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. 2025 Jul 9:10:346.
doi: 10.12688/wellcomeopenres.24387.1. eCollection 2025.

Strengthening Community Antimicrobial Stewardship in Africa: A Systematic Review of the Roles, Challenges, and Opportunities of Community Health and Animal Health Workers

Conrad Tumwine  1   2 , Reuben Kiggundu  1   3 , Fahad Lwaigale  1 , Herman Mwanja  1   3 , Hannigton Katumba  4 , Mackline Hope  1   2 , J P Waswa  3 , Flavia Dhikusooka  1 , Vivian Twemanye  3 , Andrew Kambugu  1   2 , Francis Kakooza  1   2   3 , Dathan Byonanebye  1   2   3   5
Affiliations

Strengthening Community Antimicrobial Stewardship in Africa: A Systematic Review of the Roles, Challenges, and Opportunities of Community Health and Animal Health Workers

Conrad Tumwine et al. Wellcome Open Res. .

Abstract

Antimicrobial resistance (AMR) remains a critical global health challenge, and is mainly due to inappropriate antimicrobial use in human and animal health sectors. This systematic review examines the roles of Community Animal Health Workers (CAHWs) and Community Health Workers (CHWs) in antimicrobial stewardship (AMS) across Africa where AMR burden is highest and AMS programs are limited. Following PRISMA guidelines, this systematic review analyzed 16 studies (2017-2024) from nine African nations. We identified seven key roles of CAHWs and CHWs in AMS: 1) provision of clinical services (13 studies); 2) community mobilization (8 studies); 3) health promotion (7 studies); 4) provision of preventive services (5 studies); 5) epidemiological surveillance (4 studies); 6) advocacy (2 studies), and 7) medical waste management (2 studies). Despite their roles, challenges such as lack of supportive legislation (3 studies), inadequate remuneration (2 studies), and total reliance on foreign funding hinder AMS program sustainability. While most studies (14 studies) indicated that CAHWs and CHWs had received AMS training, their roles in the national AMR strategies remain unclear. CAHW and CHWs could be leveraged in advancing health promotion, raising AMR awareness, supporting AMR surveillance, enhancing integrated management of diseases, and improving waste management within One Health frameworks. To realize this potential, there is a need to formalize CAHW/CHW roles through targeted legislation, specialized training and sustainable funding. This evidence highlights the critical need for policy reforms to harness their potential in strengthening health systems and curbing AMR across Africa. PROSPERO registration number: CRD420251027215.

Keywords: Africa; Antimicrobial Resistance; Antimicrobial Stewardship; Community Animal Health Workers; Community Health Workers; One-Health.

Plain language summary

Antimicrobial resistance is a global health that is most pronounced in Africa, where the overuse and misuse of antibiotics among humans and animals is very common. This review set out to identify the roles of Community Health and Animal Health Workers in promoting responsible use of antibiotics (antimicrobial stewardship) across Africa. In this review that included 16 studies from nine African countries, published between 2017 and 2024, we noted that community health and animal health workers provided the following antimicrobial stewardship related services; clinical treatment, community mobilization, health promotion, preventative services, diseases surveillance, advocacy and medical waste management in the communities they served. Despite the roles performed by community health and animal health workers, such programs face challenges such as poor funding frameworks, lack of enabling government policy nor legislation and poor provision of renumeration. Even though most articles reported training, their roles in antimicrobial resistance national action plans remain unclear. These workers could play a bigger role in stopping the spread of AMR by educating people, helping track drug resistance, and supporting public health efforts. To do this, governments need to create clear laws, provide proper training, and secure local sustainable funding. The findings show that strong policies are needed to support these health workers in the fight against AMR in Africa.

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Conflict of interest statement

No competing interests were disclosed.

Figures

Figure 1.
Figure 1.. Systematic review PRISMA Diagram.
See this image and copyright information in PMC

References

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