Health system determinants of access to essential medicines for children with cancer in Ghana
Background Evidence of the context-specific challenges related to childhood cancer drug (CCD) access is vital to improving outcomes for children with cancer in low- and middle-income countries, such as Ghana. We sought to determine the availability and cost of essential CCD in Ghana and identify the...
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| Format: | Article |
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/9/e002906.full |
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| author | Avram Denburg Sumit Gupta Rhonda Boateng Lorna Renner Kadia Petricca |
| author_facet | Avram Denburg Sumit Gupta Rhonda Boateng Lorna Renner Kadia Petricca |
| author_sort | Avram Denburg |
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| description | Background Evidence of the context-specific challenges related to childhood cancer drug (CCD) access is vital to improving outcomes for children with cancer in low- and middle-income countries, such as Ghana. We sought to determine the availability and cost of essential CCD in Ghana and identify the underlying determinants of access.Methods Our study integrated quantitative data on drug prices and availability with qualitative insights into health system and sociopolitical determinants of CCD access in Ghana. We analysed retrospective monthly price and stock data for 41 cancer and supportive care drugs on the WHO Essential Medicines List (EML) from private retail and public institutional pharmacies. Non-parametric analyses evaluated relationships between drug price and availability, and impacts of drug class and formulation on availability and procurement efficiency. We assessed the determinants of drug access through thematic analysis of policy documents and semi-structured interviews (n=21) with key health system stakeholders.Results Ghana lists only 47% of essential CCD on its National EML, revealing gaps in domestic formulary inclusion. Stock-outs occurred for 88% of essential CCD, with a 70-day median stock-out duration; 32% had median price ratios above internationally-accepted efficiency thresholds. Drugs procured inefficiently were more susceptible to stock-outs (p=0.0003). Principal determinants of drug access included: (1) lack of sociopolitical priority afforded childhood cancer and (2) the impact of policy and regulatory environments on drug affordability, availability and quality. Establishment of a population-based cancer registry, a nationally-coordinated procurement strategy for CCD, public financing for childhood cancer care and policies to control drug costs emerged as priority interventions to improve drug access in Ghana.Conclusion Our study provides context-specific evidence to enable responsive policy development for efficient drug procurement and supply management in Ghana and establishes a rigorous approach to the analysis of childhood cancer drug access in similar health system settings. |
| format | Article |
| id | doaj-art-82e04174957c4d8287a94de11175732c |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-82e04174957c4d8287a94de11175732c2025-08-20T02:20:58ZengBMJ Publishing GroupBMJ Global Health2059-79082020-09-015910.1136/bmjgh-2020-002906Health system determinants of access to essential medicines for children with cancer in GhanaAvram Denburg0Sumit Gupta1Rhonda Boateng2Lorna Renner3Kadia Petricca4Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, CanadaDivision of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, CanadaUnit for Policy and Economic Research in Childhood Cancer, Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, CanadaUniversity of Ghana Medical School, Korle Bu Teaching Hospital, Accra, Greater Accra, GhanaChild Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, CanadaBackground Evidence of the context-specific challenges related to childhood cancer drug (CCD) access is vital to improving outcomes for children with cancer in low- and middle-income countries, such as Ghana. We sought to determine the availability and cost of essential CCD in Ghana and identify the underlying determinants of access.Methods Our study integrated quantitative data on drug prices and availability with qualitative insights into health system and sociopolitical determinants of CCD access in Ghana. We analysed retrospective monthly price and stock data for 41 cancer and supportive care drugs on the WHO Essential Medicines List (EML) from private retail and public institutional pharmacies. Non-parametric analyses evaluated relationships between drug price and availability, and impacts of drug class and formulation on availability and procurement efficiency. We assessed the determinants of drug access through thematic analysis of policy documents and semi-structured interviews (n=21) with key health system stakeholders.Results Ghana lists only 47% of essential CCD on its National EML, revealing gaps in domestic formulary inclusion. Stock-outs occurred for 88% of essential CCD, with a 70-day median stock-out duration; 32% had median price ratios above internationally-accepted efficiency thresholds. Drugs procured inefficiently were more susceptible to stock-outs (p=0.0003). Principal determinants of drug access included: (1) lack of sociopolitical priority afforded childhood cancer and (2) the impact of policy and regulatory environments on drug affordability, availability and quality. Establishment of a population-based cancer registry, a nationally-coordinated procurement strategy for CCD, public financing for childhood cancer care and policies to control drug costs emerged as priority interventions to improve drug access in Ghana.Conclusion Our study provides context-specific evidence to enable responsive policy development for efficient drug procurement and supply management in Ghana and establishes a rigorous approach to the analysis of childhood cancer drug access in similar health system settings.https://gh.bmj.com/content/5/9/e002906.full |
| spellingShingle | Avram Denburg Sumit Gupta Rhonda Boateng Lorna Renner Kadia Petricca Health system determinants of access to essential medicines for children with cancer in Ghana BMJ Global Health |
| title | Health system determinants of access to essential medicines for children with cancer in Ghana |
| title_full | Health system determinants of access to essential medicines for children with cancer in Ghana |
| title_fullStr | Health system determinants of access to essential medicines for children with cancer in Ghana |
| title_full_unstemmed | Health system determinants of access to essential medicines for children with cancer in Ghana |
| title_short | Health system determinants of access to essential medicines for children with cancer in Ghana |
| title_sort | health system determinants of access to essential medicines for children with cancer in ghana |
| url | https://gh.bmj.com/content/5/9/e002906.full |
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