Ongoing efforts to improve antimicrobial utilization in hospitals among African countries and implications for the future.

There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no exception, especially with the highest rates of AMR globally. Key activities in NAPs include gaining a greater understanding of current antimicrobial utilization patterns through point prevalence surveys (PPS) and subsequently instigating antimicrobial stewardship programs (ASPs). Consequently, there is a need to comprehensively document current utilization patterns among hospitals across Africa coupled with ASP studies. In total, 33 PPS studies ranging from single up to 18 hospitals were documented from a narrative review with typically over 50% of in-patients prescribed antimicrobials, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole, were the most prescribed antibiotics. Appreciable extended prescribing of antibiotics up to 6 days or more post-operatively was seen across Africa to prevent surgical site infections. At least 19 ASPs have been instigated across Africa in recent years to improve future prescribing utilizing a range of prescribing indicators. The various findings resulted in a range of suggested activities that key stakeholders, including governments and healthcare professionals, should undertake in the short, medium and long term to improve future antimicrobial prescribing and reduce AMR across Africa

Improving medicine supply and availability using simulation : a case study of Uganda

Medicine availability is a concern in low and middle-income countries hospitals, contributing to delayed treatment, out-of-pocket purchases, and deaths. Supply chains moving medicines are deemed weak, preventing on-time and continuous supply and availability in hospitals. There is a lack of studies using simulation to capture the complex nature of medicine supply chains, dealing with uncertainties and dynamisms, having separate agents with individual rules governing their operations; a decision made by one agent affects the entire system's performance. Using a case study of Uganda's public health care sector, our study evaluates the medicine supply chain using Discrete Event Simulation and Agent-based modelling to improve service delivery. Also, the model examines the effectiveness of various interventions in ensuring continuous supply and availability of medicines to all public hospitals in Uganda. Observation and unstructured interviews with supply chain personnel inform model conceptualisation using process mapping and Overview Design Development protocol. The two conceptual models are a basis for building a hybrid model. Model verification and validation using expert opinions, debugging, facility records, and sensitivity analysis will be done in later stages of research to ensure usefulness and increase user confidence. Our research develops an understanding of how to organise a supply chain and allows for generalisation across low-middle-income countries. Based on the model output derived from different interventions, healthcare policymakers can make data-driven decisions as a step forward to achieving UN SDG 3 of good health and well-being, specifically 3.3 to achieve Universal Health Coverage and access to essential medicines

Perceptions of and practical experience with the National Surveillance Centre in managing medicines availability amongst users within public healthcare facilities in South Africa : findings and implications

The introduction of the National Surveillance Centre (NSC) has improved the efficiency and effectiveness of managing medicines availability within the public healthcare system in South Africa. However, at present, there is limited data regarding the perceptions among users of the NSC and challenges that need addressing. A descriptive quantitative study was performed among all registered active NSC users between August and November 2022. Overall, 114/169 users responded to a custom-developed, self-administered questionnaire (67.5% response rate). Most respondents used the Stock Visibility System (SVS) National Department of Health (NDoH) (66.7% for medicines and 51.8% for personal protective equipment (PPE) or SVS COVID-19 (64.9% for COVID-19 vaccines) or RxSolution (57.0% manual report or 42.1% application programming interface (API)) for reporting medicines, PPE, and COVID-19 vaccines to the NSC and were confident in the accuracy of the reported data. Most respondents focused on both medicines availability and reporting compliance when accessing the NSC, with the integrated medicines availability dashboard and the COVID-19 vaccine dashboard being the most popular. The respondents believed the NSC allowed ease of access to data and improved data quality to better monitor medicines availability and use. Identified areas for improvement included improving internet connectivity, retraining some users, standardising the dashboards, adding more data points and reports, and expanding user adoption by increasing licence limits. Overall, this study found that the NSC in South Africa provides an effective solution for monitoring and improving medicines availability

Ongoing efforts to improve antimicrobial utilisation in hospitals among African countries and implications for the future

There are serious concerns with rising antimicrobial resistance (AMR) across countries 67 increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives 68 globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no excep-69 tion especially with the highest rates of AMR globally. Key activities in NAPs include gaining a 70 greater understanding of current antimicrobial utilisation patterns through point prevalence sur-71 veys (PPS) and subsequently instigating antimicrobial stewardship programmes (ASPs). Conse-72 quently, there is a need to comprehensively document current utilisation patterns among hospitals 73 across Africa coupled with ASP studies. 33 PPS studies ranging from single up to 18 hospitals were 74 documented from a narrative review with typically over 50% of in-patients prescribed antimicrobi-75 als, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole were the most prescribed 76 antibiotics. Appreciable extended prescribing of antibiotics up to 6 days or more post-operatively 77 was seen across Africa to prevent surgical site infections. At least 19 ASPs have been instigated 78 across Africa in recent years to improve future prescribing utilising a range of prescribing indicators. 79 The various findings resulted in a range of suggested activities that key stakeholders, including 80 governments and healthcare professionals, should undertake in the short, medium and long term 81 to improve future antimicrobial prescribing and reduce AMR