Barriers and facilitators to adherence to national drug policies on antibiotic prescribing and dispensing in Bangladesh

Abstract Background The National Drug Policy in Bangladesh prohibits the sale and distribution of antibiotics without prescription from a registered physician. Compliance with this policy is poor; prescribing antibiotics by unqualified practitioners is common and over-the-counter dispensing widespre...

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Autores principales:	Fosiul Alam Nizame, Dewan Muhammad Shoaib, Emily K. Rousham, Salma Akter, Mohammad Aminul Islam, Afsana Alamgir Khan, Mahbubur Rahman, Leanne Unicomb
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Antimicrobial resistance (AMR) Irrational antibiotic use Drug policy Qualified physicians Quack/village doctor Low- and middle-income countries (LMICs) Therapeutics. Pharmacology RM1-950 Pharmacy and materia medica RS1-441
Acceso en línea:	https://doaj.org/article/104eb03238f146c383ca4e583bfd606e
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spelling	oai:doaj.org-article:104eb03238f146c383ca4e583bfd606e2021-11-21T12:03:00ZBarriers and facilitators to adherence to national drug policies on antibiotic prescribing and dispensing in Bangladesh10.1186/s40545-021-00342-72052-3211https://doaj.org/article/104eb03238f146c383ca4e583bfd606e2021-11-01T00:00:00Zhttps://doi.org/10.1186/s40545-021-00342-7https://doaj.org/toc/2052-3211Abstract Background The National Drug Policy in Bangladesh prohibits the sale and distribution of antibiotics without prescription from a registered physician. Compliance with this policy is poor; prescribing antibiotics by unqualified practitioners is common and over-the-counter dispensing widespread. In Bangladesh, unqualified practitioners such as drug shop operators are a major source of healthcare for the poor and disadvantaged. This paper reports on policy awareness among drug shop operators and their customers and identifies current dispensing practices, barriers and facilitators to policy adherence. Methods We conducted a qualitative study in rural and urban Bangladesh from June 2019 to August 2020. This included co-design workshops (n = 4) and in-depth interviews (n = 24) with drug shop operators and customers/household members, key informant interviews (n = 12) with key personnel involved in aspects of the antibiotic supply chain including pharmaceutical company representatives, and model drug shop operators; and a group discussion with stakeholders representing key actors in informal market systems namely: representatives from the government, private sector, not-for-profit sector and membership organizations. Results Barriers to policy compliance among drug shop operators included limited knowledge of government drug policies, or the government-led Bangladesh Pharmacy Model Initiative (BPMI), a national guideline piloted to regulate drug sales. Drug shop operators had no clear knowledge of different antibiotic generations, how and for what diseases antibiotics work contributing to inappropriate antibiotic dispensing. Nonetheless, drug shop operators wanted the right to prescribe antibiotics based on having completed related training. Drug shop customers cited poor healthcare facilities and inadequate numbers of attending physician as a barrier to obtaining prescriptions and they described difficulties differentiating between qualified and unqualified providers. Conclusion Awareness of the National Drug Policy and the BPMI was limited among urban and rural drug shop operators. Poor antibiotic prescribing practice is additionally hampered by a shortage of qualified physicians; cultural and economic barriers to accessing qualified physicians, and poor implementation of regulations. Increasing qualified physician access and increasing training and certification of drug shop operators could improve the alignment of practices with national policy.Fosiul Alam NizameDewan Muhammad ShoaibEmily K. RoushamSalma AkterMohammad Aminul IslamAfsana Alamgir KhanMahbubur RahmanLeanne UnicombBMCarticleAntimicrobial resistance (AMR)Irrational antibiotic useDrug policyQualified physiciansQuack/village doctorLow- and middle-income countries (LMICs)Therapeutics. PharmacologyRM1-950Pharmacy and materia medicaRS1-441ENJournal of Pharmaceutical Policy and Practice, Vol 14, Iss S1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Antimicrobial resistance (AMR) Irrational antibiotic use Drug policy Qualified physicians Quack/village doctor Low- and middle-income countries (LMICs) Therapeutics. Pharmacology RM1-950 Pharmacy and materia medica RS1-441
