How and Why Pharmaceutical Reforms Contribute to Universal Health Coverage Through Improving Equitable Access to Medicines: a Case of Ghana

Overview

Journal Front Public Health

Specialty Public Health

Date 2023 Jul 24

PMID 37483923

Authors

Augustina Koduah

Affiliations

Soon will be listed here.

Abstract

Background: Examining how and why a country prioritizes and implements pharmaceutical reforms tends to show complex processes and myriad efforts made toward improving access to medicines. This study examines factors that enabled the prioritization and implementation of selected pharmaceutical reform items and how these factors contributed to improving equitable access to medicines and universal health coverage in Ghana.

Methods: An analytical framework was developed to identify variables to explore in answering the study questions and frame the analysis and presentation of findings. Documents analyzed included the National Medicines Policies, Health Sector Program of Work, and other health policies. Quantitative data were sourced from databases maintained by World Health Organization and the Institute for Health Metrics and Evaluation.

Results: The three main factors, evidence, financial and technical support, and alignment to national and global policies, influenced the prioritization and implementation of access to medicines reforms. The reforms targeted rational selection and use of medicines, medicine pricing, sustainable medicine financing, and regulatory and supply chain systems. Although there were limited quantitative data to quantify access to medicine policies" impact on universal health coverage, it can be reasonably assumed that, in Ghana, access to medicine policies has contributed to financial protection and improved access to quality health services.

Conclusion: Access to medicine policies targeted at promoting rational medicine selection and use, regulating medicine pricing and improving sustainable financing for medicines as well as the regulatory and supply chain systems arguably contributed to the attainment of UHC and must be sustained. Therefore, data collection and reporting indicators for access to medicines must be prioritized.

References

Gotham D, Onarheim K, Barber M . How the MDGs gave up on measuring access to medicines. Lancet Glob Health. 2016; 4(5):e296-7. DOI: 10.1016/S2214-109X(16)00066-8. View

Perehudoff K, Demchenko I, Alexandrov N, Brutsaert D, Ackon A, Duran C . Essential Medicines in Universal Health Coverage: A Scoping Review of Public Health Law Interventions and How They Are Measured in Five Middle-Income Countries. Int J Environ Res Public Health. 2020; 17(24). PMC: 7765934. DOI: 10.3390/ijerph17249524. View

Luiza V, Mendes L, Tavares N, Bertoldi A, Fontanella A, Oliveira M . Inappropriate use of medicines and associated factors in Brazil: an approach from a national household survey. Health Policy Plan. 2019; 34(Supplement_3):iii27-iii35. PMC: 6901078. DOI: 10.1093/heapol/czz038. View

Chebolu-Subramanian V, Sundarraj R . Essential medicine shortages, procurement process and supplier response: A normative study across Indian states. Soc Sci Med. 2021; 278:113926. DOI: 10.1016/j.socscimed.2021.113926. View

Zhang C, Rahman M, Rahman M, Yawson A, Shibuya K . Trends and projections of universal health coverage indicators in Ghana, 1995-2030: A national and subnational study. PLoS One. 2019; 14(5):e0209126. PMC: 6530887. DOI: 10.1371/journal.pone.0209126. View

Koduah A, Asare B, Gavor E, Gyansa-Lutterodt M, Andrews Annan E, Ofei F . Use of evidence and negotiation in the review of national standard treatment guidelines and essential medicines list: experience from Ghana. Health Policy Plan. 2019; 34(Supplement_2):ii104-ii120. DOI: 10.1093/heapol/czz107. View

Koduah A, van Dijk H, Agyepong I . The role of policy actors and contextual factors in policy agenda setting and formulation: maternal fee exemption policies in Ghana over four and a half decades. Health Res Policy Syst. 2015; 13:27. PMC: 4450986. DOI: 10.1186/s12961-015-0016-9. View

Bigdeli M, Jacobs B, Tomson G, Laing R, Ghaffar A, Dujardin B . Access to medicines from a health system perspective. Health Policy Plan. 2012; 28(7):692-704. PMC: 3794462. DOI: 10.1093/heapol/czs108. View

Perehudoff K . Universal access to essential medicines as part of the right to health: a cross-national comparison of national laws, medicines policies, and health system indicators. Glob Health Action. 2020; 13(1):1699342. PMC: 7605313. DOI: 10.1080/16549716.2019.1699342. View

10.

Atim C, Koduah A, Kwon S . How and why do countries make Universal Health Care policies? Interplay of country and global factors. J Glob Health. 2021; 11:16003. PMC: 8645244. DOI: 10.7189/jogh.11.16003. View

11.

Ozawa S, Higgins C, Yemeke T, Nwokike J, Evans L, Hajjou M . Importance of medicine quality in achieving universal health coverage. PLoS One. 2020; 15(7):e0232966. PMC: 7347121. DOI: 10.1371/journal.pone.0232966. View

12.

Onwujekwe O, Uguru N, Russo G, Etiaba E, Mbachu C, Mirzoev T . Role and use of evidence in policymaking: an analysis of case studies from the health sector in Nigeria. Health Res Policy Syst. 2015; 13:46. PMC: 4619441. DOI: 10.1186/s12961-015-0049-0. View

13.

Stevens H, Huys I . Innovative Approaches to Increase Access to Medicines in Developing Countries. Front Med (Lausanne). 2017; 4:218. PMC: 5725781. DOI: 10.3389/fmed.2017.00218. View

14.

Gautier L, Ridde V . Health financing policies in Sub-Saharan Africa: government ownership or donors' influence? A scoping review of policymaking processes. Glob Health Res Policy. 2017; 2:23. PMC: 5683243. DOI: 10.1186/s41256-017-0043-x. View

15.

Agyepong I, Adjei S . Public social policy development and implementation: a case study of the Ghana National Health Insurance scheme. Health Policy Plan. 2008; 23(2):150-60. DOI: 10.1093/heapol/czn002. View

16.

Agyepong I, Abankwah D, Abroso A, Chun C, Dodoo J, Lee S . The "Universal" in UHC and Ghana's National Health Insurance Scheme: policy and implementation challenges and dilemmas of a lower middle income country. BMC Health Serv Res. 2016; 16(1):504. PMC: 5031274. DOI: 10.1186/s12913-016-1758-y. View

17.

Khan M, Meghani A, Liverani M, Roychowdhury I, Parkhurst J . How do external donors influence national health policy processes? Experiences of domestic policy actors in Cambodia and Pakistan. Health Policy Plan. 2017; 33(2):215-223. PMC: 5886092. DOI: 10.1093/heapol/czx145. View

18.

. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396(10258):1250-1284. PMC: 7562819. DOI: 10.1016/S0140-6736(20)30750-9. View

19.

Piggott T, Nowak A, Brignardello-Petersen R, Cooke G, Huttner B, Schunemann H . Global status of essential medicine selection: a systematic comparison of national essential medicine lists with recommendations by WHO. BMJ Open. 2022; 12(2):e053349. PMC: 8845216. DOI: 10.1136/bmjopen-2021-053349. View

20.

Koduah A, Agyepong I, van Dijk H . 'The one with the purse makes policy': Power, problem definition, framing and maternal health policies and programmes evolution in national level institutionalised policy making processes in Ghana. Soc Sci Med. 2016; 167:79-87. DOI: 10.1016/j.socscimed.2016.08.051. View