Jaime Glória, Hobeika Alexandre, Figuié Muriel
CIRAD, UMR MoISA, Montpellier, France.
MoISA, Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, Montpellier, France.
Front Vet Sci. 2022 Mar 9;8:558973. doi: 10.3389/fvets.2021.558973. eCollection 2021.
Access to veterinary drugs for livestock has become a major issue over the last decade. Analysis has tended to focus on the demand for these products, while studies looking at the drivers behind their use generally focus on farmer behavior and interactions between veterinarians and farmers. However, the use of drugs also depends on structural factors that determine the functioning of the drug supply chain and farmers' access to the drugs. This article presents an overview of the factors that limit access to veterinary drugs in sub-Saharan Africa (SSA) as well as the international policy tools and arrangements that claim to improve it.
We have conducted a scoping review of the scientific and grey literature as well as the publicly-available data from both the animal health industry and international organizations. We aimed to gather information on the veterinary drugs market in SSA as well as on the international norms, recommendations, guidelines, and initiatives that impact SSA farmers' access to these drugs.
We highlight numerous barriers to veterinary drug access in SSA. The SSA market is highly dependent on imports, yet the region attracts little attention from the international companies capable of exporting to it. It suffers from a high level of fragmentation and weak distribution infrastructures and services, and is driven by the multiplication of private non-professional actors playing a growing role in the veterinary drug supply chain. The distribution system is increasingly dualized, with on the one hand the public sector (supported by development organizations) supplying small scale farmers in rural areas, but with limited and irregular means; and on the other side a private sector largely unregulated which supplies commercial and industrial farming systems. Different innovations have been developed at the international and regional levels to try to reduce barriers, such as homogenizing national legislations, donations, and vaccine banks. Alongside decades-old inter-state cooperation, many new forms of public-private partnerships and other hybrid forums continue to emerge, signaling the private sector's increasing influence in global governance.
Policies on animal health would be bolstered by a better understanding of the drivers behind and the components of access to veterinary drugs in different regional and national contexts. Inequalities in drug access need to be addressed and a market-driven approach adopted in order to strengthen our understanding of what determines veterinary drug use at the farm level. Policies should balance the interests of the various stakeholders, being careful not to reinforce bias toward certain diseases deemed "interesting" and neglect others that could prove to be highly important for veterinary public health.
在过去十年中，牲畜兽药的获取已成为一个主要问题。分析往往侧重于对这些产品的需求，而研究其使用背后的驱动因素通常侧重于农民行为以及兽医与农民之间的互动。然而，药物的使用还取决于决定药品供应链运作以及农民获取药物的结构因素。本文概述了撒哈拉以南非洲（SSA）地区限制兽药获取的因素，以及声称可改善这一情况的国际政策工具和安排。
我们对科学文献、灰色文献以及动物健康行业和国际组织公开的数据进行了范围界定审查。我们旨在收集有关SSA兽药市场以及影响SSA农民获取这些药物的国际规范、建议、指南和倡议的信息。
我们强调了SSA地区兽药获取存在的众多障碍。SSA市场高度依赖进口，但该地区很少受到有能力向其出口的国际公司的关注。它存在高度分散、分销基础设施和服务薄弱的问题，并且受到在兽药供应链中发挥越来越大作用的私人非专业行为者增多的驱动。分销系统日益两极分化，一方面是公共部门（在发展组织支持下）为农村地区的小规模农民提供服务，但手段有限且不规律；另一方面是基本不受监管的私营部门，为商业和工业化养殖系统提供服务。国际和地区层面已开展了不同创新以试图减少障碍，例如统一国家立法、捐赠和疫苗库。除了长达数十年的国家间合作外，许多新形式的公私伙伴关系和其他混合论坛不断涌现，这表明私营部门在全球治理中的影响力日益增强。
更好地理解不同区域和国家背景下兽药获取背后的驱动因素和组成部分，将有助于加强动物健康政策。需要解决药物获取方面的不平等问题，并采用市场驱动的方法，以加深我们对农场层面兽药使用决定因素的理解。政策应平衡各利益相关方的利益，注意不要强化对某些被视为“受关注”疾病的偏见，而忽视其他可能对兽医公共卫生非常重要的疾病。
