Man standing in front of an RxGen poster and holding a flyer with text 'Fight AIDS.'.

In many developing countries, pharmacies are a primary source of health services and supplies. Photo: PATH.

A model for increasing youth’s access to reproductive health services

Editor’s note: PATH’s RXGen project helped to reduce young people’s risk of unintended pregnancy and sexually transmitted infections by making health products and information available in a discreet and convenient location: their local pharmacy. PATH worked closely with adolescents, pharmacists, and local leaders to develop and share the project—an early example of our commitment to collaborative, user-based health solutions.

During adolescence, people are more likely to take risks and less capable of predicting and dealing with the consequences than at any other time of life. Reproductive health is especially threatened; around the world, rates of sexually transmitted infections (STIs) are consistently highest among young people aged 15 to 24 years. For young women, in particular, adolescence is a time of vulnerability—a stage when their ability to negotiate safe sexual interactions is often slight. Complications from pregnancy, childbirth, and unsafe abortions are a major cause of death for girls aged 15 to 19.

PATH’s RXGen project worked to reduce adolescents’ risk of unintended pregnancy and sexually transmitted infections by making it easier for them to get important health information and products. Our point of contact for young people was their local pharmacy, an anonymous setting that had the potential to be less threatening and more accessible than a health care clinic.

The RxGen model

We recognized that in many developing countries, pharmacies are a primary source of health services and supplies. Pharmacy staff are in a good position to help their clients with critical reproductive health needs: emergency contraception, STI risk assessment, and ongoing use of contraception. The convenience, affordability, and anonymity offered by pharmacies are particularly appealing to youth.

The RxGen project improved the quality of reproductive health information and products given at pharmacies. Together with project partners, we advocated to gain the support of government and professional organizations. We trained pharmacists and pharmacy staff, helping them expand their technical knowledge and enhance their counseling skills. And we used outreach programs to educate youth about their options and build referral networks so that pharmacists could refer young clients to health care providers when diagnosis and treatment were necessary.

We launched the RxGen project in 2000 in Cambodia, Kenya, and Nicaragua, and later expanded it to include Vietnam. We partnered with public- and private-sector groups, including local nongovernmental organizations, ministries of health, private-sector pharmacy associations, and universities. These partners helped to develop strategies and find ways to make the impact of training and other system improvements sustainable.

Training pharmacy staff

The foundation of the model’s success was a comprehensive training curriculum developed for pharmacists and behind-the-counter pharmacy staff. The curriculum, which was adapted for each country, strengthened pharmacy staff’s ability to provide appropriate reproductive health services; information, especially about emergency and ongoing contraception and STI risk; and, when needed, referrals for clinical services. It also helped pharmacists develop their counseling skills through role-playing and other interactive tools.

During the first phase of the project, PATH trained more than 1,000 pharmacists and staff from approximately 530 pharmacies registered with ministries of health in Cambodia, Kenya, and Nicaragua. In the second phase of the project, a similar number of individuals were trained in these three countries and Vietnam. Throughout the project, PATH found that pharmacy staff were eager to learn new skills and increase their knowledge. They gained satisfaction from providing good care, and they appreciated opportunities to promote their services.

PATH also developed referral networks linking youth to clinical services. In Cambodia, Kenya, Nicaragua, and Vietnam, pharmacy staff used referral slips to direct youth to clinics in the vicinity, giving them a tangible reminder and a specific location to seek treatment.

Raising awareness among youth

Together with our local partners, we developed colorful, welcoming logos, each appropriate for the country in which it was used, that identified participating pharmacies. The logo served as a visible representation of the pharmacy’s willingness to help.

Pharmacies also distributed educational materials, such as brochures on contraceptive methods and STIs.

Increased knowledge, improved service

PATH evaluated the project’s impact by sending “mystery shoppers”—young men and women trained to gather information—to pharmacies as well as by talking to pharmacy counter staff, pharmacy owners, and pharmacists. During the project’s first three years, staff knowledge of and ability to provide high-quality reproductive health services to youth increased in all three countries. For example, a before-training assessment showed that 0 to 30 percent of pharmacy staff offered the right emergency contraception products to “mystery shoppers.” After training, approximately 80 percent of pharmacy staff recommended the most appropriate options.

Similarly, mystery shopper reports showed that more than half of pharmacy staff in each country spontaneously offered information about STIs when shoppers sought services after unprotected sex. At least 75 percent of mystery shoppers in all three countries reported that their visit to the pharmacy was a positive experience. Similar results were collected during ongoing monitoring activities.

Building on experience

Building on the project’s success, our RxGen team incorporated the training curriculum into undergraduate pharmacy courses and continuing education programs for pharmacists. In Cambodia, the team helped negotiate collaboration between the Pharmacists Association of Cambodia and the Faculty of Pharmacy at the University of Health Science in Phnom Penh; both organizations adopted the curriculum into their programs. To help other groups replicate and adapt the RxGen model in other areas, PATH developed a roadmap: the Youth-Friendly Pharmacy Program Implementation Kit.