Ghana’s shifting allegiances in access to medicines

Posted on 21 September 2009

by Alexander Dodoo and David Ofori-Adjei

Working in a multi-stakeholder process has had surprising outcomes for those involved in MeTA Ghana. A range of stakeholders involved in the medicines supply chain in Ghana are coming together in new ways that are changing patterns of doing business and shifting allegiances around topics of concern. Since November 2008 when MeTA Ghana held its inaugural meeting, 18 stakeholders from the public, private and civil society sectors have been meeting at regular council meetings. These include representatives from a civil society umbrella group, the Ghana Medical Association, the Pharmaceutical Society of Ghana, the National Health Insurance Scheme, the Food and Drugs Board (National Drug Regulatory Agency), the Ministry of Trade and Industry, the Ministry of Health, pharmacy wholesalers, community pharmacists, and private medical doctors and pharmacists and academics from universities.

So far the collaborative effort is working well and stakeholders are starting to let go of their extreme positions. Long held assumptions about each others’ interests are beginning to disappear. Some stakeholders, for example, have been surprised at the willingness of the pharmaceutical industry to participate and get involved. There was a widely held assumption that ‘industry’ or the private sector would not be interested in disclosure and openness, the central commitment that MeTA requires. But the local pharmaceutical industry is very interested in participating in MeTA as it gives them an opportunity to disclose information and quash misplaced beliefs that gaps and inefficiencies in the medicines supply chain are caused by them.

In MeTA Ghana the particular stakeholder interests are so varied, the main activity that binds them together is participation on the MeTA Council. However they all have a broad interest in making medicines more accessible. During the dialogue that takes place during the Council meetings, allegiances shift on different topics. For example, MeTA Ghana is trying to tackle the key issue of sub-standard and counterfeit medicines including the problem of legitimately imported or produced drugs being stored badly after they have arrived at the port. MeTA Ghana therefore became interested in testing products at the point of sale. Some Council members proposed to have mini-lab testing carried out by academic institutions alone, but through discussion and dialogue they began to see that it made sense to include the Drug Regulatory Agency (Food and Drugs Board). MeTA Ghana is now working with the Drug Regulatory Agency to test the quality of medicines through four mini-labs across the country and is providing the financial support to be able to test more.

MeTA’s goal of increasing the transparency of information around medicines is also starting to be realised, as the Minister of Health in Ghana accepted the MeTA Council’s proposal to be allowed access to the new National Health Insurance Scheme Database. A statistician is now examining the health insurance database on a regular basis to find out what medicines are prescribed, at what cost to the country, and with what effectiveness. Already there is some evidence of possible over- and inappropriate prescribing, over-use and abuse. It is a new starting point to tackle the problem.

Civil society organisations play a critical role on the MeTA Council. They have the ability to hold powerful institutions to account, and they also contribute to consumer education and public awareness. MeTA Ghana aims to inform the public about rational use of medicines and help to create citizens who are alert to medicines quality and price and can inform officials about suspect counterfeit or over-priced drugs.

MeTA Council members know that this is a long process. The long-term strategy includes the disclosure of public tenders: who won, at what price, at what cost. All stakeholders buy into this and are aware that this stage cannot be reached on ‘Day 1’, but they know they need to start creating a culture of reporting and sharing information. More difficult or sensitive issues can be approached when this is more fully developed. 

Each sector has an interest in making medicines more accessible and it is the representation and participation of each stakeholder group that is making the process work. There is a clear sense of mutual ownership and MeTA Ghana is doing all that it can to ensure this continues.

Dr. Alexander Dodoo is Senior Research Fellow at University of Ghana Medical School and Co-Chair of the Medicines Transparency Alliance in Ghana.

Professor David Ofori-Adjei is Professor at the University of Ghana Medical School and Co-Chair of the Medicines Transparency Alliance in Ghana.

A longer version of this article in Africa Health - Volume 31: No 6, is available here