Table 4

Reasons why pharmacies are appealing (selected excerpts from qualitative data)

Outlet appealThe physical pharmacy environment and its operation
Convenience (locations and hours)“The chemist is near and whenever you want it [family planning] you can access it, anytime.” Female pharmacy purchaser: injection
“The good thing with chemist is that they are many of them… when you missed a certain contraceptive at a certain chemist you can go to the next chemist because they are several of them, not like the hospital.” Female community member (FGD)
“Yes, majority of them [young people] don’t live near health centres. Second, health centres are usually busy. And it’s not every day they [can be] attended to: there are specific days they have clinics… [The client] won’t be able to make it there… even if the treatment was free. But there is a chemist—[they] can go for similar services.” Pharmacist
Anonymity“At the chemist there are not many people. I may go to Diani dispensary [a local public health facility], and there is someone who knows me and I go for family planning. I saw it would be better to go the chemist because I know that will be my secret and the attendant.” Female pharmacy purchaser: emergency contraception
“When you go to the facility, when you go to the FP room, everyone knows that you’ve gone to get FP. For young people [especially] because no one will want to see me—I’m 18, I’m 16 and I’m already using family planning. I’m not supposed to be sexually active. The kind of population that is in those FP areas, around those FP areas it’s your mothers who are either breastfeeding, or they’re pregnant and have gone for ANC.” Ministry of Health official, County level
Personnel appealThe person behind the counter
Interpersonal relationship“The chemist is just within the neighborhood and I know the guy he is my friend outside job so it wasn’t stressful for me in fact it was really fast and easy.” Male pharmacy purchaser: ECP and condoms
“The person in charge is my friend, I can go to him with my problems and he would assist me, he is not that far for me to reach him with my phone—he is my neighbor I could have a problem even at night and be able to reach out to him.” Male pharmacy purchaser: ECP
Seen as part of the community“I chose it because it has been there for many years even before I was born till the time I finished school. The attendants are just normal. Many people get help from there so I saw it good to also go there.” Female pharmacy purchaser: ECP and injection
“What I had said about the hospital, when you get there you will find the person who served you before is transferred but when you come to the chemist you will find the person that served you before.” Female community member (FGD)
Non-judgemental“I thought at the chemist they will understand me and I would talk to them [better] than at the hospital where they will say I do not need to use those things or even talk to me harshly.” Male pharmacy purchaser: ECP and condoms
“At the chemist, that person wants—since it is a business—[to] just give, as compared to the hospital where when you get there you will find nurses who are arrogant or other doctors who will insult you.” Male community member (FGD)
Service appealThe contraception-purchasing transaction
Speed“You know at the dispensary it is a must you meet with the doctor for more explanation. And maybe there is a service you need to pay for, the expenses are many at the dispensary unlike the chemist where everything is fast, when you get there you get what you want and leave.” Youth female, has purchased ECP and condoms
“You get in a hospital, there are so many people queueing outside that are waiting to see a doctor. Here comes a young lady who is in a hurry. That particular person will find it more convenient to go to a chemist shop rather than going to a hospital.” Pharmacist
Cost“It is not easy for the government hospital. It is best, if you have money, you go to private hospitals. Now that is why you see if someone does not have money, or us the young people, we just go to the chemist because there is no cash to see a doctor for Ksh 600. At the chemist you just go direct and you are served.” Male pharmacy purchaser: ECP and condoms
“Chemists are not expensive like hospitals. In hospital you can be told it is a government hospital but you end up being asked to give out a lot of money. In [the] chemist the money you get asked is for [paying for] P2 [an emergency contraceptive], yah but in hospital you will be told to do some test because we think it is this and this.” Female pharmacy purchaser: ECP
“Free does not always mean free. Sometimes, something will be free, but by the time you get it, the process is a lot. Because for us, we don’t just offer family planning, we do [mandatory] counselling. The person who is going to a chemist is someone who has made up his or her mind. But in the public facilities, you are counselled, you are explained to, you are told the different methods, then you are given a chance to make an informed choice. So, I think that… is a barrier somehow.” Ministry of Health official, County level