How to create an epidemic: Antibiotic access and drug resistance in the Philippines

Devolution of health care to the local community level since 1991 has resulted in markedly increased health disparity in the Philippines. The decentralization of administrative duties without the parallel decentralization of medical resources is believed to have contributed to this disparity. In particular, access to pharmaceuticals has been severely compromised at the local level.

In order to determine the effect of the reduction of access to pharmaceuticals on local level health care and community health, qualitative semi-structured interviews (n=100) recruited from convenience and snowball sampling in three different Philippine municipalities were conducted at the local level of both rural and municipal health units. Quantitative epidemiologic analysis of the incidence and prevalence of antibiotic resistance from municipal health units and provincial hospital records were compared.

Findings include the increased cost and decreased physical availability of pharmaceuticals has resulted in a lack of essential drugs and antibiotics and a rationing of antibiotics with markedly reduced sample dosing from municipal and local health units of one to two days; with an infeasible expectation that patients would purchase pharmaceuticals after the initial 1-2 day samples were exhausted. Quantitative data analysis reveals that the current policy of sample dosing in some municipal health units is increasing vulnerability to population drug resistance. A critical analysis of current public health policies contributing to these issues are reviewed.