Engaging Drug Shops: Critical to Increasing Family Planning Access

Small commercial drug shops have long been recognized as the first line of health care in low- and middle-income countries, especially in rural areas with few private or public clinics. Drug shops often provide a variety of health services, products, and information, which sometimes go beyond the strictures of local laws and regulations. These services range from the diagnosis and treatment of diseases such as malaria and sexually transmitted infections and ailments such as pneumonia, diarrhea, or respiratory infections to preventive care including family planning.

Small commercial drug shops are often the first line of health care in low- and middle-income countries, especially in rural areas. Photo: FHI 360.

Why are Drug Shops Important for Family Planning?

Drug shops provide an important opportunity to expand access to family planning, for women and harder-to-reach groups through convenience, anonymity, and cost savings. Drug shops as providers of methods, both sanctioned and unsanctioned, are largely missing from countries’ family planning strategies, policies, regulation, and monitoring. Most decision-makers have been slow to adapt policies and programs despite numerous studies demonstrating the feasibility of training drug shop operators to deliver various long-term methods. Instead, they are often viewed as mere merchants of limited short-term methods, which ignores their capacity for increasing uptake of family planning services and methods in a systematic and collaborative way with the public sector, social marketing groups, and product distributors.

What Do We Know?

Many studies have examined contraceptive use patterns, market trends, and the role of the private sector in improving access. The positive implications for women, providers, and communities are clear. For instance in Uganda, the scale-up of providing depot medroxyprogesterone acetate subcutaneous (DMPA-SC) through drug shops led to increased access and uptake. FHI 360, in collaboration with the Uganda Ministry of Public Health and Population and PATH Uganda, carried out a Catalytic Opportunity Fund project August 2019 to January 2020.¹

Although drug shop operators are often considered mere merchants of limited short-term family planning methods, numerous studies have shown the feasibility in training them to deliver long-term methods, thereby increasing family planning uptake. Photo: FHI 360.

What Are the Benefits of Engaging Drug Shops?

• Women: The policy shift will increase the number of channels for the access and uptake of injectable contraception, help reduce the unmet need for family planning methods, and contribute to the continuous use of contraception among current users. In the Uganda project, the number of women obtaining contraception at drug shops increased from 1,708 in October to 7,221 by end of January. Those choosing DMPA-SC increased threefold, and DMPA-implant, fourfold.
• Health care providers: Staff workloads in public health facilities will be reduced as drug shops provide an alternative outlet for FP services (injectables) as demand increases. A total of 323 drug shop operators were trained during the Uganda project reaching an additional 74 sub-counties in 20 districts. Thus, health workers could have more time to provide quality FP services such as effective counseling and adequate information to clients. Providers in rural public facilities will be able to use the time they save to focus on other maternal health needs such as childbirth.
• Communities: Contraceptive sources will be increased in the community thus improving equity in access to FP methods. Clients not comfortable with long queues at public health facilities will easily access FP services from drug shops. Because shops are usually open on weekends and for extended hours unlike most government and private not-for-profit health facilities further increases accessibility.
• Nations: Drug shops will increase the number of women seeking FP services due to accessibility alternatives hence reducing unmet need and improving the modern contraceptive prevalence rate (mCPR) of the country. Due to the Uganda project’s success, the MPHP approved a policy March 4, 2020, to allow DMPA-SC self-injection in the private sector. The health management information system was revised to include a section for capturing drug shops data showing the government’s commitment to scale up DSO provision of FP, including DMPA-SC for self-injection.

Engaging drug shops will increase family planning method choice and access, help reduce unmet need, and contribute to the continuous use of contraception among current users. Photo: FHI 360.

What We Can Do

More and more drug shops will be enlisted to help meet the growing demand for family planning, specifically injectable contraceptives, in rural and hard-to-reach areas by improving the availability of high quality and reliable services. A better understanding of the current practices, opportunities, challenges, and gaps in drug shops provision of family planning will be required of more professionals in this field as we collectively discuss mechanisms to effectively and strategically integrate these providers in our global, national and local conversations on increasing family planning access and health services more broadly.

^{1. FHI 360. “Use of the catalytic opportunity fund for DMPA-SC scale-up in Uganda: August 2019 to January 2020” (unpublished report, March 26, 2020). Durham (NC).↩}