What is it about?

Universal access to healthcare, including quality medicines, is a fundamental human right but is still out of reach for many in low- and middle-income countries. This review shows where the problems lie that cause inaccessibility of facilities and services and suboptimal quality of health care provision in East Africa. We explain these along the lines of a 6 A's framework, looking at availability, accessibility, affordability, adequacy and acceptability, plus aspects of quality, for both human and animal health. We discuss many inadequacies, like understaffing, unavailability of antibiotics or long waiting times in public facilities, sales of partial antibiotic doses in retail shops due to high prices, and substandard quality of medicines in the market for example. We then give a few recommendations on how to counter such problems and improve health services for better health outcomes for patients and less risk of antimicrobial resistance development.

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Why is it important?

The global focus lies on curbing excessive antibiotic use, creating tension between the need to improve universal access to essential drugs and the global push to reduce their use. Major constraints around access and quality of care shape patients’ health-seeking decisions leading to practices like self-medication, which might exacerbate the AMR problem. We therefore advocate for a holistic approach to tackling inadequacies in health systems, encompassing all dimensions of access and quality of healthcare, in order to improve health outcomes while simultaneously counteracting the antimicrobial resistance crisis through optimal usage of antibiotics.


This article resulted from my literature search at the start of my PhD. In the meantime we uncovered the same problems regarding access and quality of healthcare in our study area in Tanzania. Working with communities made me feel much more strongly about all the hardship that comes with inadequate and inequitable access to healthcare. Both humans and animals have a right to good health and wellbeing and I hope that our research will one day play a part in convincing stakeholders to invest more in health, which is the basis of productivity, development, growth and happiness.

Kathrin Loosli
University of Glasgow

Read the Original

This page is a summary of: Addressing antimicrobial resistance by improving access and quality of care—A review of the literature from East Africa, PLoS Neglected Tropical Diseases, July 2021, PLOS,
DOI: 10.1371/journal.pntd.0009529.
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