approach to developin equitable and sustainable partnerships
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Based on the concept note I can read visually - which describes a Zambia-based AMR/AMS research project on standardizing Point Prevalence Surveys - and the supporting evidence retrieved, here is a structured approach to developing equitable and sustainable partnerships for this type of initiative:
Approach to Developing Equitable and Sustainable Partnerships for AMS/AMR Research in Zambia
Context from the Concept Note
The proposal targets:
- Standardizing hospital-based PPS (Point Prevalence Surveys) across Zambia
- Working across public, private, and faith-based healthcare networks
- Aligning with WHO PPS framework and the AWaRe database
- Building an interoperable, open-access medication standardization toolkit
- Bridging facility-level prescription data with national AMR policymaking
These goals make equitable and sustainable partnerships not optional - they are operationally essential.
1. Foundations of Equitable Partnership
Shared Ownership from the Start
- Involve all partner institutions (tertiary hospitals, faith-based networks, private facilities) from the design stage, not just the implementation stage
- Use co-creation workshops to develop data collection tools (ATC/RxNORM coding decisions, form design, metric selection) with input from frontline staff at each site
- Ensure the lead institution (e.g., UNZA/UTHZ) is African-based, with international collaborators in a support - not directive - role. This mirrors guidance from the Africa CDC Data Sharing Framework and the African Union Data Policy Framework
Equity Across Institution Types
The concept note specifically flags public, private, and faith-based networks as targets. Equitable partnership means:
- Giving each institution type an equal voice in governance committees
- Adjusting data-sharing expectations to each facility's capacity (electronic vs. paper-based records are explicitly flagged as a current gap)
- Ensuring smaller, rural, or faith-based sites are not sidelined by complex reporting systems designed for tertiary hospitals
2. Governance and Accountability Structures
| Structure | Purpose |
|---|---|
| Multi-institution steering committee | Strategic oversight; includes representatives from all 3 hospital tiers |
| Technical working group | Oversees toolkit standardization (ATC, RxNORM, AWaRe alignment) |
| Community/patient liaison | Ensures community perspectives are embedded in AMR awareness outputs |
| Data governance board | Manages interoperability, privacy, and fair benefit-sharing of PPS data |
- Establish a Terms of Reference (ToR) for each body at project outset
- All partners should have clearly defined roles, responsibilities, and recognition in publications and reports - a frequent source of inequity in North-South research partnerships
3. Sustainability Pillars
Institutional Embedding
- Train local AMS committee members to maintain PPS cycles independently after the project ends (the concept note references existing AMS Committees in 3 tertiary hospitals - build on these)
- Integrate the standardization toolkit into existing hospital pharmacy and lab information systems rather than creating standalone systems that collapse when funding ends
Capacity Building (Not Just Training)
- Move beyond one-off workshops toward mentorship, co-authorship, and career development for frontline healthcare workers involved in data collection and analysis
- ICARS-funded projects like this one should have a deliberate exit strategy so trained staff are retained and recognized at institutional level
Regulatory and Policy Anchoring
- Align the toolkit outputs formally with the Zambia National Action Plan on AMR (the concept note references this) and seek endorsement from the Zambia Medicines Regulatory Authority
- Secure a government commitment (even in-kind: staff time, data infrastructure) to signal institutional ownership beyond the grant period
Funding Diversification
- Avoid single-funder dependence; map potential co-funders early: PEPFAR, Wellcome Trust, Global Fund, Africa CDC, Zambia Ministry of Health
- ISID/Pfizer's current RFP specifically prioritizes proposals with meaningful partnerships, sustainability plans, and local institutional buy-in - this concept note appears well positioned
4. Data Equity and Governance
This is specifically relevant given the toolkit's interoperability goals:
- Data generated across sites must be governed by a data-sharing agreement that specifies: who owns the data, who can publish from it, how community benefit is ensured
- Use open standards (WHO PPS, AWaRe, ATC) not proprietary systems - this protects all partners equally
- Ensure non-standardisation of nomenclature (identified as a key challenge in the note) is resolved collaboratively, with all sites validating the final framework before deployment
5. Communication and Trust
- Hold regular joint review meetings (at minimum quarterly) across all partner sites
- Publish interim data findings with all partner institutions listed as collaborators
- Be transparent about funding flows - inequitable resource distribution is a major cause of partnership breakdown in African health research contexts
- Acknowledge and address power asymmetries explicitly: between urban/rural sites, between academic and clinical partners, and between international funders and local implementers
6. Monitoring Partnership Health
Include partnership equity indicators in the project's M&E framework:
- % of PPS sites with locally-trained data collectors
-
of local co-authors on project outputs
-
of sites able to conduct an independent PPS cycle post-project
- Evidence of policy uptake (NAP citations, Ministry endorsements)
- Staff retention rates at AMS committee level
Summary
For this Zambia AMS toolkit proposal, equitable and sustainable partnerships require: local co-ownership of design and governance, capacity embedded in existing systems (not parallel structures), data governance that benefits all participating facilities, and policy anchoring within the National Action Plan. The ICARS model already provides a foundation - the next phase should formalise these partnership principles in the project's governance documentation from day one.
