Tayler E, Gregory R, Bloom G, Salma P, and Balkhy H (2019) Universal health coverage: an opportunity to address antimicrobial resistance?, The Lacent Global Health, Published Online September 20, 2019, DOI: 10.1016/S2214-109X(19)30362-6
On Sept 23, 2019, global leaders will gather at the UN for a high-level meeting on universal health coverage and discuss commitments and action to extend essential health services to over half of the world's population that have no access to them. 3 years ago, leaders met similarly at the UN General Assembly to consider antimicrobial resistance, perhaps the greatest threat to public health of our time. These two major global health priorities are much more closely linked than they might appear at first. If antimicrobial resistance is not controlled, health care will become more difficult, less effective, and more expensive. Conversely, action towards universal health coverage — and a positive response by countries at the meeting to the key asks proposed by the universal health coverage movement — can help expand coverage of measures to prevent and manage infection, including appropriate use of antibiotics. Countries have a great opportunity to both accelerate universal health coverage progress and tackle antimicrobial resistance, with substantial and sustainable gains.
Bloom G, Buckland Merrett G, Wilkinson A, Lin V and Paulin S (2017) Antimicrobial resistance and universal health coverage, BMJ Global Health, 2:e000518, doi:10.1136/bmjgh-2017-000518
The WHO launched a Global Action Plan on antimicrobial resistance (AMR) in 2015. World leaders in the G7, G20 and the UN General Assembly have declared AMR to be a global crisis. World leaders have also adopted universal health coverage (UHC) as a key target under the sustainable development goals. This paper argues that neither initiative is likely to succeed in isolation from the other and that the policy goals should be to both provide access to appropriate antimicrobial treatment and reduce the risk of the emergence and spread of resistance by taking a systems approach.
Bloom G, Wilkinson A and Buckland Merritt G (2017) Antimicrobial resistance and Universal Health Coverage, In Antimicrobial resistance in the Asia Pacific region: a development agenda (pp. 9-21). Manila, Philippines. World Health Organization Regional Office for the Western Pacific. Licence: CC BY-NC-SA 3.0 IGO.
Chapter two highlights priorities for an integrated approach for addressing AMR by strengthening universal health coverage (UHC). It focuses on the use of drugs in outpatient settings. The chapter gives particular consideration to low- and middle-income countries with pluralistic health systems, where government provision and health markets combine and where people seek treatment for a large proportion of common infections in weakly regulated markets.
Buckland Merrett GL, Bloom G, Wilkinson A and MacGregor H (2016) Towards the just and sustainable use of antibiotics, Journal of Pharmaceutical Policy and Practice, 9:31, DOI: 10.1186/s40545-016-0083-5
The emergence and spread of antibiotic resistant pathogens poses a big challenge to policy-makers, who need to oversee the transformation of health systems that evolved to provide easy access to these drugs into ones that encourage appropriate use of antimicrobials, whilst reducing the risk of resistance. This is a particular challenge for low and middle-income countries with pluralistic health systems where antibiotics are available in a number of different markets. This review paper considers access and use of antibiotics in these countries from a complex adaptive system perspective. It highlights the main areas of intervention that could provide the key to addressing the sustainable long term use and availability of antibiotics.
Xiao, Y. et al. (2011) Implementation of National Essential Drug Policy: Analysis from a Complex Adaptive Systems Perspective. Chinese General Practice, Volume 14, 5A: 1419-1421.