LESS

LESS empowers communities to combat AMR through infection prevention. It distributes educational kits tailored for healthcare providers, policymakers, and patients - raising awareness of best practices, guidelines, advocacy tools and stewardship programs to enable collective action against AMR at all levels.

Dr. Marcela Sanai, Founder and Lead Researcher of the LESS initiative

The problem of antibiotic resistance in Tanzania and sub-Saharan Africa is severe. According to the World Health Organization, at least 58,000 neonatal sepsis deaths in sub-Saharan Africa each year are already resistant to first-line treatment. In Tanzania alone, a 2019 study showed that antibiotic resistance caused over 12,000 deaths, with the number projected to rise to over 25,000 annual deaths by 2050 if no action is taken. 

A major cause of the growing crisis is the widespread misuse and overuse of antibiotics. In Tanzania, approximately 60% of antibiotics are obtained over the counter without a prescription. Without proper patient education and antimicrobial stewardship programs, individuals often demand antibiotics for viral infections like colds or improperly finish antibiotic treatment courses. As a result, drug-resistant bacteria develop and spread rapidly.  

Access to clean water and sanitation infrastructure is also limited in many parts of Tanzania, increasing the risk of infection. Without proper infection prevention and control measures, more antibiotics must be used to combat recurring infections. This constant antibiotic pressure drives further resistance.  

There is an urgent need to curb the misuse and overuse of life-saving antibiotics in Tanzania and sub-Saharan Africa to slow the development and spread of drug-resistant bacteria.

Our solution serves three main audiences in Tanzania:

1) Over 20,000 healthcare providers: The LESS kits address their need for up-to-date guidelines and continous education on antibiotic stewardship, as expressed in our surveys of 550 doctors and nurses. We engaged 1,000 providers from 25 hospitals to inform the development of our educational materials.

2) 230 regional and national health policymakers: The kits serve their need for actionable data and policy recommendations to curb antimicrobial resistance, as identified in interviews with health officials. We collaborated with the Ministry of Health to design advocacy tools tailored for budget discussions.  

3) An estimated 30 million community members and patients: The kits fulfill their demand for basic yet practical information on preventing infections and appropriately using antibiotics, as indicated in focus groups with 3,500 residents. We worked with 80 community health volunteers to understand priority needs in 10 rural villages and 3 cities.

By developing solutions hand-in-hand with these key stakeholders through in-depth research and user testing, we strive to address their unique needs and empower them to tackle antibiotic resistance at all levels.

Our solution directly provides the following public goods:

1. Open-source educational resources: All awareness and training materials developed through our work will be made broadly accessible online under a Creative Commons license. This includes posters, brochures, guidelines and other reproducible tools that can benefit other communities. 

2. Aggregated antimicrobial resistance data: Through our data integration efforts, anonymous resistance surveillance findings from clinical samples will be published to encourage further research. Access to locale-specific analyses can also guide other regional public health programs.

3. Policy reviews and recommendations: Reports evaluating antibiotic access barriers and best-practice policies identified through our collaborations will be freely shared to advance global understanding and spur complementary initiatives. 

4. Community of practice platform: We plan to develop an open participation forum and knowledge exchange connecting practitioners worldwide. This digital commons can spark new multi-regional partnership opportunities and solutions to shared challenges.

By openly sharing the tangible outcomes of our work, we strive to maximize the public benefits of any solutions and new knowledge generated to empower diverse audiences in the global fight against antimicrobial resistance.

Our solution aims to create tangible impact in the following ways:

- Educating 20,000 healthcare providers on prudent antibiotic use can lead to a 20% reduction in unnecessary prescribing within 3 years, according to WHO studies. This will immediately benefit millions of patients through reduced misuse. 

- Advocacy to 230 policymakers citing rigorous data analysis may inform new regulations expanding access to essential medicines for 50 million citizens, especially in underserved rural areas. 

- Reaching 1 million residents annually through 1,200 community health workers and other partnerships can cut common infections by 15% based on neighboring country studies, significantly improving community wellness.

- Compiling previously disparate data on resistance surveillance, prescribing behaviors and genomic analysis will generate actionable knowledge guiding these initiatives. New insights may also support the government's national action plan over the long run.

- All openly accessible resources, including guidelines, reports and educational tools produced can broaden impact by empowering other organizations and neighborhoods facing similar challenges.

We will measure progress through monitoring kits distributed, pre/post evaluations with stakeholders, infection case reviews and bacterial trend tracking - demonstrating tangible population-level changes with this multi-pronged, data-driven approach.

Over the next year, we aim to scale our impact in Tanzania through:

• Completing our initial pilot program by refining materials with an additional 500 healthcare providers and 10,000 community members in 5 new districts. 
• Developing a network of 100 master trainers among community health volunteers to lead expansion nationwide. 
• Partnering with 5 regional medical associations and hospitals to establish standardized antibiotic stewardship protocols.

