Ghana: pharmaceutical pricing study: policy analysis and recommendations.

Ghana has a long tradition of innovation and reform in the organization and delivery of its health services. The planned introduction of the National Health Insurance Fund (NHIF) follows earlier efforts to decentralize health service and drug management. The NHIF will replace the cash-and-carry system for financing health services medicines while maintaining local facility autonomy in managing their revolving drug funds (RDF). This autonomy increased local management’s discretion over drug procurement and pricing within clear guidelines. These guidelines state that public facilities should buy first from the public sector and should mark up at a fixed 10 percent margin for Regional Medical Stores (RMS) and for service delivery points (SDPs). The MOH/Ghana Health Services (GHS) has been receiving reports of noncompliance with these guidelines within the public sector. RMS and SDPs have reportedly increased their procurement from the private sector while the considerable variation in drug prices indicate margins in excess of 10 percent. To examine these issues and determine options for a more efficient effective and equitable pharmaceutical pricing policy a joint MOH/GHS and DELIVER team were commissioned to conduct a detailed pricing study. A team of six experts surveyed 67 public and private sector facilities in all ten regions in Ghana visiting facilities at the central regional and local level. The team tracked procurement and sales information for 35 tracer drugs through the public distribution system and attempted to compare international prices and the private distribution system. (excerpt)