by Miles Kemplay, Children’s Investment Fund Foundation @CIFFchild
For the last five years, the Children’s Investment Fund Foundation (CIFF) has invested in improving the sexual and reproductive health and rights (SRHR) of young people.
During this time, we have spent over US$220 million to prevent unplanned pregnancies, unsafe abortions, HIV, sexually transmitted infections and sexual violence among adolescents and young people, often through co-funded programs with other foundations and governments.
We have always been biased toward approaches and interventions that rapidly shift power away from those that have power—the funders, politicians, policymakers, implementers and service providers—and place it firmly in the hands of consumers seeking SRHR information, choices and services.
Self-care in healthcare is one of the most powerful ways to make this power shift a reality. It creates a real opportunity for philanthropy to accelerate progress toward universal access to SRHR. It is not a new idea, and certain services already offer such options: pregnancy test kits, a daily pill to prevent pregnancy (and now HIV) or an easy self-test to know your HIV status.
But these choices are now becoming increasingly popular for several reasons:
- There are some fundamental flaws in service delivery norms: provider bias and stigma are well known. Stigma is malicious toward those who could stand to benefit the most from self-care; less overt is the over-medicalization and gating of information and tools. We know that people only spend a fraction of the time considering their healthcare in a facility, yet that is the focus of most donor investment.
- The health system has weaknesses. Stock outs jeopardize our commitment to choice. Current gaps in recruitment and investment in infrastructure mean that hundreds of millions of people continue to lack access to basic healthcare, and millions more are disgruntled with the health services available.
- SRHR is uniquely personal by nature, and demands increasingly tailored care designed around the individual, with information and tools accessible at moments that matter, often well before an individual enters a clinic or pharmacy.
To date, our focus has been on the market dynamics underpinning self-care product innovations. For example, our work to dramatically reduce prices has allowed markets to procure millions of self-injectable contraceptives and HIV self-tests per year; our commitment to competition and supplier diversity is encouraging new, high-volume manufacturers to enter the market; we have supported research and development (with a five-year horizon) to bring new tools to market, such as peri-coital choices and a new dual-product that combines pre-exposure prophylaxis with a daily contraceptive pill.
This large-scale work—with impacts in dozens of countries— has been coupled with more discrete investments to better understand consumer decision-making and use human-centered design to reimagine how user-controlled contraception, medical abortion and HIV self-testing could be delivered. We are learning from hundreds of thousands of self-care users, early adopters, far-sighted policymakers, and pioneers like SH:24, iwantPrEPnow, In Their Hands and Population Services Kenya’s Be Self Sure.
“My colleagues and I at the Hewlett Foundation are excited about the exploration into self-care that we are seeing among some of our partners. True innovation in service delivery, which is needed to expand access to birth control and safe abortion, may mean getting out of the service delivery mindset altogether.”
-Ruth Levine, Director, Global Development and Population Program, William and Flora Hewlett Foundation
Moving forward we know we must do far more, in partnership with others, to realize this transformation in healthcare delivery. Our biggest shift has been to accelerate the policy and research underpinning this work, through our partnership with the World Health Organization on the first integrated global guidelines for self-care in SRHR. In partnership with the William and Flora Hewlett Foundation, we co-fund the Self-Care Trailblazers Group, an advocacy initiative designed to buttress global and local leaders from multiple fields who are leading efforts to establish a movement, strengthen evidence and unify voices.
A greater opportunity lies in using self-care to demonstrate our shift in values toward genuine people-centered care. Self-care can break through the rigidities in our sector that permit silos and stifle informed choice. The recent British Medical Journal series on self-care nicely outlines how to plan for unintended consequences, address risks and make self-care a critical part of informed choice.
What worries us is that institutional blockages can inhibit innovation. We have deep partnerships with fantastic organizations across the SRHR landscape that we will continue to work with to embed this shift. Equally as important, self-care is an opportunity to reduce barriers to entry for new players and partners, where philanthropy and a diversity of funding tools can be particularly useful.
One day it will be second nature to use an app to understand your fertility, to pick up a test for sexually transmitted infections from your local pharmacy or to order a self-injectable contraceptive online. Self-care means putting power in the hands of girls and women. It’s happening now, and it’s time to get onboard.
This article appears in PSI’s Impact magazine, released in tandem with Women Deliver 2019, as part of an ongoing conversation about putting #PowerInHerHands.
Banner Image: © Unitaid/Eric Gauss