Medicines in Health Systems: Advancing Access, Affordability and Appropriate Use. Chapter 5 – Annex 3: Thailand’s Antibiotic Smart Use Initiative
(2014; 6 pages)


Incentives in the healthcare delivery system—both financial and non-financial—often are misaligned. This can result in underuse, overuse and misuse of drugs. For antibiotics, overuse can drive greater drug resistance. Thailand’s Antibiotics Smart Use (ASU) project has sought to improve the rational use of these medicines through a step-wise approach beginning by improving education over antibiotic use and overuse locally and lowering barriers to behavioral change by offering alternative treatments for non-bacterial infections.

ASU has unfolded in three phases. It began as a partnership with pharmacists and doctors from Srinakharinwirot University and Chulalongkorn University. They piloted educational and training reforms to improve rational prescribing in 10 hospitals and 87 primary health centers in the Saraburi province. During this first phase, the provincial health office monitored four areas: antibiotic prescription rates; provider attitudes of effectiveness and knowledge of antibiotics; non-prescription rates in cases of non-bacterial infections; and patient health and satisfaction. Applying these same indicators, the second phase scaled up this intervention to 44 hospitals and 621 primary health centers in 3 provinces and two hospital networks. The National Health Security Office (NHSO) piloted a pay-for-performance system to realign financial incentives to prescribers and providers. Under the guidance of the Thai FDA, local health authorities managed this initiative with additional assistance from the NHSO and the Health Systems Research Institute. The third phase has strengthened and grown this network to 22 public hospital systems in 15 provinces, with the focus on longer-term sustainability.

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