Assessing the Impact of Framework Agreements on the Availability of Essential Medicines: A Case Study of 65 Essential Medicines at the Upper East Regional Medical Stores, Ghana

BackgroundAccess to Essential Medicines stands as a vital foundation to public health service delivery in any well-performing health system. In 2017, Ghanas Ministry of Health established the Framework Agreement system which selects prequalified suppliers to deliver 54 Essential Medicines (now 65 Essential Medicines) to Regional Medical Stores and Teaching Hospitals to address supply chain inefficiencies and maintain continuous availability. ObjectivesThe study assessed the impact of these Framework Agreements on medicine availability at the Upper East Regional Medical Stores (UERMS), focusing on effectiveness, implementation challenges and stakeholder perceptions. MethodsA mixed-methods cross-sectional study design was employed. Quantitative data were collected through retrospective analysis of stock records from 2015 to 2024, comparing availability and lead times before and after implementation, while qualitative data were gathered through semi-structured interviews with key stakeholders. ResultsQuantitative data showed that prior to implementation, stock availability of these 65 Essential Medicines was 100%, with average lead times of 21-22 days. However, after implementation (2017-2024), medicine availability declined, and lead times increased by more than 40%, undermining the systems objective of efficiency. Inconsistencies in supply were observed. Qualitative data showed that supplier performance faced system-level obstacles, including restricted emergency procurement flexibility, communication breakdowns between procurement entities and suppliers, and delayed payments, leading suppliers to lose commitment. ConclusionFramework Agreements demonstrate potential for better procurement transparency and cost-effectiveness yet its existing implementation model negatively impacts medicine availability in the Upper East Region. The study recommends revision to allow emergency procurement, strengthen supplier performance monitoring, decentralise some procurement responsibilities, improve communication and ensure timely payments.