As the world continues to grapple with COVID-19, we have seen our already stretched health systems face additional strains under the pandemic with millions of individuals unable to access care.
Self-care interventions, while not new, are among the most promising approaches to improving health and well-being, both from a health systems perspective and for end-users–particularly for vulnerable persons such as those negatively affected by gender, political, cultural and power dynamics. As we work towards universal health coverage (UHC), rapid advancement in medical and digital technologies is accelerating the range of interventions which were previously delivered by clinical providers that can now be acquired and managed more directly by individuals.
Since the launch of the World Health Organization (WHO) Consolidated Guideline on Self-Care Interventions for Health in 2019, many countries have increasingly taken the necessary measures to ensure self-care is both accessible and in step with formal health delivery systems. Nigeria and Uganda are among these trailblazing countries.
IN FOCUS: NIGERIA AND UGANDA
A recent case study documents the process that Nigeria and Uganda undertook to pioneer national guidelines for self-care – among the first national self-care guidelines in the global south – as the first step toward making UHC more achievable through partnership with informed and enabled health consumers.
“Self-care greatly compliments the healthcare system, by reducing considerable pressure placed on the resources and facilitating better health outcomes for the users.” With the national self-care guidelines for SRHR in place, Dr. Dinah argues that we can look forward towards a resilient healthcare system, “one that is well able to support and respond to the SRHR needs of individuals across communities in a confidential, private and timely manner, while resolving challenges such as bridging unmet need for family planning and serving vulnerable communities.”
This case study explores how Nigeria and Uganda galvanized stakeholder buy-in and commitment across multiple health areas to reach this significant milestone, and articulates key insights from the process in order to help other countries that may be considering similar work.
“When starting the process of developing the guidelines; there is a need for active front-end consensus building, through creation of a coalition of champions who can support the entire roadmap,” explained Dr. Adewole Adefalu, Country Coordinator, Nigeria, John Snow Institute, who was a key contributor to Nigeria’s guideline development process “The further engagements will then be to align stakeholder adaptation of country recommendations and spawn the necessary enthusiasm towards the development process.”
Using the WHO normative guidance as a starting point, the Ministry of Health-led, multi-partner effort can be summarized in three-phases
- generating stakeholder buy-in and conducting landscape assessment to prioritize a package of self-care interventions;
- organizing, drafting, refining and endorsing the guidelines;
- coordinating implementation and design feedback loops to inform guideline reviews and updates (planned for 2021).
A PACKAGE OF INTERVENTIONS ACROSS DIFFERENT ASPECTS OF CARE
Both Nigeria and Uganda adopted nearly all of WHO’s 24 self-care recommendations for antenatal, delivery, postpartum, and newborn care, family planning and infertility services, and sexually transmitted infections (STIs). Several of these recommendations were new in both contexts, with the rest being existing practices or services.
Moreover, the two countries added several self-care solutions beyond those included in the global guidance based on local priorities–from community distribution of misoprostol for prevention and treatment of postpartum hemorrhage in both countries, to Nigeria’s provision on self-screening for early detection of breast cancer.
Four considerations when developing national self-care guidelines:
- What is the scope of self-care interventions? The decision over the scope of interventions to be included in the self-care guidelines is critical, not to mention complex, as it influences governance, financing, monitoring and evaluation, and more.
- How can the national self-care guideline support scale-up of self-care without overcommitting to complex integration? Uganda and Nigeria’s national self-care guidelines promote service delivery integration and systems integration to support scale-up of self-care. Yet, the exact mechanisms for doing so are still being established and is a priority area for learning in the coming years.
- What safeguards should the national self-care guidelines provide to protect vulnerable populations? National guidelines should aim to articulate clear safeguards that ensure self-care interventions are accessible to vulnerable populations while not aggravating vulnerabilities in any population.
- How can national stakeholders resolve issues with WHO recommendations that are not in line with existing policies? While national laws, policies, and guidance may not align with the WHO recommendations, this can spur important dialogue around the extent to which policies may need to be revisited and can provide a forum for continuing these conversations over the coming years.
UNLOCKING THE POTENTIAL OF SELF-CARE
There is an urgent need to create the enabling environment which will fast-track national self-care policies and programs to bring self-care to scale.
“Effective implementation of self-care interventions can increase access to health information and services for persons in communities with limited access to formal health systems,” argues Dr. Anthony Nwala, Practice Lead Reproductive Health and Family Planning, Society for Family Health, Nigeria. “A self-care approach can enable individuals and increase consumer choice to quality health solutions that have the potential to transform healthcare delivery and support the UHC agenda.”
Resilient health systems have never been so vital. As health systems around the world experience unprecedented strain, and the consequences of the pandemic continue to unfold, governments, donors, advocates and civil society partners must invest in solutions that will help systems and individuals alike stand up to existing threats like HIV, lack of access to family planning, barriers to maternal health, and non-communicable diseases, and emerging and/or evolving risks like COVID-19.
To drive healthier outcomes during this crisis, and beyond, every lever available must be used to increase access to needed services, information, technology and tools. This includes equipping, empowering, and encouraging people to meet their own health needs through self-care.
For more insights and recommendations around this significant milestone in the journey to more formally recognizing self-care practices in health systems, dive into the full case study.