# Policy Framework and Barriers in Antimicrobial Consumption Monitoring at the National Level: A Qualitative Study from Pakistan

## TL;DR

This study explores how Pakistan monitors antimicrobial use and identifies barriers in data collection, emphasizing the need for policy reform to combat antibiotic resistance.

## Contribution

The study provides a qualitative analysis of national-level antimicrobial consumption monitoring in Pakistan, highlighting policy and implementation challenges.

## Key findings

- Five key themes emerged, including perception of antimicrobial consumption and data management challenges.
- Stakeholders emphasized the need for stricter legislation and addressing irrational prescribing and OTC sales.
- A One Health approach is suggested as a solution to reduce broad-spectrum antimicrobial use.

## Abstract

Objectives: The study aims to assess the strategies used to estimate antimicrobial consumption (AMC) and the barriers encountered in data collection. It also addresses the perception about AMC based on the World Health Organization (WHO) definition. Methodology: The qualitative study adhered to the standard consolidated criteria for reporting qualitative studies (COREQ) guidelines. It involved stakeholders from diverse sectors, i.e., regulatory bodies, the pharmaceutical industry, international health organizations, policy experts, medical professionals, veterinary doctors, and academia (nursing, medicine, and pharmacy). A total of 37 in-depth interviews were conducted using a semi-structured interview schema. The interviews were recorded and transcribed verbatim. Codes were generated afterward and organized into themes. Results: Data analysis yielded five themes consisting of (i) Perception about Antimicrobial Consumption, AWaRe (Access, Watch, Reserve) classification and related terms, (ii) Antimicrobial Consumption: Policy Design, (iii) Data management and record keeping for the Estimation of Antimicrobial Consumption, (iv) Levels of Estimation for Antimicrobial consumption and Organizations, and (v) Challenges and suggested solutions in estimation of AMC: One health approach is the way forward. Conclusions: The study concluded that AMC and AMR are two sides of the same coin. The solution to AMR and excessive AMC is to re-evaluate the policy and implement legislation strictly. Efforts focused on irrational prescribing and unsupervised OTC sales of antimicrobials. This will help in reducing the consumption of broad-spectrum antimicrobials.