Assessing feasibility and acceptability of increasing access to sexual and reproductive health and rights through pharmacy outlets and community health volunteers: lessons from pilot study in Kenya

Abstract

Background: Both unintended pregnancy and unsafe abortion are major public health problems in Kenya. The World Health Organization recommends the use of medication abortion to stop unwanted pregnancies. However, the extent of provision and uptake of medication abortion through private pharmacies in Kenya is not well known. This study assessed the feasibility and acceptability of utilizing pharmacy outlets and community health volunteers to increase women's and girls' access to information, medication abortion and other sexual and reproductive health services and rights.

Methods: The study utilized a single arm (intervention only) pre-test and post-test design that involved implementing a set of interventions and comparing the baseline and endline indicators using simple frequencies considering the number of respondents involved in the study. The study, referred to as Tembe Mkononi project, was conducted from 1^st February 2021 to 31^st December 2022, in Homa Bay County. Data collection involved baseline and endline interviews with 10 pharmacy staff (drawn from 9 pharmacy outlets) and 20 community health volunteers while program data was extracted from pharmacy sales records.

Results: A total of 527 clients obtained medication abortion drugs from the 9 participating pharmacy outlets between April and December 2022. There was a steady increase in the number of clients served from 15 clients in April 2022 to 112 clients in December 2022. Out of the 527 clients, 523 of them obtained family planning methods. All the pharmacy staff and community health volunteers expressed satisfaction and positive attitude towards the services provided to clients.

Conclusion: Results of the study show that the provision of medication abortion and other sexual and reproductive health services such as contraceptives to women and girls through private pharmacy outlets was feasible and acceptable. Building the capacity of community health volunteers to create awareness, strengthen referral and follow-up activities increased demand and uptake of sexual and reproductive health services including medication abortion over the project period. Overall, the interventions implemented in a rural county in Western Kenya have potential in addressing the problem of unsafe abortion which is one of the leading causes of maternal morbidity and mortality in Kenya and other developing countries.

Keywords: Community health volunteer; Homa Bay County; Medication abortion; Pharmacy; Sexual and reproductive health and rights.

Fig. 1

Conceptual framework

Fig. 2

Online pharmacy service flow-chart

Fig. 3

A girl’s journey through the Tembe Mkononi pathway for SRHR services

Fig. 4.

Screening of clients by pharmacy staff before MA service provision, April-Dec 2022 (N=10)

Fig. 5

Information by pharmacy staff to clients seeking MA services, April-Dec 2022 (N=10)

Fig. 6

Counseling and information provision by CHVs to MA clients, April-Dec 2022 (N=20)

Fig. 7

Advice and services provided by CHVs to post-MA clients at follow-up, April-Dec 2022 (N=20)

Fig. 8

No. of community dialogue forums organized by CHVs to discuss SRHR, April-Dec 2022 (N=20)

Fig. 9

Number of MA clients by age categories, April-Dec 2022 (N=527)

Fig. 10

Number of MA clients served per pharmacy outlet, April-Dec 2022 (N=527)

Fig. 11

Trend in number of MA clients served through pharmacy outlets, April-Dec 2022 (N=527). Sources of information on MA for clients

Fig. 12

Sources of information on MA by clients by age categories, April-Dec 2022 (N=527). Note: YPPs are included in the bar graphs for CHVs as a source of information