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## Uppsala University

Skip to 0 minutes and 7 secondsToday we're going to talk about antibiotic use in low-and middle-income countries. A low-income country typically spends $30-$40 per capita a year on health expenditure, which means that it's considerably less resourced than here. Yet many children die from primarily infectious causes that could be cured by anti-microbials and antibiotics. Now, what characterises low- and middle-income countries is weak health systems. And that leads to a particular effect I wanted to illustrate today by borrowing these implements from my daughter's swimming class. If these are the people who actually need antibiotics, these are the ones who actually use them. Now, how do they relate to each other? Well, in fact, they relate something like this.

Skip to 0 minutes and 58 secondsThat the people who-- there are many people who need antibiotics who don't get them, and there are many people who use antibiotics that don't need them. So we have a simultaneous problem of poor access and excess, irrational use. Now there's a small hole in the middle here also among the people who actually use antibiotics but get ineffective antibiotics due to resistance. But the point I want to make is that in a weak health system, there are many, many more people out here that have effectively lack of access to antibiotics than there are people who have a problem with ineffective resistance to these drugs. You will find a reading actually putting these in numbers.

Skip to 1 minute and 44 secondsNow, as we try to do something about this, obviously we want these cycles to overlap. We want to reduce excess use and we want to increase access. What are our options? Well, in Europe we've looked very much at controlled distribution and use. We have physicians prescribing, pharmacies selling, et cetera. So why don't we just simply do that? Well, for one, health systems are weak and most people don't see a doctor. And even in the health centre, the drugs may have run out. So as a compensation, there's a strong private sector and many go and buy drugs over- the-counter. So, say some people, why don't we just close the private pharmacies?

Skip to 2 minutes and 28 secondsWell, if we closed the drug shops, we will reduce access, which may lead to even more deaths. So what are our options? Obviously we need to engage all players and stakeholders in the health system and do a system-wide intervention. To make self-regulation, to educate the consumers, and to promote access to effective antibiotics via many channels. You can read about integrated community case management as one such strategy in the readings, and I encourage you to look at Thailand's example of involving the providers, the consumers, as well as the financial incentives to make drug use more rational.

Skip to 3 minutes and 13 secondsSo, I want you to remember that lack of access is a bigger problem than resistance in poor countries, that it takes a system-wide intervention to strengthen the health system. Putting new antibiotics is not enough, just like having a new car does not really help unless you have a road to drive it on. You need a health system to deliver these antibiotics to the people who need them at the micro level, the individual sick child and patient, but also at country level. Please see the report on how these trade policies and intellectual-property rights can actually come to limit countries effective access to working antibiotics.

# Access not excess – rational use of antibiotics

Watch professor Stefan Swartling Peterson discuss the dilemma of how to simultaneously address the access to and the excessive use of antibiotics in low- and middle-income countries.