Galvanizing momentum and commitments to make self-care a reality for all

By Members of the Inter-Agency Working Group (IAWG) and International Rescue Committee (IRC)

Globally, crises are becoming increasingly complex and compounded as conflict, infectious disease outbreaks, and climate change exacerbate both their scale and severity. The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) estimates that one in every 23 people now needs humanitarian assistance and that as we approach the new year, a record 339 million people will need humanitarian assistance and protection in 2023. Approximately one quarter of these people are women and girls of reproductive age, whose sexual and reproductive health and rights (SRHR) needs both intensify and continue to be threatened in these settings.

Self-care offers an important and exciting opportunity to ensure access to essential SRHR services across the humanitarian-development nexus. The ever-growing self-care movement is demonstrating the value of self-care but despite the encouraging progress in stable settings, investments in self-care are almost never made in places where the most vulnerable women and girls live. With up to two-thirds of the world’s extreme poor estimated to live in fragile settings by 2030, and 61% of maternal deaths and 45% of neonatal deaths occurring in fragile contexts, there is a real risk that millions of vulnerable people will be left out of the self-care revolution.

Last year, colleagues from the Inter-Agency Working Group for Reproductive Health in Crises (IAWG) authored a Call to Action to Advance Self-Care for Sexual and Reproductive Health and Rights in Humanitarian and Fragile Settings as part of the Self-Care Trailblazer (SCTG)’s annual celebration of International Universal Health Coverage (UHC) day and Human Rights Day. The article reflected efforts to pilot innovative approaches for delivering self-care in humanitarian and fragile settings, promising new ways for self-care to advance the Minimum Initial Service Package for SRH in emergencies, and a seminal call to action outlining key actions stakeholders can take to move this critical agenda forward.

Since then, colleagues from across the IAWG and SCTG continue to collaborate and make significant strides in improving coordination, learning and action. Over the past year, we have:

• Conducted a scoping review on self-care interventions for sexual and reproductive health in humanitarian and fragile settings
• Created an IAWG Self-Care Task Team to develop and implement joint actions around self-care in humanitarian/fragile settings
• Integrated a humanitarian organization into the SCTG steering committee – to improve collaboration and improve synergies between the development and humanitarian communities
• Collaborated with the SCTG’s Country Advocacy Working Group to organize a webinar on advocacy for self-care in humanitarian and fragile settings

Yet, more is needed to transform commitments into action.The International Rescue Committee recently has undertaken a global assessment to better understand the entrenched barriers and opportunities for advancing self-care in humanitarian/fragile settings. Last month, the IRC in collaboration with IAWG and the SCTG, organized a high-level technical consultation at the International Conference on Family Planning (ICFP) in Pattaya City, Thailand in November 2022. The goals of the consultation were to:

1. Review the current status of SRHR self-care, inclusive of FP, SAC, MNCH, HIV/STI, GBV, implementation and research in humanitarian and fragile settings 
2. Identify key gaps and opportunities for SRHR self-care in humanitarian and fragile settings
3. Draft an outline for a Call to Action and Roadmap to support donors, implementers, researchers and policy makers to fill gaps, leverage opportunities, and achieve commitments identified during the meeting.

This one-day event included more than 60 participants representing self-care implementers, advocates, donors, researchers and representatives from multiple ministries of health across the humanitarian-development nexus. It included presentations on the current evidence on self-care in humanitarian/fragile settings and preliminary findings from the global assessment noted above. A high-level panel discussion, moderated by SCTG Secretariat Director and Senior Technical Advisor for Self-Care, Sarah Onyango, brought together Dinah Nakiganda from the Uganda Ministry of Health, Tomoko Kurokawa from UNFPA, Shelmith Wanjiru from the African Population and Health Research Center, and John Mark Taban from the IRC’s South Sudan country program to discuss successes and challenges to date in self-care implementation, policy and research. The second half of the day included a technical working session aimed at discussing and prioritizing barriers and enablers to self-care in three critical domains: implementation; research; and policy, advocacy and investment. Over the next few months, the IAWG Self-care task team will build off the foundational work started during the technical consultation, finalize, and disseminate the call to action and roadmap for advancing self-care in humanitarian and fragile settings. 

While analysis of major findings outlined in the global assessment and technical consultation are currently underway, key themes have emerged that position us to move forward an impactful agenda over the next year. For example, there are 23 countries in the process of developing, finalizing or implementing national SRH self-care guidelines. Nearly half of them rank within the top 20 most fragile states in the world and/or host significantly large populations of refugees or internally displaced persons. Yet there is limited to no inclusion of humanitarian/fragile context considerations within new national guidelines and associated implementation plans. 

There is a clear need to ensure humanitarian stakeholders are included in national guideline development and implementation processes to explore linking self-care with emergency preparedness and task-shifting agendas taking place in these countries. Doing so can help build resilient health systems and continue to drive self-care as a tool for both empowerment and resilience – even during the hardest of times.

Currently, the wide-spread belief across the humanitarian and development sectors is that the approaches needed to implement SRH self-care programs in humanitarian and fragile settings are different than those employed in more stable settings – largely driven by a recognition that there are significant health system, policy and operational barriers in humanitarian settings. Yet, preliminary findings from our global assessment reveal that the barriers and opportunities across the nexus are often the same, although some barriers are more pronounced or compounded in crises and fragile settings. Lessons-learned across the nexus point to the need for a hyper-localized and context-specific approach when introducing self-care programming anywhere – inclusive of humanitarian and fragile settings. To expand self-care programming in the hardest to reach settings, implementers will need to start by asking women, girls and clients their SRH self-care needs and preferences, designing programs with clients and relevant community, civil society and government system stakeholders, and leveraging existing health system resources. 

This year’s Universal Health Coverage Day theme is “Build the World We Want: A Healthy Future for All.” Let’s start by ensuring every person, everywhere, can access and practice SRH self-care – and build a movement that ensures people living in crises can realize these goals too.