Women's ability to self-screen for contraindications to combined oral contraceptive pills in Tanzanian drug shops

Sexual and reproductive healthcare providers' opinions on expansion of pharmacy-led provision of contraception

INTRODUCTION

Reduced funding to contraceptive services in the UK is resulting in restricted access for women. Pharmacists are already embedded in sexual and reproductive health (SRH) care in the UK and could provide an alternative way for women to access contraception. The aim of this study was to determine the views of UK contraception providers about community pharmacist-led contraception provision.

METHODS

An anonymous questionnaire was distributed to healthcare professionals at two UK SRH events, asking respondents about: (1) the use of patient group directions (PGDs) for pharmacist provision of oral contraception (OC); (2) the sale of OC as a pharmacy medicine or general sales list medicine; (3) the perceived impact of pharmacy provision of OC on broader SRH outcomes; and (4) if other contraceptive methods should be provided in pharmacies.

RESULTS

Of 240 questionnaires distributed, 174 (72.5%) were returned. Respondents largely supported pharmacy-led provision of all non-uterine methods of contraception, excluding the contraceptive implant. Provision of the progestogen-only pill by PGD was most strongly supported (78% supported initiation). Respondents felt that the use of bridging (temporary) contraception would improve (103/144, 71.5%), use of effective contraception would increase (81/141, 57.4%), and unintended pregnancies would decline (71/130, 54.6%); but that use of long-acting reversible contraception would decrease (86/143, 60.1%). Perceived barriers included pharmacists' capacity and competency to provide a full contraception consultation, safeguarding concerns, and women having to pay for contraception.

CONCLUSIONS

UK SRH providers were largely supportive of community pharmacy-led provision of contraception, with training and referral pathways being required to support contraception delivery by pharmacists.

Over the counter: The potential for easing pharmacy provision of family planning in urban Senegal

Background: This research assessed the potential for expanding access to family planning through private sector pharmacies in Senegal, by examining the quality of the services provided through private sector pharmacies, and pharmacy staff and client interest in private sector pharmacy-based family planning services. Methods: This was a cross-sectional, descriptive study conducted in eight urban districts in and around Dakar and two urban districts outside of Dakar employing an audit of 225 pharmacies, a survey with 486 private sector pharmacy staff and a survey with 3,567 women exiting private sector pharmacies. Results: Most (54%) pharmacies reported offering method-specific counseling to clients. Family planning  commodities were available in all pharmacies, and 72% had a private space available to offer counseling. Three quarters (76%) did not have any counseling materials available. 49% of pharmacists and 47% of assistant pharmacists reported receiving training on family planning during their professional studies. Half had received counseling training. Few pharmacists met pre-determined criteria to be considered highly knowledgeable of the oral contraceptive pill (OCP) and injectable contraceptive provision (0.6% and 1.1%). Overall, 60% of women surveyed were current family planning users and 11% procured their method through a private sector pharmacy. Among non-users of family planning, and current users who did not obtain their method through a pharmacy, 47% said they would be interested in procuring a method through a private sector pharmacy. Conclusions: There is both actual and latent demand for accessing family planning through Senegal's urban, private sector pharmacies. With proper training, pharmacy staff could better provide effective counseling and provision of OCPs and injectables, and lifting the requirement for a prescription could help support gains in contraceptive prevalence.

Over the counter: The potential for easing pharmacy provision of family planning in Senegal

Background: This research assessed the potential for expanding access to family planning through private sector pharmacies in Senegal, by examining the quality of the services provided through private sector pharmacies, and pharmacy staff and client interest in private sector pharmacy-based family planning services. Methods: This was a cross-sectional, descriptive study conducted in eight urban districts in and around Dakar and two urban districts outside of Dakar employing an audit of 225 pharmacies, a survey with 486 private sector pharmacy staff and a survey with 3,567 women exiting private sector pharmacies. Results: Most (54%) pharmacies reported offering method-specific counseling to clients. Family planning  commodities were available in all pharmacies, and 72% had a private space available to offer counseling. Three quarters (76%) did not have any counseling materials available. 49% of pharmacists and 47% of assistant pharmacists reported receiving training on family planning during their professional studies. Half had received counseling training. Few pharmacists met pre-determined criteria to be considered highly knowledgeable of the oral contraceptive pill (OCP) and injectable contraceptive provision (0.6% and 1.1%). Overall, 60% of women surveyed were current family planning users and 11% procured their method through a private sector pharmacy. Among non-users of family planning, and current users who did not obtain their method through a pharmacy, 47% said they would be interested in procuring a method through a private sector pharmacy. Conclusions: Senegal's urban, private sector pharmacies are well-positioned to meet the increasing desire for modern contraception. With proper training, pharmacy staff could better provide effective counseling and provision of OCPs and injectables, and lifting the requirement for a prescription could help support gains in contraceptive prevalence.

