Developing Standards and Practice Guidelines for Pharmaceutical Services in Ghana: A review of Structure, Process and Outcome

Background: Quality pharmaceutical services drive health service-delivery and ensure access to safe, effective, and affordable medicines for Universal Health Coverage (UHC). In Ghana, despite relevant policies, robust, interpreted, and operationalised standards are required to improve pharmaceutical service-delivery. This paper presents an account on development of pharmaceutical service standards in Ghana; analyses the robustness of these standards, with recommendations for enhanced impact. Methods: A systematic, multi-step approach, with identification of practitioners, review of best practices, iterative stakeholder consensus, standards drafting and reviews was adopted to develop pharmaceutical service standards for endorsement by the Ministry of Health. Donabedian’s Structure, Process and Outcome Model, which examines: structure (as inputs), process (as throughput), and outcome (as impact), was used to assess the standards for input needs, process catalysts and assessment framework for operationalisation. Results: The standards were framed by fourteen (n = 14) pharmacy experts in: Regulation and Governance, Policy and Public Health, Pharmacy Management and Leadership, Clinical Practice and Patient Care, as well as Information, Research and Data; with consensus from stakeholders including policy makers, regulators, academia, service providers, evidence generators, and the private sector. The standards present structural criteria and operational processes. For structure, the standards have legal support and set forth clear infrastructural requirements, workforce adequacy, and digital reporting systems, with a need for investments and delineation along levels-of-care. For process: standard operating procedures (SOPs) are well defined, requiring training, continuous professional development, and adherence monitoring. For outcome: the standards lacked clear outcome-measurement-indicators as of the time of analysis, and would require such to be developed, preferably digitised. Conclusions: This assessment of pharmaceutical service standards highlights the link between structural definitions, operational processes, and measurable outcomes. Regular assessment of outcomes, using clearly defined indicators, alongside investments in infrastructure, digitisation and workforce development, is imperative for continuous quality improvement and accountability to advance UHC.