With more than 1 billion youth—people between the ages of 15 and 24— around the world, the obstacles that they face while accessing health services are great. Limited educational resources and a lack of access to digital health content make gaining knowledge about their healthcare options challenging. And even when young people can access care, factors such as provider bias may limit their ability to receive high quality, relevant care.
Radical changes must be made for young people to benefit fully from healthcare systems.
In order to shift the health system to better meet the needs of young people and reach a world where each of them has access to care, we can’t afford to ignore youth voices. Ensuring that youth are equipped with proper knowledge and resources about self-care opportunities will require young leaders at the table, providing their expertise and voicing their needs in the conversation on how best to implement self-care, while holding the system accountable to these needs.
To find solutions to improve youth’s access to self-care approaches and products, we sought out the guidance from the very young people we want to reach. Through our very first community forum, hosted by youth leaders from IYAFP, Population Services International’s flagship adolescent contraceptive program A360, and Y-ACT, the Self-Care Trailblazer Group (SCTG) convened a group of more than 50 young people to seek guidance on how best to tailor self-care approaches to young people, hear the challenges they face, and identify ways to reach young people.
As a follow-up to our summit, we hosted a podcast with three self-care youth leaders to continue the dialogue about self-care, exploring strategies for implementation and possible outcomes. They provided insights on how the healthcare system can reach and serve youth. Self-care offers young people the opportunity to fully engage in their own healthcare journey. To achieve a world where everyone has access to care, we can’t afford to ignore youth voices.
Listen to their Q&A or follow along in the transcription below!
Tihut Mulugeta: I’m Tihut Mulugeta, a Self-Care Trailblazer Group member and project advisor for PSI’s RISE project in Ethiopia. Welcome to a special podcast on self-care for universal health coverage where we will focus on how self-care can be used to support young people engaging in health care. If you’re new to the self-care space, not to worry, you’re in the right place.
Here’s how it’ll work: I’ll walk you through an overview of self-care and then we will hear from two incredible youth leaders who are working at the forefront of this space. They’ll answer questions on the importance of self-care, how the health system can support self-care programming, and the potential promise that self-care holds in transforming our health care systems.
So, let’s get started! As I mentioned before, I am a member of the Self-Care Trailblazer Group—a global coalition dedicated to expanding the safe and effective practice of self-care so that individuals can better manage their own health, health outcomes are improved, and health systems are better equipped to achieve universal health coverage. But what do we mean when we talk about self-care?
The WHO defines self-care as “the ability for individuals, families and communities to promote, maintain health, prevent disease and cope with illness with or without the support of a healthcare provider.” What this means in practice is that people can use self-care to stay healthy and take charge of their own health care, significantly facilitated by health literacy, access to tools, commodities, and products. And for young people, self-care offers an opportunity to engage with the health system in an equitable, affordable, safe, private, and confidential manner, without fear of stigma or taboo.
With over half of the world’s population under the age of 30, we know that youth need to be included as crucial advocates and partners in order to reach UHC and ensure everyone has access to healthcare. And with me today are two youth advocates, who have been engaging in self-care advocacy as members of the SCTG.
Richard Dzikunu from Ghana is the Youth Officer with Tech for Health and Bea Okech of Kenya is the Content Development and Knowledge Management Assistant at Y-Act. Thank you both for joining me and taking the time to speak with me.
I’d love to start our conversation hearing a little bit about what self-care means to you, why you are advocates for self-care, and how you engage in self-care personally in your lives.
Beatrice Okech: Self-care to me means being able to use youth-friendly innovations to access sexual and reproductive health care without the shame and stigma that is often associated with it in my society. And that also links us to why I’m an advocate for self-care, because it provides young people the privacy and confidentiality to take charge of their sexual and reproductive health in our current contexts. How I engage in self-care is often through the use of online platforms or apps, such as the MyDawa app, in Kenya, where I’m able to access contraceptives and even HIV self-testing kits very easily with privacy and confidentiality. I also use the Flo app to check my menstrual cycle, which really helps me stay on top of my menstrual health. That is why self-care is so important to me on a personal level.
TM: Thank you, Bea, I think you’ve raised some interesting points considering young people empowering themselves and taking charge of their own health, as well as using different apps so that they can take care of their health.
Richard, what do you think about self-care, what does it mean to you, and why are you an advocate?
