Addressing antimicrobial resistance by improving access and quality of care—a review of the literature from East Africa

Loosli, K., Davis, A. , Muwonge, A. and Lembo, T. (2021) Addressing antimicrobial resistance by improving access and quality of care—a review of the literature from East Africa. PLoS Neglected Tropical Diseases, 15(7), e0009529. (doi: 10.1371/journal.pntd.0009529) (PMID:34292932) (PMCID:PMC8297743)

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Abstract

Universal access to healthcare, including quality medicines, is a fundamental human right but is still out of reach for many in low- and middle-income countries (LMICs). An existing framework capturing variability of access to healthcare in low-resource settings includes the 5 dimensions: availability, accessibility, affordability, adequacy, and acceptability. This framework encompasses key components, including health infrastructure and means to access it as well as service organisation, costs, and factors that influence users’ satisfaction. However, in reality, the effectiveness of accessed healthcare is measured by the likelihood of a positive outcome. We therefore propose an expansion of this framework to include an additional dimension, “aspects of quality,” incorporating quality, which critically influences the ability of the accessed services to generate optimal health outcomes. Within this framework, we explore literature from East Africa likely relevant to a range of LMIC contexts, mainly focusing on the provision of widely used antimicrobials such as antimalarials and antibiotics. We argue that major inadequacies exist across all 6 dimensions of access and quality of drugs and their provision. While the global focus is on curbing excessive antimicrobial use to tackle the antimicrobial resistance (AMR) crisis, major constraints around access shape patients’ health-seeking decisions leading to potentially problematic practices that might exacerbate the AMR problem. We advocate for a holistic approach to tackling these inadequacies, encompassing all dimensions of access and quality of healthcare in order to improve health outcomes while simultaneously counteracting the AMR crisis.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Loosli, Kathrin and Lembo, Dr Tiziana and Davis, Dr Alicia
Authors: Loosli, K., Davis, A., Muwonge, A., and Lembo, T.
College/School:College of Medical Veterinary and Life Sciences > Institute of Biodiversity Animal Health and Comparative Medicine
College of Social Sciences > School of Social and Political Sciences > Sociology Anthropology and Applied Social Sciences
College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine
Journal Name:PLoS Neglected Tropical Diseases
Publisher:Public Library of Science
ISSN:1935-2727
ISSN (Online):1935-2735
Published Online:22 July 2021
Copyright Holders:Copyright © 2021 Loosli et al.
First Published:First published in PLoS Neglected Tropical Diseases 15(7): e0009529
Publisher Policy:Reproduced under a Creative Commons License
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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303374Supporting the National Action Plan for Antimicrobial Resistance (SNAP-AMR) in TanzaniaShona HiltonMedical Research Council (MRC)MR/S004815/1Institute of Biodiversity, Animal Health and Comparative Medicine