Key references supporting this framework:
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I can read the full concept note visually. Here is the partnership approach built directly from the stated Goal and Objectives in the document.
Approach to Developing Equitable and Sustainable Partnerships
Grounded in the Concept Note Objectives
What the Concept Note Asks For (Extracted Objectives)
GOAL: Optimise uniformity, structural reliability and comparability of hospital-based point prevalence surveys in Zambia by employing a rigorous, scalable medication standardisation framework.
Objectives:
- Conduct a comprehensive audit of structural data variations, naming conventions, and dose reporting systems in 9 hospitals in Zambia
- Use existing ICARS cohort data to co-design & pilot digital standardisation toolkits
- Develop standardised antimicrobial nomenclature using RxNORM
- Align with WHO PPS framework and AWaRe database
- Bridge facility-level prescription data with national AMR policymaking
These objectives span data auditing, co-design, digital tool development, nomenclature standardisation, and policy translation - each requiring a different type of partner. Equitable and sustainable partnerships must be structured around each of these domains.
1. Mapping Partners to Each Objective
| Objective | Partner Type Needed | Role |
|---|---|---|
| Audit of 9 hospitals (data variation, naming, dosing) | All 9 hospital pharmacy, clinical, and lab teams | Primary data providers; must be co-investigators, not just data sources |
| Co-design of digital toolkit using ICARS cohort data | ICARS technical staff + frontline AMS committee members | Co-designers; their workflow realities shape usability |
| RxNORM standardisation | Academic/informatics partners (e.g., UNZA, regional universities) + WHO collaborating centres | Technical advisory; must reflect local naming conventions first |
| WHO PPS / AWaRe alignment | Ministry of Health Zambia + WHO AFRO | Policy anchor; ensures toolkit is nationally endorsed |
| National AMR policy translation | Zambia NAP AMR technical team, policymakers | End-users; engaged from design phase, not just dissemination |
Equity principle: No partner should be merely a data source. Every institution providing data must have representation in decision-making.
2. The Co-Design Imperative (Objective 2 is the Anchor)
Objective 2 explicitly calls for co-design - this is the most important partnership principle in the entire concept note. It means:
- Before building the digital standardisation toolkit, conduct structured consultations at each of the 9 hospitals to understand how antimicrobials are currently named, recorded, and dosed in practice
- Include pharmacists, prescribers, data clerks, and AMS committee leads as named contributors - not just consultees
- Prototype, test, and revise the toolkit iteratively with partner sites before finalisation
- Reject a model where UNZA/UTHZ builds the tool and hospitals are asked to adopt it - this reproduces the very top-down non-standardisation problem the project is trying to solve
This mirrors the UKCDR/ESSENCE framework finding that equitable partnerships require LMIC institutions to drive co-design, not just validate outputs from high-income country partners.