Richard Dzikunu: Based on the WHO definition of how people can take charge of their own health and manage their own healthcare with or without support of health professionals. Who would not want to take charge of their own healthcare, whenever you want? You can decide when and where to get a service from, without having to be shy about who is listening to you and getting to know about your condition, and who is trying to stigmatize or deny you of opportunities because of your condition. That’s why for me it is very important in the broader context that people, if given the opportunity, want to take charge of their own healthcare—where they are making decisions without dealing with any systemic social or cultural bias. That is why self-care is really important for me, and also for many other young people, because there are no barriers to deciding, and we can take our own initiative with or without support.
TM: That is very insightful. One word that captured me about your speech is about opportunities. So, young people and everyone deserves to have the opportunity to take care of themselves.
We know self-care can support people in all aspects of their lives, why do you think it’s especially important in the area of sexual and reproductive health in Kenya and Ghana?
BO: That really goes back to the type of context that we live in, and unfortunately, we live in a society where young people, especially young women, taking care of their sexual and reproductive health is still frowned upon. Self-care can give young people the agency to just take charge of their reproductive health, particularly in the area of access to contraceptives, and also dealing with STI’s such as HIV, we mentioned the self-testing kits for HIV. Even the broad spectrum of contraceptives, particularly the modern forms of contraceptives that we currently have on the market. It’s still such a huge challenge for young people, and especially young women, to seek these services out and to have the comfort to be able to cater to their sexual and reproductive health. This brings us back to the point that young people truly value their privacy, I believe that self-care is what they need to have the agency to cater to their sexual and reproductive health, even as we continue to make strides in youth friendly services and making health care facilities more available. In Kenya, the number of healthcare facilities available to the population is still very disproportionate. I think that self-care can really support all aspects, especially when it comes to SRHR and healthcare for many young people.
TM: Thank you so much, Bea. Like you said, young people value their privacy, and that’s true for most young people. They see self-care as a way to value their health and need youth-friendly services as they have different needs.
RD: When it comes to Ghana, the context is not much different than what my colleague shared in Kenya, young people, particularly girls, face challenges when having to access information and services when it comes to sexual and reproductive health. For me, between 2015 and 2017 when I was working in Ghana, we realized that getting access to information was always a challenge, and the fact that even when you can get information from a facility, it depends if that facility is youth friendly, if they will judge or question why you are asking about sex or contraception. If I can be at home and be able to access all of this information in the comfort of my room, on an application or dashboard and no one is judging or questioning me, then young people can feel empowered.
The age for sexual consent in Ghana is 16. At the age of 16, we presume that young people can have sex, however, the curriculum in our schools does not teach about the sexual and reproductive health side and you are not preparing them or providing them with any information or services so that they can make decisions on how to have safe sex, decisions around keeping their pregnancy or not, and all issues when it comes to their sexual and reproductive health.
This is where it becomes important for self-care. On one hand, young people have their rights, but they are not being provided with the services. With self-care tools they are able to make their own informed decisions. In a country like Ghana where teenage pregnancy is still on the increase, then that makes us ask some basic questions—why is it on the increase? Are people not getting access to information and services that they need? The services are there, but young people are not able to go because they are judged, stigmatized, and culturally, they feel shy to even talk about sex. These are all the challenges, but if you provide this information, for instance, through digital means—like in Ghana we have an online app where young people can basically go and get the information they need. In that case, they are managing their own health and getting information. Therefore, it is relevant when it comes to sexual and reproductive health, particularly in the context in Ghana and Kenya, where sexual health and rights seems to be a taboo to not talk about.
TM: Sometimes when people think of self-care, they think it’s easy, doesn’t need support from the government and health system, and that it’s free, but we know that’s not true. What do countries that want to support self-care need to do to advance self-care for sexual and reproductive health within universal health coverage?
RD: This is a very important point because we cannot discuss self-care without also discussing the challenges. Just like you said, self-care means basic care provided where people can access that care independently, with support. But when the infrastructure does not actually exist, where am I going to seek the care from? For instance, I can get information or be directed to a service from a mobile app, but if I go to the center and there is no service, then self-care is not complete. For self-care to be complete, we must invest in health infrastructure.