spellingShingle	Antimicrobial resistance (AMR) Irrational antibiotic use Drug policy Qualified physicians Quack/village doctor Low- and middle-income countries (LMICs) Therapeutics. Pharmacology RM1-950 Pharmacy and materia medica RS1-441 Fosiul Alam Nizame Dewan Muhammad Shoaib Emily K. Rousham Salma Akter Mohammad Aminul Islam Afsana Alamgir Khan Mahbubur Rahman Leanne Unicomb Barriers and facilitators to adherence to national drug policies on antibiotic prescribing and dispensing in Bangladesh
description	Abstract Background The National Drug Policy in Bangladesh prohibits the sale and distribution of antibiotics without prescription from a registered physician. Compliance with this policy is poor; prescribing antibiotics by unqualified practitioners is common and over-the-counter dispensing widespread. In Bangladesh, unqualified practitioners such as drug shop operators are a major source of healthcare for the poor and disadvantaged. This paper reports on policy awareness among drug shop operators and their customers and identifies current dispensing practices, barriers and facilitators to policy adherence. Methods We conducted a qualitative study in rural and urban Bangladesh from June 2019 to August 2020. This included co-design workshops (n = 4) and in-depth interviews (n = 24) with drug shop operators and customers/household members, key informant interviews (n = 12) with key personnel involved in aspects of the antibiotic supply chain including pharmaceutical company representatives, and model drug shop operators; and a group discussion with stakeholders representing key actors in informal market systems namely: representatives from the government, private sector, not-for-profit sector and membership organizations. Results Barriers to policy compliance among drug shop operators included limited knowledge of government drug policies, or the government-led Bangladesh Pharmacy Model Initiative (BPMI), a national guideline piloted to regulate drug sales. Drug shop operators had no clear knowledge of different antibiotic generations, how and for what diseases antibiotics work contributing to inappropriate antibiotic dispensing. Nonetheless, drug shop operators wanted the right to prescribe antibiotics based on having completed related training. Drug shop customers cited poor healthcare facilities and inadequate numbers of attending physician as a barrier to obtaining prescriptions and they described difficulties differentiating between qualified and unqualified providers. Conclusion Awareness of the National Drug Policy and the BPMI was limited among urban and rural drug shop operators. Poor antibiotic prescribing practice is additionally hampered by a shortage of qualified physicians; cultural and economic barriers to accessing qualified physicians, and poor implementation of regulations. Increasing qualified physician access and increasing training and certification of drug shop operators could improve the alignment of practices with national policy.
format	article
author	Fosiul Alam Nizame Dewan Muhammad Shoaib Emily K. Rousham Salma Akter Mohammad Aminul Islam Afsana Alamgir Khan Mahbubur Rahman Leanne Unicomb
author_facet	Fosiul Alam Nizame Dewan Muhammad Shoaib Emily K. Rousham Salma Akter Mohammad Aminul Islam Afsana Alamgir Khan Mahbubur Rahman Leanne Unicomb
author_sort	Fosiul Alam Nizame
title	Barriers and facilitators to adherence to national drug policies on antibiotic prescribing and dispensing in Bangladesh
title_short	Barriers and facilitators to adherence to national drug policies on antibiotic prescribing and dispensing in Bangladesh
title_full	Barriers and facilitators to adherence to national drug policies on antibiotic prescribing and dispensing in Bangladesh
title_fullStr	Barriers and facilitators to adherence to national drug policies on antibiotic prescribing and dispensing in Bangladesh
title_full_unstemmed	Barriers and facilitators to adherence to national drug policies on antibiotic prescribing and dispensing in Bangladesh
title_sort	barriers and facilitators to adherence to national drug policies on antibiotic prescribing and dispensing in bangladesh
publisher	BMC
publishDate	2021
url	https://doaj.org/article/104eb03238f146c383ca4e583bfd606e
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Barriers and facilitators to adherence to national drug policies on antibiotic prescribing and dispensing in Bangladesh

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