Document Type : Original Article
Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Ghana
Department of Health Policy, Planning & Management, School of Public Health, University of Ghana, Legon, Ghana
Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Ghana
Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
London School of Hygiene and Tropical Medicine, London, UK
Nuffield Centre for International Health, University of Leeds, Leeds, UK
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
Implementing medicines pricing policy effectively is important for ensuring equitable access to essential medicines and ultimately achieving universal health coverage. However, published analyses of policy implementations are scarce from low- and middle-income countries (LMICs). This paper contributes to bridging this knowledge gap by reporting analysis of implementation of two medicines pricing policies in Ghana: value-added tax (VAT) exemptions and framework contracting (FC) for selected medicines. We analysed implications of actor involvements, contexts, and contents on the implementation of these policies, and the interplay between these. This paper should be of interest, and relevance, to policy designers, implementers, the private sector and policy analysts.
Data were collected through document reviews (n = 18), in-depth interviews (IDIs) (n = 30), focus group discussions (FGDs) (n = 2) and consultative meetings (n = 6) with purposefully identified policy actors. Data were analysed thematically, guided by the four components of the health policy triangle framework.
The nature and complexity of policy contents determined duration and degree of formality of implementation processes. For instance, in the FC policy, negotiating medicines prices and standardizing the tendering processes lengthened implementation. Highly varied stakeholder participation created avenues for decision-making and promoted inclusiveness, but also raised the need to manage different agendas and interests. Key contextual enablers and constraints to implementation included high political support and currency depreciation, respectively. The interrelatedness of policy content, actors, and context influenced the timeliness of policy implementations and achievement of intended outcomes, and suggest five attributes of effective policy implementation: (1) policy nature and complexity, (2) inclusiveness, (3) organizational feasibility, (4) economic feasibility, and (5) political will and leadership.
Varied contextual factors, active participation of stakeholders, nature, and complexity of policy content, and structures have all influenced the implementation of medicines pricing policies in Ghana.