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Perspectives of prescribing practices in public health facilities in Eswatini Posted 15/01/2021

Rational medicines use (RMU) is the prescribing/dispensing of good quality medicines to meet individual patient’s clinical needs. Policymakers, managers and frontline providers play critical roles in safeguarding medicine usage thus ensuring their rational use. Therefore, in order to investigate this, researchers carried out a study investigating the perspectives of key health system actors on prescribing practices and factors influencing these in Eswatini [1]. Public sector healthcare service delivery in the region is carried out through health facilities (public sector, not-for-profit faith-based, industrial) and community-based care.

A qualitative, exploratory study using semi-structured in-depth interviews with seven policymakers and managers, and 32 facility-based actors was conducted. Drawing on Social Practice Theory, material (health system context), competence (provider) and cultural (patient and provider) factors influencing prescribing practices were explored.

Participants were aged between 21‒57 years, had been practicing for 1‒30 years, and were a mix of doctors, nurses, pharmacists and pharmacy-technicians. Factors contributing to irrational medicines use included: poor use of treatment guidelines, lack of RMU policies, poorly functioning pharmaceutical and therapeutics committees, shortages of medicines, lack of pharmacy personnel in primary healthcare facilities, and restrictions of medicines by level of care. Provider-related factors included: knowledge, experience and practice ethic, symptomatic prescribing, high patient numbers. Patient-related factors included late presentation, language and the need to be prescribed multiple medicines.

The authors concluded that, ‘in Eswatini, prescribing practices are influenced by the interaction of factors (health system, provider and patient) that span levels (facility, region and policymaking) of the health system. Promoting RMU thus goes beyond the availability of guidelines and provider training and requires concerted efforts of multiple stakeholders.’

Conflict of interest
The authors of the research paper [1] declared that there was no conflict of interest.

Abstracted by Nondumiso BQ Ncube, Lecturer and PhD Fellow at the Department of Community and Health Sciences, School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa.

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Reference
1. Ncube NBQ, Knight L, Bradley HA, et al. Health system actors’ perspectives of prescribing practices in public health facilities in Eswatini: a qualitative study. PLoS One. 2020;15(7):e0235513

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