Determinants of Antibiotic Prescribing in Primary Care in South Africa

Studying patient-provider interactions in the private and public sectors

Principal Investigator: Mylene Lagarde
Start Date: 01 January 2017
End Date: 31 Decemebr 2018
Region: Africa
Keywords: antibiotic resistance, antiobiotic prescribing, patient-provider interactions, medical anthropology, global health, health policy, health economics


The study aims to explore how the interactions between providers and patients influence inappropriate antibiotic prescribing in public and private primary care in South Africa, in a way that will directly benefit the design of potential future public health interventions. The specific objectives are to:

  • Explore providers’ and patients’ perceptions and experiences of antibiotic prescribing in the public and private sectors; 
  • Quantify the relative importance of clinical as well as social and economic contextual factors influencing the prescribing decisions of primary care providers;
  • Evaluate the impact of different patient attitudes towards antibiotic prescribing on the prescribing practices of public and private providers; and
  • Evaluate the impact of financial incentives on the prescribing practices of private GPs.

The results will provide insights into our understanding of prescribing decisions in the public and private sector in South Africa, thereby informing the stewardship programmes for antimicrobial resistance in this country. More specifically it could support efforts to involve actors in the primary care sector in the fight against AMR, by changing clinical guidelines in the public sector, introducing new guidelines for the private sector, and encouraging payers in the private sector (i.e. Medical insurance schemes) to incentivise providers to improve their prescribing behaviour.

The project was funded by the ESRC through its AMR Initiative and  undertaken in collaboration with the Centre for Health Policy at the University of Witwatersrand in Johannesburg.


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