What are the things that young people need to have access to make their informed decisions? It’s different if there is a hospital or facility, but there are no health workers, and then there’s the instance where the facility does not exist at all—so even if you refer people to that facility, there is no way they can get a service. I think first investing in healthcare infrastructure is key, and here we are looking at primary health care services and investing in the health workers themselves. Again, when it comes to self-care, most self-care for young people is down to digital applications. My colleague from Kenya mentioned the application that she uses, and a number of the people in Ghana also use different applications. But who are the people using these digital applications? They are young people, who are educated, highly skilled in technology, and have the money to at least afford a mobile device where they can access this information. But there are young people who are not in school, who can neither read nor write, who do not know how to operate a computer or mobile phone. How do they access a counseling service if they are pregnant? It means that those who do not have the skills to use self-care tools are left out. That is why we also have to begin investing in digital skills, because there could be a digital application provided for self-care, but you need to have the means to have the skills to access those applications. For me, that is where a lot of investment should go to.
TM: I’d like to hear a little bit about the outcomes of self-care and sexual and reproductive health and rights. How have you seen either in your own life or with the people you’ve worked with or in communities how self-care has helped them access the health services they need, when and where they need them, without financial hardship?
RD: I have seen young people, some friends and colleagues, in the course of my life who have been able to access self-care tools, and it has helped them in different ways. For instance, as part of a project I did in Ghana, we are able to go to a number of schools in different regions in Ghana, we are able to speak to young girls, boys, provide information about reproductive health, and direct them to where they can get services. We also targeted young people who were out of school. For some of these young girls that got information and access to services, they were able to avoid pregnancy, stay in school and continue their education. Basically, the fact that they had timely access to information meant that they stayed in school and were able to make an informed decision. There were also young people who were pregnant and deciding if they wanted to keep it or not, then we were talking about comprehensive abortion care. Instead of taking the decision in their own hands, they were able to consult through health services or applications that gave them information on where to go for safe abortion services, avoiding death. We know a lot of stories of young people not making the right decisions because they don’t have all the information, and then they try to have an abortion and lose their lives. There are a lot of options, we’ve seen self-care tools providing timely information and services, enabling young people to make informed decisions and to use their education and become who they want to become and take their care into their hands.
TM: If you had to give advice to government officials deciding on how to improve SRHR and achieve UHC, what recommendations would you give them about self-care?
BO: For me, I think the starting point is to understand that self-care is not a replacement for primary healthcare, but rather a complementary element. The starting points would be funding and political will. When it comes to political will I think it is necessary because when we talk about actual implementation of interventions we need to start at the formulation and implementation of favorable policy frameworks that will incorporate self-care in our healthcare system to advance SRHR for UHC.
For instance, the WHO self-care guidelines of 2019 are a great place to start for government officials in Kenya to ensure that self-care is both accessible and in-step with formal health delivery systems. The best part is other countries like Nigeria and Uganda have made the first step towards this, and there is really a lot that we can learn from them in Kenya just to get the ball rolling in terms of ingraining self-care into our healthcare systems. When we talk about things like digitization of self-care practices, the subsidization of SRH services to increase their availability and access to vulnerable populations, we need to think about intentional financial investment from the government. And this is where we can also bring in the aspect of government in partnership with other stakeholders, such as the private sector and also civil society organizations (CSOs), just to increase the scope of self-care in our healthcare systems, particularly in places where access to facilities is not easy. For instance, there are places where many young people are not able to easily access a physical health care facility, maybe it’s 20 km away, sometimes even 50 to 100 km, and so accessing primary healthcare in that instance would really be a challenge. Incorporating self-care from the very start would really go a long way in addressing that challenge. When we talk about allocating resources towards self-care, I also just think about learning institutions as a starting point. My colleague Richard mentioned something about people needing that information. If we have comprehensive sexual education in our schools so young people know this is the type of information that is available, and in the event that I need support this is where I can get it, and this is where I can go to get services that look like this—I think that also empowers them to go out and take charge of their health. And, also, just thinking about learning institutions for the health care providers, I think that that would be a really great place to think about incorporating self-care. Once the health care providers are equipped with the necessary skills to provide guidance for other young people for self-care, that will help have it more ingrained in our healthcare system, which also requires a lot of investment—investment in the learning institutions, investment in the healthcare facilities, just to make sure there is always accurate and reliable information and also ensuring that services are constantly available so that we don’t find that young people are seeking contraceptives, but when they go to the actual facility or they try to use a digital app to access these services, they find that they are not in stock or available at the moment because of high-cost or high taxes, etc.. Just really bringing in the intentional financial investment and there is the aspect of political will, and multi-stakeholder partnerships which will really go a long way in incorporating self-care in our healthcare systems.
TM: Thank you for that Bea, I couldn’t agree more. And a big thank you to all who joined me as we explored ways for self-care to support young people around the world. If you’re interested in learning more about advocating for youth and continuing this conversation, you can join our youth workstream.
