Strengthening pharmacy-based reproductive health services for youth
Young people frequently encounter barriers to accessing contraceptive information and services, which leads to high rates of unintended pregnancy and increased risk of contracting HIV and sexually transmitted infections (STIs). Pharmacies in low- and middle-income countries provide quick access to medicines and health advice—they are ubiquitous, have convenient hours and locations, require no appointment, and offer anonymity. These attributes are especially appealing to adolescents. From 2000 through 2006, PATH implemented the RxGen project to provide youth-friendly reproductive health services at pharmacies. This project showed that a plan including advocacy, training, and institutional capacity-building is an effective and sustainable approach for increasing young people’s access to quality information and youth-friendly services, including emergency contraception (EC); ongoing contraception; risk identification and referral for sexually transmitted infections, including HIV/AIDS; and the management of unintended pregnancy.
RxGen project overview
PATH launched the RxGen project in 2000 in Cambodia, Kenya, and Nicaragua, where we carried out country assessments, developed a training curriculum for pharmacists and front line staff, and broadly disseminated project materials. The curriculum was a global version intended for adaptation in various country environments. In the second phase of the project, PATH expanded the model in these three countries, implemented the project in Vietnam, and catalyzed similar efforts in China and Indonesia. We partnered with public- and private-sector groups, including local nongovernmental organizations, ministries of health, private-sector pharmacy associations, and universities.
Project objectives included the following:
- Strengthen the capacity of pharmacists and pharmacy staff to deliver quality reproductive health services to youth.
- Raise awareness of pharmacy services.
- Institutionalize reproductive health services at the university pharmacy school level.
- Evaluate the feasibility and effectiveness of our approach.
During the six years of project work in four countries, we trained nearly 2,000 pharmacy staff and assessed how well the training worked. We assessed training by sending “simulated clients” to request help at pharmacies, and by direct interviews with staff. The evaluations showed that staff knowledge of EC increased substantially with training. Staff offered an EC product appropriately, and in more than half of these instances, clients also received correct information about potential EC side effects, representing between a 28 and 43 percent increase from baseline across project sites. In addition to EC knowledge and advice, two other indicators from simulated client visits and staff interviews increased substantially: the percentage of staff offering information about STI risk and the percentage offering information about routine contraceptive methods. Nearly 90 percent of the simulated clients reported that the pharmacy staff in project pharmacies had a positive attitude toward youth after training.
Curriculum for institutions
The RxGen project included work to institutionalize the training curriculum in each of the project countries:
- Cambodia: The Pharmacist Association of Cambodia and the University of Health Sciences incorporated the RxGen curriculum into pharmacist training courses.
- Kenya: The Pharmaceutical Society of Kenya developed a continuing education program that included the curriculum.
- Nicaragua: The University of UNAN León incorporated the RxGen curriculum into its pharmacist training courses.
- Vietnam: The leaders of Thanh Hoa Medical College approved the inclusion of the RxGen curriculum into the standard training curriculum for pharmacy students of the college.
RxGen implementation manual
The major project output was a comprehensive manual, the Youth-Friendly Pharmacy Program Implementation Kit. This kit provides guidelines, ideas, and prototype materials for designing and implementing a pharmacy capacity-strengthening project and is intended to guide program managers in the development of a pharmacy training initiative. It can be adapted as needed to ensure suitability in a variety of environments.
The kit consists of four main components:
- Guidelines for implementation of a youth-friendly reproductive health training program for pharmacy staff.
- Implementation tools, including a training curriculum.
- Prototype evaluation instruments.
- Samples of printed materials.
By emphasizing the needs of youth, developing the capacity of pharmacies to provide critical services to this group, and linking pharmacies to the formal health care system, the project achieved important results:
- It developed a resource—pharmacy-based services—that could address adolescent reproductive health needs related to unprotected sex in a manner and in locations that would encourage young people to use them.
- The pharmacy sector in each of the project countries achieved a higher level and quality of pharmaceutical care and better understanding of the role it plays in the health of communities.
- By sharing the results, the project inspired interest in the concept of quality pharmacy-based reproductive health services. Other organizations adapted our tools to start their own initiatives.
More information on the RxGen project
- Fact sheet on RxGen project in Kenya
- Training resources for pharmacies providing youth-friendly services in Cambodia
- PowerPoint presentation on the project and results: Reaching Youth through Pharmacies