POLICY BRIEF

MARCH 2016 Pharmacy workers in Kenya need training and support on medical information and referrals to prevent unsafe service provision

INTRODUCTION RECOMMENDATIONS accounts for close to 35% of maternal deaths in Kenya, For medical colleges, training compared to a global average of 13%. There are institutions & professional approximately 465,000 induced in associations: Kenya each year and a large proportion of these  Pharmacy workers should receive are clandestine and unsafe. In 2012 120,000 training on MA regimens, women were hospitalised for complications arising from unsafe procedures, at an estimated counselling, and legal status to cost to the Kenyan government of 65 USD per ensure correct information provision patient. and to encourage referrals to safe sources of care. STEP UP generates (MA), using the WHO  Medical training college curriculums policy-relevant research recommended regimen of combined for medicine, nursing and pharmacy to promote an evidence- and , is a safe and cost effective based approach for should be updated to include MA alternative to surgical abortion. improving access to regimens, information provision, family planning and safe abortion. In Kenya, pharmacies often act as a point of and the legal framework. information for women seeking abortion services, We work in Bangladesh,  Professional associations such as northern India, Ghana, as they offer anonymity, easy access, and the Pharmaceutical Society of Kenya, and Senegal. affordable services. Within Kenya’s current legal Kenya (PSK) , and the Kenya framework, pharmacy workers can inform Pharmaceutical Association (KPA)

abortion clients of available methods, offer should support pharmacists to Population Council referrals, and sell MA drugs when presented with Coordinating Partner provide correct information on MA. a valid prescription. Pharmacies therefore play a African Population and front line role in the provision of MA drugs and Health Research Center information. For the Ministry of Health: London School of  National guidelines on safe abortion Hygiene and Tropical Medicine ABOUT THIS STUDY should acknowledge the role of pharmacy workers in providing Marie Stopes Despite the centrality of pharmacists in the information and referrals for MA International provision of abortion services, little is known Partners in Population about their MA knowledge, attitudes or practices.  Referral linkages should be and Development This study therefore set out to bridge this gap in strengthened through incentives for the evidence. MA or post-abortion care referrals

Funded by to trained clinicians. In 2013 we interviewed 235 pharmacy workers in  Sensitivity training on MA practices Nairobi, Mombasa and Kisumu about the medical abortion services they provide. In addition, should be provided to pharmacy women pretending to seek abortion services workers and health care providers without a prescription visited 138 pharmacies as in the same setting to dispel mystery shoppers, and documented the mistrust. counselling and medications they were offered.

RESULTS Only 9% of pharmacy workers could Pharmacy workers are providing women with MA drugs and information state the WHO-approved regimen  62% of pharmacy workers provided information on for medical abortion. abortion methods to mystery shoppers, and 28% offered MA drugs.  Demand for abortion services is high: pharmacies that provide MA information and drugs reported an DISCUSSION average of 12 women seeking abortion services per Pharmacy workers in Kenya are important frontline month. Among pharmacies that do not provide MA providers of MA information and drugs (when presented information and drugs, most (74%) said that their with a prescription). They face high demand for MA clients ask for these services. services from the community, and many are providing women with MA information and drugs. However, However, pharmacy workers do not know pharmacy workers have little knowledge of correct MA correct MA regimens, side effects, or the regimens, side effects, complications, or the legality of MA, legal status of MA meaning that they cannot provide adequate information to clients. This suggests that potentially, pharmacists are  Only 9% of pharmacy workers could state the correct inadvertently putting their clients’ health at risk by WHO approved mifepristone-misoprostol MA providing incorrect or inadequate information. Their skills regimen. Knowledge of the misoprostol-only regimen, must be reinforced so that Kenya can take advantage of which is a less effective method of MA, was higher their important role at the forefront of community health. (19%).  Among those who did know the correct regimen, Comprehensive training for pharmacy workers could many were unable to name side effects or potential improve the quality of MA provision and referrals, and help complications. pharmacy workers identify opportunities to simultaneously provide clients with information on contraception and STI  Pharmacy workers also have limited knowledge of the prevention. Such efforts would be in line with current laws governing MA provision; only 30% knew that government policies to reduce the public health burden misoprostol was registered as an . caused by the prevalence of unsafe abortion and HIV, and within the boundaries of the current legal framework. Pharmacy workers want more training on MA  Only 14% of pharmacy workers have received SUGGESTED READINGS training on abortion services, and among those, only 1. Reiss K, Footman K, Akora V, Liambila W, Ngo T. 2016. half (53%) have been trained on medical methods. Pharmacy workers’ knowledge and provision of medication  Many respondents (46%) expressed desire for for termination of pregnancy in Kenya. Journal of Family training on abortion services. The most commonly Planning and Reproductive Health Care. requested training topics were: - MA methods 2. Mumah J, Kabiru CW, Mukiira C, et al. 2014. Unintended Pregnancies in Kenya : A Country Profile. - Recognition and management of abortion Nairobi: African Population and Health Research Centre. complications

- Abortion policy and law 3. African Population and Health Research Centre. Women’s Lives Matter, Preventing Unsafe Abortion in Kenya. Key Findings of a National Study: Incidence and Suggested citation: Complications of Unsafe Abortion in Kenya. 2013. APHRC Njunguru, J., Finnie, A., Footman, K., Liambila, W., Reiss, Policy Brief Issue no. 1, August 2013. K. 2016. “Pharmacy workers in Kenya need training and support on medical abortion information and referrals to 4. Liambila W, Obare F, Ikiugu E, Akora V, et al. 2015. prevent unsafe service provision.” STEP UP Policy Brief, Availability, use and quality of care for medical abortion March 2016. London: Marie Stopes International. services in private facilities in Kenya. STEP UP Research Report. Nairobi: Population Council.

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