Empowering Women, Strengthening Safety: A One Health Response to Antimicrobial Resistance in Semarang’s Food Sector

By Dr. Muh Fauzi and Team

Editor: Anti Rismayanti, SEAOHUN Regional Program Manager

As antimicrobial resistance (AMR) continues to rise globally, community-centered and cross-sectoral interventions have become increasingly essential. Under the SEAOHUN One Health Research and Training (OHRT) Awards Program, our team at Universitas Diponegoro implemented a comprehensive project titled “Handling the Threat of Formalin-Borate Bacterial Resistance in Processed Food Products: One Health Approach and Empowering Women as MSMEs.” This initiative targeted a critical but often underreported threat—unsanctioned use of formalin and borax in processed foods—and its potential impact on AMR.

The project aimed not only to study the scientific aspects of contamination and resistance but also to elevate the role of women in Micro, Small, and Medium Enterprises (MSMEs) as agents of change. Through community empowerment, evidence-based research, and robust stakeholder collaboration, the project created tangible pathways toward safer food systems and more resilient One Health responses.

Implementing a Holistic One Health Strategy

Our approach was rooted in the core principles of One Health—integrating human, animal, and environmental health. The project unfolded in several phases:

1. Field Survey and Laboratory Analysis: We began by collecting 49 samples of processed animal products from 16 traditional markets across Semarang City. These included common street foods such as otak-otak, meatballs, dim sum, galantin, and siomay—many of which lacked formal distribution permits. The laboratory analysis revealed that nearly all samples were contaminated with pathogens such as E. coli, Salmonella, and Staphylococcus aureus. Moreover, 10 samples tested positive for formalin.

Interestingly, while formalin and borax are not classified as antibiotics, their toxic properties against bacteria necessitate separate toxicity testing rather than standard AMR assays. The study shifted toward understanding how these chemicals, when misused, contribute to broader public health concerns, including misdiagnosis, delayed treatment, and community exposure to contaminated food.

2. Stakeholder Engagement and Focus Group Discussions (FGDs): A two-day FGD was held at Khas Semarang Hotel, gathering 21 representatives per day from government agencies (Health, Agriculture, Trade, Cooperatives, and MSMEs), BBPOM, academic institutions, and local media. Participants committed to clearer delineation of roles in AMR control and food safety monitoring. The FGD concluded with the signing of an integrity pact, formalizing cross-sectoral collaboration and commitment to support AMR surveillance and food safety capacity building in Semarang.

Training and Capacity Building for Women in MSMEs

The heart of our intervention was empowering women entrepreneurs. On November 22–23, 2024, we conducted a workshop at MG Setos Hotel, with 35 MSME participants. The training focused on:

• Understanding AMR and its health implications

• Natural, non-antibiotic food preservation methods

• Good hygiene and production practices

• Business development and marketing strategies

Participants received the Smart Book to Use Antibiotics Wisely, alongside notebooks and other training materials. Post-training tests revealed a 30.9% improvement in participants’ knowledge, attitudes, and practices related to food safety and AMR. This measurable outcome demonstrates the power of targeted, gender-sensitive education in transforming health behaviors and business operations simultaneously.

Impact on Academic Practice and Public Health Policy

From an academic standpoint, the project has enriched our curriculum at the Faculty of Public Health, Universitas Diponegoro. Students now engage with real-world case studies that bridge microbiological research, behavioral science, and community health. The policy brief produced after the FGD has also served as a strategic tool for influencing local government programs on AMR and food safety.

For the Semarang City Health Department and other stakeholders, this project illuminated the urgent need for integrating AMR considerations into their existing frameworks. Our advocacy led to the inclusion of AMR monitoring in the city’s food safety programs and facilitated stronger cooperation between agencies.

Forward-Looking: Building Sustainable Systems

The success of this project has laid the groundwork for a series of broader, long-term initiatives aimed at ensuring lasting impact and sustainability. One such initiative is Sinergi Pangan Lokal, a collaborative program designed to bridge the gap between MSMEs and sources of organic, fresh, and pesticide-free raw materials. By ensuring that women-led enterprises have affordable and consistent access to high-quality inputs, the program supports both safe food production and local agricultural economies.

