By Alex Ergo, Director, Health Systems Accelerator, PSI and Sarah Onyango, Senior Technical Advisor, Self-Care, PSI
High-level discussions around Universal Health Coverage (UHC) are missing one crucial element – self-care. This is not only true at the global level, but also at the national level.
With self-care, health interventions, products or information that were previously controlled and given by a clinical provider are now managed by the consumers themselves. It extends the power of health choice beyond clinic walls and into consumers’ hands. At the core of the self-care agenda is a desire to increase consumers’ voice, choice and agency over their health. As we have witnessed in the current pandemic, self-care also helps reduce the burden on strained healthcare systems, making them more resilient.
Global and national policymakers need to realize the potential of self-care in accelerating progress toward UHC. As we sensitize them to this potential, we must hone in on at least three important issues: how we effectively measure self-care, how we ensure self-care is affordable, and how we improve equitable access to self-care. The good news: we’re on it.
Effectively measuring self-care
We firmly believe that self-care increases access to essential health services and products. But can we prove it? Not yet. We will not be able to convince policymakers of self-care’s role in advancing UHC until we address how we measure it. Self-care measurements should also be incorporated into national Health Management Information Systems (HMIS).
The Self-Care Trailblazer Group (SCTG) – a global multistakeholder coalition of which PSI serves as Secretariat – is working to address this through its Evidence and Learning Working Group(ELWG). ELWG’s measurement workstream is currently developing guidance around the measurement of self-care that builds on existing evidence, tools and frameworks, and that meets the needs of national stakeholders, including ministries of health and their HMIS programs. The work has started with a landscape review of metrics currently in use. Based on this review and identified gaps, ELWG will propose a suite of standardized self-care metrics applicable across self-care products and interventions.
Making sure self-care is affordable
As we sensitize policymakers to the important contribution of self-care to the UHC agenda, we cannot ignore financial protection, which is at the core of UHC.
A government may misinterpret self-care as being fully the responsibility of consumers and may see this as a justification for government disengagement. But self-care, like any other form of healthcare, is not entirely free. Self-care products and services come at a cost, and it is important to consider who bears this cost. Where consumers are expected to bear the full cost, many self-care products and services may become unaffordable to large segments of the population, or out-of-pocket payments for these services and products may result in financial hardship for many of those accessing them.
To prevent this from happening, we must incorporate self-care into national health financing arrangements in ways that improve access and enhance financial protection. This calls for the development, testing and refining of creative solutions, which may involve:
- including self-care services and products in the package covered by a health financing scheme – this may require more efforts to demonstrate the cost-effectiveness of self-care and the potential savings
- developing adequate payment mechanisms that help integrate self-care within the broader mixed health system, adequately connecting it to both public and private healthcare providers
- establishing effective monitoring and verification systems
There is a big learning agenda here. The SCTG, through ELWG’s Costing and Financing of Self-Care Workstream, is already in the process of reviewing existing evidence around cost, return on investment, and financing for self-care.
Improving equitable access to self-care
Digital technology is revolutionizing healthcare. It provides powerful means to promote and facilitate uptake of self-care, thereby increasing access to essential health information and services at scale. The STAR project, for example, developed a digital companion for HIV self-testing users, which is now expanded to other self-diagnostics (including for COVID-19 and HEPc). The companion guides users through the self-testing process and links them to care and prevention. Project Delivering Innovation in Self-Care (DISC) additionally released Tina, a one-stop shop to access information about self-inject and other contraceptives, locate the nearest healthcare provider and find training resources to use at home. Between March and August, we had 300,000 click throughs to find out more about self-inject, and our chatbot had over 7,000 users. The SCTG, in partnership with Health Enabled, developed a framework to provide practical guidance to effectively design, implement and research digital health in support of self-care.
Despite the rapid penetration of mobile technology in many LMICs, however, access to digital solutions, and ability to use them – i.e., digital literacy – are still highly uneven. This is often referred to as the digital divide. To improve equitable uptake of self-care, we must find innovative approaches to bridge this divide. Community health workers (CHWs), for example, could play the role of intermediaries, helping consumers access and use the digital solutions. If we equip these CHWs with an AI-powered digital symptom checker, their role in guiding consumers to the health services and products they need could be further enhanced. This is something PSI hopes to demonstrate with its strategic partners in 2022.
As we strive to make national efforts to move toward UHC more consumer-powered, it is natural to look for ways to make access to quality essential health services and products easier and more convenient for consumers.
Self-care does just that.
Self-care, therefore, deserves the full attention and support of those crafting the policies that will determine the pace of progress toward UHC in the years to come.
Banner photo description: consumer using an oral-based HIV test in Kazakhstan
Banner photo credit: Daniyar Shakirov