How Was the Framework Developed?
In 2018-19, the Support for International Family Planning and Health Organizations (SIFPO) 2: Sustainable Networks project, funded by the U.S. Agency for International Development (USAID), was supporting several self-care interventions, including contraceptive self-injection and HPV self-sampling. Recognizing the gap in linking quality of care for these interventions to each other and to health systems, staff began to work with the Self-Care Trailblazers Group to organize quality of care in self-care more broadly.
A driving question for this group was, “If someone engages in self-care—on their own time and often in a private setting—how can quality of care be ensured?” Any health system has at a minimum a standard of duty to ensure quality, but what happens when the health action takes place outside the confines of a facility, or sometimes outside of any health care interaction at all? How should the health system monitor and support the care a client is accessing on their own while ensuring its approach does not inadvertently hinder a person’s ability to manage their own care? Meanwhile, what quality of care approaches already exist into which the needs of self-care can be woven?
With these questions in mind, the globally accepted Bruce-Jain Quality of Care Framework’s domains were reviewed, proposed, and adapted as core components for monitoring the quality of care in any self-care intervention, and not limited to family planning. While quality of care has been monitored in family planning service delivery under these domains since the Bruce-Jain framework was published in 1990, the Quality of Care Framework for Self-care goes beyond evaluating provider and facility quality of care and moves the focus to elements critical for quality of care specific to self-care: health care clients, digital technologies and platforms, regulated quality products and interventions, the trained health workforce, and health sector accountability.
These elements were selected from the WHO Conceptual Framework for Self-Care Interventions. While all elements in the WHO framework are critical for the ecosystem that enables self-care—for example, psychosocial support and economic empowerment—the selected elements for this quality of care framework are specifically valuable for monitoring and supporting quality when clients are engaging with self-care on their own, or in partnership with a health care provider.