3. Governance Structure
Steering Committee
- Chaired by the Zambia lead institution (not ICARS/international funder)
- Includes representatives from: public hospitals, faith-based hospitals, private facilities, Ministry of Health, and at least one patient/community voice
- Meets quarterly with documented minutes and decisions
- Has authority to modify the toolkit scope if field realities demand it
Technical Working Group (TWG)
- Pharmacists + clinical informaticists from partner hospitals
- Responsible for resolving RxNORM vs. local nomenclature conflicts (this is flagged as a known challenge - medical files, physical vs. electronic, ATC vs. unmapped generic descriptions)
- Outputs: agreed naming conventions, dose units, and metric indicators validated across all 9 sites
Data Governance Board
- Defines who owns PPS data collected at each site
- Sets rules for aggregated publication and data sharing
- Ensures no single institution (academic or international) can publish site-level data without that site's sign-off
4. Addressing the Specific Challenges Named in the Document
The concept note identifies these concrete problems - each requires a specific partnership response:
| Named Challenge | Partnership Solution |
|---|---|
| Non-standardisation of data collection tools (medical files vs. electronic) | TWG includes staff from both paper-based and electronic sites; toolkit must work for both |
| ATC vs. RxNORM vs. unmapped generic descriptions | Pharmacist-led nomenclature working group co-develops a Zambia-specific crosswalk before any digital tool is built |
| Varied metric indicators (e.g., denominators for PPS calculations) | All 9 hospitals agree on minimum dataset at project inception; stored in shared open-access registry |
| Public vs. private vs. faith-based network differences | Separate implementation leads at each institution type; single harmonised reporting standard; no penalty for legacy formats during transition |
5. Sustainability - Embedding, Not Dependency
Build on What Already Exists
- The concept note notes that AMS Committees, training materials, and 3 PPS cycles already exist in the 3 ICARS tertiary hospitals. Start there. Do not create parallel structures.
- Use the digital toolkit to formalise and replicate what already works informally at these sites
Institutional Anchoring
- Seek formal endorsement from the Zambia Medicines Regulatory Authority and the Ministry of Health AMR Technical Committee so the toolkit becomes a national standard, not a project deliverable
- Embed RxNORM/AWaRe training into pharmacy school curricula at UNZA - this ensures the standardisation is reproduced in the next generation of prescribers without requiring a grant
Post-Project Independence Indicators
Set these at project start and track throughout:
- Can each of the 9 hospitals run a PPS cycle using the toolkit independently by month 18?
- Is there a locally trained person at each site who can update the naming crosswalk?
- Has at least one national policy document cited the toolkit methodology?
- Are publication outputs jointly authored with hospital-based staff, not only academic leads?
6. Equity Checklist for This Specific Project
Based on the Liverpool School of Tropical Medicine co-developed principles and the UKCDR framework, the following should be confirmed at project inception:
- All 9 hospitals are named as institutional partners (not just "study sites") in the protocol and ethics applications
- Budget allocations are transparent and shared with all partner institutions
- PhD or research capacity opportunities are distributed across participating hospitals, not concentrated at the lead academic institution
- Data ownership agreements are signed before data collection begins
- The toolkit is open-access and freely usable by partner sites after the project ends
- At least one hospital-based co-investigator from outside Lusaka is in a named leadership role
- Publication plans specify authorship equity criteria in advance
In Summary
This concept note's strength is that its objectives already embed partnership - the co-design of the digital toolkit (Objective 2), the multi-hospital audit (Objective 1), and the policy bridging goal are all inherently collaborative. The risk is that these remain aspirational unless governance structures, data agreements, and capacity commitments are formalised before fieldwork begins. Equitable and sustainable partnerships in this project means: the 9 hospitals are partners in building the solution, not subjects of the research.
put it in a concise 1 page summary with major partners such as Zambia National public health Institute
Here is your concise 1-page summary:
Approach to Developing Equitable and Sustainable Partnerships
Project: Medication Standardisation for Hospital-Based Point Prevalence Surveys in Zambia
Background
Antimicrobial resistance (AMR) poses a critical threat to health systems globally. In Zambia, non-standardised data collection tools, inconsistent antimicrobial nomenclature (ATC/RxNORM/generic), and varied metric indicators undermine the utility of Point Prevalence Surveys (PPS) across public, private, and faith-based hospitals. This project aims to design, validate, and deploy an interoperable medication standardisation toolkit across 9 hospitals, aligned with the WHO PPS framework and AWaRe database.
