Andika ili kutafuta

Q&A Wakati wa Kusoma: 7 dakika

Kuendeleza Kujitunza nchini Uganda

Helping individuals take care of their sexual and reproductive health

Mifumo ya huduma za afya kote ulimwenguni imekuwa ikiegemezwa kwa mtindo wa mtoaji-kwa-mteja. Hata hivyo, kuanzishwa kwa teknolojia mpya na bidhaa, na kuongezeka kwa urahisi wa kupata habari, has caused a shift in how health services can be delivered—placing clients at the center of health care. Various health areas, including sexual and reproductive health and rights (SRHR), have embraced self-care interventions. These methods increase access to and use of essential health services. This is especially important as health care systems become increasingly overburdened, coupled with the urgency to respond to individuals’ and communities’ SRHR needs across all life stages.

This question-and-answer piece highlights the progress and benefits of advancing self-care for SRHR in Uganda, through the lens of the Self-Care Expert Group (SCEG), a technical working group in Uganda.

What is self-care in the context of health care, specifically SRHR? Is this a new and different concept from what individuals know and have practiced over the years?

Dk. Dinah Nakiganda, assistant commissioner for adolescent and school health at the Ministry of Health/co-chair, Self-Care Expert Group (SCEG) nchini Uganda: Self-care in the form of individual self-awareness, kujipima, and self-management of health care is not new to Uganda; it is an age-old practice where people provide themselves with information, bidhaa, or services to maintain, preserve, and promote their health and well-being.

Over the years, new products, habari, teknolojia, and other interventions have given self-care a different application, with health areas, including SRHR, taking on the concept and practice. Kwa mfano, women could self-test for pregnancy and utilize self-injectable contraceptives, and individuals could self-test for HIV even before the global self-care guidelines were put in place.

How has COVID-19 changed the overall perceptions of self-care, especially as health systems are stretched and lockdowns limit access to traditional services?

Dk. Lillian Sekabembe, deputy country representative of Population Services International, Uganda: The one benefit Uganda and other countries are having now is that the COVID-19 pandemic is forcing individuals to either resurrect, kubuni, adapt, or immediately utilize solutions with the potential to relieve the burden on the already overwhelmed and under-resourced health care system. As such, self-care interventions and their use have been amplified by the effects of the COVID-19 pandemic.

The pandemic has availed the opportunity to appreciate the value of self-care as it has elevated and brought greater control among stakeholders. The value of self-care to improve access to and health care coverage, while reducing dependency on facility-based services and the overburdened health workforce, has been so pronounced during the pandemic and associated lockdown. More so, COVID-19 has revealed unique opportunities to advance self-care, making it more consistently available, safe, ufanisi, nafuu, and convenient to those who need it.

A woman self-injects the contraceptive, subcutaneous DMPA in her leg. Courtesy of PATH/Gabe Bienczycki

Katika 2019, the WHO launched the Consolidated Guidelines for Self-Care Interventions for SRHR. Just recently, mwezi wa sita 2021, the WHO released revised version 2.1 of the guidelines. How is Uganda leveraging this global framework to advance self-care at the national level?

Dk. Dinah Nakiganda: The launch of the Consolidated Guideline for Self-Care Interventions for Health in June 2019 increased momentum for self-care globally. For Uganda, the introduction of the guideline kick-started the process of structuring self-care and introducing it within the existing health care system. The onset of COVID-19 added urgency to self-care approaches to take pressure off the health care system and facilities to improve access to essential SRHR services.

Uganda adopted a two-pronged approach for developing the self-care guideline. Kwanza, the guideline document development itself, and second, the integration of the guideline into the existing health system, also referred to as the implementation of the guideline. The first stage of this process was successfully completed, and the SCEG is in the process of test implementing the draft guideline. The purpose of implementing the guideline is to optimize opportunities for self-care uptake within the existing health care system. The lessons learned can then be applied to finalize and launch the National Guideline for Self-Care Interventions for SRHR. Six task-force teams, namely Quality of Care (QoC), Social Behavioral Chance (SBC), Finance, Human Resources, Medicines and Supplies, and Monitoring Evaluation Adaptation & Learning (MEA&L), have been formulated to facilitate seamless integration of self-care within the existing health system.

