58.02 Inappropriate Antibiotic Use and the Health Policy Agenda in Mexico

Tuesday, April 28, 2009
John Snow (The Hilton Istanbul Hotel )
Anahí Dreser, MD, MSc Instituto Nacional de Salud Pública, Mexico
Kitty K. Corbett Simon Fraser University, Canada
Veronika J. Wirtz Instituto Nacional de Salud Pública, Mexico
Stuart Anderson London School of Hygiene and Tropical Medicine
Aim. The World Health Organization (WHO) has called for international action directed to improve antibiotic use and contain antimicrobial resistance. This study aimed to analyze the perceptions that decision-makers and stakeholders in Mexico have regarding the inappropriate use of antibiotics, and policy alternatives to address this issue.
Methods. 52 semi-structured interviews were conducted with key social actors:  government officials; pharmaceutical sector representatives; NGO’s; researchers and health professionals. Coding employed codes defined a priori, as well as emerging thematic codes. The analysis was based in a public agenda setting conceptual framework.
Results. The majority of interviewees perceived inappropriate antibiotic use as a problem of less importance compared to the higher priority of access to medicines. Researchers stressed the urgency of the problem, whereas governmental actors pointed out the lack of indicators to assess its importance in the country. The problem was framed in three spheres: as something pertaining to the national culture; as a problem secondary to the lack of access to health services; and as a complex problem determined by institutional rigidity. Regarding the perception of policy alternatives, the interviewees highlighted the scarcity of resources to implement programs, and conflicts between vested interests: professional, economic, and political. Only one interviewee made reference to WHO recommendations.
Conclusions. These factors are important to explain the current inaction regarding policies to improve antibiotic use in Mexico: 1) Low problem recognition; 2) Framing of the problem in cultural and structural spheres which are difficult to act upon; 3) Unawareness of international policy recommendations on this matter; 4) The lack of recognition of responsibility regarding this problem and its solutions. These factors can help understanding barriers to action and should be considered to bring the issue of inappropriate antibiotic use to the health policy agenda in other developing countries.

Learning Objectives: 1. Participants will recognize the political dimension of developing evidence-based antibiotic policies at the national level. 2. Participants will describe five factors that can hinder the link between international policy recommendations; research at the national level; setting the national health agenda; and the development of national evidence-based antibiotic policies. 3. Participants will be able to analyze these factors in their own countries, and contribute thereafter to the development of national antibiotic policies.

Sub-Theme: Public Health and Research: Evidence Based Policy on Health