Major Partners and Their Roles
| Partner | Role |
|---|---|
| Zambia National Public Health Institute (ZNPHI) | National AMR policy anchor; links toolkit outputs to the Zambia NAP on AMR; endorses standardised PPS as a national reporting mechanism |
| University Teaching Hospital / UNZA | Lead academic institution; coordinates data audit, RxNORM crosswalk development, and toolkit co-design |
| ICARS (International Centre for Antimicrobial Solutions) | Funder and technical advisor; provides existing 3-year AMS cohort data for toolkit co-design and piloting |
| Ministry of Health Zambia | Policy co-owner; ensures toolkit integration into national health governance and AMR surveillance structures |
| 9 Partner Hospitals (public, private, faith-based) | Co-designers and primary data contributors; pharmacy, clinical, and AMS committee staff validate naming conventions and pilot the toolkit in real-world settings |
| WHO AFRO / AWaRe Programme | Technical alignment; ensures toolkit meets international PPS and antibiotic classification standards |
| Zambia Medicines Regulatory Authority (ZAMRA) | Regulatory endorsement of standardised nomenclature and dose reporting systems |
Partnership Principles
1. Co-Design, Not Consultation - All 9 hospitals contribute to toolkit development from inception. No site is a data source only; each holds co-investigator status.
2. Local Leadership - The Zambia lead institution chairs the steering committee. ICARS and international partners serve in an advisory, not directive, capacity.
3. Transparent Governance - A steering committee (quarterly), technical working group (pharmacists + informaticists), and data governance board (ownership, authorship, sharing rights) are established before data collection begins.
4. Sustainability by Design - The toolkit is open-access; RxNORM/AWaRe training is embedded in UNZA pharmacy curricula; ZNPHI formally adopts PPS outputs into national AMR reporting cycles.
Equity Commitments
- All 9 hospitals named as institutional partners in ethics and protocol documentation
- Budget allocations shared transparently with all partners
- Authorship equity criteria defined at project start
- Capacity development (mentorship, co-authorship, research skills) distributed across all sites - not concentrated at the academic lead
- Data ownership agreements signed before fieldwork begins
Sustainability Milestones
- Month 12: Each hospital independently conducts a PPS cycle using the standardised toolkit
- Month 18: ZNPHI formally integrates toolkit methodology into national AMR surveillance reporting
- Month 24: At least one national policy document cites project outputs; toolkit freely accessible to all Zambian health facilities
This partnership approach bridges facility-level prescription data with national AMR policymaking - translating a research project into a permanent infrastructure for antimicrobial stewardship in Zambia.
write it in essay and not point form
Approach to Developing Equitable and Sustainable Partnerships
Project: Medication Standardisation for Hospital-Based Point Prevalence Surveys in Zambia
Antimicrobial resistance remains one of the most pressing threats to global health, and Zambia is not immune to its consequences. Despite the country's National Action Plan on AMR and the progress made through the ICARS-funded three-year Antimicrobial Stewardship programme, a persistent structural gap remains: Point Prevalence Surveys (PPS) conducted across public, private, and faith-based hospitals are undermined by inconsistent data collection tools, non-standardised antimicrobial nomenclature, and misaligned metric indicators. This project seeks to close that gap by designing, validating, and deploying an interoperable medication standardisation toolkit across nine hospitals in Zambia, aligned with the WHO PPS framework and the AWaRe database. Achieving this goal requires not just technical innovation, but a deliberate, principled approach to partnership - one that is both equitable in its design and sustainable in its impact.
The foundation of this partnership approach rests on the recognition that no single institution can deliver this project alone, nor should it. The Zambia National Public Health Institute (ZNPHI) occupies a central role as the national AMR policy anchor, providing the institutional legitimacy needed to translate toolkit outputs into enduring national standards. By linking the project's findings directly to Zambia's National Action Plan on AMR, ZNPHI ensures that the standardised PPS methodology does not remain a research output but becomes a permanent feature of national AMR surveillance and reporting. Alongside ZNPHI, the Ministry of Health serves as a critical co-owner of the policy agenda, ensuring that the toolkit is integrated into broader health governance structures and that the momentum generated by this project outlasts the funding cycle.
