Beyond the chemist: Pharmacies to play a bigger role in family planning

For many women, the pharmacy is the health facility they can reach fastest. It may be closer to home or work, open beyond normal working hours and offer a degree of privacy that makes it easier to ask questions about contraception.

Yet buying a packet of pills or condoms from a pharmacy is not the same as receiving quality family planning care.

A five-year project in Kenya is seeking to bridge that gap by moving selected community pharmacies beyond simply dispensing contraceptive commodities to providing counselling, method choice and selected reproductive health services.

The Strengthening Pharmacy Provision of Contraceptives in Kenya Market Test project, implemented by inSupply Health with the Ministry of Health, Pharmaceutical Society of Kenya, Kenya Pharmaceutical Association, University of California, San Francisco and Kenya Medical Research Institute, set out to answer a practical question: can pharmacies expand contraceptive access while operating a model that works for both clients and businesses?

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Yasmin Chandani said the project began in 2021 to test whether community pharmacies could become quality family planning providers without losing sight of their commercial reality.

“We started this work in 2021 to really test the feasibility of community pharmacies as quality family planning providers, while at the same time maintaining a viable business model. What we have seen through this journey is that there is a business case, there is client demand and there is an opportunity to build a model that can be integrated into the health system. The work is far from over. We now have tools, lessons and evidence, and what is needed is connected action to take this forward,” Chandani said.

The project first studied the needs of pharmacies and clients, then tested different approaches before identifying models that could potentially be taken to scale.

The findings suggest pharmacies were reaching women who might not otherwise have used family planning services through this channel.

During implementation research between October 2022 and June 2024, participating pharmacies recorded 57,606 client visits. About 44 per cent of family planning clients were first-time users, while repeat clients increased from 57 per cent to 62 per cent of all visits.

The figures point to more than one-off purchases. Women were returning for services, suggesting that the pharmacy could become a continuing point of contact for family planning.

The project also tested the provision of injectable contraception, including depot medroxyprogesterone acetate, commonly known as DMPA.

DMPA is a hormonal contraceptive given by injection. DMPA-IM is administered into a muscle by a trained provider, while DMPA-SC is injected under the skin and, after appropriate training, can be self-administered by a woman.

DMPA accounted for up to 22.1 per cent of the contraceptive mix in participating pharmacies. DMPA-IM was much more widely used than DMPA-SC, at roughly six times the level of the self-injectable option.

The difference, however, was not simply about client preference. Supply was a major constraint.

Where DMPA-SC was available, particularly when DMPA-IM was unavailable, clients readily accepted it. The experience suggests that consistent supplies and better awareness could help unlock demand for self-injectable contraception.

Commodity volumes also increased during the project, rising from 2,552 units to a peak of 4,730 units before settling at about 3,671 units per month during the scale-up period.

For pharmacies, however, contraceptive provision involves more than keeping products on shelves.

A provider needs time to counsel a client, discuss available methods, protect privacy, record information and know when to refer a woman to another level of care. That has implications for how the service is financed and incorporated into normal pharmacy operations.

This is where the project’s business model becomes important. It identified opportunities through expanded product offerings, stronger relationships with clients and demand for personalised advice. Clients, particularly in urban and peri-urban areas, also valued the convenience and discretion of receiving services in pharmacies.

The approach is now taking a more visible form through Jipende Jipange. Rather than creating new health facilities, the model uses existing community pharmacies. Selected pharmacies are supported to provide a defined package of family planning and self-care services, with trained providers, private consultation spaces and identifiable Jipende Jipange branding.

The model is currently being implemented in 12 counties, including Nairobi, Kiambu, Kajiado, Kisumu, Meru, Nakuru, Narok, Kisii and Uasin Gishu, with plans to expand the model to more areas.

For a woman, the practical difference is that a participating pharmacy is intended to offer more than a product transaction. She can discuss her contraceptive needs with a trained provider, receive information on available options and be referred elsewhere when her needs go beyond the services the pharmacy can safely provide.

Dr Albert Ndwiga of the Ministry of Health said the wider health system needs to recognise the role pharmacies can play while maintaining clear standards.

“Quality healthcare requires a connected system where people can access the services they need regardless of where they live. Community pharmacies are convenient and licensed pharmacists and other professionals can support that care. We need to make sure that they are providing information and choice, prevention, education, screening and referral where appropriate, and that the services are provided safely and within the competencies of the provider,” Ndwiga said.

That means the model is not designed for every pharmacy worker to begin offering contraceptive services without additional preparation.

Providers selected for the hybrid training had to be registered or enrolled by the Pharmacy and Poisons Board, hold a valid practising licence, belong to the relevant professional bodies and work in a community pharmacy.

They also had to be willing to stock, counsel and provide short-term family planning services, submit monthly data, maintain a safe consultation space and complete the three-to-four-week hybrid training programme.

The training combines online learning with practical components because contraceptive provision involves skills that need to be demonstrated and assessed.

The project reported an average provider reporting rate of 90.8 per cent and client satisfaction of 95 per cent. Pharmacy providers also recorded high levels of confidence in providing injectable contraception.

The results, however, have also exposed what could determine whether the model survives beyond project support. Commodity availability remains critical, a client cannot choose a method that is not in stock. Reporting systems need to be simple enough for busy pharmacies to use consistently. Providers need continuing professional development, while the cost of counselling and service delivery has to be recognised in a model where pharmacies also have commercial responsibilities.

There is also a wider financing question. Public facilities may provide subsidised family planning, while private pharmacies must meet operating costs. For pharmacy-based care to become a lasting part of the health system, the service cannot depend indefinitely on project funding or intensive external follow-up.

Chandani said the lessons from the Market Test should instead inform what happens next.

“The challenges that we have seen are not reasons to stop. They are signals of what needs to be solved next. We need to deliberately integrate the pharmacy channel into Kenya’s health architecture, strengthen the links between pharmacies and other parts of the health system, simplify digital reporting, get the right incentives in place, continue with professional development and make sure that the business case remains viable,” she said.

For Kenya, the next phase is therefore less about proving that women will walk into a pharmacy for contraception. The project has already generated evidence that they will.

The harder question is whether the systems around those pharmacies can keep pace: reliable commodities, trained providers, simple reporting, appropriate financing, clear referral pathways and quality safeguards.

If those pieces hold, the familiar pharmacy on the corner could take on a new role in family planning, giving women another place to seek information, make informed choices and access appropriate care without having to begin their journey at a hospital.

That would make the pharmacy not a replacement for the public health system, but another connected doorway into it.