Obligatory medical prescription of antibiotics in Russia: Navigating formal and informal health-care infrastructures

Antimicrobial resistance control programmes often aim to fix the behaviour of antibiotic users and prescribers. Such behavioural interventions have been widely criticised in social science literature for being inefficient and too narrow in scope. Drawing on these criticisms, this article analyses how political programmes for fixing antibiotic behaviours were adapted into the practices of health-care professionals and patients in Russia. In 2018, we conducted interviews with medical doctors, pharmacists and patients in a Russian city; focusing on their practices around the policy requirement introduced in 2017 which obligated medical prescriptions of antibiotics. We conceptualised the obligatory medical prescription as a political technique which sought to change practices of self-treatment and over-the-counter sales of medications by establishing doctors as an obligatory passage point to access antibiotics. Our analysis shows that the requirement for medical prescriptions does not fulfil the infrastructural gaps that influence antibiotic practices. By navigating the antibiotic prescriptions, doctors, pharmacists and patients informally compensate for the gaps in the existing infrastructure creating informal networks of antibiotic care parallel to the requirement of obligatory prescriptions. Following these informal practices, we could map the inconsistencies in the current policy approaches to tackle AMR as a behavioural rather than infrastructural problem.

Automated summary

This study analyzes how political programmes for fixing antibiotic behaviours were adapted into the practices of health-care professionals and patients in Russia. It found that the requirement for medical prescriptions does not fulfill the infrastructural gaps that influence antibiotic practices, leading doctors, pharmacists and patients to compensate for the gaps through informal networks of antibiotic care.