What are some of the self-care interventions for SRHR that have been proposed/focused on for scale-up in Uganda? Which of these interventions already have stakeholder and/or public support?

Dk. Moses Muwonge, executive director of SAMASHA Medical Foundation: While the WHO Consolidated Guideline for Self-Care Interventions for Health published in June 2019 enlists five key recommendations with various self-care interventions to be considered for scale-up, the National Guideline for Self-Care Interventions for SRHR [nchini Uganda] highlights four of these recommendations and respective interventions, which include: Antenatal Care, Uzazi wa Mpango, Post-Abortion Care, and STIs. Stakeholders in Uganda are prioritizing the contextualization of guidance for self-care interventions for the SRHR health area as a blueprint for other health areas.

Considering the practice of self-care is with or without the support of a health provider, how can some of the critical components of health care such as quality of care, proper and effective use, continuity of care, be ensured?

Dk. Moses Muwonge: For self-care to thrive, there must be an enabling environment, quality products, and interventions available outside of formal health systems. Ensuring quality in self-care is critical, thus the WHO conceptual framework facilitates thinking around the complexities of promoting quality self-care. The quality-of-care framework for self-care, which is hinged on five pillars namely, technical competence, client safety, information exchange, inter-person connection and choice, and continuity of care, was integrated within the National Self-Care Guideline for Self-Care Interventions for SRHR [for Uganda].

Professor Fredrick Edward Makumbi, deputy dean at the Makerere School of Public Health (MaKSPH): There are some essential practical strategies for ensuring quality self-care, kama vile:

  • Training providers in counseling clients on the proper use of commodities.
  • Counseling clients who are initiating family planning methods on side effects.
  • Providing information on opportunities for method change.
  • Proper product storage as well as waste disposal and management.

Social components, kama partner involvement in self-care, remain key and must be promoted, as this may enable the implementation of safe practices including proper storage for effective use of self-care products.

Community health worker | Community health worker during a home visit, providing family planning services and options to women in the community. This proactive program is supported by Reproductive Health Uganda | Credit: Jonathan Torgovnik/Getty Images/Images of Empowerment
Community health worker during a home visit, providing family planning services and options to women in the community. This proactive program is supported by Reproductive Health Uganda. Mikopo: Jonathan Torgovnik/Getty Picha/Picha za Uwezeshaji

How can the health system attain data on self-care (e.g. uptake, mitazamo, and attitudes, na kadhalika.)? How can self-care be measured?

Professor Fredrick Makumbi: Data on self-care can be attained through village health teams, which should be trained to ensure that data is collected correctly. Other sources for self-care data may include drug shops, which should similarly be trained, empowered, and supported to generate such data; local and national level surveys; and monitoring of the HMIS on family planning services.

What are some of the benefits (to individuals and health systems) of advancing self-care for SRHR?

Dk. Olive Sentumbwe, the Family Health and Population Officer at the World Health Organization (WHO) Country Office in Uganda: Self-care interventions offer a strategy to reach people with quality health care services and information. They enable individuals to access and utilize SRHR information and services without discrimination or experiencing stigma. Zaidi ya hayo, self-care increases confidentiality, eliminates barriers to access, improves individuals’ autonomy, and enables them to make decisions regarding their own health without feeling pressured, especially among vulnerable populations like the young people. For some individuals, self-care is acceptable as it preserves their privacy and confidentiality and removes bias and stigma which may result from providers during times of client-provider interaction. In the long run, once the individual beneficiary learns where to get the product and how to use it effectively, it becomes cheaper and under the control of the user. Self-care will bring improved mental well-being and increase agency and autonomy particularly for the vulnerable groups. Research suggests that self-care promotes positive health outcomes, such as fostering resilience, living longer, and becoming better equipped to manage stress.

