Establishing effective pharmaceutical governance is a challenge for government agencies, private enterprises, and professionals working on the ground, demanding complex ethical decisions from the actors involved, especially in a lower-middle-income country like Ghana. This letter aims to share the author’s perspectives and additional considerations on the analyses of the reports in the paper “It is very difficult in this business if you want to have a good conscience”: pharmaceutical governance and on-the-ground ethical labor in Ghana by Hampshire et al. The (...) letter's authors discuss the need to advance universal health coverage in Ghana, the everyday ethics, and the disparities between the collective and individual moral consciousness of the participants, as well as other aspects of governance in the pharmaceutical sector. (shrink)