Broken supply chain: Inside Ghana’s diabetes medication crisis

Under the blistering heat of the Tema port, towering ship­ping containers stretch across the skyline—metal monoliths shielding cargo essential to life. Inside some of these containers are diabetes medications: insulin vials and oral drugs that thousands of Ghanaians depend on daily. But these life-sav­ing treatments are not moving. They are caught in a tangle of bureaucracy and inefficiency, sitting for days—sometimes weeks—turning toxic under the unforgiving West African sun.

For patients across Ghana, this is not simply a logistical problem. It is a slow-burning, nationwide health emergency hidden in plain sight.

“By the time these medications reach hospitals and pharmacies, prices have increased, supplies have diminished, and in some cases, the drugs are compromised,” said a pharmaceutical logistics expert who requested anonymity.

The first fault line in this broken system appears right at the Tema Harbour—Ghana’s busiest import gateway. Here, pharmaceutical imports undergo scrutiny from multiple regulatory agencies, including the Food and Drugs Au­thority (FDA), the Ghana Revenue Authority, and occasionally the Ghana Standards Authority.

“The system was built for thoroughness, not speed,” explains Nana Kwame Nuamah, a customs broker specialising in pharmaceu­tical imports. “A single missing document can delay clearance by weeks—while patients run out of their medication.”

Data from the Ghana Shippers Authority reveals that pharmaceu­tical imports spend an average of 21 days at port—well beyond the global benchmark of three to sev­en days. For temperature-sensitive products like insulin, these delays are not just inconvenient—they are disastrous.

After clearing the port, diabetes medications enter a distribution network that is anything but cohesive. Ghana lacks a centralised procurement and distribution mechanism for many essential drugs. Instead, numerous small-scale importers and distributors operate with little oversight.

At the Central Medical Stores in Tema—tasked with supplying public hospitals—a six-month buffer stock is mandated by policy. In practice, budget constraints and procurement inefficiencies mean chronic shortages. Review of internal records shows frequent stockouts of even basic medica­tions like metformin.

When public hospitals run dry, patients often turn to private phar­macies. In Bantama, a suburb of Kumasi, pharmacist Peter Mensah opens a refrigerator brimming with insulin vials. “We import directly or source from multiple wholesalers, so we stay stocked,” he says. “But these costs trickle down to the patient.”

A month’s supply of insulin in private pharmacies can cost between GH¢ 400 and GH¢ 800—two to three times higher than public sector rates when available.

When genuine drugs are inac­cessible or unaffordable, the black market steps in. At the FDA’s Quality Control Lab in Accra, analysts routinely inspect fake and substandard drugs seized from pharmacies and vendors.

In 2024 alone, over 200 falsified diabetes medication packages were confiscated. Some had no active ingredient, others only partial amounts—and some contained dangerous substitutes. The World Health Organisation estimates that up to 30 per cent of medications in Ghana may be substandard or counterfeit, with chronic disease treatments particularly vulnerable.

Ghana has about 38 licensed pharmaceutical manufacturers, but only two produce diabetes medications—and none make insulin. Manufacturing insulin requires advanced biotechnology infrastructure and high upfront investments of up to $20 million, far beyond the capacity of most local firms without government support or external partnerships. Without reliable local production, Ghana remains entirely dependent on imports.

The hurdles do not end at the port. Registering a new diabetes medication with the FDA can take between 12 and 18 months and cost thousands of dollars. This is a significant barrier, especially for newer, more effective treatments.

Of the 30 diabetes drugs approved by the U.S. FDA and European Medicines Agency over the last five years, only seven are registered in Ghana—including glimepiride and gliclazide (Diami­cron).

Even, once medications reach the country, the public procure­ment system often fails. The Na­tional Health Insurance Authority (NHIA), which reimburses health providers, frequently delays pay­ments—sometimes for over a year.

