As the global health community prepares to celebrate Universal Health Coverage (UHC) Day 2020 we have the chance to reflect on one of this year’s key lessons: self-care for sexual and reproductive health and rights is a key part of reaching our goal to #ProtectEveryone. You don’t need me to tell you how difficult this year has been; the COVID-19 pandemic has challenged communities and health systems around the world in unprecedented ways. As the result of the strain COVID-19 placed on our existing health systems, the pandemic has highlighted the importance of self-care for sexual and reproductive health (SRH). In the context of these opportunities and challenges, advocacy for self-care is more important than ever for achieving UHC goals.
UHC envisions health systems grounded in the principles of equity, quality, responsiveness, efficiency, and resilience. Self-care is not an alternative to a robust health system, but simply a key component within that system that allows individuals to make the SRH care choices that best suit their unique needs and circumstances.
When it comes to family planning, we know what’s needed to ensure universal access to contraceptives, including: more funding for contraceptive supplies, inclusion of contraceptives in UHC health packages, robust supply chains, and national policies that get commodities where users need them to be. This is true for provider-based care, as well as self-care, such as self-administration of oral contraceptive pills, emergency contraception, and condoms, or the self-injection of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC). The Advance Family Planning (AFP) initiative has successfully implemented the SMART approach to advocacy for family planning and reproductive health since 2009, and we know evidence-based advocacy works to secure funding, remove barriers, create policies, and gain more support for family planning.
AFP advocacy for self-care focuses on policies that ensure quality, informed decision, and contraceptive method choice. As a result of our ongoing efforts to expand SRH self-care, we have learned there are many opportunities and entry points for advocacy for self-care at the global, national, and sub-national levels. Family planning advocacy efforts to mobilize domestic budgets, revise training curricula, expand SRH access for adolescents and young people, or update data collection tools for service statistics can all contribute to moving the self-care agenda forward. Advocacy
Within efforts to expand method choice, AFP partners have successfully advocated for community access to DMPA-SC, an injectable contraceptive that can be safely and effectively self-injected by the user, in Kenya, Nigeria, and Uganda. Through this work, we’ve also learned that advocacy for self-care for SRH presents means working across a variety of institutions and decisionmakers. The results of DMPA-SC advocacy, as illustrated in selected examples below, suggest tactics and opportunities for progress on self-care for other contraceptive methods and SRH issues:
After the Ministry of Health launched National Guidelines for the Introduction and Scale-Up of DMPA-SC Self-Injection in April 2019, AFP partner, Pathfinder Nigeria, has advocated with state governments to adopt state-level scale-up plans. Gombe and Nasarawa states launched their plans in December 2019 and January 2020, respectively. Both states are now in the process of training providers to administer the method and to train women on self-injection; leaders in both states also pledged to release state funds to continue and expand these trainings. These state-level efforts will expand access to DMPA-SC for provider- and self-injection in the public and private sectors in Gombe and Nasarawa.
In addition to DMPA-SC, many methods of family planning are appropriate for self-care, including oral contraceptive pills and emergency contraception.4 In Zambia, advocates supported by AFP’s Opportunity Fund worked closely with the Zambian government to include pills, implants, injectables, IUDs, and emergency contraception in the country’s Universal Health Coverage (UHC) benefits package. As the first UHC financing reform in the region to cover family planning, including methods suited to self-care, Zambia sets an exciting example for neighboring countries working on UHC packages of their own.
As we work towards UHC and #ProtectEveryone, we must include self-care as a critical part of the healthcare system. Advocacy opportunities for self-care are plentiful. We need funding for commodity procurement and distribution; training of providers to support and assist individuals utilizing self-care; policies and regulations that allow self-care and connect self-care users with the formal health system as needed; incorporation of self-care into existing data collection systems; and more. To realize this vision, everyone has a role to play—clients, providers, trainers, regulators, data analyzers, funders—and advocacy can help secure the funding, policy, and data needed to make self-care and UHC a reality.
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