How Health Policies Shape Antibiotic Use: A Nationwide Study of “Access”-Group Antibiotics Availability and Consumption in a Middle-Income Country: The Case of Kazakhstan

Background/Objectives: Few studies have examined how health policies may influence antibiotic consumption at a global level, particularly with respect to the World Health Organization (WHO) “Access” group antibiotics. Our present study aims to address this gap by investigating how health policies affect the availability of “Access” antibiotics in a middle-income country of Kazakhstan. Methods: This study employed a mixed-methods approach: the quantitative component consisted of a time series analysis of “Access” antibiotic consumption within the period 2017–2024; the qualitative component involved an analysis of health policies centered on regulating the availability of “Access” antibiotics and their prescription at the primary care level. Results: A declining trend in the consumption of “Access” antibiotics was observed during the period from 2017 to 2023; however, in 2024 there was a rebound in consumption. The consumption of “Access” antibiotics did not reach the 60% threshold recommended by the WHO. A total of 50 “Access” antibiotics were found to be unavailable in the country, of which 9 are included in the WHO Essential Medicines List. Analysis of health policies highlighted that the registration of medicines may only be initiated by the manufacturer or its representative. Furthermore, analysis of national standards of care for common infections in primary care indicated a preference for prescribing “Watch” antibiotics, or prescribing antibiotics where their use would not be indicated. Conclusions: A coordinated policy response is needed in Kazakhstan to strengthen antimicrobial stewardship, including improving the availability of “Access” antibiotics, decentralization, revising national standards of care, and addressing regulatory barriers to medicine registration.