The behaviour of health workers in an era of cost sharing: Ghana's drug cash and carry system

This qualitative study aimed to assess possible changes in prescription patterns and resultant implications for the quality of care delivered in three southern districts of Ghana after the introduction of a full cost recovery scheme for drugs in 1992. While the availability of safe and effective drugs has improved especially in rural areas, not all patients are able to meet the cost for required medication. This has influenced the behaviour of most prescribers, who now take economical limitations into account. As a result, poorer patients may either take fewer drugs or smaller quantities than medically indicated, with possible ensuing consequences for public health. Overall, the cash-and-carry scheme does not appear to have changed health workers' attitudes towards patients; where such behavioural changes occurred they seemed to be due to personnel shortages. Generally, patients in rural facilities reported greater satisfaction with the care they received than urban residents; and medical assistants were perceived as friendlier than both nurses and doctors.