Brazilian healthcare bureaucracies and the production of antimicrobial resistance

Abstract

The growing concern over the rise of antimicrobial resistance (AMR) has brought to light the ways AMR is produced through interconnected structural, political, clinical, and biological factors. In this study, set in São Paulo, Brazil, we articulate how healthcare bureaucracies feature in this production of AMR in primary care by drawing on a series of interviews with primary care-based health professionals, health services managers, and policymakers, completed between late 2021 and early 2023. Our results show how expanding and contracting bureaucracies are highly politicized and variously contribute to the production of AMR in primary care. In particular, healthcare labour force dynamics and managerial relations within healthcare settings contribute to the bureaucratic elements of AMR risks in clinical practice. We argue that the invisibility of AMR in everyday practice is deeply entwined with its bureaucratic form; that is, with the instability between institutions and individual action, public and private sectors, work and clinical practice, and social and clinical entanglements of resistance.