainable solution to one of the most pressing health challenges of our time.

We propose to enhance the AoS.Health platform to empower local healthcare providers, focusing on paediatric clinics in Sri Lanka, to enhance community engagement around antimicrobial resistance (AMR), and its data management and analysis. In collaboration with the Ministry of Health, this initiative would directly respond to the urgent need for accurate community-level data on antibiotic use and prescribing patterns. By focusing on paediatric care, we aim to address AMR from the ground up, providing essential insights for healthcare professionals and mothers seeking treatment for their children.

Our approach involves continuous engagement with stakeholders, including healthcare workers, government officials, the communities served, ensuring the platform evolves according to needs and experiences. This collaborative effort aims to create a versatile, user-friendly tool that not only meets the immediate needs of Sri Lanka's healthcare system but also sets a global precedent for community AMR data management practices.

By leveraging the collective expertise of our stakeholders, we're developing a solution that is by and for the community, ensuring its relevance, effectiveness, and sustainability. This partnership approach embodies our commitment to combating AMR through innovation, collaboration, and a deep understanding of local and global health challenges.

The eSHIFT Partner Network commits to delivering a significant digital public good (DPG) by making its developed intellectual property (IP) and tools, including the customizable community engagement data acquisition tool, fully open-sourced and available on GitHub. This commitment from eSHIFT and its partners ensures that the advancements made in antimicrobial resistance (AMR) surveillance are globally accessible, supporting the collective effort against AMR under fair, reasonable, and non-discriminatory terms.

In addition to releasing the platform components as public goods, we are dedicated to sharing our learnings and methodologies through the production of white papers and peer-reviewed publications. This includes a comprehensive write-up of our approach, the insights gained from our work in countries including Sri Lanka, and the impact of collecting antimicrobial usage data at the community level. By documenting and publishing these findings, we aim to contribute valuable knowledge to the global AMR community, facilitating further research and innovation.

The AoS.Health/AMR platform is set to create a tangible impact by enhancing understanding of antimicrobial demand and use patterns in the community around paediatrics, and aggregating resistance data to support policy-making decisions. Our solution will enable identification of opportunities to educate members of the community – especially mothers – about appropriate antimicrobial use, and provide a framework to communicate information to paediatric clinics and pharmacists on how best to do so.  Mothers and children’s understandings are instrumental in long-term societal change and that is one reason we wish to start here. 

The customisable community data collection tool – that is the innovation proposed – will address existing gaps in AMR data collection, analysis, and dissemination. Our pilot projects in Zambia, Senegal, Nepal, and Kenya have already demonstrated the core platform's ability to integrate laboratory data effectively and support disease surveillance efforts. These initiatives have laid a solid foundation for expanding the platform's capabilities to include and integrate community participation (and data). While we start with the maternal and paediatric communities and the health workforce that supports them, our approach is to build a reference architecture for community mobile application integration into AMR surveillance & response, improving decision making and community-level interventions. 

There is a saying that you either get the results you want, or the lessons you need.  This is the foundation to iterative learning.  Our proposal is to take the hard-earned lessons in AMR surveillance from  Zambia, Senegal, Nepal and Kenya, and to not stop there.  Instead, we propose to enable Sri Lanka to leap-frog AMR surveillance lessons and then to contribute back to the knowledge pool by enabling community-level education and data flow, particularly focusing on maternal and paediatric health.  

Our platform's design follows a reference architecture, enabling scalability and reusability across different contexts. This approach ensures that these developments made for Sri Lanka can easily extend to other countries - at the national and community levels. This is the inherent benefit to a non-siloed, coherent, integrated, modular approach.  Such an approach should be  imperative given the pervasive, pressing and cross-sectoral nature of AMR.

Our goal is to release the final version of this decision-support tool, alongside the updated AoS.Health/AMR platform and associated software, as public goods. This will enable the Sri Lankan Ministry of Health and stakeholders in other countries to leverage these resources thereby strengthening their AMR surveillance and response capabilities. 

Our measurable indicators to monitor and evaluate the impact with the maternal & paediatric community engagement in Sri Lanka will include:

1. Increase in Community Data Flow: Measuring the volume and variety of data collected from community sources, compared to baseline levels prior to platform implementation.