This has real consequences. Mr Benedictus Dzeble, a health administrator at Adum Clinic in Kumasi, recalled, “Between 2018 and 2021, the NHIA owed us 22 months of arrears. We had to stop treating insured patients.” Though the scheme eventually cleared the backlog, the disruption lingered. However, we are considering going back to the scheme to treat more patients.

Other systemic flaws persist. Many rural clinics cannot prescribe certain diabetes medications due to their lower facility classification. “It’s not a matter of doctor knowl­edge,” Mr Dzeble says, “but of policy. The prescribing level must be reviewed to improve access.”

Aaron Nyamekye, Deputy National Secretary of the Pri­vate Health Facilities Association of Ghana (PHFAG), notes that payment delays also stem from administrative technicalities. “The previous government paid claims up to September 2024. The current administration has started pay­ments for 2025, but not all facilities have received theirs.”

Despite the bleak picture, there are glimmers of progress. The Pharmacy Council of Ghana has launched the National Electronic Pharmacy Platform (NEPP), which allows prescriptions to be upload­ed digitally. Pharmacies within a certain radius can respond with availability and pricing—turning access into a competitive, time-sen­sitive process.

There is also the Light Wave Health Information Management System (LHIMS), an electronic platform used by hospitals to dig­itally document patients’ informa­tion. This technology is linked to the NEPP.

Dr (Pharm) Esther Asantewaa Acherekoh, Head of Pharmacy at Manhyia Government Hospi­tal, praises the system. “It’s like a digital race. If one pharmacy can’t fulfill the prescription in time, it goes back into the pool for others to claim.

”Dr Acherekoh indicated that tech-savvy patients can upload their prescriptions to check which pharmacies have their needed med­ications in stock, adding that the system is currently being piloted with hopes it would be sustained and rolled out to other pharmacies.

She added, “Digitising pharmacy services also reduces the risk of counterfeit medications reaching patients since each transaction is traceable and verifiable on the platform.

Another promising innovation comes from the MinoHealth AI Lab in Accra, which has designed Moremi AI, an artificial intelligence platform that can screen, diagnose, generate treatment plans, and pre­scribe medications for diabetes.

According to Darlington Ak­ogo, CEO of Moremi AI, “this innovation ensures that patients in critical need receive timely medical attention regardless of their loca­tion. We are combining AI with public health strategy to bridge the gap between patients and special­ists, especially in under-resourced settings. The company is working with health facilities in the country to deploy their AI solutions across Africa and beyond.

Meanwhile, Zipline’s drone delivery network ensures tempera­ture-controlled medications reach remote clinics within 30 minutes of request.

But these innovations are only beginning to scale—and time is running out for many. Kwadwo Agyei, a 52-year-old mechan­ic from Sankore, knows this all too well. Diagnosed with Type 1 diabetes as a teenager, he has been hospitalised three times in the past year due to medication shortages.

“Last November (2024), my usual insulin was nowhere to be found,” he recalls from a hospi­tal bed, recovering from diabetic ketoacidosis. “The only option was an alternative brand at four times the cost. I tried rationing what I had—and ended up here.”

Ernest Kofi Bentsil Simmons, a nursing officer at the facility, laments, “We’re not losing this battle because we don’t understand the disease—we’re losing because patients can’t consistently access affordable medications, especially in rural areas.”

The World Bank estimates that diabetes accounts for five – seven per cent of Ghana’s total health expenditure, with an annual per-patient cost of $250–$350. The broader economic impact—lost productivity, early deaths, and preventable hospitalisations—amounts to as much as two per cent of GDP.

Fixing Ghana’s diabetes med­ication supply chain is not just a public health challenge—it’s an economic necessity.

Health experts call for urgent reforms: faster drug registration, pooled procurement to reduce costs, incentives for local produc­tion, expansion of NHIS cover­age for more diabetes drugs, and stricter enforcement to eliminate counterfeit products.

Until then, patients like Agyei will continue to suffer the conse­quences of a system that works only on paper. For millions of Ghanaians living with diabetes, re­form can’t wait. Their lives depend on it.

BY KINGSLEY E.HOPE