Another promising endeavor is Investasi Hijau di Rumah, which promotes sustainable practices at the household level. This initiative encourages small-scale organic farming, composting, and home gardening as a means of reducing environmental impact while enhancing food self-sufficiency. Through community-based activities and digital support materials, the program empowers families—especially women—to become stewards of their own food systems.

To further increase the competitiveness and safety of MSME products, Upgrade Teknologi Produksi aims to provide modern equipment and training for efficient food processing. This intervention not only helps standardize product quality but also raises safety standards, reducing contamination risks and improving consumer trust. Complementing these production-side efforts is Kampanye Makan Aman, a targeted public education campaign focused on increasing awareness of food safety and healthy consumption habits. Through workshops, digital storytelling, and media engagement, the campaign fosters informed decision-making among consumers, encouraging them to support safer and more responsible food producers.

Finally, HAKI dan Legalitas Berdaya provides crucial support for MSMEs in navigating intellectual property registration and legal compliance. This initiative enhances the legitimacy and market reach of MSME products, ensuring that their innovations are protected and their operations are aligned with national regulatory standards. Collectively, these forward-looking strategies represent a significant shift from short-term interventions to systemic transformation. They reflect a deepening commitment to One Health principles, integrating public health, environmental sustainability, and socio-economic empowerment into a cohesive framework for community resilience.

Insights and Lessons Learned

One of the first lessons we learned was the importance of adaptability. At the project's outset, we hypothesized that borax and formalin might directly contribute to antimicrobial resistance. However, laboratory analyses revealed that these chemical preservatives, while harmful, were not appropriate for AMR testing as they are not antibiotics. This realization prompted a critical shift in our research focus—from trying to establish a direct scientific link, to highlighting the broader public health risks of toxic preservatives. Flexibility in our methods and objectives allowed us to stay responsive to emerging findings and maintain the integrity of our results.

Another powerful discovery was the level of enthusiasm and commitment from stakeholders. We initially worried that government agencies and sectoral partners—often burdened with competing priorities—might see this project as just another demand on their limited time and resources. Instead, the opposite occurred. All invited stakeholders not only participated in our Focus Group Discussions but also voiced strong support for cross-sectoral collaboration and signed a joint integrity pact. Their engagement reaffirmed the value of inclusivity and consultation, and demonstrated that when given the opportunity, local institutions are eager to lead transformative change. Perhaps the most rewarding insight came from witnessing the empowerment of MSME participants. The women we trained not only absorbed new technical knowledge and business skills, but also gained confidence and a renewed sense of purpose. Several participants began sharing their insights with peers, mentoring others in their communities, and making tangible improvements in their food processing practices. This ripple effect illustrates a fundamental truth: empowering women in community-based enterprises doesn't just change individual lives—it transforms networks, catalyzes local innovation, and amplifies the reach and impact of public health interventions.

In essence, this project has shown us that the combination of scientific inquiry, community engagement, and policy advocacy—anchored in a One Health approach—can lead to meaningful, scalable, and sustainable solutions for AMR and beyond.

Conclusion

This project under the SEAOHUN OHRT Awards Program illustrates how research, education, and empowerment can converge to tackle AMR through a holistic lens. It reaffirms the essential role of community actors—particularly women—in spearheading public health innovation. As we continue expanding this model in other regions, we believe it sets a valuable precedent for inclusive, evidence-based, and sustainable One Health programming.

Team Leader: Dr. Muh Fauzi – Public Health Genomics Lab & Lecturer, Faculty of Public Health, Universitas Diponegoro

Team Members:

• Dr. Nuryanto, SGz, M.Kes – Nutritionist and Antibiotic Resistance Analyst, Faculty of Medicine

• Dr. Ir. Martini, M.Kes – Head of Department of Epidemiology and Tropical Diseases, Risk Factor Analysis

• Dr. Dra. Susiana Purwantisari, M.Sc – Phytopathologist, Department of Biology

• Siti Rahayu, SKM – Epidemiologist, Surveillance and Data Analyst