Pharmacists to start giving family planning injections in policy shift

Clinical pharmacist Farida Chakera always wanted to offer family planning injections to mothers, but without formal training, her hands were tied.

All she would do was give condoms and pills to women seeking the service. “These two did not require any counselling, they would pay and give it to them and leave,” adds Dr Chakera.

But now, community pharmacists like Dr Chakera can give injections to those seeking family planning services. Worried by the low-level uptake of modern contraceptives and family planning services, the Ministry of Health has recommended community pharmacists (CPs) give family planning injections to boost uptake.

This has led to the approval of a new national training package for pharmacists and pharmaceutical technologists in July last year by the Department of Family Health. In addition to the pills and condoms, the health care practitioners can now give injections, including subcutaneous and intramuscular

The Ministry of Health with the support from the Advance Family Planning (AFP) local partner Jhpiego engaged decision-makers, including the Pharmaceutical Society of Kenya, to support the policy change and development of a pharmacist training package.

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This change opened up an alternative for women and young people who may be reluctant to seek contraceptives at health facilities. It also expanded the role of the private sector in helping reduce commodity shortfalls.

The health care practitioners were then taken through an in-service comprehensive curriculum that integrated family planning training on how to administer them properly and safely, HIV, sexually transmitted infections, and other related services.

With the training, Dr Chakera and others are able to provide primary care close to the people and even improve the numbers. Currently, there are 4,000 pharmacists and 11,000 pharmaceutical technologists.

“All we did is to stock the commodities for nurses to come and pick them and give to the mothers. Mothers would then come to ask for the commodities but I could not give them because I had not been trained,” she told the Sunday Nation.

She added: “Better late than never, having the skills and helping the nurses, I am sure that we are going to improve the numbers and some of the cases of unplanned pregnancies because of inaccessibility of the methods are going to reduce,” Dr Chakera said.

During the practical sessions after the training, under the watch of the nurses, she was able to give the injections to the mothers.

“There is nothing as fulfilling as counselling a mother, tabling the available methods, then they make a decision on the methods that they want and I am able to give it. This makes me happy,” Dr Chakera said.

Dr Edwin Okemwa from Afia Mzuri Pharmaceutical, on the other hand, used to see close to 100 women in a month who would come for the pills and condoms but because of the new training, he is certain that the number of women in need of other methods will increase.

“Many would come looking for other methods, but all I could do is to refer them to public health facilities,” he says

In the Kenyan pharmacy curriculum, pharmacists are taught about the composition of the methods, however, the usage, for years, has always been reserved for the nurses.

“In the community set up, we give the methods, but only restricted to the daily pills and condoms but now, it is open to the injectable. I am hoping that this is just a starting point and that we will be able to open it to other services,” he said

The services will be offered by only trained pharmacists at a small fee since, after the training, they are to create space in their business to counsel clients before offering the methods.

After the training, there is a specific number generated in the system by the Ministry of Health where the pharmacists are able to record their daily data on the number of clients they have seen and the methods they have given.

“This helps in the planning and coordination of the commodities because the Ministry of Health is able to tell the highly used method in a region and the preferred method in a county thus helping in planning and bridge the gap of unmet needs,” says Health chief administrative secretary, Dr Rashid Aman.

He said the days of having pharmacists just dispensing drugs and waiting for prescription is gone.

“Pharmacists' contributions to primary care is critical since they are the most accessible and frequently visited members of the healthcare team. Many pharmacists have established practices in the sector,” he said.

Dr Michael Mungoma, chairman of the education committee, Pharmaceutical Society of Kenya and theDean Mount Kenya University, School of Pharmacy, said that the training allows the pharmacists to give integrated services.

“They are able to work with the wider health care system better and integrate the services. For instance, the pharmacists are able to refer clients in case they are not able to offer the services. The system becomes tighter,” he said.

“The government realised that client seeking services in community pharmacies is huge and this data was not being reported to the system creating a gap, hence the need to incorporate the pharmacists to get the data and plan well when it comes to resourcing the commodities,” Dr Mungoma added.

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Pharmacists are a highly trained and skilled workforce that is underutilised with the perception that they can only sell drugs.

With regards to the target set by the government that the country should meet 66 per cent of modern contraceptive coverage by 2030, the Ministry of Health realised that they can only achieve this when they partnered with the private community pharmacists.

For training eligibility, only those practising and with adequate space for counselling clients and those linked with the government can be trained to give the services.

“After the training, the Pharmacy and Poisons Board which is the regulator of pharmacists provide a unique code that is able to link the premise with the Ministry of Health’s Health Information System, as they provide the services, they report back,” he said.

The pharmacists must have undergone full training as per the Ministry of Health curriculum.

After the training, they are provided with certificates, which they should hang on their premise for easier identification.

According to the Kenya Household Health Expenditure Survey of 2013, pharmacies are the third most popular service providers for outpatient care after public health centres and dispensaries and public hospitals.

The survey found that one in 10 Kenyans consult a pharmacist, instead of going to the hospital, when they are sick, while 31 per cent of Kenyans buy medication over the counter without seeking any medical practitioner’s advice.

Among the leading reasons why Kenyans seek outpatient health services, including at pharmacies, are cases of family planning, malaria or fever, and diseases of the respiratory system including pneumonia, which has not been confirmed by a doctor.

“These patients go to chemists because they trust the pharmacists, having them in the system to provide some of these services will eventually improve the numbers in the sector,” said PPB CEO Fred Siyoi.

“The change has been necessitated by the need of the patients. This is just the beginning, we are looking at other areas instead of them only being drug dispensers, their role is changing and this will help the country in achieving Universal Health Care because we need to do more on prevention than treatment,” Dr Siyoi said.

He said the cohort is highly trained but underutilised.

“If you look at other countries, including the US and even Nigeria, the pharmacists are even giving Covid-19 injections, it is only here in Kenya that they are underutilised, incorporating them in the system would mean we open up to other services, “he said.

“We need to borrow best practices worldwide, it is easy to copy and do what is being done in other countries. It is even cheaper for us as a country,” he added.