To sell or not to sell; the differences between regulatory and community demands regarding access to antibiotics in rural Ghana

Abstract

BackgroundIn Ghana, there is extensive over-the-counter dispensing of antibiotics, resulting in high levels of inappropriate use, and an increase in antibiotic resistance. Regulations prevent Licenced Chemical Sellers (LCS, Over-the-Counter Medicine Sellers) from selling antibiotics other than Cotrimoxazole. In practice, however, these sellers sell a variety of antibiotics. This paper aims to provide insight into the differences between regulatory and community demands on the sale of antibiotics, and to explore how these differences in demand could be resolved to facilitate safe and appropriate use of antibiotics in rural Ghana.MethodsA total of 32 in-depth interviews were conducted in the Kintampo North and South Districts in Ghana; 16 among antibiotic suppliers, predominantly LCS, and 16 among community members. Six focus group discussions were also conducted among 40 community members. Data were coded using Nvivo 10 and thematically analyzed in line with study objectives. The results are presented as narratives with quotes to illustrate the findings.ResultsGenerally, antibiotic suppliers were aware that regulations prevent LCS from selling antibiotics except Cotrimoxazole. However, LCS sell all types of antibiotics because of community demand, economic motivations of LCS, and the poor implementation of regulations that are intended to prevent them from selling these medications. Factors that influence community demand for antibiotics include previous knowledge of effectiveness of some antibiotics, delays in seeking care at health facilities, financial constraints, and distance to health facilities. LCS suggested that they should be trained and allowed to sell some types of antibiotics instead of being prevented completely from selling. Community members also suggested that Community-based Health Planning and Services (CHPS) compounds should be equipped to dispense antibiotics.ConclusionThe sale of antibiotics by LCS at the community level is influenced by both structural and individual contextual factors. There is a need to educate community members on the appropriate access and use of antibiotics in rural Ghana. In addition, rather than enforcing rules that go against practice, it may be more effective to regulate the sale of antibiotics by LCS and train them to make their dispensing more appropriate. CHPS compound could also be equipped to dispense some antibiotics to improve appropriate antibiotic access at the community level.

Determinants of Inappropriate Antibiotics Use in Rural Central Ghana Using a Mixed Methods Approach

“…The study employed three consecutive approaches. First, a qualitative approach was taken to explore the factors which affect community antibiotic access using in-depth interviews (IDIs) and focus group discussions (FGDs) as reported in a previous paper (19). Second, the results of the qualitative study were used to refine a questionnaire which was deployed at the household level.…”

“…Following the qualitative interviews and using the results reported in a previous paper (19) to refine the questionnaire, a longitudinal household survey was conducted to examine potential factors which influence antibiotic use at the household level. The data collection focused on antibiotic use in the past month.…”

“…Four IDIs were conducted among suppliers of antibiotics including one pharmacists, one dispensing technician and two Licensed Chemical Sellers (LCS)/Over-the-counter medicine sellers (OTC). IDI respondents were purposely selected and they largely represent the types of antibiotic supplier/dispensers (including public and private) in the study area which were previously identified and mapped (19). Antibiotic suppliers participated in the IDIs if they were 18 years or older and dispense or sell antibiotics.…”

“…After this, a priori themes were drawn from sociodemographic, healthcare characteristics and aspects of inappropriate antibiotic use to guide the coding of transcripts. Results were presented as narrative text in order to support quantitative findings (19).…”

Together we unite: the role of the Commonwealth in achieving universal health coverage through pharmaceutical care amidst the COVID-19 pandemic

“…Other examples of issues where collaborative actions are required include SF medicines and its contribution to AMR, ensuring honest and corruption-free systems, and reviewing licencing systems so licenses to practice are based on a minimum required level of skill and knowledge to ensure public safety. For example, community unregulated sale of medicines, such as at markets and stores, in particular antibiotics, are of high concern in many LMICs [55]. The CwPAMS has brought together practitioners and policy makers and raised these issues leading to acknowledgment and action by pharmacy councils to work with unlicensed sellers of antibiotics to address these issues [34].…”