Pharmacies on the frontline of sexual and reproductive health

March 4, 2014 by Jane Hutchings

Young people make critical decisions about their health and sexuality, often in places where just talking about sex, condoms, or contraception is taboo. Who do they turn to for information?
A young woman stands before a counter in a Cambodian pharmacy, reading materials. A pharmacy staff member stands behind the counter.

Pharmacy staff in Cambodia, often frontline health care providers, received training to better serve young clients. Photo: PATH/Jolene Beitz.

Jane Hutchings, Jen Drake, and Jill Keesbury of PATH’s Reproductive Health Program recently wrote this post for The Guardian’s Global Development Professionals Network.

Every day, young people make critical decisions about their health, sexuality, and well-being—often in settings where just talking about sex, condoms, or contraception is taboo. Studies have shown that youth across Africa—including in Ghana, Kenya, Nigeria, and Uganda—prefer to access health services through pharmacies.

Pharmacies are their first, and often only, point of service for health care. In Ghana, for example, nearly 60 percent of adolescents who use family planning obtain their chosen method through pharmacies and drug shops.

Youth face distinct reproductive health challenges. Data from across the globe show that sexually transmitted infections are most common among young people. Complications from pregnancy, childbirth, and unsafe abortions are major causes of death for adolescent girls in developing countries. Equipping young people with the knowledge and tools they need to promote and protect their own health is critical to achieving broader global goals to empower women, improve maternal and child health, and reduce HIV/AIDS.

As first steps in maximizing the contribution of pharmacies to youth sexual and reproductive health, we should strengthen their capacity as frontline service providers, mobilize the skills of young pharmacists and pharmacy students, and improve the diversity of contraceptives available to youth through pharmacies. In each area, partnering with both the private and public sectors will be key.

Frontline capacity

Improving the knowledge and skills of frontline service providers can help pharmacies to better serve youth. PATH’s RxGen project in Cambodia, Kenya, Nicaragua, and Vietnam trained more than 1,000 pharmacists and staff to offer services focused on meeting young people’s needs. Focus areas included emergency contraception and ongoing contraception, risk identification and referral for sexually transmitted infections, and management of unintended pregnancy.

Pharmacy staff were eager to learn new skills and increase their knowledge. Mystery shoppers, young men and women trained to gather information, who visited the pharmacies to evaluate the project found that staff knowledge and ability to serve youth increased. At least 75 percent of mystery shoppers reported that their visit to the pharmacy was a positive experience.

In Kenya, Population Council researchers tested a relatively simple approach to communicating key reproductive health messages: pharmacy staff shared informative flashcards with youth pharmacy clients during wait times. This approach improved the consistency of information that clients received from pharmacy staff in an environment where junior frontline staff turn over regularly.

Calling young pharmacists

As severe human resource shortages continue to grip the health sector across the developing world, young pharmacists constitute an important and untapped resource. One study in Ghana found that pharmacy students are ambitious and eager to share their health knowledge with new clients; policymakers and professional bodies can leverage this motivation and potential. Linking efforts to strengthen services for youth in pharmacies with established training programs for pharmacists and pharmacy technicians would have a lasting impact.

Young pharmacists, both those in university and those just entering the workforce, bridge the divide between private-sector outlets and the young people they serve. They can tailor services and information to young clients in a new way, and ensure that the products and services most appealing to a younger clientele are offered in their pharmacies.

Many pharmacy workers are young people with little if any formal training in sexual and reproductive health. Expanding their technical capacity leads to better services for youth, as documented in the RxGen work.

More contraceptive options are needed

Making the right products available to meet young people’s needs is also important. This means offering high-quality, low-cost products—including male condoms, daily oral contraceptive pills, and emergency contraceptive pills—as appropriate options for youth facing diverse circumstances.

New contraceptive technologies are in development to broaden the methods that appeal to young people. One promising option is Sayana Press, a single-dose injectable contraceptive that has the potential to be administered by pharmacists, or even by young women themselves. Also new to the market is the Woman’s Condom, a third-generation female condom that provides on-demand, woman-initiated protection from unwanted pregnancy and diseases. This product’s unique design enables easy insertion, secure fit, good sensation, and easy removal. Global health stakeholders are also considering development of a dedicated oral contraceptive pill that could be taken before or after sex, instead of daily, as a regular method. This might be especially appealing to younger, unmarried women who are not having very frequent sex. Viewing these technologies through a youth lens can help in designing information and access options.

Coordinating the public and private sectors

Governments and donors should coordinate the important contributions of both the public and private sectors to secure the health of young people. For example, licensing pharmacies and similar facilities and instituting robust systems for oversight would ensure that youth and all clients have access to high-quality services and products.

Additionally, youth may visit pharmacies and require clinical services. For example, longer-term family planning methods such as an intrauterine device, treatment for sexually transmitted infections, prenatal care, or post-rape care. Public and private coordination must include improving referral systems and links with other health care providers.

Toward a healthier future for the world’s youth

Strengthening sexual and reproductive health services in pharmacies will require the continued involvement of youth in shaping the policies, services, and innovations to meet their needs. As noted in the recommendations issued to the UN secretary general by a high-level panel of eminent persons on the post-2015 development agenda: “Young people must be subjects, not objects, of the post-2015 development agenda. . .They must also be active participants in decision making, and be treated as the vital asset for society that they are.”

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