Implementation of a 100% Drug Prescription Fill Policy at the University of Benin Teaching Hospital, Nigeria: The Role of Effective Stakeholder Engagement and Patronage

Abstract

Aims and Objectives: To ascertain the effects, mode of participation of policy actors and evaluation of the influence of the patronage factors on the UBTH pharmacies in the implementation of the 100% drug prescription fill policy in the Hospital. Background: Effective stakeholders engagement in a public policy creation and development cycle is considered a critical activity that cannot be ignored. Many public policy failures may be attributable to the neglect of this crucial action, process and concern. The identified relevant actors of the 100% drug prescription fill policy at the University of Benin Teaching Hospital (by this research) are: the  Heads of departments & core Management, Departments e.g Pharmacy, medicine, Account etc, HODs/Core Management free expression on the proposed policy, Inputs from various departments via HODs,  inputs of Hospital based Professional Associations, Professionals like Pharmacists, Doctors, Accountants, internal auditors’ contributions, and the Hospital Patients/Clients involvements in the policy cycle development. Valid and meaningful engagement and inputs of these various stakeholder groups (devoid of tokenism, stakeholders hierarchy and other challenges of effective stakeholders engagement) are desirable for policy success. Poor policy literacy, limited resources and poor understanding by many stakeholder groups may account for the little differences in the engagement power of the various policy actor groups at UBTH policy cycle development process. However, a down-up approach of public policy development, that is all inclusive in action, trust and recognition of actors’ contributions, are all that are required for a meaningful and robust stakeholders engagement. The patronage factors identified by this research for this policy development at UBTH are: timely drug supply to Patient/Client, ready availability of drug, trusted quality of drug, affordable cost of drug, and pleasing attitude of staff to Patients/Clients. These factors needed to be improved upon to proffer lasting solutions to the identified policy issues of low patronage of the Hospital pharmacies by patients and clients, low internally generated revenue and both. These were the justifications for the promulgation of this purposive policy framework by the UBTH Management. Study Design: The study was limited to staff who were five years old and above in the Hospital, and also patients and clients who had attended their clinics for four weeks and more.  Place and Duration of Study: This research was carried out at the University of Benin Teaching Hospital, Benin City, Nigeria between January 2018 and December 2022. This was after securing an ethical approval of the Health Research Ethics Committee of the Hospital, vide protocol Number: ADM/E 22/A/Vol.VII/1483011857. Methods: The Hospital staff, patients, clients and management freely filled out the written questionnaire. Each respondent was requested by the questionnaire to ascertain the extent of engagement of each policy actor (stakeholder) group, and the impacts of the identified patronage factors, on a scoring scale of 0-5. The data were collated, and the frequency of scores for each factor was calculated. The stakeholder and the patronage powers of the respective group were determined by multiplying the frequency of score by the rating factor. The percentage power of influence was calculated for each assessed variable, as in Tables 1 & 2 and Tables 4 & 5 respectively. Only a quantitative method of data collection was used as obtained from the responses of the respondents. The data were collated, analyzed, and interpreted as much as possible, using the Repeated measures one-way ANOVA of The GraphPad Prism 6. Results: Out of about 400 questionnaires that were distributed for completion, 25(6.25%) were not retrieved due to misplacement by the respondents. 7(1.75%) were returned unattended or uncompleted by the respondents who complained of lack of time. The results were shown in Tables 1, 2. 3, 4 and 5. Table 2 was analyzed using the Repeated measures One-way ANOVA. At P < .05, there was no statistically significant difference in the engagement of the various policy actor groups at R Square 0.3598 (35.98%). However, there was a significant difference in the matching among the various policy actor groups at P < .05 and R square 0.878 (87.8%). This supposed that there was a significant difference in the consideration of the various policy actor group’s inputs by the Management, based on their conceived importance or relevance. There was no statistical significant difference among the patronage factors at P < .05 and R square value 32.9%. but there were effective and significant matching of the patronage factors at P < .05, R Sq value 90.4%. This implied that the various patronage factors were somewhat treated differently and so impacted differently on the policy formulation and implementation. Conclusion: The adequate and effective engagement of the relevant policy actor groups at the University of Benin Teaching Hospital has accelerated effective implementation of the 100% drug prescription fill policy growth and development. This  has impacted the patient’s treatment and/or management outcomes significantly through enhanced or efficient work-out-put by the staff, reduction of out-of-stock phenomenon to the very insignificant level, improved accessibility to drugs by the patients and clients, improved funding ability for drugs by the patients and clients, timely and rational drug therapy administration to the patients/clients, improved service delivery and well being of the hospital, securing and garnering  the implicit confidence, trust and faith of the clients/patients and the public in the Hospital. The new policy has positively touched the economic power of the Hospital by the perceived progressive increment in the internally generated revenue, and improved service delivery.