Antimicrobial resistance (AMR) is one of the most urgent public health crises of our time, and one of its most overlooked drivers sits quietly in medicine cabinets across India. Unused and expired antibiotics, when flushed down drains, discarded in household waste, or stored indefinitely, leach into water sources and soil, accelerate resistance, and create opportunities for accidental misuse.

India's health care facilities alone generate an estimated 484 tons of biomedical waste daily. The absence of a formal, community-level medicine disposal system means unused and expired antibiotics routinely enter the environment through unsafe practices, contributing to AMR in ways that remain largely unmeasured and unaddressed.

PATH, in partnership with the Centre for Health Research and Innovation (CHRI) and with support from GSK Cares, a CSR initiative, is piloting a community-driven and evidence-based initiative in Maharashtra to address this critical gap. Maharashtra's high urbanization, pharmaceutical activity, and existing public health infrastructure make it an ideal setting to test and deploy scalable models for safe antibiotic disposal and AMR containment.

The initiative is structured in 2 phases. Phase 1 focuses on generating robust baseline evidence through a study on Knowledge, Attitude, and Practices (KAP) across selected geographies, alongside a hackathon and technical landscaping exercise to review national and international disposal guidelines and identify gaps in local implementation. Phase 2 translates these insights into action through co-designing multidimensional interventions with government, health care providers, pharmacists, and civil society. These include community awareness campaigns grounded in behavioral science principles, capacity building of frontline health workers and community groups, and setting up pharmacy-based antibiotic take-back pilots with drop-box collection points.

The program is designed with policy integration at its core, generating evidence that can inform Maharashtra's AMR State Action Plan and contribute to national goals under India's National Action Plan on AMR (NAP-AMR) 2.0. Running through June 2028, the initiative aims to produce tested, scalable disposal models that are behaviorally informed, technologically enabled, and built for lasting systemic change.