Community health volunteers as a frontline platform for antimicrobial resistance mitigation in sub-Saharan Africa: A scoping review

Abstract

Antimicrobial resistance (AMR) is a global public health crisis disproportionately affecting sub-Saharan Africa (SSA), where it was directly responsible for approximately 255,000 deaths in 2019 alone. Despite this burden, community-level mitigation strategies remain underdeveloped. Community health volunteers (CHVs), embedded within their communities and trusted by populations with limited healthcare access, represent an underutilised but promising platform for AMR mitigation. This scoping review aimed to map the breadth, nature, and outcomes of CHV-led or CHV-supported AMR interventions in SSA; identify barriers and facilitators to implementation; and identify evidence gaps to inform future research and policy. Following the Arksey and O’Malley (2005) framework and reported according to PRISMA-ScR 2018 guidelines, we systematically searched PubMed/MEDLINE, EMBASE, Cochrane Library, AJOL, WHO IRIS, and grey literature for studies published from January 2018 to January 2026. Studies conducted in SSA involving CHVs and addressing AMR mitigation through at least one of education, surveillance, diagnostics, waste management, or One Health approaches were eligible. Data were charted using a standardised extraction form and findings synthesised narratively. Of 847 records identified, 26 studies and reports met the inclusion criteria. The evidence base encompassed educational interventions (n = 14), diagnostic integration (n = 3), waste and environmental management (n = 3), and multisectoral One Health approaches (n = 6). CHV-led educational interventions improved AMR knowledge by 49.3%–97.1% and reduced inappropriate antibiotic prescribing by 18–44%. Point-of-care diagnostic integration reduced antibiotic use by up to 24.6% without increasing adverse outcomes. Key barriers included inadequate resources, training overload, weak regulation, and lack of integrated surveillance, while facilitators included tailored training, diagnostic tools, community trust, and policy alignment. The evidence supports embedding structured AMR roles for CHVs within national AMR action plans, integrated community case management, One Health frameworks, and investment in CHV training and diagnostic capacity.