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<p>Ethiopia’s unregulated private antibiotic economy spans private hospitals, clinics, pharmacies, drug shops and informal vendors. It drives resistance through three forces: intergenerational self-medication (reservoir habit), a satisfaction imperative linking sales to customer retention, and a corner drugstore calculus prioritising immediate access over cheaper but slow public care. Non-prescribed dispensing becomes the norm and selects resistant bacteria. We propose a six-pillar framework: tiered accreditation, point-of-service education, supply chain engagement, mystery client support, technology enabled consultation and operational research. This stewardship without walls is an urgent priority for Ethiopia and similar settings.</p>

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Stewardship without walls: taming the unregulated antibiotic economy to contain antimicrobial resistance in Ethiopia

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年6月18日

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  • Balew Arega,
  • Asnake Agunie

摘要

Ethiopia’s unregulated private antibiotic economy spans private hospitals, clinics, pharmacies, drug shops and informal vendors. It drives resistance through three forces: intergenerational self-medication (reservoir habit), a satisfaction imperative linking sales to customer retention, and a corner drugstore calculus prioritising immediate access over cheaper but slow public care. Non-prescribed dispensing becomes the norm and selects resistant bacteria. We propose a six-pillar framework: tiered accreditation, point-of-service education, supply chain engagement, mystery client support, technology enabled consultation and operational research. This stewardship without walls is an urgent priority for Ethiopia and similar settings.