Understanding health system linkages: Formative research to develop strategies to support quality improvement in treatment in the private sector

了解卫生系统的联系：形成性研究，制定支持私营部门治疗质量改进的战略

• 批准号: MR/R00370X/1
• 负责人: Sian Elisabeth Clarke
• 金额: $ 25.57万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR00370X%2F1
• 关键词: Understanding; health; system; linkages; Formative

Prompt antibiotic therapy for an infected patient can make the difference between cure and death or long-term disability. Unfortunately, all around the world, some infections are becoming resistant to the antibiotic medicines used to treat them. This could lead to a future scenario in which illnesses last longer, deaths increase, and the cost of treatment rises. Under this scenario, the greatest impacts are likely to be felt in low-income countries where infectious diseases are most common and many families lack financial security. Antibiotic resistance is now considered to be one of the biggest threats to global health. The World Health Organization has called for urgent action, research and investment to counter this threat, through the development of new antimicrobial drugs and through more responsible use of existing drugs. In September 2016, global leaders met at the UN General Assembly - only the fourth time in the history of the UN that a health topic was discussed at the General Assembly - to call for concerted action by every national government to limit the development and spread of drug resistance.Poor prescription practices by health workers, such as overuse of drugs, sale of partial doses, or non-adherence by patients to the full treatment course, all create situations which are conducive to the selection and spread of resistant mutations. Health workers and pharmacists can help tackle resistance by only dispensing antibiotic drugs when they are truly needed; and by prescribing the right drug in the right quantities to treat the illness. Improving the use of antibiotic medicines thus ultimately involves guiding the treatment decisions made by health workers and patients to discourage indiscriminate use. Therefore, if effective intervention strategies are to be developed, better knowledge and understanding of the factors that influence the prescribing practices of health workers will be essential.The private sector plays an important role in provision of health care in many African countries, with many patients seeking care from private clinics and drug shops, and cannot be overlooked in strategies to control misuse of antibiotics. Neither can treatment practices and standards be addressed by focusing on one sector in isolation. The private sector interacts with, and is shaped by the organisation and performance of the public sector, demand from patients and regulatory controls. Poor practices in one sector can easily undermine or disincentivize behavioural change in another. Yet regulation of the private sector is an acknowledged weakness of the health system in many low income countries. The proposed research aims to address this challenge. We shall investigate the situations, norms, experiences, and motivations that affect health care practices in private clinics and drug shops in rural Uganda, including the influence of interactions between private providers, government health workers and public health officials, in order to generate improved understandings of how the health system can more effectively control treatment practices, and improve the quality of care that patients receive from private providers. We intend to use the knowledge and insights gained from this research to develop a comprehensive intervention strategy to improve patient care and combat irresponsible use of antibiotics in private clinics and drug shops in Uganda. This intervention strategy will be tested in future studies. We hope that our findings will also be of value to Ministries of Health and national governments in other low-income countries, and can be used to help inform the development of national plans to counter the threat of antimicrobial resistance.

对感染患者及时进行抗生素治疗可以决定治愈和死亡或长期残疾。不幸的是，在世界各地，一些感染正在对用于治疗它们的抗生素药物产生耐药性。这可能会导致未来的情况，即疾病持续时间更长，死亡人数增加，治疗成本上升。在这种情况下，受影响最大的可能是低收入国家，那里的传染病最常见，许多家庭缺乏经济保障。抗生素耐药性现在被认为是对全球健康的最大威胁之一。世界卫生组织呼吁采取紧急行动，进行研究和投资，通过开发新的抗菌药物和更负责任地使用现有药物来应对这一威胁。2016年9月，全球领导人在联合国大会举行会议--这是联合国历史上第四次在大会上讨论卫生主题--呼吁各国政府采取协调一致的行动，限制耐药性的发展和传播。卫生工作者的不良处方做法，如过度使用药物，部分剂量的销售，或患者不坚持整个治疗过程，所有这些都创造了有利于耐药突变的选择和传播的情况。卫生工作者和药剂师可以通过只在真正需要抗生素药物时分发抗生素药物来帮助解决耐药性问题;并通过开出正确数量的正确药物来治疗疾病。因此，改善抗生素药物的使用最终涉及指导卫生工作者和患者做出治疗决定，以阻止滥用。因此，如果要制定有效的干预战略，就必须更好地了解和理解影响保健工作者开处方做法的因素，私营部门在许多非洲国家提供保健方面发挥着重要作用，许多病人从私人诊所和药店寻求治疗，在控制滥用抗生素的战略中不能忽视私营部门。也不能孤立地侧重于一个部门来处理治疗做法和标准。私营部门与公共部门的组织和绩效、患者的需求和监管控制相互作用，并受其影响。一个部门的不良做法很容易破坏或抑制另一个部门的行为改变。然而，对私营部门的监管是许多低收入国家卫生系统公认的弱点。拟议的研究旨在应对这一挑战。我们将调查的情况下，规范，经验和动机，影响私人诊所和药店在乌干达农村的医疗保健做法，包括私人提供者，政府卫生工作者和公共卫生官员之间的相互作用的影响，以产生更好的理解卫生系统如何能够更有效地控制治疗的做法，并提高患者从私人医疗机构获得的医疗质量。我们打算利用从这项研究中获得的知识和见解，制定一项全面的干预战略，以改善患者护理，打击乌干达私人诊所和药店不负责任地使用抗生素的行为。这种干预策略将在未来的研究中进行测试。我们希望我们的研究结果对其他低收入国家的卫生部和国家政府也有价值，并可用于帮助制定应对抗菌素耐药性威胁的国家计划。

项目成果

Crossover-Use of Human Antibiotics in Livestock in Agricultural Communities: A Qualitative Cross-Country Comparison between Uganda, Tanzania and India.

农业社区牲畜中人类抗生素的交叉使用：乌干达，坦桑尼亚和印度之间的定性越野比较。

• DOI: 10.3390/antibiotics11101342
• 发表时间: 2022-09-30
• 期刊: Antibiotics (Basel, Switzerland)

Is it possible for drug shops to abide by the formal rules? The structural determinants of community medicine sales in Uganda.

• DOI: 10.1136/bmjgh-2022-011097
• 发表时间: 2023-02
• 期刊: BMJ GLOBAL HEALTH
• 影响因子: 8.1
• 作者: Hutchinson, Eleanor;Hansen, Kristian Schultz;Sanyu, Jacquellyn;Amonya, Lydia Peace;Mundua, Sunday;Balabanova, Dina;Clarke, Sian E.;Kitutu, Freddy Eric
• 通讯作者: Kitutu, Freddy Eric

Unsafe "crossover-use" of chloramphenicol in Uganda: importance of a One Health approach in antimicrobial resistance policy and regulatory action.

• DOI: 10.1038/s41429-021-00416-3
• 发表时间: 2021-06
• 期刊: The Journal of antibiotics
• 作者: McCubbin KD;Ramatowski JW;Buregyeya E;Hutchinson E;Kaur H;Mbonye AK;Mateus ALP;Clarke SE
• 通讯作者: Clarke SE

Life in the buffer zone: Social relations and surplus health workers in Uganda's medicines retail sector.

• DOI: 10.1016/j.socscimed.2021.113941
• 发表时间: 2022-05
• 期刊: SOCIAL SCIENCE & MEDICINE
• 影响因子: 5.4
• 作者: Hutchinson, Eleanor;Mundua, Sunday;Ochero, Lydia;Mbonye, Anthony;Clarke, Sian E.
• 通讯作者: Clarke, Sian E.