Former Pharmacist Studies Home Country’s Medicines Management.

Paul G. Ashigbie, a global health research fellow, has published his first paper as lead author—and he says the subject couldn’t be more fitting.

The qualitative study, “Challenges of Medicines Management in the Public and Private Sector Under Ghana’s National Health Insurance Scheme,” in the Journal of Pharmaceutical Policy and Practice, is an exciting step for Ashigbie, who began his career as a community pharmacist in Ghana’s capital, Accra.

His path to the School of Public Health began in 2006, when the World Health Organization (WHO) issued a recommendation to change the way much of the world was treating malaria. “I saw how a policy trickled down as an international recommendation, was adopted by the ministry of health in Ghana, the role providers played, the role industry played,” says Ashigbie, who was then working as a pharmacist and a medical representative for a Ghanaian pharmaceutical company, as well as educating health workers on the new recommendation.

“That was what consolidated my interest in public health.”

At SPH, Ashigbie completed an MPH, focusing in global health and pharmaceuticals, in 2011. He has continued as a doctoral student and research fellow at the Center for Global Health and Development (CGHD).

Ashigbie’s attention returned to Ghana when he took part in a study of medicines policies and practices in five countries, led by Associate Professor of Global Health Veronika Wirtz for the World Health Organization (WHO).

Ghana almost didn’t make the cut for that study, but Ashigbie made his case. “In my previous capacities in the field, I felt like there was something missing between what exists in the field and what exists in literature,” he says.

“I told Veronika that there still was a lot undocumented or under-documented about how medicines are covered under the National Health Insurance Scheme in Ghana,” he adds. “It was her support that enabled us to keep Ghana as one of the countries.”

When the study ended, Wirtz allocated some of her resources for a follow-up qualitative study in Ghana, led by Ashigbie.

The qualitative study examined the challenges and consequences of medicines management policies and practices under Ghana’s National Health Insurance Scheme (NHIS), and compared public and private providers.

The researchers found the NHIS increased medicines access by removing cost barriers, but challenges remain.

In particular, low NHIS reimbursement prices and long delays in reimbursement—sometimes up to nine months—cause some private health facilities to turn away NHIS-covered patients. Public-sector facilities, meanwhile, have to delay in paying medicine suppliers, causing some suppliers to avoid certain public facilities. “It becomes a vicious cycle,” Ashigbie says.

The researchers also found significant differences in oversight on medicines between public and private providers, and noted concerns about doctors prescribing more medicines when they are also the dispensers, compared to when prescribing and dispensing medicines are separated into two different positions at a facility.

The study, says Ashigbie, showed him the challenges are more complex than he had been aware of while working within the pharmaceutical industry in Ghana. That’s true, he adds, of his experience at SPH, where he has gained “a deeper understanding of the issues relating to access to medicines in the world.”

As he continues to work with those issues, Ashigbie says he’s happy—and grateful to Wirtz—that his first study as lead author could be so close to home.

—Michelle Samuels