2. Increase in AMR Data Collection: Measuring the volume and variety of data collected from institutional sources (facilities, laboratories, etc.)

3. User Engagement: Tracking the number of public health professionals, community health workers and mothers actively using the platform and participating in data flow activities.

4. Policy Influence: Assessing the extent to which the collected data informs policy decisions and AMR response strategies, through qualitative feedback from the Sri Lanka Ministry of Health and policy documents referencing the platform’s data.

5. Data Utilisation: Monitoring the frequency and way AMR data is accessed and used by researchers, policymakers, and health professionals for surveillance, research, and policy-making purposes.

6. Behaviour change: Monitoring the change in maternal behaviour with regard to antimicrobial use and the information available in the community around sound AMU practices.

From our previous pilots, we have observed significant increases in data availability, and have good ongoing user engagement. We are continuing to monitor how this data is utilised for policy. 

We anticipate several barriers in scaling the AoS.Health/AMR platform within the next year and beyond:

Financial Barriers: Securing sustainable funding is critical, especially for supporting open-source initiatives and the sustaining of the global good separate from the instance. We plan to pursue co-funding avenues, including grants and partnerships.

Technical and Infrastructure Barriers: Varied digital health infrastructure in different settings demands a flexible approach. Our mitigation is an appliance-based strategy that offers a plug-and-play solution, complemented by customised technical support to fit local needs.

Legal and Policy Barriers: Navigating data sharing laws and privacy regulations across One Health sectors requires both legal expertise and advocacy to foster enabling policies.

Cultural and Educational Barriers: Addressing the educational gap and cultural resistance towards change and adopting integrated data systems is essential. Stakeholder engagement and reassurance is essential.

Perception and Trust Issues: Overcoming scepticism about digital health solutions necessitates transparent communication about the benefits of open-source models and building trust through local partnerships and demonstrated success in pilot regions.

To overcome these barriers, eSHIFT will leverage its network of partners, engage in advocacy for supportive policies, and engage with stakeholders at all levels and at every step of the way.

eSHIFT is seeking The Trinity Challenge's support to amplify the impact of our AoS.Health/AMR platform, designed to revolutionise antimicrobial resistance surveillance in LMICs. Our unique open-source reference platform maximises accessibility and fosters collaboration, which should be the gold standard for AMR data integration and use.

The Trinity Challenge presents an invaluable opportunity to advance openly accessible digital AMR surveillance and community engagement. It would open the door to expand successful pilots into both an AMR reference platform as a public good and include a community engagement reference application into national thinking at this early digital stage of the AMR response. 

It would also empower us to build our own capacity to deliver a better version of our successfully piloted solution at scale, with Sri Lanka as the first recipient of this enhanced approach..

Critically, the support from The Trinity Challenge would enable us to contribute more significantly to the public good by releasing additional tools and methodologies as global public goods. This approach not only broadens the reach of existing innovations – ours and those of many partners – but also strengthens global health security by facilitating a more cohesive, coherent and inclusive digital response to AMR.

Community starts with… community. The reason that eSHIFT is established as a Partner Network is that we believe in working together to bring best of breed solutions together through systems integration.  The partners who have put together the AoS.Health/AMR platform thus far are deeply committed to building and sustaining a ready-to-use, integrated, interoperable and cyber-secure IT platform that connects all the essential technology components needed around AMR surveillance, response and community engagement.   

Our strength is in engineering and digital health.  The partnerships we seek are those that  broaden the utility and sustainability of AMR data management and priority use-cases in community settings. We also look for expertise in sustainable business models. 

Should eSHIFT be selected in the Trinity challenge, the AoS.Health/AMR platform – co-developed through partnerships from its inception – can easily bring many other viable projects, and particularly, we would hope, Trinity Challenge winners, to the foreground – not just nationally in one country, but internationally because of the integrated reference approach we have taken.  This approach, within the Trinity community itself, would expand an AMR technology ecosystem that is more than the sum of its parts. It delivers to beneficiaries an ever-improving comprehensive approach to AMR management.