Dear Massimo and Sara,
We all agree that inappropriate overprescription of antibiotics is a huge problem in sub-Saharan Africa (and elsewhere). Such irrational prescription is driven by a number of factors. In Massimo's experience, profit is the main driving factor. What are the different aspects of profit as a driving factor for overprescription and what can be done to address this?
What other factors contribute to misuse of antibiotics? Over-the-counter access, whereby anyone can buy whatever antibiotic one wants, is a factor. Related to this is premature discontinuation of an antibiotic 'course', on the basis that the person 'feels better', and which nevertheless provides an opportunity for drug-resistant organisms to emerge.
I have suggested that lack of availability and use of reliable healthcare information is a factor. This has two elements: availability and use. On availability, a systematic review by HIFA and partners confirmed 'a lack of up-to-date and relevant medicine information in low and lower middle-income settings'. https://www.hifa.org/news/hifas-first-systematic-review-how-primary-heal... WHO has noted that many prescribers only have access to information from pharmaceutical companies, which is of course designed to persuade prescribers to given even more medicines/antibiotics, thereby compounding the problem.
Failure to use reliable healthcare information, even when one has access to such information, is a massive problem among prescribers as Massimo describes. What can we learn to better understand this gap? Much of it may be driven purely by self-interested profit: the prescriber knows that what s/he is doing is harmful, and yet does it anyway to make more money. What do we know about such self-interested motives? Are they coommon in all healthcare settings, or particularly (as I think Massimo has suggested) in private clinics with integral pharmacies?
Looking forward to hear more on this topic.
Best wishes, Neil
Joint Coordinator HIFA Project on Information for Prescribers and Users of Medicines http://www.hifa.org/projects/prescribers-and-users-medicines
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HIFA profile: Neil Pakenham-Walsh is global coordinator of Healthcare Information For All - www.hifa.org - a global health community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in official relations with WHO. HIFA brings stakeholders together to accelerate progress towards universal access to reliable healthcare information. Twitter: @hifa_org firstname.lastname@example.org