The market systems and supply chain of antimicrobial agents in Malawi

Masoamphambe, Effita, Lipenga, Bright, Pongolani, Raymond, Phiri, MacWellings, Feasey, Nicholas ORCID: https://orcid.org/0000-0003-4041-1405, Zaremba, Joanna, MacPherson, Eleanor, Nyondo-Mipando, Alinane Linda and Mkakosya, Rajab (2025) 'The market systems and supply chain of antimicrobial agents in Malawi'. Wellcome Open Research, Vol 10, p. 123.

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Abstract

Background
A central pillar of the Global Action Plan on Antimicrobial Resistance (AMR) is to optimize use of antimicrobials. Whilst excessive use of antimicrobials drives AMR, scarcity has a negative impact on patients needing access to treatment for infectious diseases. Addressing this issue necessitates concerted efforts to enhance the antimicrobial supply chain. However, achieving tangible improvements requires a comprehensive understanding of the existing processes of antimicrobial supply. Notably, there exists a gap in the literature on the market dynamics and supply chain processes of antimicrobials in Malawi.

Methods
We used an exploratory qualitative approach to this study; data were collected through in-depth interview between March and June in 2021 in Blantyre, and findings triangulated at a workshop at the end. Purposive sampling methods were used to identify 17 study participants from both the public and private health sector. Data analysis was done using thematic analysis in NVivo 11 software.

Results
Antimicrobials are largely imported into Malawi and consumers access antimicrobials through a mixture of public, private, and parallel supply chains. Formal antimicrobial supply chain actors comprise distributors which operate under obligations set by regulators while informal supply involves distribution of unregulated antimicrobial products. Regulation of distributors is compromised by human and financial resources constraints.

Conclusion
Shortcomings in the regulation of the antimicrobial supply chain in Malawi poses potential significant challenges for the optimal management of patients with infectious disease. This includes an inability to enforce regulation of the formal market leading to poor prescription practices and unnecessary antimicrobial usage. Addressing these issues is crucial for safeguarding public health and combating the spread of antimicrobial resistance. Further research should be done to investigate the extent of the problem posed by illegal antimicrobial routes and to develop interventions aimed at strengthening regulatory frameworks and health systems to improve patient access to antimicrobials.

Item Type:	Article
Subjects:	WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department Education
Digital Object Identifer (DOI):	https://doi.org/10.12688/wellcomeopenres.23280.1
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	07 Apr 2025 10:39
Last Modified:	07 Apr 2025 10:39
URI:	https://archive.lstmed.ac.uk/id/eprint/26374

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