ArticleArchives of public health = Archives belges de sante publique2025
Unequal budgeting and limited WHO AWaRe Access antibiotics in Punjab: procurement policy gaps in Pakistan's National Action Plan against antimicrobial resistance.
Article in Archives of public health = Archives belges de sante publique, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Antimicrobial Peptides Against Antimicrobial-Resistant Bacteria: Focus on Machine Learning.Infection and drug resistance · 2026Review
- Can Pakistan achieve the UNGA 70% antibiotic access target? A scoping review of susceptibility data.Frontiers in public health · 2026Article
- Multicentric Surveillance of Antimicrobial Resistance to Generate Data-Driven Regional Antibiograms: A Laboratory-Based Cross-Sectional Study in Pakistan.Antibiotics (Basel, Switzerland) · 2025Article
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Authors and funding
6 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundProcurement-side stewardship - unaddressed by Pakistan's National Action Plan (NAP) against antimicrobial resistance (AMR) - is critical in ensuring access to needed antibiotics to curb AMR. However, a fragmented procurement model, disconnected from updated clinical evidence and inconsiderate towards budgetary allocation, is being implemented in Pakistan, affecting access to antibiotics. This study seeks to understand the implications of the current procurement policy on access to antibiotics.
methodThis study offers a descriptive content analysis of the Standard Medicine List (SML), a procurement policy currently implemented in Punjab's primary and secondary healthcare facilities (PSHFs). Using procurement data from one of the DHA's of Rawalpindi division and budget appropriation documents from the fiscal year (FY) 2023-2024, we evaluated the total cost, defined daily dose (DDDs), and cost per DDD of procured antibiotics in Punjab. We also measured the percentage of spending on antibiotics for the secondary care sector.
resultsOur analysis includes 2970 PSHFs of Punjab. Our findings suggest that SML does not ensure consistent access to antibiotics because budgetary allocations do not correspond with SML-advised quantities. If the SML-advised quantities were procured, 85% of the PSHFs' medicine budget would be consumed; however, for primary care solely, 122.5% of the medicine budget is required to procure antibiotics as per SML-indicated quantities. The total Access category DDDs procured in Punjab as per SML-advised quantities is only 44%. Furthermore, key Access category antibiotics, such as Amoxicillin, are subject to conditional procurement or are missing entirely. Overall, SML promoted the WHO AWaRe Watch category antibiotic use, with ceftriaxone being the most procured antibiotic, consuming 20.7% (1.41 billion PKR) of the total budget spending as per SML-advised quantity.
conclusionSML is misaligned with the core concept of the WHO AWaRe system and the recent UNGA target of 70% Access category antibiotic consumption. The study elucidates that PSHFs lack sufficient funds to procure SML-advised quantities, highlighting its incompatibility with the budgetary grant, which affects consistent access to antibiotics. There is a need to recalibrate the procurement policy and leverage Pakistan's NAP to propagate a national antibiotic procurement framework to restrain AMR.
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