Our ultimate goal? To take all of your insights and answers and compile them into a comprehensive list of policy recommendations that can be shared with governments and the global community to include youth needs in self-care and healthcare policy!
Join us in this illuminating session as we explore the evolution of the STAR self-testing project, sharing insights, challenges, and successes that have emerged over the years. By examining the lessons learned and considering the implications for future healthcare strategies, we hope to foster a deeper understanding of the transformative potential of self-testing in improving healthcare accessibility and patient-centric services.
This enlightening session promises to provide updates from WHO guidelines and share insights on the journey toward viral hepatitis elimination. It will also showcase outcomes from the STAR hepatitis C self-testing research and discuss how these findings could potentially inform hepatitis B antigen self-testing and the use of multiplex test kits in the context of triple elimination. Join us in this crucial discussion as we work together to fast-track the global journey toward a hepatitis-free world by 2030.
In this two-part session, the Bill & Melinda Gates Foundation, PSI, and Population Solutions for Health will share lessons and best practices from rigorous research and hands-on implementation experience in Zimbabwe. The session will cover important topics like client-centered, community-led demand creation, differentiated service delivery, sustainable financing, and digital solutions. The sessions will also cover lessons in the program.
In this session, PSI and PSH will share lessons for optimizing access to comprehensive, culturally sensitive HIV and sexual and reproductive health services. Topics will include enhancing the accuracy and reliability of sex worker population data, improving HIV case finding among men who have sex with men (MSM) through reverse index case testing, and scaling differentiated service delivery models. The session will also cover integrating mental health and substance abuse in key populations (KP) programming and lessons in public sector strengthening.
Additionally, the session will showcase solutions that MSMs have co-designed, highlighting how this collaboration has improved the consumer care experience. It will demonstrate the critical role of KP communities in establishing strong and sustainable HIV responses, including amplifying KP voices, strengthening community-led demand, and establishing safe spaces at national and subnational levels for KP communities to shape and lead the HIV response.
This enlightening session promises to provide updates from WHO guidelines and share insights on the journey toward viral hepatitis elimination. It will also showcase outcomes from the STAR hepatitis C self-testing research and discuss how these findings could potentially inform hepatitis B antigen self-testing and the use of multiplex test kits in the context of triple elimination. Join us in this crucial discussion as we work together to fast-track the global journey toward a hepatitis-free world by 2030.
In this two-part session, the Bill & Melinda Gates Foundation, PSI, and PSH will share lessons and best practices from rigorous research and hands-on implementation experience in Zimbabwe. The session will cover important topics like client-centered, community-led demand creation, differentiated service delivery, sustainable financing, and digital solutions. The sessions will also cover lessons in program management. These insights are applicable beyond Zimbabwe and can be used to scale up HIV prevention efforts in the region.
Strong surveillance systems are essential to detect and respond to infectious disease outbreaks. Since 2019, PSI has worked alongside the Ministries of Health in Cambodia, Laos, Myanmar, and Vietnam to strengthen disease surveillance systems and response. Learn more here.
As COVID-19 spread globally, so did misinformation about countering the pandemic. In response, PSI partnered with Meta to inspire 160 million people to choose COVID-19 preventative behaviors and promote vaccine uptake. Watch the video to learn how.
Early warning of possible outbreaks, and swift containment actions, are key to preventing epidemics: disease surveillance, investigation and response need to be embedded within the communities. Public Health Emergency Operations Centers (PHEOCs) are designed to monitor public health events, define policies, standards and operating procedures, and build capacity for disease surveillance and response. Learn more here.
HOW COULD PRIVATE SECTOR PHARMACIES AND DRUG SHOPS ADVANCE PROGRESS TOWARDS UNIVERSAL HEALTH COVERAGE
Private sector pharmacies and drug shops play an important role in improving access to essential health services and products for millions of people living in low- and middle-income countries (LMICs), where healthcare resources are often limited. However, the way in which these outlets are, or are not, integrated into health systems holds significant importance. Do they serve as facilitators of affordable, high-quality care? Or have they become sources of substandard health services and products?
