Injectable Contraceptive Sales at Licensed Chemical Seller Shops in Ghana: Access and Reported Use in Rural and Periurban Communities

Abstract

Ghana has made great progress in meeting most Millennium Development Goals; 1 however, the country's reproductive health indicators continue to lag. Among married women, use of modern contraceptives is low (23%) and unmet need for family planning remains high (26%). 2 Similarly, the total fertility rate decreased only slightly between 1998 and 2008, from 4.4 to 4.0. 3 As a result, the Ghanaian government has identified increasing contraceptive prevalence as a priority. 4Among the reasons for low use of contraceptives in Ghana are barriers to access, stock-outs and a shortage of trained health staff.5 These problems are more acute in rural areas of the country, where health facilities tend to be few and the distribution chain is often weaker-conditions that contribute to an urban-rural disparity in contraceptive use and unmet need. 3 In addition, access to communitybased family planning services is limited outside of select hard-to-reach areas where nurses have been mandated to provide family planning as part of the Community-Based Health Planning and Services (CHPS) model. CHPS zones are currently being scaled up, but as of 2011, only 22% of the population was being served under CHPS. 6In many countries, private-sector drug shops are the first place people seek health care, especially in areas with few health facilities or pharmacies. [7][8][9][10] In Ghana, such shops are called licensed chemical sellers and are independent businesses operated by nonpharmacists who have a minimum of a secondary education and are licensed by the Pharmacy Council to sell some over-the-counter medicines. Shop operators sometimes receive training from the Licensed Chemical Seller Association and Pharmacy Council, but it is not required to obtain a license. As privately owned enterprises, licensed chemical seller shops are positioned to provide socially marketed family planning methods using their existing infrastructure, which is sustained by the sale of other health products. Most pill and condom users in Ghana (75% and 54%, respectively) receive their contraceptives from such shops; however, the country's most popular method-the threemonth injectable contraceptive, depot medroxyprogesterone acetate or DMPA-is a prescription drug and is available only from a qualified medical provider or for purchase, but not injection, from a pharmacy.3 Most injectable users (87%) rely on public-sector health facilities to receive their injections, even though these facilities often experience stock-outs of the method.

Sale and provision of injectable contraceptives in drug shops in developing countries: conclusions from a technical consultation

“…However, it is often difficult to obtain from the public health sector in rural areas because of limited access to clinics, acute staff shortages and stockouts. Several recent studies document current practices and the potential of DMPA provision in drug shops [1,[4][5][6]. The sale and provision of injectable contraceptives in drug shops is not a new phenomenon; it is quite commonalthough currently unlawful -in countries such as Uganda and Nigeria.…”

Getting closer to people: family planning provision by drug shops in Uganda

“…In addition, as a private enterprise, drug shops are less likely than public-sector health facilities to suffer from commodity stock-outs and thus are potentially a sustainable source of contraceptive methods 5 . Recognition of the utility of drug shops in providing short-acting contraceptive methods is growing in Africa 6 – 8 . The recent introduction in Uganda and elsewhere of Sayana Press, a subcutaneous formulation of DMPA (depot medroxyprogesterone acetate), increases the prospects for non-clinic provision of DMPA and may catalyze policy action in favor of DMPA provision in drug shops 9 – 11 …”

Assessing the Competency and Acceptability of Community Health Worker Provision of Standard Days Method® in Family Planning Services in Gisagara District, Rwanda

“…), and generally report high levels of satisfaction with their health worker (Stanback, Mbonye, and Bekiita ; Lebetkin et al. ; Hoke et al. ; Charyeva et al.…”

“…and Samadi ; Lebetkin et al. ; Stanback, Mbonye, and Bekiita ), emergency contraception (Chin‐Quee, Stanback, and Graham ; Khan, Hossain, and Rahman ), implants (Charyeva et al. ), and Fertility Awareness Methods such as the Lactational Amenorrhea Method (IRH ; Sebastian et al.…”