Top Issues to Affect Pharmacy Practice in 2016
Tuesday, 12 January 2016
Posted by: Psgh Editor
Top Issues to Affect Pharmacy Practice in 2016
This year a number of seminal policies, regulations and laws will be rollout by some regulatory bodies. While some of these policies will certainly affect pharmacy practice in Ghana from close quarters, others will indirectly shake up the practice landscape from afar. This piece aims to inform pharmacists about some of these issues and how it may affect their practice and business operation.
Pharmacy Council’s Policy on Supervision
This policy was initially unveiled in 2012 by the Pharmacy Council (PC). An announcement that accompanied the policy trundled out a number of key facts that led to its development: poor supervision of pharmacies in Ghana among other things. The implementation framework actually revealed that it would be implemented in phases each year starting from 2013. 2015 was supposed to be a phase where starting from Greater Accra and Ashanti Regions, all pharmacies in these provinces shall be supervised by fulltime pharmacists.
However, this was held in abeyance following opposition from a section of stakeholders, specifically the Government and Hospital Pharmacists Association (GHOSPA) members. In view of this, it was communicated by the PC that it would be shifted to 2016 in Greater Accra and Ashanti Regions. The PSGH has however intervened following engagement with the PC to allow for concessions to be granted to facilities owned by pharmacists but engaged in other fulltime jobs.
If the policy is implemented in alignment with its original intentions it should open up employment opportunities especially to newly qualified pharmacists. However, pharmacy owners should be expecting a potential hike in compensation rates for superintendent pharmacists in these regions.
Income Tax Act 1015 (Act 896)
The legislative arm of government passed a law, Income Tax Act 1015 last year September. Contained in this law are a pack of new tax provisions to replace existing tax regimes effective 1st January 2016.
These new tax regimes will affect pharmacists and/or their businesses at varying depths. For example, withholding tax on services which was 5% prior to the law has been spiked to a staggering 15%. Agitations from businesses are however provoking a retreat from the government to peg it at 7.5%.
NHIS Medicine List Review
The National Health Insurance Medicine List (NHIML) of 2014 has been reviewed and a new list is expected to be used for billing by providers in 2016. Pharmacists should anticipate sweeping raise of prices of drugs on the new list—apparently to reflect the cost of drugs on the market.
While some medicines saw significant leaps in prices others unfortunately remained stagnant. Artemether Lumefantrine Tablet, 20mg + 120mg (24’s), e.g., saw 40% rise in price compared to Amlodipine Tablet 5mg which saw a zilch price change.
On the extreme, is cut in prices that affected some of the medicines. Glimepiride Tablet 2mg for example had 9% shaved off from the original price of GHC 1.37.
This new list may contain the odd phenomenon of eroding margins of medicines on the shelves of pharmacies operating as service providers under the scheme.
Supply Chain Master Plan
The Ministry of Health is set to reform the procurement and distribution processes of some health commodities under a broad framework: Health Financing and Implementation Plan. The plan according to the Budget Statement and Economic Policy 2016, is aimed at addressing “the financing and supply chain issues within the health sector.”
The Supply Chain Master Plan, the specific arm targeting health commodities will result in the centralization of the procurement of more than 200 medicines, collectively termed Focus List under the plan. Service delivery points—from teaching hospitals down to health centers—manned by pharmacists will obtain most of their medicines from a central source.
This policy will be sent to parliament for approval in 2016. It is worthy to note that this policy is being implemented amid fears of crippling smooth pharmaceutical service delivery in hospitals owing to the depth of its inherent red tapes.
PSGH Constitution Review
Under the Professional Bodies Registration Decree, 1973 (NRCD 143) professional bodies registration with the Registrar General Department of Ghana is mandatory. Under this law it is an offence and liable on summary conviction to imprisonment, a fine or both if a person or a professional in bad standing with a professional body holds himself out as registered. By extension, since the PSGH is the only body of pharmacists registered under the law, a person commits an offence if “not having the qualification for admission to or enrolment in or for being accepted as a member of, such a body [PSGH] [but] knowingly represents that he has such qualification.”
Under this decree also, it is a requirement for registered bodies to develop a constitutional framework to guide its governance and operations.
The PSGH this year is poised to adopt the final work of a committee tasked to review its constitution which was last reviewed in 2006.
The newly reviewed constitution will likely affect the makeup of the Governing Board (GB) of PSGH. Relatively new interest groups may get representatives to promulgate their interest at the GB meetings. The existing membership welfare package may also experience reforms to reflect prevailing economic circumstances.
The reviewed constitution will likely be adopted by the PSGH membership at this year’s Annual General Meeting.
Standard Treatment Guidelines 2016
The Ghana Standard Treatment Guidelines (STG) was last reviewed in 2010—6 years now since the last review contrary to policy statements which recommends biannual revision. The wait may be nearing an end this year.
Progress towards the latest review has been tremendous. The technical committee for the review has completed its work. The buck now stops at the health ministry to adopt this essential treatment guideline which supports clinicians to make diagnostic and therapeutic decisions.
Pharmacists should be on the lookout for a compendium whose statements of recommendation are heavy on the principle of evidence-base medicine.
Condition of Service Document by the Ministry of Health
Agencies under the health ministry—Ghana Health Service, Teaching Hospitals, Christian Health Association of Ghana (CHAG)—will collectively sign a conditions of service document agreement with the Government and Hospital Pharmacists Association(GHOSPA). The document will spell out in clear terms all the entitlements and privileges of pharmacists working in the public sector. The significance of this coup lies in the fact that it is the first of its kind in the history of the health ministry. Existing service conditions have been criticized as being patchy across the various agencies under the Ministry of Health.
To confront this problem, the ministry has drafted a framework conditions of service document currently being negotiated with the executives of GHOSPA.
Although it appears GHOSPA’s executives are finding it hard to pull it off at the negotiation table for the past 3 months since the start of the negotiation process owing to reportedly entrenched government negotiators, 2016 is certainly set to bring closure to the matter.
Inadequate NHIS Budgetary Allocation
The National Health Insurance Scheme (NHIS), according to the budget statement released last year November by the Ministry of Finance, is expected to receive “an amount of GH¢1,497.3 million.” However, given that the NHIS’s annual expenditure on claims alone—including reimbursement for medicines--is currently pegged at GH¢ 1029.00 million, coupled with the expected upward review of the prices of medicines on the NHIML, the budgetary allocation figure of GH¢1,497.3 million appears to be inadequate.
Perhaps this inadequacy is better appreciated when the scheme’s administrative expenses and persistent rise of drug costs following the Cedi’s innate progressive depreciation are brought into perspective.
These factors and many other NHIS-related issues are certainly set to put a crimp in the cash flows of NHIS service providers—hospitals and stand-alone pharmacies. And this will have a ripple effect on wholesale pharmaceutical distributors who particularly supply medicines to these providers on credit basis.