Self-care is a driver for universal health coverage 

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 Aubrey Weber, Technical Officer, Research Utilization,  Benjamin Eveslage, Technical Advisor, Online HIV Services,  Catherine Packer, Research Associate, Reproductive, Maternal, Newborn and Child Health, FHI 360 

Self-care and universal health coverage (UHC) are hot topics in the global health and development sectors. They are often discussed in silos, but recent programmatic efforts have illustrated how interconnected they actually are. The World Health Organization (WHO) defines self-care as “the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health care provider.” UHC ensures that all individuals and communities receive the health services they need without suffering financial hardship, and it includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.

Although the COVID-19 pandemic and related restrictions on movement are exacerbating health inequities worldwide, operating under this context has taught us more about the potential of self-care to meet the health care needs of diverse populations. There is an urgent need to accelerate self-care and UHC initiatives so that individuals can take charge of their own health care needs and have equitable access to health care.

Photo (left): A community worker demonstrates to a friend how to book HIV services on their own phone using QuickRes. Photo credit: KP STAR Project IntraHealth Namibia.

Self-care supports UHC

Self-care – including digital self-care – drives UHC in two important ways: by increasing access to health services and reducing the cost of health services to the client. Accessing self-care online, through phones or in person, increases reach and access. When clients can use medical devices or commodities without the assistance of a health provider (e.g., HIV self-testing and self-injectable contraception), they can take care of their health needs at home with more privacy, which is appealing to many people. By eliminating or reducing time spent visiting a health provider, some self-care options also have the potential to reduce financial and opportunity costs to clients. The following FHI 360-supported efforts highlight how self-care can lead to equitable access to health care, a key component of UHC.

Improved access to health services with online booking platform is the first app of its kind for online reservations and case management. It is currently in use in more than 10 countries across Africa, Asia, and the Caribbean. Clients can use their smartphones to book appointments and seek local health services while maintaining confidentiality. The USAID- and PEPFAR-supported EpiC and LINKAGES projects have used the client-led online booking system and other online reservation apps to connect individuals to nearby health services with great success, which has been particularly useful during the COVID-19 pandemic. While these apps were created for HIV programs, they also allow clients to book a broader range of services including STI testing and treatment, and family planning and general health consultations, thereby increasing access to services from the convenience of a phone.

Photo credit: PEPFAR & USAID EpiC Guyana Project
Ensuring equity with free SMS-based reporting and tracking of HIV self-tests in Tanzania

Partnerships with technology or telecom companies can offer free or low-cost solutions for people to use their phones to support their own health services.  EpiC Tanzania is collaborating with the government to ensure that clients can message through SMS to report self-test results and track HIV self-test kits at no charge to the client or project. The purpose of using SMS-based reporting and tracking is to support HIV self-testing across hard-to-reach populations (including key populations) by capturing secondary distribution, tracking self-test results, and facilitating links to confirmatory testing among reactive tests (and links to PrEP for those with nonreactive results).

Increasing access to preventive health care through self-injectable contraception 

FHI 360 is a leader in research related to the self-injectable contraceptive method DMPA-SC, and in its introduction and scale-up in the public and private sectors of several countries – including Afghanistan, Benin, Malawi, Senegal, Uganda, and Zambia. When women are trained how to self-inject and provided enough doses to last for up to one year, they have the freedom to use the method at a private and convenient location of their choosing. Self-injection is particularly optimal during COVID-19; it only requires one visit to a health provider to be trained and given enough pregnancy protection for up to one year, thereby simultaneously reducing physical contact with the health care staff and avoiding disruptions in contraceptive services. Further, having autonomy and control over one’s fertility—at all times, but especially during a pandemic— is important for health, economic stability, and peace of mind. In FHI 360’s seminal randomized controlled trial in Malawi, self-injection was shown to significantly improve continuation compared to provider-administered DMPA-SC. Self-injection of DMPA-SC increases use of an effective and safe family planning method and increases equity in health care delivery to marginalized groups such as adolescents and low-income rural women.

This year’s theme for UHC Day is “Health For All: Protect Everyone,” which is especially important and timely as COVID-19 continues to exacerbate existing inequities in access to health care worldwide. The primary tagline for UHC day is, “To end this crisis and build a safer and healthier future, we must invest in health systems that protect us all – now.” During the pandemic, many people around the world have suffered disproportionately from reduced access to key health services. Self-care is one strategy to achieve more equitable access to health care and should be treated as an essential component of UHC.