For over 50 years, PSI’s social businesses have worked globally to generate demand, design health solutions with our consumers, and work with local partners to bring quality and affordable healthcare products and services to the market. Now consolidating under VIYA, PSI’s first sexual health and wellness brand and social business, our portfolio represents the evolution from traditionally donor–funded projects towards a stronger focus on sustainability for health impact over the long term. Across 26 countries, the VIYA model takes a locally rooted, globally connected approach. We have local staff, partners and providers with a deep understanding of the markets we work in. In 2022, we partnered with over 47,000 pharmacies and 10,000 providers to reach 11 million consumers with products and services, delivering 137 million products. VIYA delivers lasting health impact across the reproductive health continuum, from menstruation to menopause. Consumer insights drive our work from start to finish. Their voices, from product exploration to design, launch, and sales, ensure that products not only meet consumers’ needs but exceed their expectations. The consumer is our CEO.
In 2019, our human-centered design work in East Africa explored ways that our work could support and accompany young women as they navigate the various choices required for a healthy, enjoyable sexual and reproductive life. Harnessing insights from consumers, VIYA is revolutionizing women’s health by addressing the confusion, stigma, and unreliability surrounding sexual wellness. Across five markets – Guatemala, Kenya, South Africa, Uganda and Pakistan – VIYA utilizes technology to provide women with convenient, discreet, and enjoyable tools for making informed choices about their bodies. The platform offers a wealth of high-quality sexual wellness information, covering topics from periods to pleasure in an accessible and relatable manner. Additionally, VIYA fosters a supportive community where users can share experiences and receive guidance from counselors. In 2023, VIYA will begin offering a diverse range of sexual wellness products and connect users with trusted healthcare providers, ensuring comprehensive care tailored to individual needs.
By: Fana Abay, Marketing and Communications Director, PSI Ethiopia
In rural Ethiopia, women and girls often face significant barriers in accessing healthcare facilities, which can be located hours away. Moreover, there is a prevailing stigma surrounding the use of contraception, with concerns about potential infertility or the perception of promiscuity. To address these challenges, the Smart Start initiative has emerged, linking financial well-being with family planning through clear and relatable messaging that addresses the immediate needs of young couples—planning for the lives and families they envision. Smart Start takes a community-based approach, utilizing a network of dedicated Navigators who engage with women in their localities. These Navigators provide counseling and refer interested clients to Health Extension Workers or healthcare providers within Marie Stopes International-operated clinics for comprehensive contraceptive counseling and services.
In a significant development, PSI Ethiopia has digitized the proven counseling messaging of Smart Start, expanding its reach to more adolescent girls, young women, and couples. This approach aligns with the priorities set by the Ethiopian Ministry of Health (MOH) and is made possible through funding from Global Affairs Canada. The interactive and engaging digital messaging has revolutionized counseling services, enabling clients to make informed and confident decisions regarding both their finances and contraceptive choices.
Clients who received counseling with the digital Smart Start tool reported a higher understanding of their options and were more likely to choose contraception (74 percent) compared to those counseled with the manual version of Smart Start (64 percent). Navigators also found the digital tool more effective in connecting with clients, leading to higher ratings for the quality of their counseling.
By December 2023, PSI Ethiopia, working in close collaboration with the MOH, aims to reach over 50 thousand new clients by leveraging the digital counseling tool offered by Smart Start. This innovative approach allows for greater accessibility and effectiveness in providing sexual and reproductive health services, contributing to improved reproductive health outcomes for women and couples across the country.
By: Christopher Lourenço, Deputy Director, Malaria, PSI Global
Community health workers (CHWs) are critical lifelines in their communities. Ensuring they have the training, support, and equipment they need is essential to keep their communities safe from malaria, especially in the hardest to reach contexts.
For example, in Mali, access to formal health services remains challenging, with four in ten people living several miles from the nearest health center, all without reliable transportation or access. In 2009, the Ministry of Health adopted a community health strategy to reach this population. The U.S. President’s Malaria Initiative (PMI) Impact Malaria project, funded by USAID and led by PSI, supports the Ministry with CHW training and supervision to localize health services.
In 2022, 328 thousand malaria cases were recorded by CHWs); 6.5 thousand severe malaria cases were referred to health centers, according to the national health information system.
During that time, the PMI Impact Malaria project (IM) designed and supported two rounds of supportive supervision of 123 CHWs in their workplaces in the IM-supported regions of Kayes and Koulikoro. This included developing and digitizing a standardized supervision checklist; and developing a methodology for selecting which CHWs to visit. Once a long list of CHW sites had been determined as accessible to supervisors for a day trip (including security reasons), the supervisors telephoned the CHWs to check when they would be available to receive a visit [as being a CHW is not a full-time job, and certain times of the year they are busy with agricultural work (planting, harvesting) or supporting health campaigns like mosquito net distribution].