Self-care eases the stretch on the health system and enhances efficiencies in handling critical health issues. Kwa mfano, the management of the COVID-19 pandemic resulted in the reassignment of a significant portion of health providers to COVID-19 case management, hence reducing the bandwidth of skilled human resource available to respond to the non-COVID-19-related health needs of individuals. Self-care increases coverage of some services to the public, hata hivyo, when self-care is not a positive choice but born out of fear or because there is no alternative, it can increase vulnerabilities and lead to poor health outcomes.

How can self-care for SRHR facilitate the advancement of the gender equality and equity agenda in Uganda and enable women to exercise their health rights?

Bi. Fatia Kiyange, deputy executive director at Center for Health Human Rights and Development: Self-care interventions for SRHR unleash power into the hands of women and girls. This allows them to take care of their own health, giving them choice and autonomy.

Women and girls grapple with a range of SRHR-related issues, ranging from the inability to access and utilize modern methods of contraception to preventing sexually transmitted infections and reproductive-health cancers.

As such, self-care becomes a reliable and effective approach for responding to the SRHR needs of women and girls in the most affordable, confidential, and effective manner while maintaining quality of care.

What challenges/lessons/best practices have you observed in the process of advancing self-care interventions at the national level, using DMPA-SC as an example?

Bi. Fiona Walugembe, project director at Advancing Contraceptives Options, PATH Uganda: Disposal of used injectables, integration of data on self-care into the Health Management Information System (HMIS), inadequate time for health providers to effectively train users in self-injection, stakeholder buy-in for self-care and lengthy policy approval processes were the most outstanding challenges encountered as we scaled up the DMPA-SC in Uganda.

Dk. Lillian Sekabembe: Potential product stock-out due to interruptions in the supply chain and the health system’s readiness to entrust individuals with information and products have been key challenges that affect advancing self-care.

Bi. Fiona Walugembe: Whereas self-care has been in existence, its use in the SRHR realm is relatively new. Stakeholders need to think creatively, use evidence, and collaborate with experts as well as influential leaders in championing the concept. Best practices, such as the use of human-centered design approaches for program design, establishing monitoring and evaluation frameworks as well as leveraging existing health systems are critical.

What can be done to ensure that self-care does not become “a poor man’s” solution to the problems of the health system?

Dk. Moses Muwonge: Self-care for SRHR will be implemented in the public sector where free services are [already] provided. This will include community health workers who will reach out to vulnerable communities and build their self-care awareness. While on the other hand, the expectation is that those who can afford it will access products for self-care from the private sector, where individuals buy commodities and services they need.

What’s the vision for success for self-care in Uganda?

Dk. Dinah Nakiganda: At the start of the process, stakeholders struggled with developing a vision for structuring self-care in Uganda. Hata hivyo, through the SCEG, stakeholders hope to see an increase in awareness of the self-care concept, community acceptance of self-care, and integration of self-care interventions with respect to governance in order to strengthen health systems and achieve universal health care coverage.

Mhudumu wa afya ya jamii | Mhudumu wa afya ya jamii Agnes Apid (L) akiwa na Betty Akello (R) na Caroline Akunu (kituo). Agnes anawapa wanawake hao habari za ushauri na upangaji uzazi | Jonathan Torgovnik/Getty Picha/Picha za Uwezeshaji
Precious Mutoru, MPH

