It is difficult not to agree that 'doctors perception', 'pharma Reps pressure', and 'doctors rushing to issue a prescription' are some of the causes of over- and irrational prescribing.
But it is also the case that patients misunderstanding that antibiotics is necessary for viral infections, rather like the common belief that injections are better than tablets even when the patient can take oral medication, rather than tablets, also contribute to unnecessary use of antibiotics.
It is also true that public education against these erroneous beliefs is useful and can lead to controlling or even eliminating them. It does not mean that the blame is heaped on the patients alone, rather it reinforces the good practice of enabling a shared decision-making culture at the point of care.
Context is almost everything in public health which means that it is neglected at the peril of researchers or clinicians.
HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: www.hriwestafrica.com Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.
Email: jneana AT yahoo.co.uk