Supervisors directly observed how CHWs performed malaria rapid diagnostic tests (RDTs) and administered artemisinin-based combination therapy (ACT). They recorded CHW performance using the digitized checklist, interviewed community members, reviewed records, and provided on-the-spot coaching. They also interviewed the CHWs and tried to resolve challenges they expressed, including with resupply of commodities or equipment immediately or soon afterwards.
Beyond the observed interactions with patients, supervisors heard from community members that they were pleased that CHWs were able to provide essential malaria services in the community. And the data shows the impact.
In IM-supported areas of Mali, 36% of CHWs in the first round were competent in performing the RDT, which rose to 53% in the second. 24% of CHWs in the first round compared to 38% in the second were competent in the treatment of fever cases and pre-referral counseling. Between both rounds, availability of ACT increased from 80 percent to 90 percent.
Supportive supervision with interviews and observations at sites improved the basic competencies of CHWs between the first and second rounds, and additional rounds will help to understand the longer-term programmatic benefits.
By: Dr. Dorothy Balaba, Country Representative, PSI Ethiopia
In Ethiopia, PSI leads the implementation of USAID Transform WASH (T/WASH) activity with consortium partners, SNV and IRC WASH. Contrary to traditional models that rely on distribution of free or heavily subsidized sanitation products, T/WASH utilizes a market-based sanitation approach. This approach creates sustainable and affordable solutions, by integrating market forces and supporting businesses to grow, while creating demand at the household level.
During the last six years, T/WASH has worked alongside the private sector and government (Ethiopia’s Ministry of Health, Ministry of Water and Energy, and Ministry of Labor and Skills), among other stakeholders, to increase household access to affordable, quality sanitation products and services. For example, more than 158 thousand households have invested in upgraded sanitation solutions with rapid expansion to come as the initiative scales and market growth accelerates.
T/WASH has successfully trained more than 500 small businesses, including community masons and other construction-related enterprises, with technical know-how in sanitation product installation, operational capacities, and marketing and sales skills needed to run successful, growing businesses. The Ethiopian government is now scaling the approach to all districts through various national, regional, and local institutions with requisite expertise. T/WASH has also worked the One WASH National Program, Ministry of Health, Ministry of Water and Energy, and Ministry of Labor and Skills to examine policies that influence increased household uptake of basic WASH services, such as targeted sanitation subsidies, tax reduction to increase affordability, and increased access to loan capital for business seeking to expand and households needing help to improve their facilities.
To share the journey to market-based sanitation, representatives of the Ethiopian Ministry of Health and the USAID Transform WASH team took to the stage at the UN Water Conference in 2023.
“Rather than relying on traditional aid models that often distribute free or heavily subsidized sanitation products, market-based sanitation creates sustainable and affordable solutions, integrating market forces and supporting businesses to grow.”
— Michael Negash, Deputy Chief Party of T/WASH
By: Dr Karin Hatzold, Associate Director HIV/TB/Hepatitis
Building upon the success and insights gained from our work with HIV self-testing (HIVST), PSI is actively applying this approach to better integrate self-care, more broadly, in the health system beginning with Hepatitis C and COVID-19. Self-testing has emerged as a powerful tool to increase access to integrated, differentiated, and decentralized health services, accelerating prevention, care, and treatment for various diseases, while also increasing health system resilience against COVID-19.
Here’s how we got there.
Seven years ago, the landscape of HIV self-testing lacked global guidelines, and only the U.S., the UK and France had policies in place that allowed for HIV self-testing. High disease burdened countries in low-and-middle-income-countries (LMICs) lacked evidence and guidance for HIVST despite major gaps in HIV diagnosis.
However, through the groundbreaking research from the Unitaid-funded HIV Self-Testing Africa (STAR) initiative led by PSI, we demonstrated that HIVST is not only safe and acceptable but also cost-effective for reaching populations at high risk with limited access to conventional HIV testing. This research played a pivotal role in informing the normative guidelines of the World Health Organization (WHO) and shaping policies at the country level. As a result, more than 108 countries globally now have reported HIVST policies, with an increasing number of countries implementing and scaling up HIVST to complement and partially replace conventional testing services. This became especially significant as nations tried to sustain HIV services amidst the disruptions caused by the COVID-19 pandemic.
