Task Shifting With Pharmacists to Increase Access and Uptake of Medical Abortion and Contraceptive Services among Adolescents in Kenya

The World Health Organization (WHO) recommends and recognize the importance of involvement of community providers in self-care including medical abortion (MA) among patients. In Kenya, young people between the ages of 15 to 24 constituting one-fifth of the total population are disadvantaged in accessing affordable and quality drugs at the pharmacies or chemists. Although, Misoprostol and mifepristone, used all over the world for MA are sold in many pharmacies in Kenya, adolescent women encounter barriers, including long queues, vigorous screenings and questioning to ascertain whether they are ‘genuine' or mystery clients when accessing these drugs. The Kenyan, Family Planning guidelines also authorize pharmacies to dispense various forms of contraception, including pills and condoms. These contraceptives can be accessed for free in Kenyan public facilities but are available for sale from private pharmacies. KMET implements an Adolescents health program dubbed Safire, that supports adolescents integrated Sexual and Reproductive Health through a task shifting. The goal is to Improve access of quality adolescent sexual reproductive health (ASRH) services to women ages 10-19 years through task-shifting to minimize missed opportunities. The objective is to evaluate the acceptability, efficiency, and effectiveness of Safire delivery model in providing quality ASRH services for girls. The program received support from Kenya pharmacy Association and Ministry of health to map, recruit, and train 108 pharmacists and 56 health providers in Kiambu, Uasin Gishu, and Bungoma Counties. The pharmacists and providers were trained on quality provision of Sexual and Reproductive Health information and Services to patients. The pharmacies were then linked with trained community volunteers from likeminded civil society organizations (CSOs) to conduct community education and make referrals for sexual reproductive health information and services including abortion. After receiving the services, the volunteers follow up such clients to assess their satisfaction and feedback on services received from the pharmacies. The project has served 7,900 girls (aged 10-19 years) with MA services with 84% (6,636) receiving post-abortion family planning (PAFP) from March 2020 to February 2022 and no reported complication. Among the girls served, successful referrals by community volunteers to the pharmacies constituted 60% (4,740) during the period. Most of the clients served reported high satisfaction level after following up by the volunteers. The strengthened relationship among community health volunteers and the pharmacists created a synergy enabling cross referrals of clients for various services. This improved successful referrals and linkages. Routine quality of care assessments, support supervision and mentorship empowered the pharmacists for improved quality service provision. The engagement of local commodity distributors at negotiated price ensured reduced stock outs among the pharmacist and prices standardization for quality MA products to clients. The ministry of health should invest in training pharmacists as a task shifting approach in offering quality adolescent sexual reproductive information and services in Kenya.