Health system actors’ perspectives of prescribing practices in public health facilities in Eswatini: A Qualitative Study

• Published in: PloS one Vol. 15; no. 7; p. e0235513
• Main Authors: Ncube, Nondumiso B. Q, Knight, Lucia, Bradley, Hazel Anne, Schneider, Helen, Laing, Richard, Thet Wai, Khin
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 09.07.2020; Public Library of Science (PLoS)
• Subjects: Behavior; Data collection; Drug stores; Evaluation; Guidelines; Health care; Health care facilities; Health facilities; Health sciences; Hospitals; Medical personnel; Medicine; Medicine and Health Sciences; Nurses; Patients; People and Places; Pharmaceuticals; Pharmacists; Physicians; Practice guidelines (Medicine); Public health; Public sector; Qualitative reasoning; Qualitative research; Schneider, Richard; Technicians; Eswatini; South Africa; Swaziland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0235513

Rational medicines use (RMU) is the prescribing/dispensing of good quality medicines to meet individual patient's clinical needs. Policy-makers, managers and frontline providers play critical roles in safeguarding medicine usage thus ensuring their rational use. This study investigated perspectives of key health system actors on prescribing practices and factors influencing these in Eswatini. Public sector healthcare service delivery is through health facilities (public sector, not-for-profit faith-based, industrial) and community-based care. A qualitative, exploratory study using semi-structured in-depth interviews with seven policymakers and managers, and 32 facility-based actors was conducted. Drawing on Social Practice Theory, material (health system context), competence (provider) and cultural (patient and provider) factors influencing prescribing practices were explored. In Eswatini, prescribing practices are influenced by the interaction of factors (health system, provider and patient) that span levels (facility, region, and policy-making) of the health system. Promoting RMU thus goes beyond the availability of guidelines and provider training and requires concerted efforts of multiple stakeholders.