'Superbugs’ pose a serious threat to public health. They are micro-organisms that have become resistant to antimicrobial drugs. It’s a typical story where too much of a good thing backfires in the longer term. Since the discovery of penicillin in 1928, the use of antibiotics has made major contributions to public health. But inappropriate prescription and use patterns of antibiotics in human medicine and animal husbandry have accelerated the development of antimicrobial resistance. This is increasingly eroding the therapeutic efficacy and undermining many of the advances that were realised thanks to antimicrobial therapy.
The Belgian Health Care Knowledge Centre was assigned by the Belgian Minister of Public Health to formulate proposals and recommendations to promote the prudent use of antibiotics in Belgium in the human and veterinary sector, to effectively reduce antibacterial resistance. The governance of the use of antibiotics has the character of a wicked problem and is a politically very sensitive topic in Belgium.
We developed a systems map of the Belgian antibiotics policy arena, with its friction points and opportunities, based on an extensive stakeholder consultation with representatives from intersectoral coordination bodies, public health administrations, hospital and ambulatory care practice, veterinarians and farmers, and pharmaceutical companies.
Besides enabling us to gain deeper understanding of dynamics driving the prescription and use patterns of antibiotics in Belgium, the systems map was used to support a process of stakeholder engagement in a politically sensitive context. The map-based stakeholder engagement process resulted in a prioritised set of suggestions to improve Belgian antibiotic policy and of interventions for prudent antibiotics’ prescription and use.
The systems map offered an integrated view of the factors that influence the prudent use of antibiotics for humans and animals. As such, it was used as a ‘boundary object’ for dialogue between stakeholders. This allowed the group to come to some level of consensus. Our approach revealed that the underlying thrust of the stakeholders’ suggestions for improvement is the wish to strengthen the One Health approach and a genuine culture of antibiotic stewardship across all sectors, based on informational, operational, financial, and human supports at the locus of clinical and therapeutic decision-making.