Health System Determinants of Medication Error Underreporting in Ghana: A Nationwide Cross-Sectional Study

Abstract Background: Medication errors (MEs) remain a major threat to patient safety globally, with underreporting particularly pronounced in low- and middle-income countries. Weak reporting systems limit opportunities for learning and system improvement. This study examined health system barriers and determinants of medication error underreporting among healthcare professionals in Ghana, with a view to informing patient safety policy and system strengthening Methods: A cross-sectional survey was conducted among healthcare professionals in five tertiary Ghanaian healthcare facilities, evaluating their medication error reporting practices, perceived barriers, and both individual and institutional factors affecting reporting. Descriptive statistics and multivariate logistic regression analysis were used to analyze the data. Results: A substantial number of healthcare professionals reported never formally reporting medication errors, especially those involving wrong administration routes (61.2%); and wrong medications (56.4%). The most common reported barriers were lack of training on reporting (55.5%), concerns about victimization (49.7%), fear of legal consequences (48.8%), damage to professional reputation (45.8%), and complicated reporting procedures (45.2%). Younger healthcare professionals (20–29 years) were significantly more likely to perceive barriers compared to older colleagues. Higher educational attainment (BSc, AOR = 9.11, 95% CI: 2.40–34.68, p =0.001) was associated with greater perceived barriers, while pharmacists were less likely than doctors to perceive barriers (AOR = 0.52, 95% CI: 0.34–0.81, p =0.004). Conclusions: Medication error underreporting in Ghana reflects systemic weaknesses in reporting infrastructure and patient safety culture. Addressing these gaps requires policy-driven interventions, including the establishment of non-punitive and confidential reporting systems, simplification of reporting procedures, and integration of training and feedback into routine clinical governance. Strengthening institutional accountability and fostering a just culture that prioritizes learning over blame are critical to improving reporting practices and advancing patient safety in resource-constrained health systems.