Frameworka of Selected Indicators Used to Map the Antibiotic Supply Chain in Bangladesh
| Indicator | |||
|---|---|---|---|
| Element | Characteristic | Metric(s) | Rationale/Assumption |
| Supply chain | Linkages | Schematic | Maps product flow from manufacture to use |
| Manufacturers | Market structure | Market share of the top 10 by value (concentration) | For identification and classification |
| Ownership | % local/domestic | Local production supports accessb (availability) | |
| Overall production capacity | % supplied locally | ||
| Source of active ingredients | % sourced locally | ||
| Specialization in antimicrobial production | Proportion of manufacturers producing the top 10 by volume (%); high/low | Low specialization can protect against shortages and guarantee availability but may be a risk for drug quality | |
| Regulationc | Technical capacity | WHO classification of NRA | A WHO Stringent Regulatory Authority of Maturity Level 3 or 4 is a competent NRA able to ensure medicines quality in the supply chain |
| Demand points | Pharmacy density | No./ 5 km2 and No./10,000 population | Quantification and dispersion measures of (geographic) access; poor surveillance of a large number of pharmacies can impede product quality |
| Pharmacist density | No./10, 000 population | A measure of professional capacity to guard against potential misuse | |
| Veterinary clinic density | No./ 5 km2 | Geographical accessibility to licensed demand points promotes rational use | |
| Veterinarian density | No./10,000 population | A measure of professional capacity to guard against potential misuse | |
| Product quality | Prevalence of SF medicines | A measure of the integrity of the supply chain | |
| Antimicrobial products with market authorization (license) | WHO AWaRe categories | % | High % of Watch and Reserve groups may indicate (potential) misuse |
| Medically important antibiotics | % | ||
| Listing of top 10 in EML | % | Proxy for rational selection and use–the acceptability component of access | |
| Pricing/price controls | Present/absent | Proxy for access (affordability). High prices may promote misuse through poor adherence | |
Abbreviations: AWaRe, Access Watch and Reserve classification; EML, Essential Medicines List; NRA, National Regulatory Authority; SF, substandard and falsified medicines; WHO, World Health Organization.
↵a This framework is not intended to be exhaustive.
↵b Access is described here using the 5-dimensional framework of Wirtz et al.,7 consisting of availability, affordability, geographical accessibility, acceptability, and quality.
c Regulation is an overarching feature of the supply chain, not 1 distinct element.