Barriers to implementing National Action Plans on antimicrobial resistance using a One Health Approach: policymakers' perspectives from South Africa and Eswatini.

OBJECTIVES: Antimicrobial resistance poses a global public health concern that threatens human, animal, and environmental health. If it is not addressed, it is estimated to cost the global economy between USD 90 trillion and USD 210 trillion, and the death burden could balloon to 10 million lives per year by 2050. This study aimed to explore policymakers experiences on barriers to implementing National Action Plans on antimicrobial resistance using a One Health approach in South Africa and Eswatini. METHODS: Thirty-six policy makers were recruited using purposive and snowballing sampling in South Africa and Eswatini. Data were collected between November 2018 and January 2019 in South Africa, and February to March 2019 in Eswatini. Data was then analysed based on Creswell methods. RESULTS: Three themes and five subthemes emerged from our findings. The themes were resource barriers, political barriers, and regulation barriers to the implementation of National Action Plans on antimicrobial resistance in South Africa and Eswatini. CONCLUSION: South African and Eswatini governments should commit funds to their One Health sector budgets to enable the implementation of National Action Plans on antimicrobial resistance. Specialized human resources issues need to be prioritized to unlock barriers of implementation. A renewed political commitment is needed to combat antimicrobial resistance in a One Health approach, as it plays a significant role in resource mobilization from regional and international organizations to support the resource-constrained countries to successfully implement policies.

Medicines availability at a Swaziland hospital and impact on patients.

BACKGROUND: The burden of non-communicable diseases (NCDs) in low- and middle-income countries is increasing. Where patients are expected to make increased out-of-pocket payments this can lead to treatment interruptions or non-adherence. Swaziland is no exception in this regard. AIM: The aim of the study was to investigate the availability of medicines for NCDs in a hospital and the impact of out-of-pocket spending by patients for medicines not available at the hospital. SETTING: The study was conducted at Raleigh Fitkin Memorial Hospital in Manzini, Swaziland. METHODS: Exit interviews to assess availability of a selected basket of medicines were conducted with 300 patients diagnosed with diabetes, hypertension or asthma. The stock status record of a basket of medicines for these conditions in 2012 was assessed at the Central Medical Stores. Results were analysed using the Statistical Package for Social Sciences version 20.0. RESULTS: Most of the patients (n = 213; 71%) confirmed not receiving all of their prescribed medicines at each visit to the hospital in the past six months. On average patients spent 10­50 times more on their medicines at private pharmacies compared to user fees in the health facility. Stock-outs at the Central Medical Stores ranging from 30 days to over 180 days were recorded during the course of the assessment period (12 months), and were found to contribute to inconsistent availability of medicines in the health facility. CONCLUSION: Out-of-pocket expenditure is common for patients with chronic conditions using this health facility, which suggests the possibility of patients defaulting on treatment due to lack of affordability.