Adapting the WHO Self-Care Guidelines to the Local Context: Lessons from Uganda 

By Dr. Lillian Sekabembe, Deputy Country Representative, and Precious Mutoru, Advocacy and Partnerships Coordinator, PSI Uganda 

With the WHO’s published, Consolidated Guideline on Self-Care Interventions for Health, self-care had been formally recognized as a core strategy for strengthening health systems and advancing universal health coverage, while reducing strain on overburdened health systems.  

But what does it look like to put these guidelines to practice? In Uganda, we, alongside the government, sought to find out.  

Step by Step: Piloting the WHO Guidelines  

The Uganda Ministry of Health kick-started the process of structuring self-care for sexual and reproductive health and rights (SRHR); first, by establishing the Self-Care Expert Group (SCEG) to coordinate the development of national SRHR self-care guidelines. To adapt the WHO’s guidelines to Uganda’s needs, the SCEG adopted an iterative evidence-based approach, implemented in three phases — inception, development and guideline test implementation. 

The guidelines were tested in 10 public and 8 private sector facilities. Research is ongoing to understand the acceptability, feasibility, and applicability of the National Guidelines in supporting SRHR self-care practices.  

Preliminary findings suggest that the guidelines helped to facilitate the acceptance and use of SRHR self-care practices. For example, in the Mukono District just west of Kampala, SRHR self-care practices such as HIV self-testing, male condom use, and the use of iron supplements during pregnancy were prevalent in part, because these products were readily available and health providers supported self-care practices. Other popular self-care interventions included self-injectable contraception and rapid diagnostic test kit for Malaria, though their use is undermined by commodity stockouts. Other self-care interventions including self-sampling for human papilloma virus (HPV) and sexual and gender-based violence (SGBV) kits gained significantly less traction as only a few health facilities were equipped to support these practices.  

The takeaway? Self-care isn’t reliant on the individual alone. Consumers have questions and, at times, may need support from health facilities for varying self-care interventions.  

Across all levels, the adoption of self-care policy and practices led to positive changes in health seeking behaviors. Specifically: 
  • Consumers favor SRHR self-care interventions, saying that it saves them time and money. Consumers further emphasized the importance of trusted health workers, as they feel most comfortable with practicing self-care following instruction from a health provider.   
  • Health providers, particularly those in the public sector facilities, say self-care helps to minimize the overcrowding of clinics and hospitals and prioritize more hands-on healthcare needs. For instance, a health provider in one of the public sector health facilities shared that after the self-care training, they adopted group testing for malaria using rapid diagnostic test kits with expecting mothers during their antenatal care appointments, increasing the efficiency of their malaria and antenatal care.  

With self-care, health providers recommend building robust follow-up mechanisms to ensure continuity of care. Further, both public and private health facilities need improved platforms to help record self-care data, which is not currently being captured effectively. From this data we can glean learnings about how to improve, localize and scale self-care interventions.  

The Ugandan National Guidelines on Self-Care Interventions for SRHR will be finalized and presented for approval by 2023, which includes a suite of operational tools for training, monitoring, evaluation and learning, quality assurance, and a costed implementation plan, customized SCTG SBC framework. SRHR self-care presents a unique opportunity for health systems to deliver optimized, equitable, high-quality healthcare to diverse communities. The Ugandan experience has important implications for how countries can develop feasible, effective and contextually relevant national guidelines that align with global standards for SRHR self-care. 

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This article is a part of PSI’s ICFP 2022 Impact Magazine. Explore the magazine here.

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