We Know What is Right but Cannot Do It: Understanding Antimicrobial Resistance Among Practicing Veterinarians and Veterinary Paraprofessionals in Zambia

Abstract

Antimicrobial resistance (AMR) is a growing threat to animal and public health, yet little is known about how frontline veterinary actors in low-resource settings interpret and manage it in daily practice. Zambia’s veterinary system faces significant structural and economic constraints that shape antimicrobial use (AMU) behaviours, but these dynamics remain poorly understood. This qualitative study used Constructivist Grounded Theory to explore how veterinarians and veterinary paraprofessionals understand, recognise and respond to AMR. Data were collected through six focus group discussions and seventeen key informant interviews conducted in key livestock production areas of Zambia. The emergent core category, “navigating antimicrobial resistance in a resource-constrained veterinary system,” captured how veterinary professionals balance stewardship ideals with the realities of limited diagnostic capacity, weak pharmaceutical regulation, farmer-driven misuse and high disease burdens. Participants largely recognised AMR through treatment failure rather than laboratory confirmation, due to the cost, scarcity, and slow turnaround time of antimicrobial susceptibility testing. Over-the-counter access to antibiotics, peer-to-peer prescribing and economic hardship were major drivers of inappropriate AMU. Despite these challenges, professionals demonstrated growing One Health awareness and engaged in grassroots stewardship through farmer education, biosecurity promotion and preventive health strategies. AMR in Zambia’s veterinary sector is sustained not by knowledge deficits but by structural constraints that limit the feasibility of rational antimicrobial use. Meaningful progress will require investment in diagnostic infrastructure, regulation of antimicrobial access, supportive economic mechanisms and strengthened cross-sectoral collaboration. Veterinary paraprofessionals represent a particularly important entry point for scalable, community-level stewardship interventions.