Community pharmacies enhancing access to contraceptives in Kisumu County

A woman who seems afflicted by a fever walks in. She complains of a toothache and asks for specific medication.

However, after a brief consultation with the pharmacist, she is handed over an assortment of pills and a note. She is advised to see a dentist for further direction. Among the pills is a 30-day oral contraceptive pill. She pays and melts into the busy street, blending in with the crowd.

On the shelves is a colourful display of various drugs for different ailments. Antihistamines are on one shelf, followed by a stack of painkillers neatly laid out on the left side. On the right-hand are two charts with a message in Swahili: Amua kupata watoto wakati utakapo taka (Decide to have children at your own time). This is a strong selling point for contraception methods, as the chart illustrates the different methods available.

When 24-year-old Maureen Osano gave birth to her first child in 2022, she immediately knew it was time for her to consider contraception. With her husband, they agreed to a 2-year gap between their children, and as such, the young family opted for a contraception plan that would allow them to implement this decision.

Maureen has a small envelope tucked in her armpit. She welcomes us into her shop, which sells motorcycle spare parts. Her husband opened the shop, and she runs the sales and overall management to boost the household income. 

“I just got my monthly refill from the chemist next to her shop,” she tells us. She has been getting her contraception plan from the facility for the last 18 months.

“I did not want to go to the public hospital where I delivered my child, the nurses there were not very friendly. I saw them shouting at one mother; I was terrified and was looking for a friendlier person who could assist me with understanding contraceptives.”

She had planned for a long-acting contraceptive method to align with her plan of the two-year spacing between births. At the facility, however, the longest-acting method available was the Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC), popularly referred to as ‘DEPO’, an injectable contraceptive that lasts three months. 

“Three days after the injection, I had severe cramps that came with irregular menstruation. I could bleed for three continuous weeks. After three months, I had to switch to pills; I have been using them since.” 

Access to contraceptives

Health Ministry’s data shows that Kenya has been on an upward trend in the uptake of modern contraceptives, with married women using contraceptive methods at 57% in 2022 compared to only 32% in 2003. The government, however, intends to increase the prevalence of modern contraceptive use to 66% by 2030 to align with Sustainable Development Goal (SDG) 3.7, which seeks to ensure universal access to sexual and reproductive healthcare services.

According to data published in the Kenya Demographic Health Survey 2022, Kenya has an unmet contraceptive need of 14%. The highest burden is from adolescent women aged 20–29 years. Some of the factors listed for the unmet need include stigma, often intimate partner stigma, long distances to facilities that offer family planning services, myths around contraceptive use, as well as stockouts of preferred methods. 

Crunching the numbers

In data published by the Kenya Population Council, a non-government organisation registered in 1993, contraceptive use in Kenya is fluid, with 18% of contraceptive users reporting a change in their preferred methods annually. 

While public health facilities offer the bulk of contraception services at 60%, community pharmacies serve 10% of the population within reproductive age. Community pharmacies are authorised to provide select family planning services, including condoms, oral contraceptives, and emergency contraceptives. 

However, the lack of a proper documentation channel has made it difficult to measure the utilisation of modern contraception methods offered by community pharmacies. In low- and middle-income urban areas, such as Nyalenda, these pharmacies play a crucial role in access to contraception.

In 2024, the Kisumu County government partnered with the USAID Boresha Jamii project to roll out a tool that tracks the uptake of modern contraception from community pharmacies. The project is implemented by the Jaramogi Oginga Odinga University of Science and Technology, and is one of six projects implemented in Kisumu and Kakamega counties. In the Kisumu Central constituency, 14 pharmacies have been onboarded, and they furnish the County Government with data that includes the users' age, sex, and preferred method of contraception. 

According to the Kisumu County coordinator for reproductive health Agnes Dawa, community pharmacies play a crucial role in bridging reproductive health needs and need to be accounted for in the list of health providers, to enable the facilities benefit from additional services such as capacity building of the staff, to efficiently dispense reproductive health services.

“We realised that these pharmacies get a lot of clients; we needed to capacity build the pharmacists because family planning is not just about getting the commodity but also involves a lot of counselling,” Dawa said.

The pharmacists are also onboarded on to the Kisumu County health dashboard, where they can refer clients to the nearest public facility should they require longer-acting methods of contraception, such as the implant. The referrals are also made if the client has underlying conditions that may need further medical examination before a contraceptive method is initiated. 

“Since we are not giving them commodities, we rely on them to give us these data to show we are catering to the over 40% of people within reproductive age who are opting for these pharmacies to access contraceptives,” Dawa explained.

Bridging the gap

Maurice Ombima has been keying clients' data to the county government of Kisumu sinceMat 2024. While he appreciates the challenge of some clients' resistance to sharing their details, especially their age, he agrees that the continuous engagement with the county government gives community pharmacists a sense of responsibility in rolling out sexual and reproductive health services.

“We feel included, and through our association, we see more people offering to be included in the program. In a way, it has also helped us with stocking because now we know the age of the people we serve, and it is easy to advise and refer a client.” 

With support from USAID, the project is also being scaled up to Kisumu East sub-county, with the county government gearing to set up data channels that will offer real-time updates on the trends of contraceptive use in order to develop accurate interventions as required. 

“We are exploring public-private engagements so that we do not have a vacuum. These channels have proven valuable in mapping out people we miss in our database, so we look forward to this as an ongoing project,” Dawa added.

With Kenya still grappling with teething problems towards attaining universal health coverage, Kisumu County, through the support of USAID Boresha Jamii project, is leading from the front, filling the gaps in reproductive health services access for the betterment of the residents.