Antimicrobial resistance (AMR) is a growing global health threat requiring robust biosafety, biosecurity, and surveillance systems across human, animal, and environmental sectors. However, evidence on how these systems function at sub-national and facility levels remains limited, particularly in decentralized settings such as Kenya. This scoping review was conducted in line with PRISMA-ScR reporting standards to map evidence on AMR containment systems in Kenya. Peer-reviewed and grey literature covering governance, surveillance, laboratory capacity, workforce, biosafety and biosecurity, digital systems, and One Health integration between January 2022 - February 2026 were systematically identified and thematically synthesized, with methodological quality assessed using the Mixed Methods Appraisal Tool. A total of 31 studies (23 peer-reviewed and 8 grey literature) were included. Human health systems were the most frequently represented domain (n = 27), followed by data integration and digital platforms (n = 16) and animal health (n = 14). Governance and policy-related components were reported in fewer studies (n = 10), while environmental health was the least represented (n = 8). Despite strong national policies and digital platforms, implementation was uneven across counties and facility levels, with key constraints including workforce shortages, infrastructure gaps, fragmented financing, and limited use of surveillance data. These findings highlight persistent gaps in sub-national implementation and One Health integration that limit the effectiveness of AMR containment systems in Kenya.
Open access
Pharmaceutical and Antibiotic Environmental Impacts
Pedro Armando, Sonia Andrea Naeko Uema, Elena MarÃa Vega
Argentina is a federal republic with approximately 44 million people, divided into 23 provinces and an autonomous city, Buenos Aires. The health system is segmented into public, social security and private subsystems. The social security and private sectors cover more than 60% of the population. Total health expenditure in 2017 was 9.4% of gross domestic product. Primary health care (PHC) was considered as the principal strategy for universal coverage policy for health system reform in Latin America at the end of 20th century. The most remarkable characteristics of the Argentinian health system are its fragmentation and disorganization. An increase of public sector demands, due to a socioeconomic crisis, led to the subsequent collapse of the system, caused primarily by a sustained lack of investment. First care level decentralization to the Integral Health Service Delivery Networks (IHSDN) becomes the cornerstone of a PHC-based system. Pharmacists and community pharmacies are not formally mentioned in PHC policies or IHSDN. However, pharmacies are recognized as healthcare establishments as part of the first care level. Community pharmacists are the only health care professional whose profit comes from the margin on product sales. Contracts with social security and private insurances provide small margins which reduce the viability of community pharmacies. There is a preference by community pharmacies to diversify product sales instead of providing professional services. This is driven by marketing and economic pressures rather than patient care and health policies. Dispensing is the main professional activity followed by management of minor illness and associated product recommendations. Currently, there are no national practice guidelines or standard operating procedures for the provision of pharmaceutical services and there is no nationally agreed portfolio of services. National pharmacy organizations appear to have no official strategic statements or plans which would guide community pharmacies. There are some isolated experiences in community pharmacies and in public first care level pharmacies that demonstrate the possibilities and opportunities for implementing pharmaceutical services under the PHC approach. There is a real lack of integration of community pharmacies and pharmacists in the healthcare system.
OBJECTIVE: To evaluate implementation of the National Essential Medicines Scheme (NEMS) in rural China. METHODS: Two rural counties/districts in each of three provinces where NEMS had been implemented were surveyed. Information was collected from NEMS staff at the province, county/district, township and village levels; patients with chronic disease were also interviewed. Service provision, finances, prescriptions, inpatient records and the expenditures of patients with certain diagnoses were investigated in township hospitals and village clinics. The results were compared with the corresponding data recorded before NEMS was introduced. FINDINGS: Following the introduction of NEMS, drug procurement in each study location was systematized. Total drug costs declined. This, and improved prescribing, reduced the costs of outpatient and inpatient care and led, apparently, to increased uptake of health services. However, the prices of some drugs had increased and the availability of others had declined. The compensation of health-care providers for NEMS-related reductions in their incomes had been largely ineffective. As a result of the introduction of NEMS, health facilities relied more on public financing. Many health-care providers complained about higher workloads and lower incomes. CONCLUSION: Although it was well conceived, the introduction of NEMS into China's decentralized, fee-for-service system of health care has not been straightforward. It has highlighted the problems associated with attempts to modernize health care and health financing for patients' benefit. Sustainable mechanisms to compensate health-care providers for lost income are needed to ensure that NEMS is a success.