Leave no one’s health behind: self-care as a key component of health systems for all

By Marielle Hart and Nienke Westerhof 

Why now? 

Self-care has never been more relevant than now, as health systems around the world are overwhelmed by COVID-19. Governments have increasingly stepped up self-care and digital health interventions to reduce the burden on health systems and allow people to take care of their health needs, despite COVID-19 related measures and lockdowns, increasing shortage of health workers, and inability to reach clinics. 

Even before COVID-19, Aidsfonds has seen self-care as a crucial step to not only realizing a world without AIDS by 2030 but also to achieving universal health coverage (UHC). WHO defines UHC as all people having access to the health services they need, when and where they need them, without financial hardship. The “where and when they need them” is the very essence of self-care as people are not dependent on the availability of doctors, nurses or the capacity or accessibility of health clinics for all of their health needs.Through accessing self-care, they can take care of their own health, in their own home, when they need it, which, at the same time, increases people’s autonomy, choice and power over their health. This is especially the case for adolescent girls and young women and young people living with and affected by HIV, who often face enormous obstacles to accessing clinic-based health care due to poverty, gender-based violence and vulnerabilities, lack of privacy, and out of fear of stigma. Their health is left behind. 

Self-care leads to better health outcomes and quality of life

For this reason, Aidsfonds has been working with these groups to equip, empower, and encourage them to meet their own health needs through self-care. In particular, we have implemented the following self-care interventions: 

• The Stepped Care Model for sexual and reproductive health connects young people to off- and online services that directly meet their needs. When their needs change, the services change with them, optimizing efficiency and quality of healthcare and increasing health outcomes as a result. 
• A partnership with Healthy Entrepreneurs is bringing self-care to communities in rural and remote areas. Through this program, community health workers are trained as community health entrepreneurs, who can make a living by selling reliable and affordable high impact products, distributing condoms, offering HIV self-testing and referrals, and improving health knowledge in their remote communities.
• With the Thandizo tool, community health care workers can better support young people living with HIV to adhere to treatment. The app identifies risks for non-adherence, provides referrals, tips and advice based on individual needs. At the same time, through the app, data is gathered and provides information about the needed interventions. 
• Through youth-led advocacy in Get Up Speak Out and PITCH, we have made great steps in empowering young people and supporting an enabling environment through reducing age of access to services, making services more youth-friendly, and changing laws and policies. 

What we have learned from all these interventions is that by putting young people themselves in the lead and capacitating them to participate actively in their health care, they become more aware of their own health, body and physical conditions and through responsible use of products and services including condoms, HIV self-testing, and oral PrEP, their health outcomes improve. This, in combination with socio-cultural and economic change and increasing realization of human rights, will not only allow for more equitable access to health services for young people living with and affected by HIV but it will also lead to a better quality of life overall. 

What’s next?

Our new projects YouthWise and EmpoweRING: Prevention by Choice will build on our experience and new exciting developments in the healthcare field. 

YouthWise aims to amplify the voices of adolescents and young people living with HIV in Kenya and Malawi to enable them to practice self-care and fulfill their sexual and reproductive health and rights needs, in a supportive and respectful environment. 

Through the EmpoweRING project, we will advocate for accelerated approval and uptake of the Dapivirine vaginal ring as an HIV prevention tool for women and girls in Uganda, Kenya, Tanzania and Rwanda. The Dapivirine ring is the first discrete, women-controlled, long-acting HIV prevention product. The project will be implemented using the Youth Advocates model, seeking to empower and build resilience among adolescent girls and young women in addressing HIV needs.

The next UN High Level Meeting (HLM) on UHC in 2023 provides a critical opportunity at the country-level to advocate for self-care as a key component of a health system that allows adolescents and young people to make the HIV, SRHR and health choices that best suit their unique needs and for self-care services and commodities to be included in national UHC plans and budgets. To bring country-level realities and evidence to the HLM, Aidsfonds will conduct policy research with country case studies on how self-care is or should be taken up in UHC. We will also collaborate with the WHO and governments to create local ownership to implement the WHO normative SRHR self-care guidelines at the country level.

In 2022, we will also expand our youth-led self-care prevention and treatment work to more countries, including Tanzania and Zambia. Stay tuned! 

Aidsfonds is a Dutch non-profit organisation working towards a world without AIDS with a focus on the people and regions most affected. We aim to accelerate worldwide HIV prevention, treatment, care and support, by piloting and upscaling community-based interventions together with governments and local partners. We consider self-care to be critical for ending AIDS and achieving UHC. Here you can find more information on our self-care work.