Is enhancing the professionalism of healthcare providers critical to tackling antimicrobial resistance in low- and middle-income countries?

Abstract

Background: Healthcare providers' (HCPs) professionalism refers to their commitment and ability to respond to the health needs of the communities they serve and to act in the best interest of patients. Despite attention to increasing the number of HCPs in low-and middle-income countries (LMIC), the quality of professional education delivered to HCPs and their resulting professionalism has been neglected. The Global Action Plan on Antimicrobial Resistance (AMR) seeks to reduce inappropriate use of antibiotics by urging patients to access antibiotics only through qualified HCPs, on the premise that qualified HCPs will act as more responsible and competent gatekeepers of access to antibiotics than unqualified HCPs. Methods: We investigate whether weaknesses in HCP professionalism result in boundaries between qualified HCPs and unqualified providers being blurred, and how these weaknesses impact inappropriate provision of antibiotics by HCPs in two LMIC with increasing AMR-Pakistan and Cambodia. We conducted 85 in-depth interviews with HCPs, policymakers, and pharmaceutical industry representatives. Our thematic analysis was based on a conceptual framework of four components of professionalism and focused on identifying recurring findings in both countries.Results: Despite many cultural and sociodemographic differences between Cambodia and Pakistan, there was a consistent finding that the behaviour of many qualified HCPs did not reflect their professional education. Our analysis identified five areas in which strengthening HCP education could enhance professionalism and reduce the inappropriate use of antibiotics: updating curricula to better cover the need for appropriate use of antibiotics; imparting stronger communication skills to manage patient demand for medications; inculcating essential professional ethics; building skills required for effective collaboration between doctors, pharmacists, and lay HCPs; and ensuring access to (unbiased) continuing medical education.

Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future

“…Enhance the professionalism of HCWs including initiatives to reduce inappropriate prescribing of antimicrobials where this occurs ( Godman et al., 2020a ; Khan et al., 2020 )…”

“…• Enhance the professionalism of HCWs including initiatives to reduce inappropriate prescribing of antimicrobials where this occurs (Godman et al, 2020a;Khan et al, 2020 • Promote and fund operational/national research on the impact of COVID-19 on infectious diseases (including AMR) and non-infectious diseases especially the unintended consequences ( Table 3). This is particularly important in Africa where national programmes are just starting to address AMR as well as NCDs including CVD, diabetes, and mental health (Mendelson and Matsoso, 2015;Keates et al, 2017;Ghana Ministry of Health, 2018;Godman et al, 2020a;Godman et al, 2020b;Godman et al, 2020c) • Continue to promote research into potential risk factors for morbidity and mortality among African patients given the differences that can exist between patients in Africa and those in high income countries • Continue with research programmes aimed at mitigating against infectious diseases (including AMR) and non-infectious diseases across countries to add to the debate about the potential impact of unintended consequences • Instigate research into new ways to manage patients with both infectious diseases and NCDs where there are constraints on patient access including better use of new technologies including telemedicine and consultations through the internet/ mobile telephones NB: AMR, Antimicrobial Rsistance; CVD, Coronary Vascular Disease; EBM, Evidence-base medicine; HTA, Health Technology Assessment; NCDs, Noncommunicable diseases; PPE, Personal Protective Equipment; SME, Small and Medium size enterprise.…”

Availability and price changes of potential medicines and equipment for the prevention and treatment of COVID-19 among pharmacy and drug stores in Bangladesh; findings and implications

“…Pharmacists and others could also offer online or phone counseling services for patients, promote the rational use of medicines, and potentially offer vaccination services 130,135 . However, this may require improved professionalism among pharmacists and store owners [136][137][138] . Pharmacists and others also need to balance demand and supply of medicines, which is essential in countries with high patient copayments and existing concerns with the availability of medicines in healthcare facilities 126,139 .…”

Community Pharmacies, Drug Stores, and Antibiotic Dispensing in Indonesia: A Qualitative Study

“…However, in keeping with ndings in India [41,42], our study also found that attendance by pharmacists does not guarantee appropriate dispensing, partly due to potential con icts of interest between their professional ethics and the economic incentives of those who own and manage the pharmacies. Another reason is that some pharmacists were reluctant to deny antibiotics to clients who asked for them, suggesting that the educational curriculum in universities should be reformed to include speci c training on interpersonal communication skills to manage patient demand for medications [43,44].…”