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 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?
The 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 access 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 unavailability for the procurement of such medications from the 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
6. Anti ulcers
7. Antidiabetics and
Perhaps the most interesting one is the 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.
The Beauty of the 54 Medicine Policy
As noted in the introduction of this article, 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.
Partial Policy Implementation and Policy Failure
Empirically, policy failure may be attributed to the heterogeneity of factors such as delayed resource allocation, wrong implementation method, the 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 the attainment of policy objectives.
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 shortages of the 54 essential medicines do 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.