Community pharmacies, lived spaces and street-level bureaucracy in antibiotic dispensing in Kisumu, Kenya

Okeyo, Allan Odhiambo (2026) Community pharmacies, lived spaces and street-level bureaucracy in antibiotic dispensing in Kisumu, Kenya. GRADUS, 13 (1). ISSN 2064-8014

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Abstract

Community pharmacies function as critical, accessible healthcare spaces where antibiotic utilisation is often negotiated outside formal clinical settings. Despite regulations requiring prescriptions, antibiotics are frequently dispensed without them, particularly in low-and middle-income countries. This study examines community pharmacies as lived spaces where street-level bureaucratic practices such as gatekeeping and discretionary decision-making intersect with antibiotic access and use. A mixed-methods descriptive study was conducted in Manyatta ‘A’ Sub-Location of Kisumu County, Kenya. Data were collected from 102 pharmacy clients through semi-structured questionnaires, supplemented by 31 unstructured household interviews, 8 key informant interviews, and 3 focus group discussions. Quantitative data were analysed descriptively, while qualitative data were analysed thematically. The majority of pharmacy clients were young women (73% aged 18–30), who often sought antibiotics based on self-diagnosis and prior experience. Amoxicillin (38%), Septrin (18%), and Flagyl (17%) were the most commonly purchased antibiotics, primarily for respiratory and gastrointestinal symptoms. Pharmacy staff exercised discretion in dispensing, balancing professional guidance with commercial pressures and client autonomy. The pharmacy counter emerged as a key site of negotiation, where lay knowledge and cultural practices influenced antibiotic access. Community pharmacies serve as vital lived spaces where antibiotic utilization is mediated by social, cultural, and economic factors. The findings highlight the need for strengthened regulatory enforcement and professional support for pharmacy workers to promote rational antibiotic use. Future interventions should leverage the strategic role of pharmacies as access points for public health education and stewardship.

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