@article {Karkie2100657, author = {Sujan Karki and Margaret Chappell and Ben Johns and Sarah E.K. Bradley}, title = {The Know-Do Gap: Understanding and Improving Service Quality Among Pharmacies Providing Injectable Contraceptives Through a Mystery Client Study in Nepal}, volume = {10}, number = {3}, elocation-id = {e2100657}, year = {2022}, doi = {10.9745/GHSP-D-21-00657}, publisher = {Global Health: Science and Practice}, abstract = {Key FindingsTrained and accredited pharmacists in Nepal are allowed to administer injectable contraceptives. Private pharmacists in Nepal CRS Company{\textquoteright}s Sangini network provided quality counseling on injectable contraceptives to mystery clients, suggesting that pharmacists can successfully expand their family planning offerings and equip clients with the information needed to select an appropriate method of their choice.While Sangini pharmacists met counseling standards, the mystery client study identified know-do gaps in providing privacy, assessing client needs, and determining medical eligibility for hormonal methods.Key ImplicationPolicy makers should consider that private pharmacies such as those in the Sangini network provide a promising opportunity to increase access to injectables and increase women{\textquoteright}s contraceptive options. Pharmacists are able to adhere to quality standards for counseling on injectables and other contraceptive methods.Nepal is one of the first countries to license pharmacists to administer injectable contraceptives, through Nepal CRS Company{\textquoteright}s (CRS) Sangini private pharmacy network. There are more than 3,400 Sangini pharmacies in Nepal, including in hard-to-reach mountain areas, where these outlets are a key access point to injectables and other short-acting methods for those who lack access through the public sector or prefer the private sector.We compared the performance of Sangini pharmacists in (1) CRS-led technical support visits, when providers were aware of being observed, and (2) mystery client visits, when providers were not aware of being observed, to assess any gaps between pharmacists{\textquoteright} knowledge and practices. We also assessed how well Sangini providers counseled on injectables and compared counseling on injectables with counseling for oral contraceptives.We found high levels of adherence to training guidelines on counseling on injectables. However, we identified significant differences between pharmacists{\textquoteright} understanding of what they should do and what they actually do in practice, referred to as the know-do gap, in providing privacy, assessing client needs, and determining medical eligibility for hormonal methods. CRS took several steps to narrow the know-do gap through its programming, which may be a useful example for other countries as they expand the role of pharmacies in family planning service provision. Despite highlighting several areas for improvement, the findings show that Sangini providers both know how to and practice appropriate counseling on both injectable and oral contraceptives, suggesting that pharmacists can successfully expand their family planning offerings and equip clients with the information needed to select an appropriate method of their choice.}, URL = {https://www.ghspjournal.org/content/10/3/e2100657}, eprint = {https://www.ghspjournal.org/content/10/3/e2100657.full.pdf}, journal = {Global Health: Science and Practice} }