Self-care interventions for advancing sexual and reproductive health and rights – implementation considerations | Published in Journal of Global Health Reports

Self-Care Interventions for Sustainable Development Goals (SDGs)

Introduction

Self-care refers to the ability of people to promote their own health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health worker. In fact, most healthcare being implemented across the globe is self-care, and not, as often assumed, medicalized care. It is estimated that 65%-85% of health care is provided by the individual or the family without professional intervention using traditional, non-allopathic or allopathic means.¹ Self-care interventions include drugs, devices, diagnostics and digital tools that support self-care. With evidence-based normative guidance, an enabling environment in which they can be used, and with appropriate linkages to health systems, self-care interventions provide the possibility of greater self-determination, as well as a means of increasing healthcare access and coverage.

World Health Organization (WHO) Guidelines on Self-Care Interventions

Recognizing laypersons as active agents in their own health care, the World Health Organization (WHO)’s global normative guideline on self-care interventions² recommends people-centred, holistic approaches to health and well-being for sexual and reproductive health and rights (SRHR), with consideration of the environment in which people live and their individual circumstances, needs and desires across their life course. Examples of such interventions include: self-monitoring of blood glucose and/or blood pressure during pregnancy; self-administration of injectable contraception; use of ovulation predictor kits; pregnancy self-testing, for contraception and fertility care; self-management of medical abortion for safe abortion care; self-collection of samples to self-test for sexually transmitted infections (STIs), human immunodeficiency virus (HIV); or human papillomavirus (HPV) for, respectively, reducing sexually transmitted infections, knowing HIV status and improving, cervical cancer screening; and lubricants for sexual health and well-being.

Implementation Framework for Self-Care Interventions

This WHO guideline supports the provision of self-care interventions to increase people’s options about when and how to seek healthcare. It offers flexibility in the choice of interventions and in the degree and manner of engagement with health services. The guideline also considers the needs of all people across the gender spectrum, recognizing that there may be differences in the barriers that individuals and communities face accessing quality interventions, in their needs and priorities, in the nature of support required, as well as differences in preferred points of access. The guideline is informed by a conceptual framework that includes key enablers such as health literacy, which is crucial as access to correct health information and the capacity of people to use it effectively shapes self-care patterns. Ultimately, understanding how well SRHR outcomes are advanced through the use and uptake of self-care interventions requires implementation research under real-life conditions.

Figure 1.Framework for implementing self-care interventions for SRHR (FIS-SRHR).

Studies on Self-Care Interventions

Studies across different countries, using a variety of research methods, have consistently shown that self-care is the most dominant form of care in high-, low-, and middle-income country contexts.²

Implementation Considerations for Self-Care Interventions

As outlined in the WHO conceptual framework for self-care interventions that informed the guideline, the ability of individuals and communities to self-care depends on the availability, accessibility, affordability and acceptability of a range of quality, evidence-based self-care interventions. In alignment with this, the WHO classification of self-care interventions³ for health takes a people-centred approach, describing what self-care means in all its dimensions and presenting a standardised language to support dialogue between public health practitioners working in key areas, including analysis and synthesis of evidence and research. Building on previous studies and aligning with the classification scheme, we describe key implementation considerations, including: agency, information, availability, utilization, social support, accessibility, acceptability, affordability, and quality. These considerations form the foundation of a model implementation framework that was developed using a general ecological health systems approach, highlighting the interaction between micro-level (e.g., agency), meso-level (e.g., social support) and macro-level (e.g., availability) dynamics.

Implementation Framework for Self-Care Interventions for SRHR

In this paper, we

SDGs, Targets, and Indicators

1. SDG 3: Good Health and Well-being

   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.
   • Target 3.d: Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction, and management of national and global health risks.

   The article discusses self-care interventions that promote health and well-being, such as self-monitoring of blood glucose and blood pressure, self-administration of injectable contraception, and self-management of medical abortion. These interventions contribute to achieving universal health coverage and improving access to essential health-care services and medicines.

2. SDG 5: Gender Equality

   • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.

   The article emphasizes the importance of self-care interventions for sexual and reproductive health and rights (SRHR), such as self-testing for sexually transmitted infections (STIs) and self-management of medical abortion. These interventions contribute to ensuring universal access to SRHR and reproductive rights.

3. SDG 10: Reduced Inequalities

   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies, and practices and promoting appropriate legislation, policies, and action in this regard.

   The article highlights the importance of addressing socio-cultural norms, values, and gender dynamics that can create barriers to accessing and utilizing self-care interventions. By promoting self-care and addressing discriminatory practices, self-care interventions can contribute to reducing inequalities in health outcomes.

4. SDG 17: Partnerships for the Goals

   • Target 17.17: Encourage and promote effective public, public-private, and civil society partnerships, building on the experience and resourcing strategies of partnerships.

   The article emphasizes the need for multi-stakeholder partnerships to create enabling environments for the implementation of self-care interventions. These partnerships involve collaboration between governments, civil society organizations, and other stakeholders to promote self-care and improve health outcomes.

Table: SDGs, Targets, and Indicators

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Source: joghr.org

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