Ensuring affordable basic health coverage for all calls for us to develop health systems that put more care and control in consumers’ hands. At the Fifth Global Symposium on Health Systems Research, PSI shared examples of how we’re putting this into practice across our network.
One way we’re giving consumers more control is ‘self-care’—defined by the WHO as “the ability of individuals, families and communities to promote, maintain health, prevent disease and to cope with illness with or without the support of a health care provider.” While this is something people have practiced for millennia, changing populations and new emerging digital and medical technologies are inviting new possibilities. With this in mind, PSI and others are promoting self-care as a new frontier in primary care and a critical component to health systems to achieve universal health coverage (UHC).
On October 8th, 2018 PSI along with the World Health Organization, the United Kingdom’s Department for International Development, PATH, and the Liverpool School of Tropical Medicine, showcased what self-care looks like in practice by profiling three examples: HIV self-testing; subcutaneous DMPA (self-injectable contraceptives); and HPV DNA testing (self-collection). The interactive session explored programming, research and policy in self-care, the impact to date and how self-care strengthens national health systems and vice versa.
There were six key takeaways from the session:
- Self-care interventions can increase choice and access to primary care(i.e. the first point of entry into the health system) and therefore can contribute toward broader aims of UHC.
- Self-care particularly offers opportunities to reach vulnerable and marginalized populations by reducing barriers to care-seeking (i.e. distance to care, cost, and stigma associated with care-seeking). But ensuring self-care increases health equity cannot be assumed; issues such as cost and access for poor populations will require scrutiny.
- Self-care does not replace a health system; it’s part of a health system and should be developed within a health system’s framework. For example, regulation, quality, financing, supplies, and the workforce all need to consider self-care and vice versa. It is not a self-care or a health systems approach – it needs to be both, a win-win outcome.
- The concept of self-care is not new, but new technologies and evolving consumer expectations are advancing options for self-care. Self-care is the ultimate form of task sharing or task shifting.
- The private sector is key to extending access to self-care through products and devices purchased in drug-shops, pharmacies, retail outlets, etc. The private sector is also a key driver of the movement to self-care—at the point of design and manufacture—through innovation in terms of new medical and digital technologies in support of self-care.
- There is still a lot to be done! Terms need to be defined; frameworks, guidance and guidelines created; and more evidence is required on subjects as diverse as cost-effectiveness to how to integrate users of self-care back into the health system (e.g. if an HIV self-test or HPV DNA test were to come back positive). And before we get carried away, self-care alone will never be the silver bullet for UHC, for which multiple strategies are required. However, evidence suggests that self-care can be a source of great optimism as a pathway to enhanced primary care and achieving UHC.
Please reach out to Pierre Moon [email protected] and Andrea Cutherell, [email protected], if you want more information about PSI’s self-care work.
Banner image © 2016 PATH/Gabe Bienczycki, Courtesy of Photoshare
