Advancing health system strengthening through improving access to medicines: A review of local manufacturing policies in Ghana.

Providing access to quality-assured medicines is a fundamental component of strengthening health systems. Yet, the World Health Organization (WHO) estimates that 13.6% of all medicines in low- and middle-income countries (LMIC's) may be substandard or falsified (SF) impeding patient outcomes, imposing financial burden, and contributing to antimicrobial resistance. Circulation of SF medicines also undermines trust in the health system and legitimate health care professionals. It may erode trust in the manufacturers of genuine pharmaceutical products as well as health professionals who prescribe and dispense them. Failure to address challenges in medicines quality assurance and supply risks jeopardizing progress towards universal healthcare coverage. This editorial draws on perspectives from a Ghanaian context and highlights the importance of ensuring an adequate and stable medicine supply, specifically through mechanisms to foster local manufacturing. This will serve to address the problem of SF medicines, as well as providing opportunities for mutual benefit with multiple related sectors. The WHO's mechanism on substandard and falsified medical products 2020 highlights multiple sectors have a key role in combatting SF medicines. Although key considerations and initiatives in other sectors are beyond the scope of this article, local manufacturing should be viewed with WHO's a multilevel systemwide approach.