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Related post: Disease Initiative (the U.S. Agency for International Development, PAHO,
and neighboring countries), began to design a pilot intervention to persuade
community members to change the way they used medicines to treat respi-
ratory and diarrheal diseases among children under age ??ve.
� Imagine that you were part of the task force. Identify the main target au-
diences for changing antibiotic use in these children and the behaviors
that each target audience should adopt.
� Assess the underlying determinants of the behaviors that contribute to
the development of antimicrobial resistance.
� Propose how you would persuade the target audiences to adopt the new
� Identify the four Ps (product, place, price, and promotion) that you think
the steering committee should recommend as the main components of
Homedes, N., and A. Ugalde. 2001. �Improving the Use of Order Donepezil Pharmaceuticals through
Patient and Community Level Interventions.?? Social Science and Medicine 52:
INS (Instituto Nacional de Salud). 2003. Vigilancia de la Resistencia Antimicrobiana
en el Peru. Informe Peru. Lima: INS.
Ministry of Health (Peru). 2006. �Evaluacion de la Situacion de los Medicamentos
en el Peru.?? Ministry of Health, Department of Medicines, Consumables, and
Drugs (MINSA/DIGEMID), Lima. http://www.digemid.minsa.gob.pe/daum/
Mitnick, C., J. Bayona, E. Palacios, S. Shin, J. Furin, F. Alcantara, E. Sanchez,
M. Sarria, M. Purchase Donepezil Becerra, M. C. Smith, S. Fawzi, D. Kapiga, D. Neuberg, J. H.
Maguire, J. Y. Kim, and P. Farmer. 2003. �Community-Based Therapy for
Multidrug-Resistant Tuberculosis in Lima, Peru.?? New England Journal of
Medicine 348 (2): 119�28.
PAHO/SAIDI (Pan Buy Donepezil American Health Organization and South American Infectious
Disease Initiative). Donepezil Online 2009. Per??l de Pais Peru Resistencia Antimicrobiana.
Washington, DC: PAHO.
Ramis, O. 2007. �Medicines Transparency Alliance Peru Scoping Study.?? DFID
Health Resource Centre, London.
Changing the Use of Antibiotics in Peru 283
WHO (World Health Organization). 2002. �Antimicrobial Resistance.?? Fact sheet
N�194, WHO, Geneva. http://www.who.int/mediacentre/factsheets/fs194/en/.
. 2009. �Rational Use of Medicines.?? http://www.who.int/medicines/areas/
rational_use/en/. Accessed September 24, 2009.
Yeager, B., E. Barillas, A. Sosa, and A. Barojas. 2006. �Workshop Order Donepezil Online with SAIDI
National and International Partners to Prioritize the Objectives and Activities of
a Plan to Contain and Prevent Antimicrobial Resistance in Paraguay?? and SAIDI
Steering Committee Meeting, June 20�30. Submitted to United States Agency
for International Development by the Rational Pharmaceutical Management
Plus Program. Management Sciences for Health, Arlington, VA. http://pdf.usaid.
284 Case Study H
Re?ections on the Use of Antibiotics in Peru
The group that developed the campaign in Callao identi??ed mothers of
young children as the most important target audience because they were
the ones purchasing the medicines and supervising their use. The mothers
were busy and not easy to reach. Clearly, they were concerned with the
health of their children, but they also had both economic and time con-
straints to manage. And in communicating to those mothers, the interven-
tion�s planners did not want to simply come out against the use of antibiotics.
Instead the public health community needed those mothers to continue to
use antibiotics but to use them in a more restrained and appropriate fashion.
The second-most-important actors were doctors and pharmacists. As
noted in the case, they had obvious economic motives for collaborating in
the pervasive polypharmacy. Doctors also desired both to please patients
and, in public clinic settings, to move them through quickly. In such situa-
tions they had every reason to promptly provide patients with the prescrip-
tions they expected. But neither health professionals nor most mothers
wanted to contribute to a rise in antimicrobial resistance that would cause
them all signi??cant problems in the years ahead.
After considering these factors, the committee decided that an intensive,
one-week campaign was needed to get the attention of the public and to
shift the community toward a �healthy culture?? focused on the rational use
of antibiotics. Buy Cheap Donepezil The campaign was designed in response to the considerations
reviewed above: �Los Antimicrobianos son necesarios . . . debemos usarlos con
responsabilidad?? (Antimicrobial drugs are Generic Donepezil necessary we must use them
The week began with a press conference, and the campaign was
announced with huge posters all over the city. During the week, marches,
festivals, and other public events were held, all with press coverage. Cam-
paign materials were distributed in schools, in pharmacies, and on the
street. Materials with the campaign logo and slogan were produced and
� 10,000 pens
� 5,500 spiral notebooks
� 10,000 magnetic mini phone books
� 15,000 posters
� 50,000 bifold brochures
� 5,000 plastic bags
� 5,000 folders.
Changing the Use of Antibiotics in Peru Buy Donepezil Online 285
The campaign Purchase Donepezil Online organizers hoped that a saturation effort would expose
most of the target audience repeatedly to the message about �responsible
use?? as they traversed their life-path points during the week.
The more detailed messages for consumers attempted to spell out the
implications of the general slogan and appealed to mothers� sense of respon-
sibility. They included a number of themes designed to move the commu-
nity toward rational use and away from both self-medication and purchasing
medicines from the informal sector:
� Using antimicrobials without a doctor�s prescription is harmful to your
health and that of your family.
� Antimicrobials from the black market put your life at risk.
� Caring for your health is your responsibility. If you feel ill, go to a health
� Buy antimicrobials in pharmacies and drugstores registered with the
ministry of health.
� When you are prescribed medications, complete the entire treatment.
� Taking antimicrobials when you have a virus will not cure your infection.
A complementary set of messages was produced for doctors and other
health workers. Miniconferences were held at hospitals and at the local
university to convince these professionals that they had a responsibility to
improve the use of antibiotics. To appeal to this target audience�s intrinsic
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