Antananarivo — When Lalaina Mihobintsoa speaks about his commitment to combating antimicrobial resistance (AMR), his words are simple yet powerful. “I want everyone around me to understand why we need to act,” he says with conviction. A veterinary medicine student, he chose to become an AMR ambassador to raise awareness in his community. “It’s not complicated: if we share the right practices, we can prevent many problems,” he explains with a smile.

AMR occurs when microbes—bacteria, viruses or parasites—become resistant to the medicines designed to eliminate them. In practical terms, this means that common infections, once easy to treat, become dangerous. This phenomenon is fuelled by the overuse of antibiotics, self-medication and poor hygiene. Its consequences go beyond the medical field, threatening public health, the economy and food security. In agriculture, uncontrolled use of antimicrobials in animals promotes the spread of resistant bacteria, compromising exports and food quality.

In Madagascar, AMR causes about 5400 deaths each year—a figure that illustrates the scale of the problem and its impact on families and the health system. Infections become harder to treat, leading to prolonged hospital stays and high costs for households.

To address this threat, the government adopted a National Action Plan (NAP-AMR) in 2019, aligned with World Health Organization (WHO)’s Global Action Plan, which outlines measures for surveillance, awareness and rational prescription. This plan serves as a roadmap to coordinate efforts through a multisectoral “One Health” approach, linking human, animal and environmental health. Among the proposed solutions, mobilization of young people plays a central role in ensuring sustainability.

Speaking about this approach, Dr Lethicia Lydia Yasmine, Secretary General of the Ministry of Public Health, emphasizes: “It is essential to involve young people because they represent an influential demographic force, capable of quickly adopting and spreading good practices, innovating in awareness campaigns and ensuring the sustainability of efforts.”

This strategy is supported by WHO, which focuses on engagement of young people. For Dr Ilo Ramahatafandry, AMR project coordinator at WHO Madagascar, the role of young people is decisive: “Young people are key agents of change. They have a natural influence within their communities,” she explains.

In this context, about fifty ambassadors, supported by WHO, have been trained to educate their peers and communities on simple actions that save lives. Mihobintsoa is one such ambassador. “Every action counts! I explain to people that before taking an antibiotic, it is essential to consult a doctor, follow prescriptions and maintain good hygiene. That’s how we protect our health and that of others,” he says. 

Mihobintsoa recalls a debate organized by WHO during World Antimicrobial Awareness Week (WAAW) in 2024, where he convinced economics students to share messages within their social circles. “That day, I realized that awareness goes beyond medicine—it concerns everyone,” he says. 

“During the same event, I led an awareness session in my neighbourhood. At the end, a mother told me she would no longer give antibiotics to her children without medical advice. Feedback like that motivates me,” he adds proudly.

In Antsirabe, Rakotoarisoa Sitraka Irinah, also a medical student, shares the same determination: “AMR is not a theoretical concept—it’s a reality that can affect anyone,” she explains. Irinah organizes sessions in neighbourhoods and on campuses and uses social media to reach young people. She stresses the importance of speaking simply and in the local language: “Our daily habits, like buying antibiotics without a prescription, can make medicines ineffective.” For her, every young person can act by getting informed, avoiding self-medication and raising awareness among their peers: “We have a voice that carries real influence,” she asserts, convinced that collective mobilization is key to preserving treatment effectiveness.

The national strategy includes raising awareness among all stakeholders—farmers, breeders and health professionals—and relies on key tools such as prescription guides, surveillance protocols and an integrated platform for data collection and analysis. A dedicated state budget is also planned to ensure implementation and sustainability of initiatives.

Significant progress has been made with the establishment of pilot surveillance for certain priority pathogens in animal health, assessment of laboratory capacities to monitor AMR in human and animal health, as well as in the environment and food. A draft interministerial decree to regulate the market and use of antimicrobials in humans and animals has been developed, with strong regulatory dimensions.

However, this progress faces challenges. Maintaining long-term engagement of young volunteers is a major difficulty. Issues evolve, and without continuous training, message quality may decline. Material resources are often lacking: posters, visual aids and transportation to reach rural areas. Measuring impact is also essential to convince decision-makers and partners to sustain efforts.

To address these challenges, WHO collaborates with authorities and local partners. It organizes regular training sessions to update knowledge for young people and other stakeholders, produces visual materials adapted to communities and facilitates partnerships between key ministries in the “One Health” approach—especially Youth and Sports—and universities to broaden the reach of actions. “WHO is here to support the country, knowing that communities and young people drive change,” says Dr Laurent Musango, WHO Representative in Madagascar.

The fight against AMR does not rely solely on policies or technical tools but on human commitment. Lalaina wants to go beyond awareness to contribute to national strategies, while Mihobintsoa sees herself as a bridge between the medical world and youth, convinced that “our daily habits can make medicines ineffective.” Both share the same ambition: to train other ambassadors, create spaces for dialogue and carry Madagascar’s voice beyond borders. Their determination illustrates a generation ready to act together to preserve treatment effectiveness and protect the future.