By leveraging our expertise, PSI is conducting research to identify specific areas and populations where the adoption of Hepatitis C and COVID-19 self-testing could significantly enhance testing uptake and coverage. This research serves as the foundation for developing targeted strategies and interventions to expand access to self-testing, ensure that individuals have convenient and timely options for testing for these diseases, and are linked to care, treatment and prevention services through differentiated test and treat approaches.
By: Shawn Malone, Project Director, HIV/AIDS Gates Project in South Africa, PSI Global
In South Africa, where the HIV response has lagged in reaching men, PSI’s Coach Mpilo model has transformed the role of an HIV counselor or case manager into that of a coach and mentor who provides empathetic guidance and support based on his own experience of living with HIV. Coaches are men who are not just stable on treatment but also living proudly and openly with HIV. Situated within the community and collaborating closely with clinic staff, they identify and connect with men struggling with barriers to treatment and support them in overcoming those barriers, whether that means navigating the clinic or disclosing their HIV status to their loved ones.
PSI and Matchboxology first piloted the model in 2020 with implementing partners BroadReach Healthcare and Right to Care as well as the Department of Health in three districts of South Africa. Since then, the model has been rolled out by eight implementing partners in South Africa, employing more than 300 coaches and reaching tens of thousands of men living with HIV. To date, the model has linked 98 percent of clients to care and retained 94 percent of them, in sharp contrast to the estimated 70 percent of men with HIV in South Africa who are currently on treatment.
Given the success of the program, South Africa’s Department of Health and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) have each embraced the Coach Mpilo model in their health strategy and are embedding it in their strategies and programs.
“The men we spoke to [while I was traveling to South Africa for a PrEP project with Maverick Collective by PSI] were not only decidedly open to the idea of taking a daily pill…many were willing to spread the word and encourage friends to get on PrEP too. We were able to uncover and support this new way forward because we had flexible funding to focus on truly understanding the community and the root barriers to PrEP adoption. This is the philanthropic funding model we need to effectively fight the HIV epidemic, and it’s beneficial for all sorts of social challenges.”
– Anu Khosla, Member, Maverick Collective by PSI
By: Hoa Nguyen, Country Director, PSI Vietnam
In late 2022, with funding from the Patrick J. McGovern Foundation, PSI and Babylon partnered to pilot AIOI in Vietnam. By combining Babylon’s AI symptom checker with PSI’s health provider locator tool, this digital health solution analyzes symptoms, recommends the appropriate level of care, and points them to health providers in their local area. The main goal is to support people in low-income communities to make informed decisions about their health and efficiently navigate the healthcare system, while reducing the burden on the healthcare workforce. The free 24/7 service saves people time and subsequent loss of income from taking time off work and from having to pay unnecessary out-of-pocket expenses. Under our global partnership with Meta, PSI launched a digital campaign to put this innovative product in the hands of people in Vietnam. By the end of June 2023 (in the nine months since product launch), 210 thousand people accessed the AIOI platform; 2.4 thousand people created personal accounts on the AIOI website, 4.8 thousand triages to Symptom Checker and linked 2.2 thousand people to health facilities.
Babylon’s AI symptom checker and PSI’s health provider locator tool captures real-time, quality data that supports health systems to plan, monitor and respond to consumer and provider needs. But for this data to be effective and useable, it needs to be available across the health system. Fast Healthcare Interoperability Resources (FHIR) standard provides a common, open standard that enables this data exchange.
PSI’s first consumer-facing implementation of FHIR was launched in September 2022 as part of the Babylon Symptom Checker project in Vietnam, enabling rapid alignment between PSI and Babylon’s FHIR-enabled client records systems. PSI already has several other consumer health FHIR implementations under active development in 2023, including PSI’s collaboration with the Kenya MOH to launch a FHIR-enabled WhatsApp national health line for COVID-19 health information. PSI will also look to adopt and scale health workforce-facing FHIR-enabled tools, such as OpenSRP2, which will be piloted in an SRH-HIV prevention project in eSwatini in partnership with Ona by the end of 2023.
— Martin Dale, Director, Digital Health and Monitoring, PSI
By: Dr. Zayar Kyaw, Head of Health Security & Innovation, PSI Myanmar
Under a three-year investment from the Indo-Pacific Center for Health Security under Australia’s Department for Foreign Affairs and Trade (DFAT), PSI is enhancing disease outbreak surveillance and public health emergency preparedness and response capacities in Myanmar, Cambodia, Laos, and Vietnam. When PSI conducted a review of existing disease surveillance systems in Myanmar, it identified several gaps: although the Ministry of Health had systems in place for HIV, tuberculosis, malaria and other communicable diseases, they were fragmented, with different reporting formats and reliance on paper-based reporting. In addition, private sector case surveillance data were not routinely captured, yet private clinics and pharmacies are the dominant health service delivery channel in the country. This hindered effective disease prevention and control efforts.