Advocacy & Partnerships Coordinator, Huduma za Kimataifa za Idadi ya Watu

Precious ni mtaalamu wa afya ya umma na mtetezi dhabiti wa afya na ustawi wa jamii kote ulimwenguni., kwa maslahi makubwa katika afya ya ngono na uzazi na usawa wa kijinsia. Na uzoefu wa karibu miaka mitano katika uzazi, afya ya uzazi na vijana, Precious ana shauku kubwa ya kubuni masuluhisho yanayowezekana na endelevu kwa masuala mbalimbali ya afya ya uzazi na kijamii yanayoathiri jamii nchini Uganda., kupitia miundo ya programu, mawasiliano ya kimkakati na utetezi wa sera. Kwa sasa, anahudumu kama mratibu wa utetezi na ushirikiano katika shirika la People Services International - Uganda, ambapo anashirikiana na washirika katika bodi kutekeleza malengo yatakayokuza ajenda ya uzazi wa mpango na afya ya uzazi kwa upana nchini Uganda.. Precious anajiunga na shule ya mawazo ambayo inasisitiza kwamba kuboresha afya na ustawi wa watu nchini Uganda na duniani kote.. Zaidi ya hayo, yeye ni mhitimu wa Global Health Corps, bingwa wa kujitunza kwa afya ya ngono na uzazi na usimamizi wa maarifa nchini Uganda. Ana MSc. katika Afya ya Umma kutoka Chuo Kikuu cha Newcastle - Uingereza.

Alex Omari

Afisa wa KM wa Afrika Mashariki, Maarifa MAFANIKIO, Amref Afya Afrika

Alex ni Afisa wa Kiufundi wa Upangaji Uzazi/Afya ya Uzazi katika Taasisi ya Amref Health Africa ya Ukuzaji Uwezo.. Anafanya kazi kama Afisa wa Usimamizi wa Maarifa wa Mkoa (Afrika Mashariki) kwa mradi wa Maarifa SUCCESS. Alex amekwisha 8 uzoefu wa miaka katika vijana na vijana afya ya ngono na uzazi (AYSRH) muundo wa programu, utekelezaji, utafiti, na utetezi. Kwa sasa ni mshiriki wa Kikundi cha Kufanya Kazi cha Kiufundi cha mpango wa AYSRH katika Wizara ya Afya nchini Kenya. Alex ni mshiriki aliyechaguliwa wa Jumuiya ya Kifalme ya Afya ya Umma (FRSPH) na aliyekuwa Mratibu wa Nchi wa Kenya kwa Muungano wa Kimataifa wa Vijana wa Upangaji Uzazi (IYAFP). Ana Shahada ya Kwanza ya Sayansi (Afya ya Watu) na Mwalimu wa Afya ya Umma (Afya ya Uzazi) kutoka Chuo Kikuu cha Kenyatta, Kenya. Kwa sasa anasomea shahada yake ya pili ya Uzamili katika Sera ya Umma katika Shule ya Serikali na Sera ya Umma (SGPP) huko Indonesia ambapo pia ni msomi wa uandishi wa sera za afya na afya ya umma na mchangiaji wa tovuti kwa Jarida la Mapitio ya Kimkakati.

Sarah Kosgei

Meneja wa Mitandao na Ubia, Amref Afya Afrika

Sarah ni Meneja Mitandao na Ubia katika Taasisi ya Ukuzaji Uwezo. Amemaliza 10 uzoefu wa miaka mingi wa kutoa uongozi kwa programu za nchi nyingi zinazolenga kuimarisha uwezo wa mfumo wa afya kwa afya endelevu katika Mashariki., Kati, na Kusini mwa Afrika. Yeye pia ni sehemu ya sekretarieti ya Women in Global Health - Africa Hub inayomilikiwa na Amref Health Africa, Sura ya Kikanda ambayo hutoa jukwaa la majadiliano na nafasi ya ushirikiano kwa uongozi wa mabadiliko ya kijinsia ndani ya Afrika. Sarah pia ni mwanachama wa Huduma ya Afya kwa Wote (UHC) Rasilimali Watu kwa Afya (HRH) kamati ndogo nchini Kenya. Ana digrii katika Afya ya Umma na Shahada ya Uzamili katika Utawala wa Biashara (Afya Ulimwenguni, Uongozi na Usimamizi). Sarah ni mtetezi mwenye shauku wa huduma ya afya ya msingi na usawa wa kijinsia katika Afrika Kusini mwa Jangwa la Sahara.

28.2K maoni
Shiriki kupitia
Nakili kiungo