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Pharma-cartography: Navigating the complexities of antibiotic supply to rural livestock in West Bengal, India, through value chain and power dynamic analysis

Hennessey, Mathew; Ebata, Ayako; Samanta, Indranil; Mateus, Ana; Arnold, Jean-Christophe; Day, Dominic; Gautham, Meenakshi; Alarcon, Pablo


Mathew Hennessey

Ayako Ebata

Indranil Samanta

Ana Mateus

Jean-Christophe Arnold

Dominic Day

Meenakshi Gautham

Pablo Alarcon


Lian Francesca Thomas


Antibiotic resistance threatens provision of healthcare and livestock production worldwide with predicted negative socioeconomic impact. Antibiotic stewardship can be considered of importance to people living in rural communities, many of which depend on agriculture as a
source of food and income and rely on antibiotics to control infectious diseases in livestock. Consequently, there is a need for clarity of the structure of antibiotic value chains to understand the complexity of antibiotic production and distribution in community settings as this
will facilitate the development of effective policies and interventions. We used a value chain approach to investigate how relationships, behaviours, and influences are established during antibiotic distribution. Interviews were conducted with key informants (n = 17), value chain stakeholders (n = 22), and livestock keeping households (n = 36) in Kolkata, and two rural sites in West Bengal, India. Value chain mapping and an assessment of power dynamics, using manifest content analysis, were conducted to investigate antibiotic distribution and identify entry points for antibiotic stewardship. The flow of antibiotics from manufacturer to stockists is described and mapped and two local level maps showing distribution to final
consumers presented. The maps illustrate that antibiotic distribution occurred through numerous formal and informal routes, many of which circumvent antibiotic use legislation. This was partly due to limited institutional power of the public sector to govern value chain
activities. A ‘veterinary service lacuna’ existed resulting in livestock keepers having higher reliance on private and informal providers, who often lacked legal mandates to prescribe and dispense antibiotics. The illegitimacy of many antibiotic prescribers blocked access to formal training who instead relied on mimicking the behaviour of more experienced prescribers–who also lacked access to stewardship guidelines. We argue that limited institutional power to enforce existing antibiotic legislation and guide antibiotic usage and major gaps in livestock healthcare services make attempts to curb informal prescribing unsustainable. Alternative options could include addressing public sector deficits, with respect to both healthcare services and antibiotic provision, and by providing resources such as locally relevant antibiotic guidelines to all antibiotic prescribers. In addition, legitimacy of informal prescribers could be revised, which may allow formation of associations or groups to incentivise good antibiotic practices.


Hennessey, M., Ebata, A., Samanta, I., Mateus, A., Arnold, J., Day, D., …Alarcon, P. (in press). Pharma-cartography: Navigating the complexities of antibiotic supply to rural livestock in West Bengal, India, through value chain and power dynamic analysis. PLoS ONE, 18(2), e0281188.

Journal Article Type Article
Acceptance Date Jan 18, 2023
Online Publication Date Feb 2, 2023
Deposit Date May 17, 2023
Publicly Available Date May 22, 2023
Journal PLOS ONE
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 18
Issue 2
Pages e0281188
Keywords Multidisciplinary


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