The sale of artemisinin-based combination therapy (ACT) by private licensed chemical shops (LCS) without testing is contrary to current policy recommendations. This study assessed the accuracy and perception of test-based management of malaria using malaria rapid diagnostic test (mRDT) kits at private LCS in two predominantly rural areas in the middle part of Ghana. Clients presenting at LCS with fever or other signs and symptoms suspected to be malaria in the absence of signs of severe malaria were tested with mRDT by trained attendants and treated based on the national malaria treatment guidelines. Using structured questionnaires, exit interviews were conducted within 48 hours and a follow-up interview on day 7 (±3 days). Focus group discussions and in-depth interviews were also conducted to assess stakeholders' perception on the use of mRDT at LCS. About 79.0% (N = 1,797) of clients reported with a fever. Sixty-six percent (947/1,426) of febrile clients had a positive mRDT result. Eighty-six percent (815/947) of clients with uncomplicated malaria were treated with the recommended ACT. About 97.8% (790/808) of clients with uncomplicated malaria treated with ACT were reported to be well by day 7. However, referral for those with negative mRDT results was very low (4.1%, 27/662). A high proportion of clients with a positive mRDT result received the recommended malaria treatment. Testbased management of malaria by LCS attendants was found to be feasible and acceptable by the community members and other stakeholders. Successful implementation will however require effective referral, supervision and quality control systems.

BackgroundGhana has scaled-up malaria control strategies over the past decade. Much as malaria morbidity and mortality seem to have declined with these efforts, there appears to be increased consumption of artemisinin-based combination therapy (ACT). This study explored the perception and experiences of community members and medicines outlet practitioners on malaria case detection using rapid diagnostic test (RDTs) to guide malaria therapy.MethodsThis was a cross-sectional study using both quantitative and qualitative approaches for data. In-depth interviews with structured questionnaires were conducted among 197 practitioners randomly selected from community pharmacies and over-the-counter medicine sellers shops within two metropolis (Kumasi and Obuasi) in the Ashanti Region of Ghana. Two focus group discussions were also held in the two communities among female adult caregivers.ResultsMedicine outlet practitioners and community members often used raised body temperature of individuals as an index for malaria case detection. The raised body temperature was presumptively determined by touching the forehead with hands. Seventy percent of the practitioners’ perceived malaria RDTs are used in hospitals and clinics but not in retail medicines outlets. Many of the practitioners and community members agreed to the need for using RDT for malaria case detection at medicine outlets. However, about 30 % of the practitioners (n = 59) and some community members (n = 6) held the view that RDT negative results does not mean no malaria illness and would use ACT.ConclusionsThough malaria RDT use in medicines outlets was largely uncommon, both community members and medicine outlet practitioners welcomed its use. Public education is however needed to improve malaria case detection using RDTs at the community level, to inform appropriate use of ACT.

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Background Licences to operate pharmacy premises are issued by statutory regulatory bodies. The Health Institutions and Facilities Act (Act 829) and Health Professions Regulatory Bodies Act (Act 857) regulate pharmacy premises and the business of supplying restricted medicines by retail, respectively, and this could create a potential regulatory overlap for pharmacy practice in Ghana. We theorise that the potential overlap of regulation duties stems from how law-makers framed issues and narratives during the formulation of these Acts. Objective To describe the policy actors involved, framing of narratives and decision-making processes relating to pharmacy premises licensing policy formulation. Methods A qualitative study was conducted and data gathered through interviewing eight key informants and reviewing Hansards, reports, bills, memoranda and Acts 829 and 857. Data were analysed to map decision-making venues, processes, actors and narratives. Results The Ministry of Health drafted the bills in July 2010 with the consensus of internal stakeholders. These were interrogated by the Parliament Select Committee on Health (with legislative power) during separate periods, and decisions made in Parliament to alter propositions of pharmacy premises regulations. Parliamentarians framed pharmacies as health facilities and reassigned their regulation from the Pharmacy Council to a new agency. The Pharmacy Council and the Pharmaceutical Society of Ghana could not participate in the decision-making processes in Parliament to oppose these alterations. The laws’ contents rested with parliamentarians as they made decisions in venues restricted to others. Legislative procedure limited participation, although non-legislative actors had some level of influence on the initial content. Conclusion Implementation of these laws would have implications for policy and practice and therefore understanding how the laws were framed and formulated is important for further reforms. We recommend additional research to investigate the impact of the implementation of these Acts on pharmacy practice and business in Ghana and the findings can serve as bargaining information for reforms.

Background: Licence to operate pharmacy premises are issued by statutory regulatory bodies. The Pharmacy Council regulated pharmacy premises until the Health Facilities Regulatory Agency (HeFRA) was mandated by Act 829 (2011) to license pharmacy premises. The Pharmacy Council under Act 857 (2013) now regulates the business of mixing, compounding, preparing, or supplying restricted medicines by retail. Objective: To describe the policy actors involved, framing of narratives and decision-making processes relating to pharmacy premises licensing policy formulation.Methods: A descriptive qualitative study was conducted and data gathered through interviewing eight key informants and reviewing Hansards, reports, Bills, memoranda and Acts 829 and 857. Data were analysed to map decision-making venues, processes, actors and narratives. Results: The Health Institutions and Facilities Bill (2010) and the Health Professional Regulatory Bodies Bill (2010) were designed within the Ministry of Health bureaucratic system and processes with inputs and consensus from all stakeholders including the Private Hospitals and Maternity Homes Board and the Pharmacy Council. Between 28 October 2010 and 20 July 2011, the Health Institutions and Facilities Bill which established HeFRA, was subjected to legislative procedures and decisions by parliamentarians. The parliamentarians framed pharmacies as health facilities and reassigned its regulation to HeFRA. Similarly, the parliamentarians deliberated on the Health Professional Regulatory Bodies Bill which established the Pharmacy Council between 4 March 2011 and 21 December 2012. To which all content relating to licensing pharmacy premises were deleted from the Bill. Conclusion: The content of these policies rested with parliamentarians (with legislative power) and was largely based on how they framed issues relating to pharmacy premises regulation. Legislative procedure limited participations although non-legislative actors had some level of influence on the initial content. As legislative processes may be similar in other LMICs, this paper can contribute to learning and the formulation of Pharmacy premises regulation.