The University Teaching Hospital and the University of Zambia anchor the academic and technical dimensions of the partnership. As the lead coordinating institution, they oversee the comprehensive data audit across all nine hospitals, drive the development of a Zambia-specific RxNORM nomenclature crosswalk, and coordinate the co-design and piloting of the digital standardisation toolkit. ICARS, as both funder and technical advisor, contributes the existing three-year AMS cohort data that makes co-design possible, while WHO AFRO and the AWaRe programme provide the international technical alignment that ensures local outputs meet global reporting standards. The Zambia Medicines Regulatory Authority (ZAMRA) plays an equally important role by providing regulatory endorsement of the standardised nomenclature and dose reporting systems, giving the toolkit formal standing within Zambia's medicines governance architecture.
Critically, the nine participating hospitals - spanning public, private, and faith-based networks - are not merely study sites or data sources. They are co-designers and institutional partners whose frontline pharmacists, prescribers, AMS committee members, and data clerks possess the practical knowledge that no external team can replicate. The diversity of these facilities is itself an asset: the fact that some operate on paper-based records while others use electronic systems, and that antimicrobial naming conventions vary significantly across them, means that the toolkit developed through this process will be genuinely fit for the heterogeneous realities of Zambian healthcare delivery. This co-design principle - placing hospital staff as contributors to the solution rather than subjects of the research - is the single most important safeguard against producing a standardisation framework that looks rigorous on paper but fails in practice.
Governance arrangements will be established before data collection begins to ensure that all partners operate within a transparent and accountable structure. A steering committee, chaired by the Zambian lead institution and inclusive of representatives from all partner institution types, will provide strategic oversight. A technical working group composed of pharmacists and clinical informaticists from across the nine hospitals will resolve the naming convention conflicts that have historically plagued PPS data quality. A data governance board will define data ownership, authorship rights, and sharing protocols, ensuring that no single institution - academic or international - can appropriate site-level data without the express agreement of the generating institution.
Sustainability is built into the design of the partnership rather than treated as an afterthought. The toolkit will be open-access and freely available to all Zambian health facilities beyond the project period. Training in RxNORM and AWaRe classification will be embedded into the University of Zambia pharmacy school curriculum, ensuring that the next generation of Zambian prescribers and pharmacists enters the workforce already equipped with the skills to maintain standardised PPS practices. ZNPHI's formal adoption of the toolkit methodology into national AMR reporting cycles by month eighteen represents the clearest marker of sustainability: the point at which this project's outputs become the country's infrastructure.
Equity commitments run through every layer of this approach. All nine hospitals will be named as institutional partners in ethics and protocol documentation, not as participant sites. Budget allocations will be shared transparently. Capacity development opportunities - mentorship, co-authorship, research skills training - will be distributed across all partner sites rather than concentrated at the academic lead. Authorship criteria will be agreed upon at the outset. These are not procedural formalities; they are the conditions under which genuine partnership becomes possible, and under which the communities most affected by AMR in Zambia can be confident that this project serves their priorities, not only the priorities of its funders.
Together, these partners and principles form a partnership architecture capable of bridging the gap between facility-level prescription data and national AMR policymaking - and of doing so in a way that leaves Zambia's health system stronger than it found it.
what is the training and capacity stregthening trajectory for this project in a LMIC
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Training and Capacity Strengthening Trajectory for the Zambia AMS Standardisation Project in a Low- and Middle-Income Country Context
In a low- and middle-income country like Zambia, training and capacity strengthening cannot be treated as a supplementary activity that runs alongside the main project. It must be the spine of the project itself. The history of externally funded AMR and AMS initiatives in sub-Saharan Africa is littered with technically sound interventions that collapsed once international support was withdrawn, precisely because the human and institutional capacity to sustain them was never sufficiently developed at the local level. For this project - which aims to standardise Point Prevalence Survey methodology and build an interoperable medication nomenclature toolkit across nine hospitals - the capacity strengthening trajectory must be deliberate, phased, and deeply embedded in the day-to-day work of the institutions involved.