Building on our extensive private sector malaria surveillance work under the BMGF-funded GEMS project in the Greater Mekong Subregion, PSI implemented a case-based disease notification system using social media channels to overcome the limitations of paper-based and custom-built mobile reporting tools. These chatbots, accessible through popular social media platforms like Facebook Messenger and Viber, proved to be user-friendly and required minimal training, maintenance, and troubleshooting. The system was implemented in more than 550 clinics of the Sun Quality Health social franchise network as well as nearly 470 pharmacies. The captured information flows to a DHIS2 database used for real-time monitoring and analysis, enabling rapid detection of potential outbreaks. Local health authorities receive instant automated SMS notifications, enabling them to promptly perform case investigation and outbreak response.
In 2022, private clinics reported 1,440 malaria cases through the social media chatbots, while community mobilizers working with 475 private providers and community-based malaria volunteers reported more than 5,500 cases, leading to the detection of two local malaria outbreaks. Local health authorities were instantly notified, allowing them to take action to contain these surges in malaria transmission. During the same time, pharmacies referred 1,630 presumptive tuberculosis cases for confirmatory testing – a third of which were diagnosed as tuberculosis and enrolled into treatment programs.
By: Anya Fedorova, Country Representative, PSI Angola
The shortage of skilled health workers is widely acknowledged as a significant barrier to achieving Universal Health Coverage. To address this challenge, PSI supported ministries of health to develop a digital ecosystem that brings together stewardship, learning, and performance management (SLPM). The ecosystem enhances training, data-driven decision-making, and the efficiency of healthcare delivery.
Here’s what it looks like in practice.
In July 2020, PSI Angola, alongside the Angolan digital innovation company Appy People, launched Kassai, an eLearning platform that targets public sector health workers in Angola. Through funding from USAID and the President’s Malaria Initiatve (PMI), Kassai features 16 courses in malaria, family planning, and maternal and child health – with plans to expand learning topic areas through funding from ExxonMobil Foundation and private sector companies. A partnership with UNITEL, the largest telecommunication provider in Angola, provides all public health providers in Angola free internet access to use Kassai.
Kassai’s analytics system to follow learners’ success rate and to adjust the course content to learners’ performance and needs. Kassai analytics are integrated with DHIS2 – the Health Management Information System (HMIS) of Angolan MOH, to be able to link learners’ knowledge and performance with the health outcomes in the health facilities. The analytics track learners’ performance by course and gives visibility by health provider, health facility, municipality, and province. Each course has pre-and post-evaluation tests to track progress of learning, too.
By the end of 2022, there were 6,600 unique users on the Kassai platform and 31,000 course enrollments. PSI Angola’s partnership with UNITEL, the largest telecommunication provider in Angola, allows for free internet access to learn on the Kassai for all public health providers in Angola. Building on its success for malaria training, Kassai now also provides courses in family planning, COVID-19, and maternal and child health. This reduces training silos and provides cross-cutting benefits beyond a single disease.
Implementing the SLPM digital ecosystem brings numerous benefits to health systems. It allows for more strategic and efficient workforce training and performance management, enabling ministries of health to track changes in health workers’ knowledge, quality of care, service utilization, and health outcomes in real time. The ecosystem also supports better stewardship of mixed health systems by facilitating engagement with the private sector, aligning training programs and standards of care, and integrating private sector data into national HMIS. Furthermore, it enables the integration of community health workers into the broader health system, maximizing their impact and contribution to improving health outcomes and strengthening primary healthcare.
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With overarching commitments to flexibility in our work, and greater wellbeing for our employees, we want to ensure PSI is positioned for success with a global and holistic view of talent. Under our new “work from (almost) anywhere,” or “WFAA” philosophy, we are making the necessary investments to be an employer of record in more than half of U.S. states, and consider the U.S. as one single labor market for salary purposes. Globally, we recognize the need to compete for talent everywhere; we maintain a talent center in Nairobi and a mini-hub in Abidjan. PSI also already works with our Dutch-based European partner, PSI Europe, and we’re creating a virtual talent center in the UK.
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