Pharmaceutical Governance and Access to Quality Medicines in Ghana

Abstract

Medications play a critical role in modern healthcare delivery, serving preventive and curative purposes while mitigating any negative effects caused by drugs. The discovery of medicine has enabled the management and cure of ailments such as sepsis, malaria, and HIV. Access to essential medicines is a cornerstone of achieving Universal Health Coverage, but poor governance poses a significant obstacle to this goal. Ghana has made strides in pharmaceutical governance, but studies have uncovered issues such as inadequate availability of medicines for National Health Insurance Subscribers and the prevalence of substandard and falsified medications. Existing studies that could help explain these problems were found to have some gaps which this study was designed to fill. Therefore, this study aimed to discover how governance of the pharmaceutical life cycle influences access to quality medicines in Ghana. This study was conducted using institutional theory as its context and guided by the philosophy of pragmatism in its choice of methodology. As a result, a mixed method research approach was employed. The sample size for the quantitative data consisted of 500 healthcare seekers who had visited health facilities within two weeks before data collection. For the qualitative data, 40 participants with significant experience at health facilities were purposefully selected, along with pharmacists of hospitals, managers of community pharmacies, and itinerant medicine sellers. The quantitative data was analysed with descriptive statistics and probit regression. Thematic analysis was used to analyse the qualitative data. The study discovered that while Municipal hospitals claim that they adhere to prescription regulations, the teaching hospital considered some of the regulations as outdated and unsuitable for a tertiary hospital. Patient involvement in the prescription process was also investigated, which revealed a moderate level of patient involvement in the prescription process. It was also discovered that prescribers were involved in medicine sales to patients. Overall, the study found that the prescription behaviour of health professionals significantly impacts the affordability of medicines for health seekers. Waiting time at the dispensary, organisation of the dispensary, and information on dosage and side effects were identified as factors that affect the rational use of medicines by patients. Additionally, the study found that Ghana's medicine pricing policies affected the availability of medicines for National Health Insurance subscribers at medicine outlets. Finally, the study assessed the functions of the FDA in regulating medicine quality in Ghana. It was found that the FDA effectively works to eliminate substandard and falsified medicines but struggles with regulating herbal medicines due to social values. It also faces problems due to its collaboration with other state agencies, leading to poor-quality medicines in Ghana. Overall, this study contributes significantly to empirical literature and Institutional theory by demonstrating that applying the elements of good governance can facilitate the isomorphic process explained by the Institutional theory.