Supply Chain and Delivery of Antimicrobial Drugs in Smallholder Livestock Production Systems in Uganda

Michel Mainack Dione,Emily Awuor Ouma,Francis Ejobi,Winfred Christine Amia,Barbara Wieland

doi:10.3389/fvets.2021.611076

Michel Mainack Dione, Emily Awuor Ouma + Show 3 more

Open Access

https://doi.org/10.3389/fvets.2021.611076

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Abstract

This study assessed the veterinary drug supply chain in Uganda, the constraints faced by the actors, and how the challenges influence the use of antimicrobial (AMs) by livestock farmers. We carried out stakeholder consultation workshops, key informant interviews and a knowledge, practices, and awareness survey with actors of the veterinary drug supply chain. We also profiled drugs stored in 23 urban and peri-urban drug shops in Lira and Mukono districts to record the commonly sold drugs. The veterinary drug supply chain is made of several actors including wholesalers, retailers, Animal Health Service Providers (AHSP) and farmers. Nearly ninety per cent of drug retailers and veterinary practitioners did not receive specialized training in veterinary medicine, and most of veterinary practitioners have been in the drug business market for more than 10 years. Antibiotics and anti-helminthics were the most stocked drugs by retailers, with antibiotics ranking highest in terms of contribution to annual financial profits, accounting for 33%. The choice of a drug by veterinary practitioners was mainly informed by past success with efficacy of the drug, and financial capacity of the client (the farmer) to meet the treatment cost. Many veterinary practitioners were not conversant with veterinary drug policies of the country, with Mukono having a higher number (72%) compared to Lira (37%). Veterinary practitioners from Lira district compared to Mukono and those mainly serving small scale farmers relative to large scale smallholders were more knowledgeable about antibiotics and AMR. Several supply chain constraints were identified as potential drivers of misuse of antibiotics that could contribute to AMR. These included low level of education of supply chain actors, particularly drug retailers, poor handling of drugs at purchase and administration practices, low enforcement of policies and regulations, and lack of awareness of stakeholders about policies that regulate drug use. Thus, future interventions to reduce misuse of AM drugs in livestock production systems in Uganda such as capacity building, should also target veterinary input suppliers, and deliberately involve a strong policy advocacy component.

Highlights

While access to quality drugs by livestock producers remains a challenge, there is misuse of drugs that are accessible
Drug retailers consider farmers as their first-choice customers because they pay higher prices as compared to Animal Health Service Providers (AHSP), who tend to bargain for lower prices as they have better market information of the products from wholesalers
The drug business is operated by personnel with sometimes limited training in drug management, which is in line with findings of Ilukor et al [3] and Byarugaba [4] who reported that the animal health sector in Uganda has a high percentage of non-trained service providers

Summary

Introduction

While access to quality drugs by livestock producers remains a challenge, there is misuse of drugs that are accessible. Dar et al [2] reported that there is a high level of farmer self-prescription, with around a third of countries allowing over-the-counter sales of drugs This situation is an indicator of poor-quality animal health services and animal husbandry practices but may result in an increase in AMR risks in both animals and humans. Implementation of regulations and policies that govern the delivery of veterinary drugs is a challenge due to lack of resources and commitment of the government [4] Veterinary input suppliers such as drug wholesalers, retailers and veterinary practitioners are important actors in the drug supply chain, since they play an important role in ensuring quality of products to livestock farmers [5, 6]. The study was implemented using three approaches: [1] qualitative assessment and description of the veterinary drug supply chains and its challenges; [2] profiling of veterinary drugs stocked by retailers and description of sales practices and [3] a KAP survey with veterinary practitioners about AMR and their perception of policies that govern the sale of veterinary drugs

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