Five ways advocates can help ensure that self-care is part of universal health care

Join the SCTG as we celebrate UHC Day to promote health for all. Throughout our 12 Days of UHC series, SCTG members and partners share insights and lessons from their organizations on how self-care is part of the solution to achieving our goal — build a safer and healthier future and health systems that serve and protect us all.

By Deogratias Agaba, Senior Communications Officer, Advocacy & Public Policy, PATH

Self-care interventions for health, including sexual and reproductive health, have an important—yet largely untapped—potential to transform health systems and accelerate progress towards universal health coverage (UHC). When embedded within the primary health care continuum and reinforced by responsive and resilient health systems, self-care approaches can have a dramatic impact on health and well-being. Self-care can also reduce pressure on overextended health systems, while increasing people’s ability to make informed decisions about their health.

As countries strive to achieve UHC, we must ensure inclusion of self-care products and services. Here are five actions advocates can take to advance UHC—and how to elevate self-care within advocacy.

1. Stand up for our health needs.

Progress on UHC and self-care requires an active and engaged citizenry. Citizens must be equipped to speak up about barriers to accessing health services and challenge the status quo if it does not provide the care they deserve, or the information and tools they need for self-care. And governments must listen to them.

There is still a lot of work left to ensure that individuals, families, and communities are able to identify and take action to address their own health needs—especially women, girls, and other marginalized populations.

As advocates, we can use our tactics and influence to push for an equilibrium between supply and demand of health care services, where the government and all citizens work together to improve the quality of health care. We have demonstrated the strength of citizen engagement in health in my country, Uganda, where citizens take it upon themselves to monitor the quality of health services. They do this under the protection of our Constitution, which gives them the power to take charge of their own health affairs and hold the government accountable. The upcoming election of leaders for another five-year term of office has provided Ugandan citizens with an even timelier platform to articulate their health needs that should be given priority in all the candidates’ manifestos.

2. Hold leaders accountable for adequately funding primary health care that includes self-care.

Primary health care (PHC) is a vital building block on the way to achieving UHC, as approximately 80 percent of medical services can be provided at the PHC level. World leaders recognized PHC in the UHC declaration, and also signed onto the Astana declaration in 2018 as a re-commitment to building sustainable health systems and closing gaps in access to primary care.

Despite PHC’s importance, it remains underfunded in many countries.

In Uganda, the government contributes only 15 percent of all health funding, with the rest coming from external funders and out-of-pocket payments by individual citizens. Uganda spends approximately US $18 per capita on PHC, well below the US $84 per capita that the Ministry of Health estimates is needed to attain the required scope and coverage of PHC.

Self-care, the ultimate task-shifting strategy, can support health systems in more efficiently using limited resources. By enabling people to access self-care technologies in their own homes and communities, such as self-injectable contraception, self-testing for HIV, and vaginal self-sampling to screen for human papillomavirus (HPV, the virus that can cause cervical cancer), countries can relieve some pressure on health systems while giving people more decision-making power and autonomy. That said, it is critical to ensure that these approaches are linked to health systems—for example, through appropriate counseling, referral, and follow-up care—and ensure that additional costs are not simply passed on to individuals.

3. Support comprehensive mechanisms to prevent catastrophic health costs.

recent report from the World Health Organization found that more people today are suffering financial hardship from health costs than 15 years ago. An estimated 925 million people spend more than 10 percent of their household income on health care. As a result, many countries are developing insurance mechanisms to try and avoid these catastrophic health costs.

In Uganda, where more than 20 percent of citizens live on less than US $1 a day, parliament is expected to pass a National Health Insurance Bill in the near future. Once passed into law, the bill will establish a national health insurance scheme that will require Ugandans to contribute to a pool of resources that will finance health care for all citizens, regardless of age or income. With a well-resourced insurance system in place, Uganda expects individuals will pay less out of pocket for healthcare—potentially alleviating one of the country’s leading causes of poverty.

However, as the national insurance system is being set up, advocates must be vigilant—as should advocates in other countries undertaking similar efforts. We must ensure there is strong political commitment to make the system responsive to people’s health needs, along with adequate funding in insurance schemes for the tools, products, and services that can make self-care interventions feasible for all. Countries like Uganda are developing a basic package of self-care services that must be accounted for in health insurance schemes.

4. Encourage leaders to innovate, and to support innovation.

We won’t reach our goals acting within the mindset of business as usual. We need to innovate. There is significant room for innovation when it comes to self-care. This can mean digital applications and messaging systems to help people get the information and support they need; services that provide on-demand delivery of self-care products; telemedicine platforms that enable patients to more easily connect with providers; and new formulations of products for self-administration.

No matter which forms it takes, innovation will be an essential component of realizing UHC . As advocates, we must urge our leaders to invest in innovation of all kinds to accelerate progress.

5. Stay the course, but emphasize self-care as a catalytic and complementary approach.

World leaders recognized the importance of primary health care forty years ago at Alma-Ata. That declaration gained some traction, but implementation stalled for a variety of reasons—especially lack of political will. Today, we have the political momentum and the technological advancements to make achieving universal access to health a reality. And WHO’s consolidated guideline on self-care has helped ignite self-care initiatives around the world. It now rests with countries to advance self-care through policies and programming, in alignment with UHC efforts. It may, however, take a bit of an advocate’s time and effort, to push for adoption of such guidelines.

As advocates, we cannot let up until we truly realize health for all—and enable people to take charge of their own health.