Philip Afeti Korto, the writer


In general, public policies are designed
or formulated to solve defined public problems that affect society as a whole
or only a segment of society.

In tandem with the foregoing assertion,
one may submit poignantly that regardless of how a public policy is designed to
look nice on paper, the public problem the policy is meant to address would
remain unresolved if the policy was not implemented effectively within the
required period and with the required resources.

As such, it is advisable that
policymakers should involve the street-level bureaucrats implementing policy
right from the policy formulation stage.

If public policy is meant to solve a
public problem, must policy implementation rather worsen an existing situation?

54 Medicine Framework Contract/ Policy introduced by the MOH

In any curative medical treatment of
disease conditions, the timely administration of the prescribed medications in
the right doses cannot be overlooked. In this vein, the required medications must
be timely accessible to patients at affordable prices especially when a
positive correlation has long been established between a healthy population and
economic growth of a nation.

Until the Ministry of Health (MOH)
introduced the policy that chiefly seeks to scrap 17.5% VAT on some essential
medicines in the country, various health facilities under the auspices of the
Ghana Health Service (GHS) used to procure the 54 restricted medications under
the framework contract from the respective Regional Medical Stores (RMS) or
from private suppliers /open market with certificates of non-availability
issued by the RMS.

With the introduction of what I call the
54 medicines policy, health facilities in the GHS can no longer procure those
medicines from private suppliers and for that matter, the RMS will not issue
the certificates of non-availabilty for the procurement of such medications
from open market.

The 54 medications listed under the
policy include but not limited to:

1. Anti-malarial drugs 2. Analgesics
e.g. plain paracetamol, Ibuprofen

3. Antihypertensive drugs

4. Antibiotics

5. Antidepressants

6. Anti-ulcers

7. Anti-diabetics and

8. Hematenics

Perhaps the most interesting one is ORS.

These are basic or essential medications
that must not be in short supply at the hospitals but the policy is making it
difficult for the hospitals to procure those medications from other sources
even if the Regional Medical Stores do not have consignments to supply.

In a free market situation, the market
forces of demand and supply must be free from any intervention by a government
or other authority and from all forms of economic privileges, monopolies and
artificial scarcities.

 Methinks Ghana is not inimical to competition
and free market dynamics to warrant the limits the supply of the 54 framework
contract medicines by only some selected suppliers. However, the policy itself
may not be totally bad especially on paper.

beauty of the 54 Medicine Policy

As noted in the introduction of this
article, a public policy is designed to solve a public problem. The proposed
and adopted solutions to the defined problem tend to become or paint out the
objectives of a given public policy.

According to the MOH therefore, the 54
medicine policy is primarily meant to cut down the prices of those medications
by 30%.

One would therefore agree unreservedly
that the policy objective makes the policy beautiful on paper because the
intentions are not antagonistic to the course of affordable healthcare delivery
on the altar of Universal Health Coverage (UHC) at all. On paper, the policy is
pro-poor in nature but the hurdle lies with its effective implementation.

Policy Implementation and Policy Failure

Empirically, policy failure may be
attributed to heterogeneity of factors such as delayed resource allocation,
wrong implementation method, problem not well defined, policy implementers or
street-level bureaucrats not involved in the policy design hence their
discretions at the implementation stage work against attainment of policy

Per the arrangements put in place for
implementing the 54 medicine policy, some 16 selected pharmaceutical companies
are required to supply the selected medicines to the Regional Medical Stores.

 As indicated earlier, the health facilities
cannot procure these medications from any other source apart from the RMS.

It is sad to observe, contrariwise to
this structured arrangement also called the Blanket Purchase Agreement (BPA)
that the 54 selected essential medications have been in short supplies at the
public hospitals as a result of the policy because each of the 10 RMS does not
have stock. It can be logically inferred therefore that the RMSs do not equally
get enough supplies from the 16 selected pharmaceutical companies. These artificial
shortage of the 54 essential medicines does not only work against the beauty of
the policy and its main objective but can also lead to preventable deaths or
much cost for the patients to treat the disease conditions those medicines cure
or treat. If so, where lies the intended value in cutting down the prices of
those medicines by 30%?

Another implication is that the policy
implementers at the health facility may be compelled to use their discretions
contrary to the policy directives and stock the medications to prevent
badmouthing by the patients. As it is now, authorities of public hospitals are
facing the wrath of patients for the former’s failure to dispense basic
medications like plain paracetamol, folic acid, ORS etc to patients. If this is
not an alarming and a frustrating situation, then what should it be called? The
preventable shortage of the selected medications at public hospital
dispensaries leads to conundrum between the patients and the frontline workers
at the pharmacies because the hospital pharmacies have been unable to serve
prescriptions containing the protected medications.


Naturally, it behooves one who critiques
a policy or an arrangement to equally propose alternative solutions to dealing
with the problem at hand. I will therefore attempt some recommendations.

Methinks in order to forestall the total
failure of the 54 medicine policy, the MOH should:

1. Focus on the timely supply of the
medicines to the RMS.

2. Permit the RMS or the facilities to
replenish stock from private suppliers when necessary.

3. Even remove the policy to restore the
old procurement arrangement in place for these medicines.


It has been established empirically that
most public policies in Africa fail at the point of implementation. It is thus
the duty of policymakers to attach seriousness to policy implementation just as
they do to Policymaking. Again, street-level bureaucrats implementing policy
must be involved right from the agenda setting stage of public policy.

Until then, one can only hope that the
MOH will reason with the writer so as to forestall artificial shortages of such
essential medicines at our public hospitals. TO say the 54 selected medicines
are essential alone means a lot to quality healthcare delivery with Universal
Health Coverage in mind.

Asante Sana.

Source: Philip Afeti Korto

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