Asiful Chowdhury, at ARK Foundation in Bangladesh, leads a CHORUS Innovation Fund project on ‘Exploring the potential of drug sellers in shaping the approach to AMR in urban health settings of Bangladesh’. 

We asked Asiful about his inspirations, learnings and highlights of his project. Asiful shares insights into the challenges faced by drug sellers, and the importance of using participatory video as a means to explore the voices of a target group. 

1. Can you explain your research in 100 words

Antimicrobial resistance (AMR) is a global threat, and Bangladesh also has a high burden of AMR. Among the multiple groups of stakeholders who can influence the AMR containment, drug sellers are one of the most important. They play a vital role in the work against antimicrobial resistance, due to their role in selling antibiotics without prescription, selling counterfeit antibiotics, or providing incorrect advice on how to use antibiotics. We conducted a feasibility research study with formal (have license) and informal (haven’t license) drug sellers in the Bangladeshi urban health system to better understand their position and role and how to improve their skills and knowledge in addressing AMR.

2. What makes your research project ‘innovative’?

A relevant earlier research study was conducted among animal drug and feed sellers, but in this study we worked with human drug sellers. We adopted both quantitative and qualitative method to explore necessary information in the study, and most innovatively, we used Participatory Video (PV) as a research method. We worked with the drug sellers to develop short videos as a participatory learning and action research method, and to explore their experiences and challenges in dispensing antimicrobials.

3. In your view, what is the most important aspect of your research project?

The research study will generate evidence based on both quantitative and qualitative data which will eventually help the stakeholders to take necessary steps for strengthening the role of drug sellers in shaping the approach to antimicrobial resistance.

4. What drew you to this area of research? 

At the time of buying medicine in the pharmacy, as per advice of a physician, I observed that some of the customers at the pharmacy explained to the drug sellers about morbidity of themselves or their family members and sought suggestion about using antibiotics, as they had heard about that antibiotic from others. Sometimes, the drug sellers suggest a particular antibiotic drug to use and/or sell the antibiotic drug without any prescription. This type of practice may lead to people taking antibiotics incorrectly or unnecessarily, which can contribute to the development of AMR. These contexts inspired me to be involved in this research related to drug sellers and AMR.

5. What has surprised you most during your project?

We faced some challenges in this project. We faced delays in receiving letters of support from regulatory bodies due to the busy schedules of government officials, and the changes in senior government personnel following the political and social unrest of August 2024 in Bangladesh. Working with policymakers is challenging due to their limited availability and shifting priorities and focus during the unrest and changes in government. We also found some of the selected pharmacies that were open when we were conducting the mapping, were closed when we returned to conduct our survey, due to the unrest and changes in government.

 

6. What has been your biggest learning?

We conducted a KAP (knowledge, attitude and practices) survey among drug sellers. Findings revealed that a substantial proportion of drug sellers have self reported correct knowledge, good practice and positive training interest regarding AMR related issues, however there is significant inequality in their knowledge, practice and training interest according to level of general education, and professional pharmacy related education, the type of drug selling establishment and years of experience for drug selling.

We held a focus group discussion with the drug sellers as part of the participatory video development process, and discussions revealed important information regarding the mis-selling or mis-use of antibiotics. Drug sellers face many issues that influence the selling of antibiotics, including the influence of the pharmaceutical companies, pressure from other local drug sellers, and pressure or expectation to provide the antibiotics from customers – who could go to another seller in the neighbourhood if they do not receive what they are asking for. This would have economic and reputational impact for the seller and their livelihood.

 

7. What would you like other researchers to learn from your project?

Building rapport and maintaining communications with the relevant government officials is crucial to ensure support and facilitation of project implementation. This all takes time, however advocacy work and collaboration will be beneficial for any implication of take up at the national level.

The development of the Participatory Video (PV) also takes time, however we have found this method to be a powerful tool of participatory action research, portraying the voice of the target group (drug sellers). As it portrays the voice of the drug sellers, we are using the participatory videos as part of our co-designed training package we are developing, to help take up and acceptance of the package amongst other drug sellers.

 

8. What more would you like to do with your project or research area – if funding wasn’t a constraint?

We would have loved to take the project further to complete the co-designing of the training package and roll it out to groups of drug sellers.

9. Is there anything else you would like to share about your project, or the process?

For the effective prevention of AMR in the community, we need comprehensive awareness about AMR, its consequences, how to prevent it and apply those learnings in our daily life. There are multiple groups of stakeholders who can influence the containment of AMR such as health service providers/ professionals, drug sellers, farm owners and consumers. We also need regular monitoring and supervision by regulatory bodies (e.g Directorate General of Drug Administration) to ensure the practice of dispensing antibiotic drugs only with the prescription of registered physicians.

Image 1: Participatory Video Workshop. Image Credit, ARK Foundation

Image 2: Training of data collectors. Image credit, ARK Foundation

Feature Image: Conducting the KAP survey with drug seller. Image credit, ARK Foundation