The trajectory begins before any data is collected. The first phase, running through approximately the initial six months of the project, is fundamentally diagnostic and relational. It involves a comprehensive assessment of the existing research and technical capacity at each of the nine partner hospitals. This means understanding not only what skills are present - among pharmacists, clinicians, data clerks, and AMS committee members - but also what structural conditions either enable or constrain capacity development: workload pressures, staff turnover rates, access to computers and internet connectivity, and the degree to which hospital leadership supports AMS activities. This assessment is not a bureaucratic exercise; it shapes every subsequent training decision. Without it, training programmes risk being designed for an idealised hospital workforce rather than the real one. The ESSENCE Seven Principles for strengthening research capacity in LMICs, endorsed by the WHO, are explicit on this point: understanding the local context and accurately evaluating existing capacity is the necessary precondition for everything that follows.
From this baseline, the project moves into a structured, multi-layered training phase that spans the core implementation period. The first layer targets frontline data collectors - the pharmacists, nurses, prescribers, and pharmacy technicians at each hospital who will actually conduct PPS cycles and populate the standardised toolkit. Training at this level is practical and contextual. It focuses on the correct use of WHO PPS methodology, the logic of the AWaRe classification system, and the application of the RxNORM nomenclature crosswalk developed specifically for Zambia. Crucially, this training is not delivered as a one-off workshop and then abandoned. It is reinforced through supervised practice during the first two PPS cycles, with trained mentors - drawn from the more experienced ICARS tertiary hospital sites - available for on-site and remote support. This peer-to-peer mentorship model is particularly well-suited to the Zambian context because it distributes expertise horizontally across institutions rather than maintaining it vertically within an academic centre.
The second training layer targets mid-level leaders: AMS committee chairs, chief pharmacists, and hospital quality improvement officers. These are the people who will determine whether standardised PPS practices are institutionalised or quietly abandoned after the project ends. Their training goes beyond technical skills to encompass data interpretation, quality assurance of PPS outputs, and the use of antibiotic use data to drive prescribing behaviour change at the ward level. They are also trained in the governance and data management aspects of the toolkit, including how to update the nomenclature crosswalk when new antimicrobials are introduced, how to submit data to ZNPHI's national AMR surveillance system, and how to read and act on comparative reports across hospital sites. This leadership-level capacity is what converts a research tool into a management tool, and it is what makes the difference between a project that produces data and one that changes practice.
The third and most strategically significant layer addresses research and academic capacity. In LMIC settings, one of the most consistent equity failures in international health research partnerships is the concentration of intellectual and publication opportunities at the lead academic institution - or worse, at the international partner. This project deliberately counters that tendency by providing structured research mentorship to clinicians and pharmacists at the nine partner hospitals who have not previously been involved in formal research. This means supporting at least two to three staff members from non-academic hospital sites to participate as named co-investigators, to contribute to data analysis, to present findings at national AMR forums, and to be listed as co-authors on project publications. For some, this may represent their first peer-reviewed publication. For the institutions, it builds the internal research culture that makes future grant applications and independent PPS cycles possible. The TDR-SORT IT model of operational research training - which uses researchers' own routinely collected data to solve problems they manage - is directly applicable here and offers an established framework the project can draw on.
Running across all three layers is a deliberate investment in digital and data literacy, which is a foundational gap in many Zambian hospital settings. Staff who have previously recorded PPS data on paper forms or in unstructured spreadsheets will need support to transition to the interoperable digital toolkit. This is not simply a matter of software training; it involves building comfort with structured data entry, understanding why standardised fields matter for aggregation, and developing the habit of flagging data quality issues rather than silently correcting them. Given that the concept note identifies the physical-versus-electronic records divide as one of the core challenges the project must address, this digital capacity strand cannot be underestimated.
By the final phase of the project, the capacity strengthening trajectory should have produced a measurable shift in the locus of expertise. At project inception, the knowledge of how to conduct a standardised PPS using the WHO framework and the AWaRe database largely resides with ICARS and the lead academic institution. By project close, it should reside primarily within the nine partner hospitals and within ZNPHI. The test of this shift is not whether staff can follow a protocol when a supervisor is present, but whether they can run an independent PPS cycle, troubleshoot data quality problems, update the nomenclature crosswalk, and use the results to inform prescribing policy - entirely on their own. This is the standard against which the capacity strengthening trajectory of the project should be evaluated, and it is the only standard that gives the project a credible claim to sustainability in a low- and middle-income country context.
