PATH develops a model for increasing youth’s access to reproductive health services

During adolescence, people are more likely to take risks and less capable of predicting and dealing with the consequences than at any other time of life. Reproductive health is especially threatened; rates of sexually transmitted infections (STIs) are highest among young people aged 15 to 24 years. For young women, in particular, adolescence is a time of vulnerability—a time when their ability to negotiate safe sexual interactions is often slight. Complications from pregnancy, childbirth, and unsafe abortions have become the major causes of death for girls aged 15 to 19.

PATH is working to reduce adolescents’ risk of unintended pregnancy and sexually transmitted infections by making it easier for them to get the health information and products they need. Our point of contact is the pharmacy, an anonymous setting that is less threatening and more accessible than a health care clinic.

The RxGen model

In many developing countries, pharmacies are a primary source of health services and supplies. Pharmacy staff are in a good position to help their clients out with critical reproductive health needs: emergency contraception, STI risk assessment, and ongoing use of contraception. The convenience, affordability, and anonymity offered by pharmacies are particularly appealing to youth.

PATH’s RxGen project improves the quality of reproductive health information and products given at pharmacies. Together with project partners, we advocate for the support of government and professional organizations and train pharmacists and pharmacy staff—helping them expand their technical knowledge and enhance their counseling skills. We also use outreach programs to educate youth about their options and build referral networks so that pharmacists can send young people to a health care provider when diagnosis and treatment are necessary.

PATH launched the RxGen Project in 2000 in Cambodia, Kenya, and Nicaragua and has now expanded it to include Vietnam. We have partnered with public- and private-sector groups, including local nongovernmental organizations, ministries of health, private-sector pharmacy associations, and universities. These partners have helped develop strategies and find ways to make the impact of training and other system improvements sustainable.

Training pharmacy staff

The foundation of the model’s success is a comprehensive training curriculum that we developed for pharmacists and behind-the-counter pharmacy staff. The curriculum, which we adapted for each country, strengthens pharmacy staff’s ability to provide appropriate reproductive health services; information, especially about emergency and ongoing contraception and STI risk; and, when needed, referrals for clinical services. It also helps pharmacists develop their counseling skills through role-playing and other interactive tools.

During the first three years, or first phase, of the six-year project, PATH trained more than 1,000 pharmacists and staff from approximately 530 pharmacies registered with ministries of health in Cambodia, Kenya, and Nicaragua. In the second phase of the project, a similar number of individuals have been trained in these three countries and Vietnam. We have found that pharmacy staff are eager to learn new skills and increase their knowledge. They gain satisfaction from providing good care, and they appreciate opportunities to promote their services.

Bridging the gap between pharmacies and clinics

PATH also worked to develop referral networks linking youth to clinical services. In Cambodia, Kenya, Nicaragua, and Vietnam pharmacy staff use referral slips to direct youth to clinics in the vicinity, giving them a tangible reminder and a specific location at which they should seek treatment.

Raising awareness among youth

To increase young people’s access to knowledge about reproductive health issues and the services that pharmacies provide, PATH and its local partners developed a set of logos, each appropriate for the country in which it is used, that identify participating pharmacies. When youth see that sign, they know they can expect discreet, knowledgeable assistance and support. It’s a visible representation of the pharmacy’s willingness to help.

All participating pharmacies distribute educational materials, such as brochures on contraceptive methods and STIs. Some of these materials were already in use; others have been created by PATH and our partners to meet specific needs.

Increased knowledge, improved service

PATH evaluates the project’s impact by sending “mystery shoppers” (young men and women from the communities involved who were trained to gather the needed information) to pharmacies as well as by talking to pharmacy counter staff, pharmacy owners, and pharmacists. During the first three years, we found that staff knowledge of and ability to provide high-quality reproductive health services to youth had increased in all three countries. For example, a before-training assessment showed that 0 to 30 percent of pharmacy staff offered the right emergency contraception products to mystery shoppers; after training, approximately 80 percent of pharmacy staff recommended the most appropriate options.

Similarly, mystery shopper reports showed that more than half of pharmacy staff in each country spontaneously offered information about STIs when shoppers sought services after unprotected sex. At least 75 percent of mystery shoppers in all three countries reported that their visit to the pharmacy was a positive experience. We are seeing similar results during ongoing monitoring activities.

Building on our experience

Our RxGen team is building on the project’s initial successes by incorporating the training curriculum into undergraduate pharmacy courses and continuing education programs for pharmacists. In Cambodia, the team helped negotiate collaboration between the Pharmacists Association of Cambodia and the Faculty of Pharmacy at the University of Health Science in Phnom Penh. Both organizations have adopted the curriculum into their programs. PATH is also working to have the curriculum institutionalized in Nicaragua and Vietnam.

To help other groups replicate and adapt the RxGen model in other areas, PATH has developed a roadmap: the Youth-Friendly Pharmacy Program Implementation Kit. Available in both English and Spanish, the kit contains a description of start-up strategies and activities, five teaching modules, handouts and job aids, prototype materials, and evaluation instruments.