Background: Antimicrobial resistance (AMR), recognised as a serious and growing threat to global health, is driven by antibiotic use. Understanding factors influencing antibiotic use is essential to design and implement effective interventions to reduce unnecessary antibiotic use and AMR. This study aims to explore the practices and views of the key actors associated with the use of antibiotics for pig farming in Thailand, from local farmers to officers in central government institutions. Methods: A total of 31 in-depth interviews were conducted with pig farmers (n=13), drug retailers (n=5), veterinarians (n=7), and government officers (n=3) and representatives of health professional councils (n=2). Direct observations were conducted in pig farms. Thematic analysis based on practices, views and interests of actors regarding antibiotic use in pig production in Thailand. Results: There are various factors influencing the use of antibiotics. The factors may trigger greater antibiotic use including lack of knowledge and awareness about antibiotics and AMR, economic incentives, and loose regulatory frameworks. Farmers considered that antibiotics are necessary to maintain animal health, prevent and control diseases, and ensure economic gains, so using antibiotics was considered a worthwhile investment in pigs. There was limited information about antibiotic use in the curriculum and lack of clinical practice guidelines for health professionals. Veterinarians faced challenges in diagnosis and lacked antibiotic prescribing guidelines. Pharmaceutical companies applied market promotion strategies to increase sales; and used professionals as mediators with farmers. There was no control of antibiotic sale and prescription via the regulatory environment. The national policy on AMR could be facilitating factor to optimise use of antibiotics but its influence was weak relative to other influences which favoured antibiotic use. Conclusions: Our study highlights the need to improve antibiotic use in pig production in Thailand. Access to veterinary services and reliable information about animal health needs to be improved among farmers. Innovative low-cost investment in biosecurity could improve farm management and decrease reliance on antibiotics. Developing professional training and clinical guidelines, and establishing a code of conduct, are needed to improve practices in antibiotic prescription and sale amongst health professionals and industry.

Background Thailand, an upper-middle country, had demonstrated exemplary outcomes of Universal Health Coverage (UHC). The country has achieved UHC since 2002 when the whole population was covered by the three public health insurance schemes. Prior studies do not provide long series of UHC financial risk protection. This study assessed financial risk protection as measured by the incidence of catastrophic health spending and impoverishment in Thai households prior to and after UHC in 2002.Methods We used data from a fifteen-year series of annual national household socioeconomic surveys between 1996 and 2015, which were conducted by the National Statistical Office. The survey covered about 52,000 nationally representative households in each round. Descriptive statistics were used to assess the incidence of catastrophic payment as measured by the share of out-of-pocket payment for health by households exceeding 10% and 25% of household total consumption expenditure, and the incidence of impoverishment as determined by additional number of non-poor households falling below the national and international poverty lines after health payment.Results Using the 10% threshold, the incidence of catastrophic spending dropped from 6.0% in 1996 to 2% in 2015. This incidence reduced more significantly when 25% threshold was applied (from 1.8% to 0.4% in the same period). The incidence of impoverishment against national poverty line reduced considerably, from 2.2% in 1996 to approximately 0.3% in 2015. When the international poverty line of US$ 3.1 per capita per day was used, the incidence of impoverishment was 1.4% and 0.4% in 1996 and 2015 respectively; and when US$ 1.9 per day was applied, the incidence was negligibly low.Conclusion The significant decline in the incidence of catastrophic health spending and impoverishment was attributed to the deliberate design on the Thai UHC that provides comprehensive benefit package, zero co-payment at point of services. The well-founded healthcare delivery systems also play critical role in supporting and sustaining the function of the UHC.

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