Paper short abstract:

The prioritisation of global human antibiotic reduction obscures their inseparability from past national policy. We take the case of Thailand and its metrics. We demonstrate how Thailand's research played a role in the WHO's GAP as "global assemblage", which extends to local health centres.

Paper long abstract:

We argue that the prioritisation of global human antibiotic reduction imperatives, obscures their inseparability from past national and sub-national policy, research and programmes. We take the case of Thailand and its development of metrics to monitor and evaluate the reduction of human antibiotic use as a means to explore. We demonstrate how Thailand's research and policy on antibiotic use and rational drug programmes have played an important role in the development of the WHO's GAP as "global assemblage", which now extends to health centres in Thailand, where health workers responsibilised for the reduction of national antibiotic use. Analysing practices of diagnosis, prescription and data entry, guidelines and policy documents as well as a graphical user interface for monitoring staff's performance together with interviews of key policy actors, we argue that antibiotic use targets disrupt, but do not always change, health workers' prescription practices in ways intended. In fact, health workers and patients create ways to continue caring while also creating data that meets the designated prescriptions targets. This follows what we call a form of 'conscientious practice', a means by which health workers attempt to maintain their professional legitimacy, sustain patient care and the semblances of functioning the "global assemblage" of human antibiotic reduction. Given the concern for AMR, we call on those in global health and national policy to consider the limitations of targeting health worker prescriptions. Furthermore, we call for more discussions of the relations between categories of global, national and local and the potential consequences for care.