Barriers and facilitators for integration of guidelines on operating health shops: a case of family planning services

Journal of Pharmaceutical Policy and Practice

Geetanjali Lamba¹  Zubin Cyrus Shroff¹  Malizgani P. Chavula²  Doreen Sitali²  Joseph M. Zulu³  George Sichone⁴  Chileshe H. Mpandamabula⁵  Charles Michelo⁶  Cecilia Mwenda⁷  Wesely Mwambazi⁷ 

[1] Alliance for Health Policy and Systems Research, Science Division, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland;Department of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia;Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia;Department of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia;Participatory Research and Innovations Management, Lusaka, Zambia;Rigor Data Research, Lusaka, Zambia;School of Public Health, Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia;The Zambia Medicines Regulatory Authority, Lusaka, Zambia;

关键词: Health shops;    Guidelines;    Integration;    Health system;    Zambia;   

DOI  :  10.1186/s40545-021-00337-4

来源: Springer

【 摘 要 】

BackgroundThe Zambia Medicines Regulatory Authority (ZAMRA) piloted the implementation of Guidelines on Operating Health Shops in Zambia in 2016, with a view to making basic medicines more accessible to communities. The guidelines aim to transform ordinary drug shops into health shops, which are dispensing facilities permitted to sell a ZAMRA-prescribed list of medicines over the counter. However, studies that explore the integration and uptake of guidelines into the health system are lacking. This study aims to inform future improved implementation of these guidelines by examining the current acceptability of guidelines within the Zambian health system, especially in relation to family planning services.MethodologyData collected through documentary review, key informant interviews with district pharmacists, staff from ZAMRA and in-depth interviews with 24 health shop owners and dispensers were analyzed using thematic analysis. A conceptual framework on the integration of health innovations into health systems guided the analysis.ResultsThe Guidelines on Operating Health Shops were implemented to address the problem of inadequate access to quality medicines especially in rural areas. Factors that facilitated the acceptability of the guidelines included their perceived relevance and simplicity, comprehensive training and improved knowledge among health shop operators on the guidelines, development of a governance and reporting structure or steering committee at the national level as well as perceived improved health outcomes at the community level. Factors that hindered acceptability of the guidelines included the high cost of implementing them, a restricted list of drugs which affected consumer choice, limited communication between the local council and the operators of health shops, health shop owners not owning the health shop premises restricting their ability to adapt the building, and cultural norms which constrained uptake of family planning services.ConclusionIn addition to training, facilitating the acceptability of the guidelines among health shop owners requires paying attention to operational issues such as location, ownership of the shop, size of infrastructure as well as financial costs of implementing guidelines through decentralizing the registration process and thus reducing the cost of registration. It is also important to have effective communication strategies between operators and the regulators of health shops.

【 授权许可】

CC BY