A New Tool to Map Self-Care Policy and Practice

By Andrea Cutherell, Dr. Austen El-Osta, Dr. Sarah Onyango, and Kasey Henderson

Countries around the world are advancing self-care policy and practice to strengthen accountable and responsive health systems and to support universal health coverage (UHC). The World Health Organization’s (WHO) first normative guidance on self-care approaches (WHO Consolidated Guideline on Self-Care Interventions for Health, 2019) provided motivation for these advancements, as did the COVID-19 pandemic which tested already strained health systems. These advances offer an opportunity to better capture changes in policy development and implementation and to highlight opportunities for further policy reform.

 In 2020, the Self-Care Academic Research Unit (SCARU) at Imperial College London was commissioned by the Self-Care Trailblazer Group (SCTG) to develop a first of its kind, pragmatic self-care policy and practice mapping tool. The purpose of this tool is to understand the extent to which countries are implementing the 24 recommendations outlined in the 2019 WHO Consolidated Guideline on Self-Care: Sexual and Reproductive Health and Rights (SRHR) in policy and practice.

With support from the SCTG, the tool was first applied in Kenya, Nigeria, and Uganda between October 2020 and March 2021, at a time when Nigeria and Uganda were in the process of developing national self-care guidelines by adopting the global normative guidance.  

The study found that self-care policies and practices in all three countries were relatively advanced for perinatal health and family planning; while some were more nascent, including those for self-sampling for sexually transmitted diseases. The policy environment for eliminating unsafe abortions was the least advanced. The preliminary results are available in this Self-Care Policy Mapping Deck, while full manuscripts are under development.

What’s Next?

Most importantly, the policy mapping exercise is being used to advance self-care policy and practice in exciting ways:

SCTG National Self-Care Networks–led by White Ribbon Alliance affiliate in Nigeria and the Center for Health, Human Rights and Development in Uganda– used the results to inform their national self-care advocacy objectives. 

  • In Nigeria, SCARU Director, Dr. Austen El-Osta, presented the self-care policy mapping findings to the Federal Ministry of Health-led Self-Care Think Tank in Nigeria, which informed the country’s self-care policy mechanism and advocacy objectives for 2021, which include building health literacy for effective self-care implementation as well as advocacy for improved self-care products and the removal of existing barriers.
  • In Uganda, the SCARU policy mapping analysis highlighted the gaps in the legal and policy frameworks for self-care while being used to identify advocacy opportunities for self-care policy reform. 

With support from Population Services International’s Maverick Collective initiative, the policy mapping tool will be applied in Mozambique, Malawi, and Nepal to inform recommendations for a basic minimum package of self-care interventions tailored to each country’s context. This initiative will gather evidence to inform future policy guidelines and programs by creating an understanding of the feasibility and acceptability of self-care interventions, and of what consumers require to adopt them effectively, safely, and sustainably.

But the work doesn’t stop there. The SCTG is also developing an accompanying policy dashboard to articulate the self-care policy status across a broad range of interventions in a growing selection of countries. We hope this tool can be used by self-care advocates, manufacturers, implementers and policy makers to track the progress of self-care policies and to use the information to inform strategy development.

Interested in replicating this in your own country?

Over the lifespan of this policy mapping project, we were able to improve our understanding of how to conduct policy mapping for this purpose. And we’ve working toward a policy mapping tool that may be used for replication in other countries and across various settings. 

To explore the adaptation of this tool, contact Andrea Cutherell and Austen El-Osta at [email protected].