Skip to main content

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

  • Chapter
  • First Online:
Antimicrobial Resistance in Developing Countries

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    For detailed discussion of best practices for each set of activities, see MSH n.d.

References

  • 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: http://www.who.int/alliance-hpsr.

  • 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: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1940250.

  • 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 

  • 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: http://www.msh.org/seam/reports/measuring_access_Dec2000.pdf.

  • 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 

  • The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM). 2008. Source: http://www.theglobalfund.org/en/performance/results/.

  • 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 

  • Haak, H. 2003. Access to Antimalarial Medicines: Improving the Affordability and Financing of Artemisinin-Based Combination Therapies. WHO: Geneva. Source: http://www.emro.who.int/rbm/background%20documents/egy04/afford.pdf.

  • International Conference on Improving Use of Medicines (ICIUM). 2004. Source: http://mednet3.who.int/icium/icium2004/recommendations.asp

  • Islam, M., ed. 2007. Health Systems Assessment Approach: A How-To Manual. Arlington. Arlington, VA: Management Sciences for Health.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Management Sciences for Health (MSH). In press. MDS-3: Managing Access to Medicines and Essential Health Commodities. Arlington, VA: MSH.

    Google Scholar 

  • 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: http://www.aids2006.org/PAG/PSession.aspx?s=473.

  • 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: http://apha.confex.com/apha/135am/techprogram/paper_160781.htm.

  • 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: http://www.cgdev.org/doc/ghprn/Concept%20Paper.pdf.

  • Pirmohamed, M., Atuah, K. N., Dodoo, A. N., and Winstanley, P. 2007. Pharmacovigilance in developing countries. BMJ 335:462.

    Article  PubMed  Google Scholar 

  • Radyowijati, A. and Haak, H. 2002. Determinants of Antimicrobial Use in the Developing World. Child Health Research Project, Special Report 4:1.

    Google Scholar 

  • 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 

  • 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: http://apha.confex.com/apha/135am/techprogram/paper_160700.htm.

  • 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.

    PubMed  Google Scholar 

  • 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: http://apha.confex.com/recording/apha/135am/pdf/free/4db77adf5df9fff0d3caf5cafe28f496/paper153789_1.pdf .

  • 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 

  • 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.

    PubMed  Google Scholar 

  • 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: http://www.msh.org/seam/country_programs/3.1.4.htm

  • 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 

  • Trachtenberg, J. and Sande, M. 2002. Emerging resistance to nonnucleoside reverse transcriptase inhibitors: A warning and a challenge. JAMA 288 (2):239–241. Source: http://jama.ama-assn.org/issues/v288n2/ffull/jed20035.html.

    Google Scholar 

  • UNDP (United National Development Programme). 1997. Governance for Sustainable Human Development: A UN Policy Document. Source: http://mirror.undp.org/magnet/policy/.

  • 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 

  • 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 

  • WHO (World Health Organization). 2001. Interventions and strategies to improve the use of antimicrobials in developing countries. Geneva: WHO.

    Google Scholar 

  • WHO (World Health Organization). 2002. World Health Report 2000: Health Systems: Improving Performance. Geneva: WHO.

    Google Scholar 

  • WHO (World Health Organization). 2006. Human Resources for Health (HRH). Geneva: WHO. Source: http://www.who.int/whr/2006/en/.

  • WHO (World Health Organization). 2007. Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes. WHO’s Framework for Action. Geneva: WHO.

    Google Scholar 

  • WHO (World Health Organization). 2008. Good Governance for Medicines Programme. Geneva: WHO. Source: http://www.who.int/medicines/ggm/en/index.html.

Download references

Acknowledgments

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Maria A. Miralles .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Miralles, M.A. (2010). Strengthening Health Systems to Improve Access to Antimicrobials and the Containment of Resistance. In: Sosa, A., Byarugaba, D., Amábile-Cuevas, C., Hsueh, PR., Kariuki, S., Okeke, I. (eds) Antimicrobial Resistance in Developing Countries. Springer, New York, NY. https://doi.org/10.1007/978-0-387-89370-9_22

Download citation

Publish with us

Policies and ethics