The longer-term horizon extends beyond the project itself. By embedding RxNORM and AWaRe training into the University of Zambia's pharmacy curriculum, the project ensures that future graduates enter Zambian hospitals already oriented to standardised antimicrobial data practices. By working with ZNPHI to formally incorporate the toolkit's PPS outputs into national AMR reporting cycles, the project creates an institutional demand for the skills it has developed - which is the most powerful mechanism for sustaining capacity in any LMIC setting. Capacity that is needed is capacity that is maintained.
COULD THERE BE AN OPPORTUNITY FOR MASTERS OF PHD IF YES WHAT WOULD THEIR STUDIES LOOK LIKE
Yes, absolutely - this project is exceptionally well-suited to generating both Master's and PhD studies. Here is a full essay laying out the opportunity and what those studies would look like.
Masters and PhD Opportunities Embedded in the Zambia AMS Standardisation Project
Research projects of this nature - multi-site, data-rich, policy-relevant, and operating at the intersection of clinical practice, informatics, and public health governance - are precisely the kind of platforms on which postgraduate training in low- and middle-income countries should be built. The Zambia medication standardisation project does not merely tolerate the presence of postgraduate students; it genuinely requires the depth of inquiry that Masters and PhD research provides. The questions this project raises are too complex and too consequential to be answered through routine project monitoring alone. They demand systematic investigation, theoretical grounding, and the kind of sustained intellectual engagement that only a postgraduate researcher can bring.
The opportunity exists at two distinct levels. A Master's degree, typically spanning one to two years, is suited to questions that are bounded, operational, and directly actionable within the project's own timeline. A PhD, spanning three to five years, is suited to questions that are generative - questions whose answers will reshape how AMS surveillance is understood and practiced not only in Zambia but across comparable LMIC settings. Both levels of study can be conducted by Zambian researchers, hosted at the University of Zambia or through a co-tutelle arrangement with an international partner university, and directly supervised by the project's principal investigators.
Master's Level Studies
At the Master's level, the most natural and immediately useful study would focus on the extent and nature of antimicrobial nomenclature variation across the nine participating hospitals. This is Objective 1 of the project - the comprehensive audit of structural data variations, naming conventions, and dose reporting systems - and it is a question that has never been formally answered in Zambia. A Master's student conducting this study would systematically collect and analyse PPS data forms, pharmacy dispensing records, and electronic health record entries from all nine sites, mapping the range of names used for the same antimicrobial agents, the inconsistencies in dose units and route descriptions, and the degree to which existing ATC and RxNORM codes either capture or fail to capture Zambian clinical practice. The thesis would produce a formal taxonomy of the nomenclature landscape and a set of evidence-based recommendations for the national crosswalk. The student would graduate having made a direct, citable contribution to national AMR policy, and the project would have the rigorous foundational data it needs to build a credible standardisation framework.
A second Master's study could focus on the usability and acceptability of the digital standardisation toolkit among frontline health workers. This is a question of implementation science - not whether the toolkit works technically, but whether the people who are supposed to use it actually can and will, given the real conditions of Zambian hospital pharmacy practice. Using mixed methods - structured usability testing, observation of PPS data entry sessions, and in-depth interviews with pharmacists and data clerks - the student would assess where the toolkit creates friction, where it aligns well with existing workflows, and what adaptations would improve uptake without compromising standardisation. This kind of study is critically important in LMIC settings where digital health tools designed by academics or informatics specialists frequently fail at the point of frontline adoption, and its findings would directly inform the final version of the toolkit before national rollout.
