Strengthening Health Systems to Improve Access to Antimicrobials and the Containment of Resistance



This chapter provides an overview of contemporary health systems issues related to improving access to essential medicines, which includes many antimicrobials. Key conceptual frameworks are presented that guide the exploration of challenges to improving sustainable access, including appropriate use of medicines, as well the design and evaluation of interventions. Critical topical areas that have emerged as a result of the push to rapidly implement global programs that have a strong focus on improving access to antimicrobials are highlighted. Finally, a case study is presented to illustrate how a health systems approach was applied to guide the design of an intervention to improve access to and use of medicines, including antimicrobials, in Tanzania.


Health System National Health Insurance Scheme Essential Medicine Drug Shop Pharmaceutical Service 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The Strengthening Pharmaceutical Systems (SPS) Program is supported by the US Agency for International Development under the terms of cooperative agreement number GHN-A-00-07-00002-00 with Management Sciences for Health. The opinions expressed herein are those of the author and do not necessarily reflect the views of the US Agency for International Development.


  1. Alliance for Health Policy and Systems Research (AHPSR). 2004. Strengthening Health Systems: The Role and Promise of Policy and Systems Research. Geneva: Global Forum for Health Research. Source:
  2. Basaza, R., Criel, B., and Van der Stuyft, P. 2007. Low enrollment in Ugandan community health insurance schemes: underlying causes and policy implications. BMC Health Services Research 7: 105. Source:
  3. Caines, K. and Buse, K. 2004. Assessing the Impact of Global Health Partnerships: Synthesis of Findings from the 2004 DFID Studies on Global Health Partnerships: Assessing the Impact. London: DFID Health Resources Center.Google Scholar
  4. Center for Pharmaceutical Management (CPM). 2003. Defining and Measuring Access to Essential Drugs, Vaccines, and Health Commodities: Report of the WHO-MSH Consultative Meeting, Ferney-Voltaire, France, December 11–13, 2000. Prepared for the Strategies for Enhancing Access to Medicines Program, Arlington, VA: Management Sciences for Health. Source:
  5. Fitzgerald, J. and Gomes B. 2003. An open competition model for regional price negotiations yields lowest ARV prices in the Americas. Presented to the 8th World STI/AIDS Conference, Punta del Este, Uruguay, December 2–5, 2003.Google Scholar
  6. The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM). 2008. Source:
  7. Gray, A. 2004. Access to Medicines and Drug Regulations in Developing Countries: A Resource Guide for DFID. London: DFID Health Systems Resource Centre.Google Scholar
  8. Haak, H. 2003. Access to Antimalarial Medicines: Improving the Affordability and Financing of Artemisinin-Based Combination Therapies. WHO: Geneva. Source:
  9. International Conference on Improving Use of Medicines (ICIUM). 2004. Source:
  10. Islam, M., ed. 2007. Health Systems Assessment Approach: A How-To Manual. Arlington. Arlington, VA: Management Sciences for Health.Google Scholar
  11. Liu, X. Hotchkiss, D. R., and Bose, S. 2008. The effectiveness of contracting-out primary care services in developing countries. Health Policy and Planning 23:1–13.CrossRefPubMedGoogle Scholar
  12. Management Sciences for Health (MSH). In press. MDS-3: Managing Access to Medicines and Essential Health Commodities. Arlington, VA: MSH.Google Scholar
  13. Matowe, L. 2006. Using the Monitoring-Training-Planning Approach to Build Problem-Solving Skills for Health Care Staff to Support Pharmaceutical Management during ART Scale Up. Presented at the XVI International Aids Conference, Toronto, 13–18 August. Source:
  14. Matowe, L. 2007. Building a regional network of academic experts to increase capacity in pharmaceutical management in East Africa. Presented at the Annual meeting of the American Public Health Association, November 7, 2007. Source:
  15. Nugent, R., Pickett, J., and Back, E. 2008. Drug Resistance as a Global Health Policy Priority. Drug Resistance Working Group Background Paper. Center for Global Development. Source:
  16. Pirmohamed, M., Atuah, K. N., Dodoo, A. N., and Winstanley, P. 2007. Pharmacovigilance in developing countries. BMJ 335:462.CrossRefPubMedGoogle Scholar
  17. Radyowijati, A. and Haak, H. 2002. Determinants of Antimicrobial Use in the Developing World. Child Health Research Project, Special Report 4:1.Google Scholar
  18. Roberts, M, Hsiao, W., Berman P., and Reich, M. 2004. Getting Health Sector Reform Right: A Guide to Improving Performance and Equity. New York: Oxford University Press.Google Scholar
  19. Rutta, E., Liana, J., and Mbwasi R. 2007. Building capacity for pharmaceutical services where pharmacies do not exist: The ADDO experience in Tanzania. Presented at the Annual Meeting of the American Public Health Association, November 7, 2007. Source:
  20. Ruxin, J, Paluzzi, J. E., Wilson, P. A., Tozan, Y., Kruk, M., and Teklehaimanot, A. 2005. Emerging consensus in HIV/AIDS, malaria, tuberculosis, and access to essential medicines. Lancet 365: 618–21.PubMedGoogle Scholar
  21. Senauer, K., Briggs, J., Saleeb, S., and Adeya, G. 2007. Improving child health through informed policy decisions and targeted interventions to strengthen medicine management in the community: The example of Senegal. Presented at the Annual Meeting of the American Public Health Association, November 7, 2007. Source: .
  22. Shretta, R. and Thumm, M. 2007. Global Fund Grants for Malaria: Lessons learned in the implementation of ACT policies in Ghana, Nigeria and Guinea-Bissau. Rational Pharmaceutical Management Plus Program. Arlington, VA: Management Sciences for Health.Google Scholar
  23. Siddiqi, S., Masud, T. I., and Sabri, B. 2006. Contracting but not without caution: experience with out-sourcing of health services in countries of the Eastern Mediterranean Region. Bulletin of the World Health Organization 84(11): 867–875.PubMedGoogle Scholar
  24. Strategies for Enhancing Access to Medicines Program (SEAM). 2007. Tanzania: Accredited Drug Dispensing Outlets—Duka la Dawa Muhimu Summary Report. Arlington, VA: Management Sciences for Health. Source:
  25. Tawfik, J., Kinoti, S., and Blain, G. 2002. Introducing Antiretroviral Therapy (ART) on a Large Scale: Hope and Caution. AED Global Health, Population and Nutrition Group. Washington, D.C.: Academy for Educational Development.Google Scholar
  26. Trachtenberg, J. and Sande, M. 2002. Emerging resistance to nonnucleoside reverse transcriptase inhibitors: A warning and a challenge. JAMA 288 (2):239–241. Source: Scholar
  27. UNDP (United National Development Programme). 1997. Governance for Sustainable Human Development: A UN Policy Document. Source:
  28. UNHMP (United Nations Health Millennium Project). 2005. Prescription for Healthy Development: Increasing Access to Medicines. Report of the Task Force on HIV/AIDS, Malaria, TB and Access to Medicines, Working Group on Access to Essential Medicines.Google Scholar
  29. UNHMP (UN Millennium Project). 2005. Prescription for Health: Increasing Access to Medicines. Report of the Task Force on HIV/AIDS, Malaria and Tuberculosis Access to Essential Medicines Working Group on Access to Essential Medicines. Sterling, VA: Earthscan.Google Scholar
  30. WHO (World Health Organization). 2001. Interventions and strategies to improve the use of antimicrobials in developing countries. Geneva: WHO.Google Scholar
  31. WHO (World Health Organization). 2002. World Health Report 2000: Health Systems: Improving Performance. Geneva: WHO.Google Scholar
  32. WHO (World Health Organization). 2006. Human Resources for Health (HRH). Geneva: WHO. Source:
  33. WHO (World Health Organization). 2007. Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes. WHO’s Framework for Action. Geneva: WHO.Google Scholar
  34. WHO (World Health Organization). 2008. Good Governance for Medicines Programme. Geneva: WHO. Source:

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Center for Pharmaceutical Management, Management Sciences for HealthArlingtonUSA

Personalised recommendations