Mitigating Antimicrobial Resistance at the Grassroots: Empowering Food Handlers in Metro Manila Through One Health Training

By Dr. Geraldine B. Dayrit and Team 

Editor: Anti Rismayanti, SEAOHUN Regional Program Manager 

Antimicrobial resistance (AMR) is rapidly becoming one of the gravest threats to global public health. As bacteria evolve and develop resistance to commonly used medications, particularly due to misuse in both human and animal health, communities worldwide face the mounting risk of untreatable infections. In the Philippines, where antibiotic use in agriculture is widespread and often unregulated, the potential for resistant strains to travel from farm to table is especially alarming. Food handlers, while central to ensuring the safety of what we eat, are often overlooked in national AMR strategies.

Recognizing this urgent challenge, our team from the University of the Philippines Manila launched a community-centered initiative entitled “Impact of a Training Program on the Bacterial Antimicrobial Resistance Knowledge, Attitudes, and Practices of Food Handlers in the Greater Manila Area.” This project was implemented under the SEAOHUN One Health Research and Training (OHRT) Awards Program and aimed to build the capacity of food vendors—those who directly influence daily food safety practices—in combating AMR through tailored education, training, and behavior change interventions rooted in One Health principles.

Implementation Experience

Our project, spanning from June to October 2024, followed a carefully structured process of community engagement, scientific inquiry, and stakeholder collaboration. The journey began with the design and administration of a Knowledge, Attitudes, and Practices (KAP) survey to assess the baseline awareness of AMR among food vendors across various public markets in Manila, including Paco, Divisoria, Roxas, and Blumentritt. With the help of promotional materials and targeted outreach, we successfully engaged over 80 participants, ensuring representation from meat, seafood, fruit and vegetable, and street food vendors.

After analyzing the survey data, we developed specialized training modules that addressed the specific knowledge gaps and occupational risks identified. The training sessions were not one-size-fits-all but were instead carefully customized based on the type of product handled by each vendor. For instance, fruit and vegetable handlers were taught safe washing and handling techniques to reduce microbial contamination, while seafood and meat vendors learned about cold chain maintenance and cross-contamination prevention. Street food vendors, whose working conditions are often informal and resource-constrained, were trained in practical, low-cost hygiene interventions.

Our partners from government agencies played a pivotal role in this phase. Experts from the Manila Health Department, the Bureau of Plant Industry, the National Meat Inspection Service (NMIS), and the Bureau of Fisheries and Aquatic Resources (BFAR) provided lectures, discussed national and local food safety regulations, and offered real-world insights into best practices. These sessions were followed by a post-training evaluation using the same KAP tool, which enabled us to measure knowledge gains and behavior change.

Like any community-based initiative, we encountered several challenges. These included inclement weather that disrupted workshop schedules, unanticipated withdrawals from participants, and unexpected costs—particularly related to ethics review processes. To address these, we adopted a flexible and responsive approach, rescheduling activities as needed, tapping into our networks to recruit replacement participants, and adjusting the budget without compromising core objectives. Through perseverance and adaptive management, we ensured the smooth implementation and completion of the project.

Strengthening One Health Competencies

The project significantly deepened our practical understanding and application of the One Health approach. It provided opportunities for our team to enhance not only technical skills, such as research instrument design, data analysis, and training facilitation, but also interpersonal competencies including negotiation, community mobilization, and problem-solving. The interdisciplinary nature of the initiative—bringing together professionals from public health, agriculture, veterinary science, and community development—underscored the importance of collaborative action in addressing complex health issues like AMR.

Our staff and junior team members also gained confidence and competence in stakeholder engagement, navigating institutional procedures, and delivering training in lay-friendly language. These capacities are transferable to future research and community outreach efforts and will enrich our ongoing contributions to One Health education.

Reflections as Educators

As faculty members at the University of the Philippines Manila, this initiative has become a valuable extension of our educational mandate. The experiences and insights gained have already started informing our classroom teaching, particularly in subjects related to microbiology, food hygiene, and epidemiology. Case studies from the project are now being used to stimulate discussions and encourage critical thinking among students. Beyond curriculum content, the project demonstrated to our students the power of community engagement and how academic research can translate into real-world impact. We are currently exploring the development of elective courses or modules that will formalize AMR and food safety training for students across health, agriculture, and environmental disciplines.

Anticipated Impact and Future Plans

Looking ahead, we anticipate that the ripple effects of this project will extend well beyond its initial duration. The improved knowledge and practices observed among food vendors are just the beginning. Participants who once lacked awareness of AMR are now more informed and empowered, with many expressing a desire to share their learnings with fellow vendors. This organic form of peer education can significantly broaden the reach of our training messages.

We are also in active discussion with the Manila Health Department to institutionalize our training modules within their existing food safety programs. If successful, these sessions could become part of the mandatory orientation or recertification process for market vendors across Metro Manila. Our team is preparing a manuscript that consolidates our findings and will be submitted for peer-reviewed publication. To ensure open access and timely dissemination, we are exploring preprint platforms and journals that support researchers from low-resource settings.

Contribution to the One Health Agenda

This initiative reinforces the core tenets of the One Health approach. By placing food handlers—an often-overlooked group—at the center of AMR prevention strategies, we challenge the traditional siloed approach that places disproportionate responsibility on hospitals and clinics. Instead, we present a community-based, systems-thinking model that recognizes the role of everyday actors in safeguarding public health. The project also fostered multi-sectoral collaboration, aligning our efforts with the Philippines’ National Action Plan on AMR and demonstrating how decentralized, locally driven interventions can meaningfully support national goals.

Lessons and Insights

Several valuable lessons emerged from our experience. Building strong relationships with local government units and public institutions early in the process was crucial in securing buy-in, resources, and logistical support. Tailoring the training to each vendor category proved highly effective, as it allowed us to connect with participants’ daily realities and offer practical, actionable solutions. Equally important was our commitment to flexibility. The willingness to adapt timelines, reallocate responsibilities, and recalibrate activities ensured that we remained responsive to on-the-ground conditions.

Perhaps the most profound realization was the eagerness of food handlers to learn and improve. Their enthusiasm reminded us that change is possible when people feel respected, heard, and included in the process. It also affirmed our belief that education—when rooted in empathy and relevance—can be a powerful force for public health transformation.

Conclusion

Through the support of the SEAOHUN OHRT Awards Program, our project demonstrated that combating AMR does not require high-end technology or top-down directives alone. Sometimes, the most impactful change begins in local markets, through honest conversations, shared meals, and collaborative learning. By empowering food handlers with knowledge and practical skills, we are contributing to safer food systems, healthier communities, and a more resilient One Health future for the Philippines.

Project Leader: Dr. Geraldine B. Dayrit, University of the Philippines Manila - College of Public Health

Team Members:

• Fresthel Monica M. Climacosa

• Eric David B. Ornos

• Kathyleen S. Nogrado

• Regine O. Mendiola

• Ma. Kristina Carmela P. Aguilar

• Isabella Vera T. Cabanlig

• Normela Patricia F. Burigsay

• Arabelle Iza Barbin