In celebration of Self-Care Month, the Self-Care Trailblazers Group (SCTG) released three case studies on partner countries that have made notable strides in institutionalizing self-care policies and funding at national and subnational levels.
The SCTG supports civil society organizations in several countries to help create an enabling policy environment for self-care, while also serving as “learning centers” for self-care advocacy. Specifically, in 2020, the SCTG selected National Self-Care Network leads from Nigeria (White Ribbon Alliance Nigeria, or WRA Nigeria), Senegal (PATH Senegal), and Uganda (Center for Health, Human Rights and Development, or CEHURD) to develop and lead in-country, self-care advocacy efforts and serve as models for guideline adoption and implementation efforts in subsequent countries. All three countries have made significant progress, as detailed in the living case studies, and each offers valuable insight for other similarly positioned countries hoping to implement their own self-care policies and guidelines.
SHARED APPROACHES FOR SUCCESS
While Nigeria and Uganda have already established national self-care guidelines and begun to integrate self-care into country-level policies, Senegal is working to finalize its guideline with the support of a coalition of self-care experts. Each country continues to take a unique approach to institutionalizing self-care. However, while the three countries may be at different stages in guideline development and implementation, similarities exist across their approaches that have resulted in success thus far.
1. Leveraging Government Leadership in the Advancement of Self-Care
A strong relationship with decision-makers is key. In Uganda and Nigeria – two countries that pioneered national guidelines for self-care in 2020, which were among the first national self-care guidelines in the world – self-care technical working groups (TWGs) within the Ministry of Health (MOH) oversaw the development of national self-care guidelines. Critically, these national TWGs created a collaborative space between self-care experts and activists and government leaders. For both Nigeria’s Nigeria Self-Care Network under the Federal Ministry of Health (FMOH) and Uganda’s Self-Care Expert Group under the MOH, the government sees the TWGs as trusted partners with valuable legal and policy expertise. In Uganda, CEHURD is an active member of the Self-Care Expert Group and in Nigeria, White Ribbon Alliance (WRA) Nigeria is a founding member of the Nigeria Self-Care Network.
In Senegal, the Self-Care Pioneers Group launched in 2020 as a multi-sectoral coalition led by PATH Senegal and housed within the Family Planning Division of the MOH. PATH Senegal is a recognized leader on health innovation and self-care and had already collaborated with the Family Planning Division, MOH to hold a Self-Care Symposium prior to establishing the Self-Care Pioneers Group. The symposium set the stage for the launch of the coalition, which has representation and leadership from various government divisions to help move the self-care agenda forward. The Self-Care Pioneers Group has benefited greatly from the leadership role played by the Family Planning Division, MOH. Not only does the MOH lend credibility to the coalition, but it also opens doors within other government divisions.
2. Knowing Stakeholders’ Key Interests
No one organization or stakeholder can drive the self-care movement alone, which is why the advocacy focal points in Uganda, Nigeria, and Senegal conducted rigorous stakeholder mapping and engaged with key actors in consultations and meetings.
Immediately after approval of the National Self-Care Guideline in Nigeria, advocates sprang into action to ensure a coordinated, subnational advocacy initiative. First, they mapped out who had existing self-care programs or advocacy initiatives at the state level and who had financial or technical resources to bring to the domestication effort. Then, in collaboration with the FMOH, advocates identified 13 states for the first phase of intensive outreach. With advocacy tools in hand, advocates embarked on a self-care “road show,” dividing up travel and outreach to the priority states. This outreach consisted of a self-care orientation meeting with wider stakeholders and community members, including local government maternal and child health coordinates, civil society organizations, women and youth groups, and more. Bringing these stakeholder groups into the self-care conversation produced a strategic and well-coordinated advocacy effort with impressive results in a short period of time, including commitments from eight states to adapt and adopt the National Self-Care Guideline.
In Senegal, the value of in-depth stakeholder consultations cannot be overstated. One of the first major activities of the Self-Care Pioneers Group was to convene in-depth consultations to better understand self-care opportunities and barriers for different stakeholder groups: health professionals, civil society, and decision-makers and partners. The consultations unearthed key entry points and concerns for each group. For example, health professionals need more information and training on the benefits of self-care to themselves as providers and their patients, as well as a clear delineation between what is considered self-care (acceptable) and self-medication (unacceptable); civil society stressed the importance of improving women’s autonomy and decision-making to effectively practice self-care; and decisions-makers emphasized the need to strengthen links between the health system and patients and develop strong messages about the value of self-care. This has helped the Self-Care Pioneers Group tailor evidence and messaging to each stakeholder group.
Lastly, CEHURD, the advocacy focal point under the SCTG in Uganda, joined the national self-care conversation when the National Self-Care Guideline for sexual and reproductive health and rights (SRHR) was under development. The organization led a stakeholder mapping exercise to identify who was working on self-care, how, and where, with a special focus on mapping sectors beyond health (gender, education, labor, social development) and groups historically excluded from power (LGBTQI+, persons with disabilities). The mapping itself helped bring new self-care supporters into the Uganda self-care movement. During the stakeholder mapping, CEHURD learned that various government line ministries are working in silos rather than approaching the institutionalization of self-care as muti-sectoral. This realization has informed CEHURD’s continued advocacy, which has focused on institutionalizing self-care across different sectoral areas and stakeholders.
3. Positioning Self-Care as “Multi-Issue” and “Multi-Sector”
Stakeholder analyses in Uganda, Nigeria, and Senegal revealed a wide range of interests in self-care among key actors, thus the need for an adjusted advocacy approach to leverage key entry points for each group. The institutionalization of self-care in all national policies and programs requires a multi-sectoral approach and strong collaboration across government ministries and agencies. Self-care advocates must create opportunities for inter-ministerial dialogue to promote collaboration and coordination among government bodies. Self-care should be seen as part of the ongoing health and human rights issues that a country must focus on. For example, positioning self-care from a human rights lens helped CEHURD mainstream the concept among key decision-makers and influencers in Uganda.
In addition, keeping the vision and framing of self-care broad and not targeted to specific self-care interventions or technologies proved useful in each country, particularly in Senegal where self-care is a newer concept. Ultimately, self-care is about putting people at the center of decision-making for their health. This self-care framing has been well received and has significantly expanded the tent of supporters.
NEXT STEPS: CONTINUED ADVOCACY FOR SELF-CARE
While the road to subnational implementation of the National Self-Care Guideline is long, advocates have already made notable progress. The Self-Care Pioneers Group in Senegal is now focusing its energies on informing the development of the National Self-Care Guideline. The coalition has already participated in several workshops, with the most recent one aimed at identifying the components of the guideline and determining implementation modalities for each component.
In Uganda, CEHURD will continue its advocacy to socialize self-care and institutionalize it across different sectoral areas and stakeholders, especially gender, education, and UHC. CEHURD will also continue to grow the self-care movement at the national level through development of a national advocacy strategy for self-care to guide implementation of advocacy interventions on self-care and SRHR.
Self-care advocates in Nigeria will now focus their attention on holding state-level leaders accountable to their commitments. This includes organizing an official launch of the National Self-Care Guideline targeting federal and state leaders, supporting states in the process of adapting/adopting the guideline, developing Costed Implementation Plans and securing funds, and sensitizing communities about self-care.
Read more about Uganda, Nigeria, and Senegal’s paths toward institutionalizing self-care in each country’s living case study.
