How Enrollment into Health Insurance Scheme Can Curb Antibiotics Abuse in Nigeria

Antimicrobial Resistance (AMR) is a major threat to global health, rooted in factors like antibiotic misuse. Babatunde Akinola, a public health expert and Country Project Director at Management Sciences for Health (MSH), USAID MTaPS, discussed this issue with Lafiya360, focusing on how health insurance schemes could help tackle antibiotic abuse in Nigeria.

Lafiya360: Can you provide an overview of antimicrobial resistance and why it’s a significant global health concern?

Akinola: Antimicrobial Resistance (AMR) happens when antibiotics no longer work against the infections they are meant to treat. This means that when someone is seriously ill and given antibiotics that should cure their infection, the medicine doesn’t work, and the person doesn’t get better. That is basically what AMR is all about.

This assumes that you are prescribed the correct antibiotics for the correct infection, which are two separate issues. Sometimes, due to problems within the healthcare system, laboratories may not be fully operational. As a result, doctors may prescribe medications based on their judgment without lab tests. When the patient doesn’t improve because the antibiotics aren’t effective, it indicates a deeper problem.

AMR is a major global health issue because antibiotics are crucial for saving lives and helping people recover from illnesses. When sick individuals can’t get effective antibiotics to treat their infections, it becomes a serious problem. This growing concern is why global attention is focusing on AMR. Many antibiotics that used to work are now failing, posing a significant threat with enormous economic and social consequences.

The World Health Organization estimates that bacterial AMR was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths. The misuse of antimicrobials have also been identified as the main drivers in the development of drug-resistant pathogens.

Lafiya360: What are the main factors contributing to the rise of antimicrobial resistance?

Akinola: There are an array of factors that contribute to the spread of AMR, among them incorrect prescribing, misuse by patients, and the ubiquity of counterfeit antimicrobials. We also face challenges with our laboratories, many of which are not well equipped. Despite having skilled personnel capable of conducting accurate tests, they often lack the necessary equipment to do so.

Doctors and prescribers often have no choice but to rely on their clinical experience to prescribe antibiotics when patients present with infections. Ideally, a sensitivity test should be done to determine if an antibiotic will be effective, but these tests are often not conducted.

Even with the best intentions, doctors might sometimes prescribe the wrong antibiotic. Using an incorrect antibiotic for an infection can lead to resistance, making the antibiotic ineffective when it’s genuinely needed later. Additionally, the high cost of some antibiotics is a significant issue. When these expensive but necessary antibiotics are unavailable, alternative drugs are used, which may not be as effective.

Lafiya360: What are the current strategies in place to combat antimicrobial resistance, and how effective have they been?

Akinola: For my organization, MSH, we work with the government of Nigeria through the Nigeria Centre for Disease Control and Prevention (NCDC), the public health institution responsible for containing antimicrobial challenges in the country. I know there are lots of policies in place at the national level to be able to influence the way antibiotics are prescribed but this needs to trickle down to the state and local government levels.

One of the things the government is also doing with the support of partners like MSH, is that they are instituting antimicrobial stewardship programme at tertiary and some secondary facilities. This programme focuses on improving prescribing practices, helps in strengthening laboratories practices so that laboratory scientists have the right skill sets to carry out their duties.

There are other programmes supporting the right equipment at that level so that we have the capacity and test are done as at needed. This helps the prescribers to prescribe the right antibiotics. Also, there are awareness programmes that are on to enlighten the public about the danger of self-medication especially with antibiotics. This is to ensure everyone knows that these drugs are meant to be used for specific infections and not just taken without guidance from the professionals.

We still have a lot of work to do, like sensitization and training for prescribers. We are trying to develop new curriculum that provides guidance to pharmacists, medical doctors, nurses and all professionals involved in antibiotics use and prescription so that they get to know what their responsibilities are. Most importantly, it’s to ensure that laboratories have the capacity to be able to test accurately and in time.

Lafiya360: How can individuals and communities contribute to efforts to address AMR?

Akinola: The community has a lot of contributions to do in the sense that they should create awareness that antibiotics are not just drugs we jump to use when there is an ailment. All communities have Primary Health Centres (PHCs), some are also linked to secondary-level care, we want to encourage them to patronize those people. The government also need to improve on sensitization programmes and ensure people understand the danger of antibiotic misuse.

If the community becomes aware of what needs to be done, then the community will be the ones helping their people not to self-medicate.

A major challenge people in the community face is out-of-pocket expenses. Most people cannot afford the high cost of treatment at the health facility, so they resort to drug stores for treatment. The government can tackle this by enrolling more persons into the health insurance scheme, they will be able to access better quality services at organized health facilities, either in the private or public sector. If this is done, I believe people will find more solace in going to organized settings for their treatment.

A major reason people go to the drug stores in the community is because they get their drugs in tiny batches and at low cost. For instance, people can get one capsule at a time at their community drug stores but this is not the case in major health facilities. When people don’t take the full course of antibiotics as prescribed, they are contributing to AMR. When you go to a health facility instead of a drug shop, you’ll get the full course prescribed, and education from the provider about the importance of completing the medication regime.