Afari-Asiedu Samuel, Hulscher Marlies, Abdulai Martha Ali, Boamah-Kaali Ellen, Wertheim Heiman F L, Asante Kwaku Poku
Kintampo Health Research Centre, Research and Development Division, Ghana Health Service , Kintampo, Bono East Region, Ghana.
Radboudumc Center for Infectious Diseases , Radboud University Medical Center, Nijmegen, The Netherlands.
J Pharm Policy Pract. 2021 Jul 22;14(1):62. doi: 10.1186/s40545-021-00349-0.
Dispensing of antibiotics by over the counter medicine sellers (OTCMS) is a major driver of inappropriate use and resistance in low and middle income countries. Recent studies in Ghana revealed the need to consider training OTCMS and Community-based Health Planning and Services (CHPS)/health posts to dispense some antibiotics. Feasibility of training OTCMS and CHPS to dispense some antibiotics was explored in this study.
This was an explorative study involving 10 in-depth interviews (IDIs) among staff of Ghana health services (GHS), pharmacy council and the association of OTCMS at the district and regional levels. Next, findings were presented to the Ghana Antimicrobial Resistance (AMR) platform for further discussions at the national level. Five IDIs were also performed among selected members of the AMR platform as a follow-up on emerging issues. Data were thematically analysed and presented as narratives with quotes to support the findings.
Two opposing views were found in our study. Leadership of OTCMS and GHS staff at the district health directorate supported the suggestion that OTCMS and CHPS should be trained to dispense specific antibiotics because they are already dispensing them. The leadership of OTCMS explained that some of their members are experienced and could be trained to improve their practices. In contrast, participants from pharmacy council, GHS in the region and national AMR platform generally alluded that OTCMS and CHPS should not be trained to dispense antibiotics because their level of education is inadequate. GHS personnel from the region further explained that training OTCMS could further compromise inappropriate antibiotic use in the context of already weak regulation enforcement. GHS and pharmacy council in the region rather suggested that OTCMS and CHPS should focus on public health education on disease prevention and appropriate antibiotic use.
There is general lack of consensus among stakeholders on whether OTCMS and CHPS should be trained to dispense specific antibiotics. Further stakeholder engagement is required to carefully consider this suggestion as views on feasibility differ. Ministries of health and healthcare agencies in Ghana and LMIC should improve access to approved health services to improve antibiotic use in rural settings.
在低收入和中等收入国家，非处方药品销售商（OTCMS）配发抗生素是抗生素使用不当和产生耐药性的主要原因。加纳最近的研究表明，有必要考虑培训非处方药品销售商以及基于社区的健康规划与服务机构（CHPS）/卫生站来配发某些抗生素。本研究探讨了培训非处方药品销售商和CHPS来配发某些抗生素的可行性。
这是一项探索性研究，对加纳卫生服务机构（GHS）、药剂师理事会以及地区和区域层面的非处方药品销售商协会的工作人员进行了10次深入访谈（IDI）。接下来，研究结果提交给加纳抗菌药物耐药性（AMR）平台，以便在国家层面进行进一步讨论。还对AMR平台的选定成员进行了5次深入访谈，作为对新出现问题的跟进。对数据进行了主题分析，并以带有引语的叙述形式呈现结果以支持研究发现。
我们的研究发现了两种对立的观点。地区卫生局的非处方药品销售商和GHS工作人员的领导层支持培训非处方药品销售商和CHPS来配发特定抗生素的建议，因为他们已经在配发这些药品。非处方药品销售商的领导层解释说，他们的一些成员经验丰富，可以接受培训以改进他们的做法。相比之下，药剂师理事会、地区GHS以及国家AMR平台的参与者普遍暗示，不应培训非处方药品销售商和CHPS来配发抗生素，因为他们的教育水平不足。该地区的GHS人员进一步解释说，在监管执法已经薄弱的情况下，培训非处方药品销售商可能会进一步加剧抗生素的不当使用。该地区的GHS和药剂师理事会反而建议，非处方药品销售商和CHPS应专注于疾病预防和适当使用抗生素方面的公共卫生教育。
利益相关者对于是否应培训非处方药品销售商和CHPS来配发特定抗生素普遍缺乏共识。由于对可行性的看法不同，需要进一步让利益相关者参与，以仔细考虑这一建议。加纳以及低收入和中等收入国家的卫生部和医疗机构应改善获得经批准的医疗服务的机会，以改善农村地区的抗生素使用情况。