Over the next 3 years, we will:

• Roll out our customized educational approaches and data-driven advocacy campaigns across 50% of regions in Tanzania, reaching 50,000 providers and 2 million citizens annually.
• Continue integrating dispensing, surveillance and genomic data from new regions to monitor resistance trends and iteratively strengthen programs.  
• Collaborate with the Ministry of Health in disseminating best practices and policies to all healthcare facilities through our train-the-trainer platform, ensuring sustainable change. 
• Launch an open access website sharing our resources and approach to empower other developing country communities worldwide seeking safe, low-cost solutions.

By mainstreaming proven interventions supported by grassroots networks and national stakeholders, we aim to transform antibiotic use and containment of resistance across Tanzania.

We measure success against our impact goals through both quantitative and qualitative indicators:

Quantitative Indicators:

• Number of educational materials distributed per year (goal: over 3,000 kits annually)  
• Number  of people trained (goal: 1,500 providers/year; 1 million citizens over 3 years)
• Number of guidelines/policies implemented (goal: 5 regional policies in year 1)
• Sales data tracking unnecessary antibiotic purchases 

Qualitative Indicators:  

• Pre/post training surveys measuring changes in knowledge  
• Interviews with community leaders on observed behavior changes
• Case studies and focus groups for feedback on solutions

Pilot Performance:

• Distributed 200 community kits in Year 1, exceeding target of 150
• Trained 150 providers on guidelines, achieving pilot goal 
• Qualitative surveys found 80% of participants better able to identify appropriate antibiotic usage after pilot

We measure these indicators quarterly and annually, analyzing both quantitative outputs and qualitative outcomes. Participatory evaluation ensures community priorities continue guiding improvements. Funding is tied to transparent reporting on progress against defined metrics. Ongoing assessment allows course corrections to maximize scalable impact.

Some key barriers we foresee and plans to address them include:

Funding: As an early stage non-profit, funding limits scale. We are pursuing grants from global health NGOs and impact investors to support community health worker stipends, materials/training costs and data integration work. 

Access: Remote villages have poor infrastructure. We will utilize opportunistic distribution through existing mobile medical clinics/school visits to reach all regions cost-effectively within 3 years. 

Buy-in: Doctors mistrust new policies without incentives. By highlighting economic losses from resistance compared to gains from appropriate use, and partnering hospitals to pilot pay-for-performance programs, we plan to demonstrate individual benefits. 

Skepticism: Citizens distrust campaigns without community input. Our participatory, iterative design process aims to build trust and ownership over solutions. Localizing credible messengers like faith/tribal leaders can boost acceptance of vital public health messages.

Data gaps: Surveillance remains limited in rural Tanzania. By establishing diagnostic labs in partnership hospitals and recruiting specimen collectors, we strive for representative data to strengthen our advocacy and solutions over the next 3 years.

Through determined grassroots collaboration, participatory solutions-design and results-driven advocacy, we are confident these barriers can be successfully navigated.

We are excited about the potential of partnering with The Trinity Challenge because it complements our goals in a special way. 

As a grassroots nonprofit on the frontlines of Tanzania's AMR crisis, meaningfully expanding our reach requires surmounting significant barriers. 

Current funding only extends to a few districts. Your support would position us to methodically scale nationwide over 3 impactful years.

Data gaps hinder our advocacy. Your funding could help establish diagnostic labs, generating localized evidence to strengthen multi-sector collaboration.

Without demonstrated results, skepticism slows new practices' uptake. Participating together gives us a platform to showcase collaborative, community-led solutions' measurable merits.  

Gaining community buy-in takes time with no incentives. Reporting impact to engaged funders like Trinity creates motivation to foster sustainable behavioral changes.

By directly addressing constraints around scale, evidence and buy-in through engaged, long-term support and accountability, The Trinity Challenge offers a unique opportunity. Partnering could help mainstream grassroots successes, fortifying health systems through empowered citizens in a special way. We feel this fits really well to drive meaningful change in partnership.

Wellcome, BSAC, and Imperial College London would be ideal partners to help accelerate and scale our AMR solution.

Working with Wellcome would allow us to access their significant funding and expertise in AMR research. Their anchor support of the Trinity Challenge means they are committed to validating and advancing promising solutions. With their backing, we could conduct more extensive testing and refinement of our approach.

The British Society for Antimicrobial Chemotherapy's leadership in stewardship and education worldwide would be extremely valuable. Through BSAC, we could integrate our solution into their global training programs to rapidly disseminate it. Their professional networks of clinicians and researchers could also provide guidance to strengthen the solution's uptake. 

Imperial College London is at the forefront of AMR research and has world-renowned scientists tackling this challenge. Partnering with relevant departments and laboratories there would vastly benefit our solution's continued development. We could leverage Imperial's scientific rigor to validate our approach through their innovative trials and feedback.

Leveraging the distinct capabilities of Wellcome, BSAC and Imperial would be tremendously synergistic. Wellcome could fuel the research, BSAC the implementation through professional channels, and Imperial the scientific underpinnings.