Access to health in the context of antimicrobial resistance

1. Access to health in the context of antimicrobial resistance
Presented by Ayako Ebata
Institute of Development Studies
University of Sussex, UK
THET Annual Conference 2017
23 October, 2017

2. Background: antimicrobial resistance and poor people
• Antimicrobial resistance (AMR) in humans and animals: a global public health issue
Resistant genes travel among humans, animals and ecosystem
• Implications for the poor:
Increased duration and cost of medical treatment
Limited access to last resource drugs
Inappropriate prescribing, driving more resistance
Decreased profitability of livestock production
• Driving forces behind AMR in developing countries:
Weak health systems (both humans and animals)
Pluralistic health systems
Financial resources of patients to receive quality health care
The structure of pharmaceutical industries
Government policies
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3. Case study: Myanmar’s Yangon region
• Weak health systems (both humans and animals)
Limited diagnostic capacity in regional hospitals and veterinary clinics
 patients are sent to a public hospital in Yangon, diagnosis and treatment delayed
 symptom based prescription
Limited number of graduates with medical/veterinary qualifications
 only 1,000 official veterinarians exist in the whole country
 antimicrobials can be purchased off the counter at village shops
 shopkeepers with varying knowledge and training in medicine advice customers
the quantity and duration of medicine to be applied for both humans and animals
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4. Case study: Myanmar’s Yangon region
• Pluralistic health systems
The poor rely on public hospitals while the rich pay for world-class medical care
(e.g. medical tourism to Thailand)
Private clinics are more expensive but provide faster services than public clinics
Public sector practitioners operate private clinics  create bias toward serving in
cities than rural areas
• Financial resources of patients to receive quality health care
Close relationship between income cycle and health care access
Cost not limited to medical treatment but transportation
 rural-urban bias
Readily available antimicrobials as a quick and cheap remedy
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5. Case study: Myanmar’s Yangon region
• The structure of pharmaceutical industries
AMR as a public health issue: without regulatory framework, pharmaceutical industry is
not held accountable
Commercial interest in antimicrobial procurement
Marketing of pharmaceutical products directly with hospitals and farmers
 for farmers, companies are an important source of information in the absence of
public veterinary services
• Government policies
Regulatory framework to control antimicrobial access and control
 policies need to allow broad access to antimicrobials while promoting rational use
Policies regarding livestock vaccination, improving health systems, regulating the
pharmaceutical industry (e.g. import), etc.
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6. Conclusion
• Issues such as AMR indicate the complexity of improving health for the poor members of
our societies;
• There are many driving forces of AMR that are embedded in the social, economic and
political environments that need deliberate addressing to tackle AMR;
• Government policies, both at the national and international levels, shape national and
local health systems, financial capacity of individuals to seek health, and pharmaceutical
market.
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7. Thank you for your attention.