CAMO-Net India researchers Dr Vrinda Nampoothiri and Dr Vidhi Shukla are contributing their expertise in ethnographic research to work supporting the implementation of India’s second National Action Plan on Antimicrobial Resistance.
Policies designed to improve antibiotic use do not operate in a vacuum. In hospitals, everyday decisions are influenced by professional hierarchies, established routines, relationships, available resources and the expectations of patients and healthcare professionals.
Understanding these influences was central to the contribution made by Dr Vrinda Nampoothiri and Dr Vidhi Shukla of CAMO-Net India at a recent Expert Working Group meeting organised by the Indian Council of Medical Research (ICMR).
The meeting focused on the implementation of India’s second National Action Plan on Antimicrobial Resistance, known as NAP-AMR 2.0, which covers the period 2025–29.
Vrinda and Vidhi were invited to present findings from their ethnographic work with surgical departments at the Kochi and Faridabad campuses of Amrita Hospital. They highlighted the importance of considering local context, social norms and cultural nuances when designing interventions intended to change clinical practice.
Ethnographic research helps researchers understand how care is delivered in everyday settings. By observing clinical practice and listening to the people involved, it can reveal why particular behaviours develop, how decisions are negotiated and what may prevent an intervention from working as intended.
From clinical practice to national policy
The India team’s contribution builds on a wider body of research examining the social and organisational factors that influence infection management.
Earlier published research involving Vrinda used ethnographic observation, patient case studies and interviews to investigate infection management across surgical pathways in India and South Africa.
The study identified barriers at different points in the surgical pathway and found that professional hierarchies could limit the involvement of nurses, pharmacists and other healthcare professionals in antimicrobial decision-making. It also highlighted the important, but sometimes overlooked, roles played by senior surgeons and nursing staff.
These findings illustrate why interventions cannot rely solely on distributing clinical guidance. The same recommendation may be interpreted and implemented differently depending on who is expected to make a decision, whose expertise is recognised and whether team members feel able to question established practice.
Putting NAP-AMR 2.0 into action
India’s NAP-AMR 2.0 was launched in November 2025. It aims to strengthen ownership of the country’s response to antimicrobial resistance, improve coordination between sectors and increase engagement with the private sector.
Its priorities include raising awareness, strengthening education and training, expanding laboratory capacity, improving infection prevention and control, and supporting more responsible antimicrobial use.
The plan was developed through an extensive consultation process. An official report of the national expert consultations describes contributions from clinicians, microbiologists, researchers, public health professionals, administrators, veterinarians, professional associations and civil society organisations.
The consultations also recognised that changing antimicrobial use requires a better understanding of behaviour and called for greater involvement from social scientists. The Expert Working Group provides an opportunity to bring this perspective into the practical implementation of the national plan.
Developing a shared approach to KAP assessment
As part of the next stage of this work, Vrinda and Vidhi will collaborate with a multidisciplinary group of experts to develop a standardised methodology and generic protocol for assessing knowledge, attitudes and practices relating to antimicrobial resistance.
Knowledge, attitudes and practices assessments – often known as KAP assessments – can help identify what different groups understand about antimicrobial resistance, how they perceive the risks and responsibilities associated with antimicrobial use, and what happens in practice.
A standardised approach could make it easier to collect consistent evidence across different settings and population groups. At the same time, the CAMO-Net India team’s ethnographic experience will help ensure that the methodology remains sensitive to differences in professional roles, healthcare environments, social expectations and local culture.
By connecting detailed observation of clinical practice with national planning, Vrinda and Vidhi’s involvement demonstrates the value of including social and behavioural evidence in the response to antimicrobial resistance. This can help ensure that interventions are not only technically sound, but realistic, relevant and sustainable for the people expected to put them into practice.
