Provision of Injectable Contraceptives within Drug Shops: A Promising Approach for Increasing Access and Method Choice

"Private medicine retailers are fast becoming key players in promoting access to medicines in low- and middle-income countries."

This technical brief from Advancing Partners & Communities (APC) introduces the concept of using community drug shops to expand access in developing countries to a broader range of family planning methods. It outlines the possibilities of adding provide injectable contraceptives, along with oral contraceptive pills, to the products and services that these shops make available, especially in rural communities. It presents existing evidence on the practice and barriers, along with what is needed to: expand the practice; generate more evidence; develop training; and strengthen regulation, supervision, monitoring, and evaluation.

Due to convenience and popularity of local drug shops as health provision outlets that are already a source of some kinds of contraception products and due to some reported evidence of success in marketing injectable contraception products that women then take elsewhere for safe injection, the training of drug shop owners to administer the injections is a next possible step: "Injections given outside the formal health care system have been found to be safe if the providers are trained and supervised adequately. There is some research and programmatic evidence that drug shop operators can be trained to safely provide a wide variety of family planning methods, including injectables.... In particular, training drug shop operators to support safe provision of injectables should be considered in countries where they are already illegally providing injectables and are likely to continue the practice....In many countries, drug shop operators have as much or more medical training as volunteer community health workers. Thus, they could be trained to screen clients and even to give safe injections, as community health workers increasingly do across Africa and have done in Asia and Latin America for many years."

Research in Bangladesh has demonstrated that, when trained and supported, "private sector workers, such as drug shop staff, can safely and effectively provide quality family planning services, including injectable contraceptives." Creating a supportive policy environment globally and locally and influencing stakeholders to amend prohibitive regulations can be supported by disseminating and discussing evidence on the practice. Organising educational tours for "key officials from ministries of health, pharmacy councils, and other regulatory councils [can give] them a first-hand look at drug shop operators who are safely providing injectable contraceptive." Engaging the national pharmacy council of each country in removing restrictions can help to move the practice forward, as can advocating for its inclusion in national family planning and sexual and reproductive health policy and service delivery guidelines, along with training, accreditation, and regulation of drug shop owners.

Other communication-related means of pushing the practice forward include: generating more evidence to support the practice; exploring how to motivate owners of these businesses to become trained and effective in providing injectables as part of their family planning services; and creating point-of-sale information and promotional materials, including client brochures, screening and standard procedure checklists, and social marketing materials like product inserts and other client materials. Along with regulation and supervision, "franchise and social marketing models hat build upon the existing drug shop operator associations and support development of locally-led associations where none exist" may help with normalising the practice.