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Self-care presents an opportunity to strengthen overstretched health systems by offering delivery efficiencies while placing people at the center of its design. Countries around the world are recognizing this potential, many of whom are adopting and adapting the World Health Organization’s Consolidated Guideline on Self Care Interventions for Health, which provides clear recommended self-care approaches worthy of integration in national/subnational health systems. This shift to integrate self-care more formally within health systems requires a new set of behaviors. Not just for the consumer (or ‘self-carer’) but for the entire health ecosystem around them, including, perhaps most importantly, the healthcare provider. But critical questions remain:
The Population Services International-led Delivering Innovation in Self-Care (DISC) program—being implemented in Nigeria and Uganda—aims to answer these questions as they relate to self-injectable contraception, DMPA-SC. And, in doing so, demonstrate that self-care offers health systems a new and critical partner: consumers themselves.
In 2020-2021, DISC conducted extensive programmatic research, including interviews with ‘early adopters’ of DMPA-SC, prospective users, and the public and private sector providers on whom women rely (distilled in this Insight Synthesis Report). In collaboration with the PATH-led Access Collaborative initiative and the Ministries of Health in Nigeria and Uganda, we honed in on the insight that fear of the needle and/or pain was a major barrier at the decision stage to self-inject. Yet, most providers aren’t trained to address this fear. This presented a behavior change opportunity worth testing: what if providers were equipped to directly address client fear to self-inject? Would more women voluntarily choose to self-inject?
In response, DISC launched the ‘Moment of Truth’ Innovation in 20 public and private outlets–designated as “Innovation Sites,” –throughout Nigeria and Uganda to test this question and to incubate and test new training approaches. Our work in the innovation sites is focused on optimizing the training curriculum for self-inject providers by improving providers’ confidence in counseling women to take up self-injectable contraceptives and helping them to address client fears related to taking up self-inject. Innovation Sites were launched in September 2021 and qualitative and quantitative data were captured over a six-week period. The emerging results are promising. While qualitative findings need to be explored to fully understand the drivers of performance, voluntary uptake conversion rates dramatically increased following exposure to the ‘Moment of Truth’ Innovation approach. In fact, Innovation Sites in both countries quickly outperformed global benchmarks for self-injection conversion rates in both public and private sectors (see figure).
DISC is currently in the process of analyzing the results to optimize provider training and associated activities. We’re also working with partners to identify pathways to scale up in Nigeria and Uganda—either through other partners or by incorporating the training into national curricula.
This small-scale innovation illustrates the potential for consumer insights to better inform behavior change of a health ecosystem and, in doing so, support the evolution of health systems to be more responsive and resilient.
During its ongoing update of the National Family Planning Curriculum, the Uganda Ministry of Health is incorporating a module on addressing client fear. In Nigeria, the Ministry of Health is excited about this approach and sees it as something that may inform policy change. If the results are as promising as they appear to be during our initial stages of analysis, this relatively simple adjustment to provider curriculum could help encourage providers to offer self-injection. It could also increase the potential for women to experience her own power and agency over her sexual and reproductive health care needs, a unique advantage of this self-care method. Equally important, this small-scale innovation illustrates the potential for consumer insights to better inform behavior change of a health ecosystem and, in doing so, support the evolution of health systems to be more responsive and resilient, with consumers at their core.
With overarching commitments to flexibility in our work, and greater wellbeing for our employees, we want to ensure PSI is positioned for success with a global and holistic view of talent. Under our new “work from (almost) anywhere,” or “WFAA” philosophy, we are making the necessary investments to be an employer of record in more than half of U.S. states, and consider the U.S. as one single labor market for salary purposes. Globally, we recognize the need to compete for talent everywhere; we maintain a talent center in Nairobi and a mini-hub in Abidjan. PSI also already works with our Dutch-based European partner, PSI Europe, and we’re creating a virtual talent center in the UK.
PSI is firmly committed to the meaningful engagement of young people in our work. As signatories of the Global Consensus Statement on Meaningful Adolescent & Youth Engagement, PSI affirms that young people have a fundamental right to actively and meaningfully engage in all matters that affect their lives. PSI’s commitments aim to serve and partner with diverse young people from 10-24 years, and we have prioritized ethics and integrity in our approach. Read more about our commitments to the three core principles of respect, justice and Do No Harm in the Commitment to Ethics in Youth-Powered Design. And read more about how we are bringing our words to action in our ICPD+25 commitment, Elevating Youth Voices, Building Youth Skills for Health Design.
PSI works to ensure that its operations and supply chains are free from slavery and human trafficking. Read more about this commitment in our policy statement, endorsed by the PSI Board of Directors.
Since 2017, PSI has been a signatory to the United Nations Global Compact, a commitment to align strategies and operations with universal principles of human rights, labor, environment and anti-corruption. Read about PSI’s commitment to the UN Global Compact here.
The health of PSI’s consumers is inextricably linked to the health of our planet. That’s why we’ve joined the Climate Accountability in Development as part of our commitment to reducing our greenhouse gas emissions by 30 percent by 2030. Read about our commitment to environmental sustainability.
PSI does not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, protected veteran status or any other classification protected by applicable federal, state or local law. Read our full affirmative action and equal employment opportunity policy here.
PSI is committed to establishing and maintaining a work environment that fosters harmonious, productive working relationships and encourages mutual respect among team members. Read our policy against discrimination and harassment here.
PSI is committed to serving all health consumers with respect, and strives for the highest standards of ethical behavior. PSI is dedicated to complying with the letter and spirit of all laws, regulations and contractual obligations to which it is subject, and to ensuring that all funds with which it is entrusted are used to achieve maximum impact on its programs. PSI provides exceptionally strong financial, operational and program management systems to ensure rigorous internal controls are in place to prevent and detect fraud, waste and abuse and ensure compliance with the highest standards. Essential to this commitment is protecting the safety and well-being of our program consumers, including the most vulnerable, such as women and children. PSI maintains zero tolerance for child abuse, sexual abuse, or exploitative acts or threats by our employees, consultants, volunteers or anyone associated with the delivery of our programs and services, and takes seriously all complaints of misconduct brought to our attention.
PSI affirms its commitment to diversity and believes that when people feel respected and included they can be more honest, collaborative and successful. We believe that everyone deserves respect and equal treatment regardless of gender, race, ethnicity, age, disability, sexual orientation, gender identity, cultural background or religious beliefs. Read our commitment to diversity and inclusion here. Plus, we’ve signed the CREED Pledge for Racial and Ethnic Equity. Learn more.
PSI affirms gender equality is a universal human right and the achievement of it is essential to PSI’s mission. Read about our commitment to gender equality here.