Self-Testing and Self-Care: Breakthroughs for COVID, but Already Being Put to Good Use in the Global South

by Karl Hofmann, President & CEO, PSI

In mid-May, the Washington Post featured an article about innovation in COVID-19 testing technology: “An easier coronavirus test is within spitting distance.” Improvements in testing promise to overcome the discomfort of the existing deep nasal swab, plus the inevitable need for testing to involve close contact between the tester and testee. At-home solutions involving a saliva test seem more likely to be popular to the user and more effective at overcoming our testing challenge.

Similarly, Bill Gates wrote on April 24 about the potential breakthrough of at-home testing: “Another diagnostic test under development would work much like an at-home pregnancy test. You would swab your nose, but instead of sending it into a processing center, you’d put it in a liquid and then pour that liquid onto a strip of paper, which would change color if the virus was present. This test may be available in a few months.”

The at-home pregnancy test – something we all take for granted and which is available in every US pharmacy and supermarket – was once a controversial idea.  Resistance to home pregnancy tests came from medical professionals and others who argued that we couldn’t possibly trust women to handle the news that they were pregnant without a professional nearby to guide her reactions. How anachronistic, we think! But it wasn’t that long ago.

The good news is the self-care revolution that the Washington Post and Bill Gates see as part of a response to America’s COVID-19 testing anguish is already well underway in the lower resourced parts of the world, where healthcare systems are often over-stretched and where medical professionals are in short supply.

The World Health Organization in May 2019 introduced the first-ever global self-care guidelines, to help health ministries, particularly in the Global South, understand how better to take advantage of the great advances in technology that can help make health consumers’ lives easier. This week, as most of our world leaders convene digitally for the 73rd World Health Assembly to discuss COVID-19, they will want to recall this very timely set of guidelines.

In the context of COVID-19 in the US, self-care approaches for testing have multiple benefits, chiefly a less intrusive, more pleasant experience for the consumer, and enhanced safety due to less physical contact. In the Global South context, self-care strategies for HIV self-testing, or for long-acting reversible contraception, or for safe medical abortion, share in some of those attributes.  Better consumer experiences and less stress on the health system are pretty attractive reasons to get behind self-care.

What about those circumstances where it really is necessary for a medical professional’s advice or guidance? Here too, the Global South has many lessons for us. Much of Africa skipped right over the copper landline generation, and cellphones are ubiquitous even in very remote parts of the continent. In 2018, three-quarters of the African population had a SIM connection, and a rising proportion of cellphone users have access to smartphones and broadband. Three-quarters of Nigeria’s internet usage is via mobile technology. Digital referral networks can connect most health consumers with health providers, even in the lowest resource settings. Certainly, there are gaps and shortages of quality providers. But connectivity is less of a barrier than ever before.

Will Africa show us the way to a fully networked health system, where consumer power is enshrined in self-care strategies that are supported by the “health system?” Will the system capitalize on the strengths of both the public and private sectors? Will health systems be freed up to deal with the highest needs, and doctors and patients interact through telehealth and e-medicine?

Self-care puts the consumer at the center, offering the option for you to decide: When and where do I want to administer a therapy or test, and how do I want to best structure my environment for the information to be useful to me? Self-care also relieves the burden on health care systems that may be overwhelmed by a crisis (such as COVID-19), or simply under-resourced and unable to provide quality, respectful and enjoyable care for routine matters such as contraception.

Can we put consumers more at the center of their health care decisions? Can we give them more choice and unlock their own power to be not just consumers of health, but also healthy consumers?  Self-care approaches offer vital opportunities in the time of a pandemic and for the future.

Banner image credit (c)Unitaid/Eric Gauss

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