Getting closer to people: family planning provision by drug shops in Uganda.
Getting closer to people: family planning provision by drug shops in Uganda.
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DOI：
10.9745/ghsp-d-14-00085
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发表时间：
2014-11-13
期刊：
影响因子：
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通讯作者：
Stanback J
中科院分区：
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作者：
Akol A;Chin-Quee D;Wamala-Mucheri P;Namwebya JH;Mercer SJ;Stanback J
私营药店可以有效地提供避孕方法，特别是注射避孕药，补充政府服务。乌干达4个城市周边地区的大多数药店顾客都是DMPA的持续使用者;从其他供应商，主要是政府诊所转来的，因为药店缺货较少，而且更方便（位置更近，等待时间更短，时间更灵活）;对服务质量感到满意。药店在其所在地区的计划生育服务总市场份额中占很大一部分。私营药店可以有效地提供避孕方法，特别是注射避孕药，补充政府服务。乌干达4个城市周边地区的大多数药店顾客都是DMPA的持续使用者;从其他供应商，主要是政府诊所转来的，因为药店缺货较少，而且更方便（位置更近，等待时间更短，时间更灵活）;对服务质量感到满意。药店在其所在地区的计划生育服务总市场份额中占很大一部分。私营部门的药店往往是撒哈拉以南非洲的第一个保健点。培训和支持药店和药房工作人员提供各种避孕方法和信息是一种有希望的高影响力做法，需要更多的信息来充分记录执行经验和影响。2010年9月至2011年3月，我们在乌干达4个地区培训了139名药店经营者（DSO），以安全地进行肌内注射DMPA（长效醋酸甲羟孕酮）避孕注射。2012年，我们接触了其中54个DSO，并对其585名计划生育客户进行了方便抽样采访，以评估客户的避孕药具使用情况以及对护理质量和服务满意度的看法。最后，我们比较了2011年4月至6月3个区的药店、社区卫生工作者（CHW）和政府诊所的服务统计数据，以确定药店计划生育服务的市场份额。大多数接受采访的药店计划生育客户都是社会经济地位较低的妇女。绝大多数（89%）是计划生育的持续使用者。DMPA是首选避孕药。几乎一半的药店客户从其他供应商，主要是从政府诊所，主要是由于更方便的位置，更短的等待时间，和更少的缺货药店。所有的客户都报告说，DSO尊重他们，93%的人相信药店经营者能维护隐私。四分之三的人认为药店提供负担得起的计划生育服务。大多数DMPA客户（74%）对从药店获得的方法非常满意，98%的人打算从药店获得下一次注射。2011年4月至6月，3个地区的诊所、社区卫生工作者和药店提供了相同比例的两年保护，药店以36%的比例略领先，其次是诊所（33%）和社区卫生工作者（31%）。药店可以是一个可行和方便的短效避孕方法，包括DMPA的来源，作为政府服务的补充。乌干达和其他地方的计划生育方案应考虑将药店纳入以社区为基础的计划生育提供者网络。
Private drug shops can effectively provide contraceptive methods, especially injectables, complementing government services. Most drug shop clients in 4 peri-urban areas of Uganda were continuing users of DMPA; had switched from other providers, mainly government clinics, because the drug shops had fewer stock-outs and were more convenient (closer location, shorter waiting time, more flexible hours); and were satisfied with the quality of services. The drug shops provided a substantial part of the total market share for family planning services in their areas. Private drug shops can effectively provide contraceptive methods, especially injectables, complementing government services. Most drug shop clients in 4 peri-urban areas of Uganda were continuing users of DMPA; had switched from other providers, mainly government clinics, because the drug shops had fewer stock-outs and were more convenient (closer location, shorter waiting time, more flexible hours); and were satisfied with the quality of services. The drug shops provided a substantial part of the total market share for family planning services in their areas. Private-sector drug shops are often the first point of health care in sub-Saharan Africa. Training and supporting drug shop and pharmacy staff to provide a wide range of contraceptive methods and information is a promising high-impact practice for which more information is needed to fully document implementation experience and impact. Between September 2010 and March 2011, we trained 139 drug shop operators (DSOs) in 4 districts of Uganda to safely administer intramuscular DMPA (depot medroxyprogesterone acetate) contraceptive injections. In 2012, we approached 54 of these DSOs and interviewed a convenience sample of 585 of their family planning clients to assess clients' contraceptive use and perspectives on the quality of care and satisfaction with services. Finally, we compared service statistics from April to June 2011 from drug shops, community health workers (CHWs), and government clinics in 3 districts to determine the drug shop market share of family planning services. Most drug shop family planning clients interviewed were women with low socioeconomic status. The large majority (89%) were continuing family planning users. DMPA was the preferred contraceptive. Almost half of the drug shop clients had switched from other providers, primarily from government health clinics, mostly as a result of more convenient locations, shorter waiting times, and fewer stock-outs in drug shops. All clients reported that the DSOs treated them respectfully, and 93% trusted the drug shop operator to maintain privacy. Three-quarters felt that drug shops offered affordable family planning services. Most of the DMPA clients (74%) were very satisfied with receiving their method from the drug shop and 98% intended to get the next injection from the drug shop. Between April and June 2011, clinics, CHWs, and drug shops in 3 districts delivered equivalent proportions of couple-years of protection, with drug shops leading marginally at 36%, followed by clinics (33%) and CHWs (31%). Drug shops can be a viable and convenient source of short-acting contraceptive methods, including DMPA, serving as a complement to government services. Family planning programs in Uganda and elsewhere should consider including drug shops in the network of community-based family planning providers.