A human rights and gender equality approach are vital to transforming health systems to become more people-centred.
People-centredness, especially in the delivery of sexual reproductive health services (SRH), requires a holistic approach to the care of each person. This means taking account of their individual circumstances, their needs and preferences across their whole life, as well as the environment in which they live. The Self-Care Global Values and Preferences Survey (GVPS), which helped shape the recommendations in the WHO Guideline on Self-Care Interventions for Health and Well-Being did just that.
More than just actions that can improve outcomes, self-care interventions are person-centered, evidence-based, quality tools with the human right of access to health care at their core. To roll out self-care interventions, a skilled, trained workforce is essential.
WHO is working with health workers around the world to help build their understanding of self-care interventions and develop their capacity to support their use.
Edward Kimani Mwangi, a health worker in Nairobi, Kenya, takes HIV self-testing kits directly to those living in informal urban settlements. He serves those at high risk of acquiring HIV, and without this direct approach, many people would not be able to access testing. The reasons for this are varied and include lack of awareness of testing options; stigma; not being able to pay for the cost of travelling to a clinic or hospital for testing and not being to take time off work to attend an appointment.
As Edward says, “Self-care is power. Self-care is the ability for us, the common folk, to take care of our own health care. And my message is: how do we get more self-care interventions to the people?
By raising awareness of self-testing and taking the self-testing kits into the community, people are able to more quickly and simply check their HIV status and it is changing the way they are seeing testing, treatment and the management of HIV.
Accurate information about self-care as well as the self-care interventions themselves must also be available in communities in a language and format that is accessible and appropriate to their context. Pharmacists and local health workers can play an important role in facilitating this access and in reducing stigma, discrimination, violence or coercion in health care. In doing so, underserved individuals and communities can have increased access to healthcare.
Access through digital platforms, new medical devices and technologies and care givers also play an important role in providing information and increasing access for everyone.
An enabling environment for self-care interventions also requires the development of supportive national laws and policies. These, along with providing a safe environment free from violence, coercion, stigma and discrimination, are critical for empowering people to take an active part in their own healthcare.
In Uruguay, for example, the legalization of abortion in 2012 paved the way for women to access a range of options, including the self-management of medical abortion. This self-care intervention provides women with greater autonomy and is an approach that is contributing to a reduction in maternal mortality from abortion in Uruguay.
In Morocco, the piloting of the self-administered injectable contraception in several areas is another example of broadening access to self-care interventions. Regardless of their situation, women there can now choose to use a self-administered injection, providing themselves with long-lasting contraceptive cover that is safe, effective, convenient and affordable.
Speaking about the roll out of the injectable contraception in Morocco, Dr Nadia Bezad from Opals, a non-government organisation, which was involved in the pilot, said: “Self-care interventions for SRHR has been a breath of fresh air for health workers like us. It allows us to significantly improve quality coverage for our clients.”
Learn more: WHO/HRP/IBP webinar on equitable access to self-care interventions
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