Access

Reducing overuse of antibiotics is key, but equally important is ensuring access to these essential medicines for those in need.

Regulations to control the distribution and use of antibiotics can help to minimize the development of resistance and conserve the effectiveness of this non-renewable resource. However, limited access to effective treatment in many low- and middle-income countries compromises health, as well as animal welfare, health and productivity. This results in increased health care and societal costs. Unsatisfactory access to some antibiotics is a global problem today. Access to antibiotics varies globally and is dependent on a number of factors, including a country’s regulatory framework and robustness of the health system. Regulation for access without excess must be instituted worldwide and supported by strong political will and leadership.

While limiting the sale of antibiotics to prescriptions may seem like an easy solution and functions well in some countries, enforcing prescription-only laws may cut off access to antibiotics for parts of the population, particularly in rural areas and in resource-limited settings that lack access to prescribers.

Monitoring access

An important factor in the availability of antibiotics is the price of medicines, both in the health and agriculture sector. In the former, survey methodology for measuring medicine prices, availability, affordability and price components has been developed and tested in over 50 countries.

Essential medicines lists

The WHO model list of essential medicines “presents a list of minimum medicine needs for a basic health-care system, listing the most efficacious, safe and cost–effective medicines for priority conditions. Priority conditions are selected on the basis of current and estimated future public health relevance, and potential for safe and cost-effective treatment”.

The WHO Model List of Essential Medicines provides guidance for the development of national and institutional essential medicine lists. The WHO list promotes health equity and aims to assure the availability of quality, affordable and effective medicines for treatment of widespread or high-priority diseases.

Having an essential medicines list can result in higher quality of care, better management and use of medicines and more cost-effective use of resources. In countries where essential medicines policies have been implemented to coordinate long-term interventions at multiple levels of their health systems, a reduction in antibiotic use has been shown. Clear standard operating procedures on drug procurement and ensuring first line antibiotics are available and used correctly can improve public and private sectors.

Improving logistics and supply chain management

To secure access to medicines, in general, and to antibiotics in particular, a well-functioning supply system that relies on strong organizational and management support, including appropriate infrastructure, is required. Functional supply chains can promote public and animal health by increasing program impact, enhancing quality of care, improving cost effectiveness and efficiency. The supply chain of pharmaceutical products relies on several activities including product selection, quantification and procurement, and inventory management, storage and distribution. To ensure that these activities are performed in an effective and efficient manner, logistic management information systems, organization and staffing, budgeting, supervision and evaluation are all key components. Working with improvement of pharmaceutical management can ensure proper access to antibiotics, but it can also create the right preconditions for appropriate use of antibiotics and ensure quality of antibiotics in the market.

Selected Resources