Antibiotics, rational drug use and the architecture of global health in Zimbabwe

Rising concerns around antimicrobial resistance (AMR) have led to a renewed push rationalise antibiotic prescribing in low- and middle-income countries (LMICs). There is increasing unease conceptualising use as individuals behaving ‘(ir)rationally’ recognition that rising emergent of contributing wider economic political challenges. But between these individual societal ‘drivers’ an everyday articulation care through substances, written-in the scripts, delivery chains pedagogics global healthcare. This article focuses on this ‘architecture’ over time across spaces has knitted-in antibiotics rhetorics control inform current responses AMR. Based historically informed ethnographic research Zimbabwe, we examine points continuity change 20th Century rational drug (RDU) discourses contemporary socio-political formations AMR stewardship (AMS), paying particular attention their co-evolution with process pharmaceuticalisation. We illustrate how framework techniques RDU were embedded within programmes increase access essential medicines such complemented building one Africa's strongest postcolonial health systems Zimbabwe. Whilst was focused securing safety patients affordability for systems, AMS aim secure medicines. Continuous both persistent rhetoric ‘irrational use’. Health workers Harare, attuned values language programmes, enact practice architecture which been designed-in. illustrates struggle optimise framings action. propose reconfiguring frontline prescribers are able provide ‘good’ without necessarily turning antibiotics. To design-out reliance would require beyond '(ir)rationality', redrafting blueprints inscribe practice.