A third Master's opportunity lies in examining the knowledge, attitudes, and practices of prescribers across the nine hospitals regarding antimicrobial classification systems, specifically the WHO AWaRe framework. Despite AWaRe being the international standard for rationalising antibiotic use, there is very limited published evidence on how well Zambian prescribers understand or apply it in clinical decision-making. A student investigating this question would conduct a structured survey across the hospital sites, analyse patterns by cadre, specialty, and institution type, and use the findings to design targeted educational interventions. This study would generate evidence that is directly applicable to the training programme the project needs to deliver, while also contributing to the global literature on AWaRe implementation in sub-Saharan Africa.
PhD Level Studies
At the PhD level, the questions become broader, more theoretically engaged, and more generative in their implications. The most compelling PhD study emerging from this project would address the systemic factors that have prevented PPS data from influencing AMR prescribing policy in Zambia, despite the existence of PPS data from three cycles conducted during the ICARS project. This is a question about the relationship between evidence and policy in a low-resource health system - why data that exists is not used, what institutional, political, and technical barriers stand between a PPS dataset and a prescribing guideline revision, and what conditions would need to change for that relationship to function reliably. Using a health systems research framework - likely a combination of implementation science theory and political economy analysis - the PhD researcher would trace the journey of PPS data from collection to policy decision across multiple hospital and ministry stakeholders. The thesis would produce both a theoretical model of evidence-to-policy translation in Zambian AMR governance and a set of practical recommendations for how the standardisation toolkit can be designed to overcome the barriers it identifies. This would be a genuinely landmark study in the Zambian AMR literature.
A second PhD could focus on the broader question of health data interoperability in Zambia's mixed public-private-faith-based hospital landscape. This project confronts directly the challenge of aggregating data across institutions that use different record systems, different software platforms, and different organisational cultures around data quality. A PhD researcher investigating this question would situate the Zambia AMS toolkit within the wider global literature on health information systems interoperability in LMICs, use the nine-hospital implementation as a detailed case study, and develop a generalisable framework for designing interoperable health data systems in heterogeneous LMIC hospital networks. The theoretical contribution would extend well beyond AMR - it would speak to electronic health record design, national health information architecture, and digital health governance in resource-limited settings - making it publishable in high-impact health informatics and global health journals.
A third PhD opportunity, perhaps the most forward-looking of all, would examine whether and how the RxNORM standardisation framework developed for Zambia can be adapted and applied in other LMIC settings with different pharmaceutical landscapes and healthcare system structures. This would be a comparative multi-country study, potentially extending to two or three other sub-Saharan African countries with similar AMR burdens and PPS ambitions, examining what elements of the Zambia crosswalk are transferable and what requires contextual adaptation. This study would directly position Zambia - and the Zambian researcher who conducts it - as a regional leader in AMS informatics, and it would give the project a continental reach that single-country research cannot achieve.
What These Studies Would Look Like in Practice
In all cases, the postgraduate researchers would be embedded in the project as active contributors, not as observers. Their data collection would serve dual purposes: advancing their thesis and generating the evidence the project needs to achieve its objectives. Their supervisory teams would include both the project's principal investigators and independent academic supervisors, ideally with a co-supervision arrangement involving a Zambian and an international academic, to ensure both contextual grounding and exposure to global standards of research training. Their work would be presented at project review meetings, national AMR forums, and ultimately at international conferences, ensuring that Zambian researchers are visible in global scientific conversations about AMR from early in their careers.
Funding for these positions could be built into the project budget from the outset, framed not as an add-on but as a core capacity strengthening deliverable. ICARS, Wellcome Trust's African postgraduate fellowship schemes, the Carnegie Corporation's African universities programme, and bilateral arrangements between UNZA and partner universities in the United Kingdom, Sweden, or the Netherlands all represent plausible funding pathways. The key is that these opportunities are identified and ring-fenced before the project begins, rather than being offered only to whoever happens to be available when a data gap becomes inconvenient.
The graduates of these programmes would not leave Zambia for positions abroad. They would be the next generation of AMS committee leaders, pharmacy school faculty, ZNPHI surveillance officers, and Ministry of Health technical advisors - the very people without whom no amount of standardisation toolkit design will translate into lasting change in how antimicrobials are used and monitored in Zambia. That is the most compelling argument for embedding Masters and PhD opportunities in this project: the research is not separable from the capacity, and the capacity is not separable from the sustainability of everything the project is trying to build.
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