Thailand’s policy work

Realizing the enormous costs of antibiotic resistance to Thai society, Thailand has paved its own unique road to dealing with resistance.

Before 2007, rational use of medicines was a concept not routinely practiced in Thailand. Furthermore, there were very little resources in the fight against the irrational use of antibiotics. In addition, the consumer demand for antibiotics is high.

Antibiotics Smart Use in short

The Antibiotics Smart Use (ASU) program started in 2007 as an action research project to promote the rational use of antibiotics by strengthening human resources, improving health facility infrastructure, and empowering communities. The primary concept is: “No antibiotics for non-bacterial infection.” ASU targets three conditions not requiring antibiotic treatment: upper respiratory tract infections (especially common cold with sore throat), acute diarrhea and simple wounds. ASU stands out because it induced behavioral change with limited resources through a local approach with a clear simple health message that got carried and promoted by small teams of trained health educators creating local networks with local ownership that connect to central networks. The program was scaled-up to the entire country where a pay-for-performance element was added.

Read more about the ASU program in RATIONAL USE: Inspirational examples.

Community-level initiative evolving to national policy

Thailand’s ASU illustrates an example where a policy was started as a project from the community-level and not from a top-down approach. Through various community, local and provincial government structures, it was taken to the national level. However, the decentralized network with local ownership has remained in place and has been considered crucial in maintaining sustainability especially during financial and human resource constraints.

Key stakeholders that initiated ASU at the local level included physicians, pharmacists, nurses, health volunteers, local administrators and community leaders who all promoted the rational use of antibiotics in their various health-care settings and communities. Key interventions are highlighted in Box 1.

Intervention effectiveness was assessed in terms of four indicators:

• A reduction in antibiotic prescription rates;
• Improved knowledge and attitudes of prescribers;
• Percentage of patients with the targeted conditions who were not prescribed antibiotics (since they did not need them); and
• Patients perceived health and satisfaction with the treatment outcome.

Integration into the National Program

Starting from 2012, ASU became integrated into Thailand’s national program to curb antimicrobial resistance known as the Antimicrobial Resistance Containment Program (AMRCP). AMRCP was initiated in 2011 by a group of stakeholders with a shared vision of how to contain and prevent the emergence and spread of common antibiotic resistant bacterial infections in Thailand with a One Health approach.

A Committee on Research and Development of AMRCP was appointed by Thailand’s Health Systems Research Institute to design a desirable antimicrobial resistance containment system. AMRCP includes ten containment operational actions described in detail in RATIONAL USE: Examples from the field. The AMRCP program is supported by the Thai Health Promotion Foundation, the Health Systems Research Institute (Thailand), the faculty of medicine at the Siriraj Hospital, the Government pharmaceutical organization (Thailand) and the International Development Research Center (Canada).

Selected Resources