Time for a Fresh Look at a Time-Tested Strategy to Achieve 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 Tariah Adams, Senior Communications and Advocacy Officer, White Ribbon Alliance Nigeria

The World Health Organization (WHO) estimates that half the world’s population lacks access to basic health services. This depicts inequities between and within countries, gaps between the rich and poor, men and women, the young and the old and among people of different ethnic backgrounds. Universal health coverage (UHC) is the promised solution for all to have access to higher quality health services with no barriers. Making this vision a reality remains a significant challenge globally. As the world explores opportunities to deliver UHC for all it is time to consider new and bold strategies to make this a reality, strategies that are grounded in self-care. 

Take primary health care (PHC) as an example, it is often described as the engine for UHC. One of its key pillars is the community, which focuses on individuals and what they can do for their own health – the first line of defense on all health-related issues. Self-care sits perfectly in this pillar, creating an enabling environment so that people can exercise their innate power to make informed decisions concerning their health.

According to the WHO, “self-care is the ability of individuals, families and communities to promote health, prevent diseases, maintain health, and cope with illness and disability with or without the support of a health-care provider.”  Self- Care has  untapped potential and is the ultimate example of  task-shifting.  It’s also an opportunity to increase progress on the road to UHC.

The recent COVID-19 pandemic clearly shows that healthcare systems are overburdened. A recent Global Financing Facility (GFF) survey of 63, 000 health facilities, reveals disruptions in outpatient visits, vaccinations, and care for new mothers, pregnant women and safe deliveries by health workers during the COVID-19 pandemic. This placed women at greater risk of complications or death. In Nigeria, there was a more than 10% decrease in family planning services in April and a 15% decrease in in May of this year; Nigeria also experienced a 6% decrease in women delivering babies at health facilities during the pandemic. This disruption was not just due to restrictions on movement during lockdown because of the COVID-19 pandemic. The same GFF survey showed many Nigerians could not access the services they needed, in large part because they could not afford to pay. Although this scenario played out during the Covid-19 in 2020, lack of affordable healthcare is the norm for many in developing and developed countries alike

As the world designs strategies to meet the UHC 2030 goals there is a need to promote solutions that prevent disruptions in vital healthcare services, reduce the burden of care on the health workers, and improve access and affordability. Self-care has the potential to meet all of these needs. One example: self-administration of injectable contraceptives means fewer clinic visits are required, reducing the burden on women and health workers and eliminating the cost of administrating contraceptives. We must promote innovations that support efficient service delivery, increase the reach of safe and effective services without compromising the quality of care provided, and puts the power back where it started — with the individual — to achieve UHC. These innovations must be designed and delivered in a manner that ensures equity for all woman, whether she lives in a remote community in sub-Saharan Africa, is part of the urban poor in the West, or is a rural farmer in south-east Asia, living with disability or without.

As we continue on the road to UHC, we must remember that no one country or donor group can do this alone.It will take a concerted global approach to make this happen. We must bring together the strategists and the innovators, the young and the more experienced, the optimists and the skeptics, and other key stakeholders to develop context-based sustainable solutions that promote self-care. These initiatives must be supported and entrenched within local laws, guidelines and established within clinical care protocols and global communities of practice.  We do not need to wait for another pandemic to overwhelm our health systems to innovate for UHC, the time to start is now.