Family planning provision in pharmacies and drug shops: an urgent prescription

Drug shops and pharmacies have long been recognized as the first point of contact for health care in developing countries, including family planning (FP) services. Drug shop operators and pharmacists should not be viewed as mere merchants of short-acting contraceptive methods, as this ignores their capacity for increasing uptake of FP services and methods in a systematic and collaborative way with the public sector, social marketing groups and product distributors. We draw on lessons learned from the rich experience of earlier efforts to promote a variety of public health interventions in pharmacies and drug shops. To integrate this setting that provides convenience, confidentiality, access to user-controlled contraceptive methods (i.e., pills, condoms and potentially Sayana Press®) and a gateway to clinic-based FP services, we propose three promising practices that should be encouraged in future interventions to increase access to quality FP services.

Over the counter: The potential for easing pharmacy provision of family planning in Senegal

Background: This research assessed the potential for expanding access to family planning through pharmacies in Senegal, by examining the quality of the services provided through pharmacies, and pharmacy staff and client interest in pharmacy-based family planning services. Methods: This was a cross-sectional, descriptive study conducted in eight urban districts in and around Dakar employing an audit of 250 pharmacies, a survey with 486 pharmacy staff and a survey with 3,569 women exiting pharmacies. Results: Most (54%) pharmacies reported offering method-specific counseling to clients. Family planning  commodities were available in all pharmacies, and 72% had a private space available to offer counseling. Three quarters (76%) did not have any counseling materials available. 49% of pharmacists and 47% of assistant pharmacists reported receiving training on family planning during their professional studies. Half had received counseling training. Few pharmacists met pre-determined criteria to be considered highly knowledgeable of the oral contraceptive pill (OCP) and injectable contraceptive provision (0.6% and 1.1%). Overall, 60% of women surveyed were current family planning users; of these, 11% procured their method through the pharmacy. Among non-users of family planning, and current users who did not obtain their method through a pharmacy, 47% said they would be interested in procuring a method through a pharmacy. Conclusions: Senegal’s urban pharmacies are well-positioned to meet the country’s increasing desire for modern contraception. With proper training, pharmacy staff could better provide effective counseling and provision of OCPs and injectables, and lifting the requirement for a prescription could help support gains in contraceptive prevalence.

Community-based provision of family planning in the developing world: recent developments

PURPOSE OF REVIEW

The study reviews important contributions to the peer-reviewed literature on the community-based provision of family planning in developing countries, from 2012 to the present.

RECENT FINDINGS

The major areas on which recent reports have focused include pilot studies, drug shops, and new contraceptive technology. The key studies focus largely on the provision of injectable contraception at the community level.

SUMMARY

Decades of previous research on community-based family planning has focused on the traditional community health worker. Yet, recent developments in this field have expanded many areas that have been studied previously. A major emphasis of recent research has dealt with broadening the community-based locations from which clients can obtain injectable contraception. Drug shops in developing countries are promising locations for family planning services. They are ubiquitous, frequently accessed, and generally sustainable businesses. Also, a new formulation of injectable contraception in an easy-to-use delivery device is garnering global attention for its potential benefits in community-level use. Additional research and programmatic interventions are needed to better understand the training, policy, regulatory, and logistical needs to ensure quality service delivery.

Getting closer to people: family planning provision by drug shops in Uganda

BACKGROUND

Private-sector drug shops are often the first point of health care in sub-Saharan Africa. Training and supporting drug shop and pharmacy staff to provide a wide range of contraceptive methods and information is a promising high-impact practice for which more information is needed to fully document implementation experience and impact.

METHODS

Between September 2010 and March 2011, we trained 139 drug shop operators (DSOs) in 4 districts of Uganda to safely administer intramuscular DMPA (depot medroxyprogesterone acetate) contraceptive injections. In 2012, we approached 54 of these DSOs and interviewed a convenience sample of 585 of their family planning clients to assess clients' contraceptive use and perspectives on the quality of care and satisfaction with services. Finally, we compared service statistics from April to June 2011 from drug shops, community health workers (CHWs), and government clinics in 3 districts to determine the drug shop market share of family planning services.

RESULTS

Most drug shop family planning clients interviewed were women with low socioeconomic status. The large majority (89%) were continuing family planning users. DMPA was the preferred contraceptive. Almost half of the drug shop clients had switched from other providers, primarily from government health clinics, mostly as a result of more convenient locations, shorter waiting times, and fewer stock-outs in drug shops. All clients reported that the DSOs treated them respectfully, and 93% trusted the drug shop operator to maintain privacy. Three-quarters felt that drug shops offered affordable family planning services. Most of the DMPA clients (74%) were very satisfied with receiving their method from the drug shop and 98% intended to get the next injection from the drug shop. Between April and June 2011, clinics, CHWs, and drug shops in 3 districts delivered equivalent proportions of couple-years of protection, with drug shops leading marginally at 36%, followed by clinics (33%) and CHWs (31%).

CONCLUSION

Drug shops can be a viable and convenient source of short-acting contraceptive methods, including DMPA, serving as a complement to government services. Family planning programs in Uganda and elsewhere should consider including drug shops in the network of community-based family planning providers.