The Boyd Orr Centre for Population and Ecosystem Health, Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom.
School of Social and Political Sciences/Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
PLoS Negl Trop Dis. 2021 Jul 22;15(7):e0009529. doi: 10.1371/journal.pntd.0009529. eCollection 2021 Jul.
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.
全民获得医疗保健，包括优质药物，是一项基本人权，但在低收入和中等收入国家（LMICs），许多人仍然无法实现这一目标。一个现有的框架，捕捉在资源有限的环境中获得医疗保健的可变性，包括 5 个方面：可及性、可及性、可负担性、充分性和可接受性。这个框架包含了关键的组成部分，包括卫生基础设施和获得它的手段，以及服务组织、成本，以及影响用户满意度的因素。然而，在现实中，所获得的医疗保健的有效性是通过产生积极结果的可能性来衡量的。因此，我们建议扩大这个框架，包括一个额外的维度，“质量方面”，纳入质量，这对所获得的服务产生最佳健康结果的能力有重大影响。在这个框架内，我们探讨了来自东非的文献，这些文献可能与一系列 LMIC 背景有关，主要集中在广泛使用的抗微生物药物，如抗疟药和抗生素的提供上。我们认为，在药物的获取和质量的所有 6 个方面都存在重大不足。虽然全球的重点是遏制过度使用抗生素来解决抗生素耐药性（AMR）危机，但获取方面的主要限制影响了患者的寻医决策，导致可能存在问题的做法，可能加剧 AMR 问题。我们主张采取全面的方法来解决这些不足，包括医疗保健获取和质量的所有方面，以改善健康结果，同时对抗 AMR 危机。
