Access, excess, and ethics—towards a sustainable distribution model for antibiotics

Figures & data

Table I. Sample description.

Profession	Operational setting	Stakeholder category
Official, malaria NGO	International	NGO
Official, malaria NGO	International	NGO
Co-ordinator, health care NGO	Tanzania	NGO
Health advisor on development research	International	HIC donor agency
MD	Uganda	Clinician
MOH official	Ghana	Government
Project co-ordinator	Pakistan	NGO
Pediatrician	Uganda	Clinician
CEO, pharmaceutical company	Uganda	Industry
AMR task force member, MOH	India	Government
Head of research, pharmaceutical company	India	Industry

Text box 1. Distribution models for hypothetical scenario.

Model 1: The new antibiotic will be broadly available without prescription. The MOH also explores the possibilities of community case management and point-of-care diagnostics to minimize excessive and unnecessary use

Model 2: The MOH decides to put a tight restraint on the new antibiotic. A physician's prescription will be required to obtain it, and the drug will only be available within the public sector and at certain authorized private pharmacies

Text box 2. Interview guide.

How do you perceive the problem of antibiotic resistance?

Main causes

Potential solutions

What are your reflections on the first plan of action, and what consequences do you expect?

Health outcomes—system outcomes

Access/excess/resistance/sustainability

Point-of-care diagnostics and community case management

Public sector versus private sector

Equity issues

Possible improvements to prevent further resistance

What are your reflections on the second plan of action, and what consequences do you expect?

Health outcomes—system outcomes

Access/resistance/sustainability/black market access/leakage

Level of restraint—public versus private, hospitals versus pharmacies

Equity issues

Trust in health system

Possible improvements to ensure access

How would you organize the regulation and distribution of a new antibiotic given the current state of the antibiotic pipeline?

Sustainability

Equity

Feasibility

Conclusion—is there anything you would like to add to the discussion?

Table II. Final thematic framework.

Theme	Sub-theme
Barriers to rational access to antibiotics	Drivers of resistance
	Patients
	Public sector
	Private drug sellers
	Governance
Balancing access and excess	Access versus rational use
	Restricting availability
Learning from other communicable diseases	H1N1
	Malaria
A system-wide intervention	Governance
	Information
	Service delivery
	Human resources
	Medicines and technologies
	Finance
	People