Professional learning in healthcare settings in resource-limited environments: what are the tensions for professionals’ knowing and learning about antimicrobial resistance?

ABSTRACT

This article examines tensions that professionals in healthcare settings in low-to-middle income countries (LMICs) face in the evolving field around surveillance of antimicrobial resistance (AMR). Few public health problems are of greater global importance today than AMR, that poses a threat to our ability to treat infections. In this context, the microbiology laboratory occupies a prominent place and the knowledge field of microbiology is expanding. In this study, we interviewed twenty-three (n = 23) professionals with expertise on AMR and public health systems to synthesise knowledge on strengthening AMR surveillance in LMICs. By drawing on a practice approach [Schatzki, T. R. 2001. “Practice Ttheory.” In The Practice Turn in Contemporary Theory (1–14), edited by T. R. Schatzki, K. Knorr-Cetima, and E. von Savigny. New York: Routledge.] combined with socio-cultural and cultural-historical theories (CHAT) [Engeström, Y. 1987. Learning by Expanding: An Activity-Theoretical Approach to Developmental Research. Helsinki: Orienta-Konsultit] the analysis reveals seven tensions between elements of the systems and discusses how such tensions serve to frame implications for implementing a capacity strengthening programme. The analysis shows that the novelty of the AMR as well as being a multi-disease and multisectoral by nature challenges existing forms of professional practice in healthcare settings. It also suggests that AMR requires to be dealt with through inter-professional and inter-sectoral approaches, while maintaining a focus across the local, national, and global systems, which is essential for initiatives that are set to address challenges to global health.

KEYWORDS:

• Antimicrobial resistance
• professional learning
• low-and-middle income countries (LMICs)
• CHAT
• health context
• professional practice

Acknowledgements

The authors wish to thank all the participants of this study. Thanks also to Mott Macdonald and the UK Government Department for Health and Social Care for funding this study and the support they provided in the recruitment of participants. We are also grateful to Mr. Tim Seal, Senior Project Manager at the Open University, for his work on project management and support in data collection.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 The Fleming Fund is a £265 million UK aid investment to tackle antimicrobial resistance in low- and middle-income countries around the world. The programme is managed by the UK Department of Health and Social Care, in partnership with Mott MacDonald, the Fleming Fund Grants Management Agent.

2 See e.g. WHO https://www.who.int/antimicrobial-resistance/national-action-plans/en/

3 See e.g. the GLASS Resource Centre https://www.who.int/glass/resources/en/

Additional information

Funding

This research was funded by UK Aid, Department of Health and Social Care, Fleming Fund 2018–2019.