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Worldwide Self-Care Trends and Future in West Africa

Self-care for sexual and reproductive health has advanced significantly in the last two years, following the publication of the World Health Organization’s (WHO) self-care guidelines in 2018, recently updated in 2022. According to Senior Technical Advisor for Self-Care Sarah Onyango, remarkable progress has been made at national levels, with several countries developing and adopting national self-care guidelines.

Self-care is also more prominent in global platforms, including the UN General Assembly, and the World Health Assembly, and there are several global commitments, including FP2030, that embrace self-care as an essential part of achieving universal healthcare. In addition, Ms. Onyango believes that we are seeing increased awareness and engagement around self-care. “We are seeing this trend at conferences and other forums where self-care is featured prominently in healthcare discussions.” This trend also applies to West Africa.

The Self-Care Trailblazers Group works closely with the Ministries of Health in Senegal and Nigeria, and with local non-governmental organizations to advance self-care. Other countries in the region, including Burkina Faso, are also working on self-care and have developed national self-care guidelines. Niger has expressed a strong commitment and is one of the countries leading discussions to ensure that self-care is included in next year’s World Health Assembly.

Overall, there is a positive reaction, enthusiasm, and interest in improving self-care for sexual and reproductive health.

Meet Sarah Onyango

Aïssatou: Can you introduce yourself?

Sarah: My name is Sarah Onyango. I’m a Senior Technical Advisor for Self-Care at Population Services International (PSI). I am also the Project Director for the Self-Care Trailblazers Group (SCTG), a global coalition that brings together individuals and organizations to advocate for self-care globally.

Meeting in Senegal on self-care
Sarah meets with the Knowledge SUCCESS and PATH teams in Senegal.

Understanding Self-Care in Sexual and Reproductive Health

Aïssatou: What does self-care mean in the context of sexual and reproductive health?

Sarah: I think one of the points I would like to mention, and we know about it a lot, is that self-care has been in existence for a very long time. Self-care is something that we have practiced for generations. What happened in 2018 was that WHO developed guidelines to help improve access to sexual and reproductive health and rights through self-care.

What does this mean? We see this as offering opportunities and empowering individuals, especially women and girls, to make decisions around their own reproductive health. We see self-care as addressing issues of inequity. Through self-care, we are able to reach those who would normally not be reached by traditional health care, including young people who prefer not to use the traditional health facilities, poor people, and other marginalized people. For people living in humanitarian circumstances, this could be the critical access to care.

In summary, self-care has the potential to increase access to health care, through empowering individuals to manage their own health, and contribute to achieving universal health coverage.

Tracking Progress in Self-Care Initiatives

Aïssatou: You talked about progress that countries are making at different levels, both in francophone and anglophone countries in West Africa and East Africa. How are you tracking the data?

Sarah: The SCTG prioritizes the importance of accurately measuring self-care services. Through its Evidence and Learning Working Group (ELWG), the SCTG has established a work stream that is specifically working on measurement of self-care. The work stream has developed key indicators that countries can use or adopt to measure self-care at the country level. These indicators are specific to different interventions, to HIV self testing, to Subcutaneous DMPA (DMPA-SC), and to self-managed abortion where it is legally allowed. The SCTG is working with focus countries to adopt these indicators and institutionalize them as part of their national health management information systems. We are supporting Nigeria to adopt several of these indicators and incorporate them in their system.

Many other countries are implementing different self-care initiatives, which are monitored at the country level. At the global level, the SCTG has developed a country monitoring dashboard to monitor the impact of self-care on health care. The dashboard tracks five areas of performance in countries – laws and policies, regulatory environment, service delivery, community practices, and political commitment. With these indicators, we are able to see the state of readiness in a country to expand and to scale up self-care, use the information for advocacy, and mobilize the resources that are needed to move self-care to the next level.

Challenges in Implementing Self-Care and SRHR

Aïssatou: Can we talk about the challenges of self-care and sexual and reproductive health and rights (SRHR)?

Sarah: One of our major challenges is with health providers—they are our critical stakeholders, but they can also be a challenge to self-care services because they see self-care as undermining their role, and quality of care/services. The other challenge is with private sector providers— who fear losing their business or resources if individuals are able to provide care for themselves. We work closely with health providers and the private providers, through professional health associations and other platforms to create awareness of the benefits of self-care, and build support for self-care.

Another challenge we see is with regards to commodities and commodity security. Although governments and ministries are very supportive of self-care, we are still seeing gaps in availability of commodities and the quality of products. Sometimes individual clients are not able to take home adequate doses of the products they need for self-care.

There is also some opposition to self-care, which is likely linked to the opposition to SRHR more broadly, and the notion that if we empower women, they will abuse the system.

And finally, financing self-care is a major challenge. Although several countries have adopted the WHO guidelines for self-care, many governments/ministries of health have not yet set aside specific funding for self-care. We have recently done work on what it costs to provide self-care and will be working with our partners to see how we can advocate for greater funding and support for self-care.

Future Opportunities for Self-Care in West Africa

Aïssatou: What opportunities are there regarding self-care in the coming years? And since you are now in Senegal, let’s talk about the coming years for West Africa and the Ouagadougou Partnership (OP) region.

Sarah: As for the opportunities for West Africa and the OP region, we are at that stage where we’ve got the tools, we’ve got a very conducive policy environment. I think in the next years, two years, three years, four years, we should be able to scale up self-care so that it’s accessible universally within countries and within sub-countries.

So, I think in the Western Africa region, this is an opportunity to scale up self-care. I was recently on a field visit and was amazed at how women have taken up DMPA-SC. They are ready to inject themselves. They like the independence, they like the freedom.

These self-care interventions are really expanding in reach, and we are seeing that as exponential. So, I think in West Africa, across the continent, this is a chance for us to increase the success of SRHR services through these self-care initiatives.

Aissatou: Is there anything else you would like to add before we wrap up?

Sarah: I’d just like to thank you and the team here. We work closely with PATH Senegal as our national self-care network lead in Senegal, bringing together the Pioneers Group and we are amazed at the work that they are doing to build support for self-care at all levels, under the leadership of the ministry of health.

We are really supportive of this work and look forward to institutionalizing the guidance into practice in the country, and mobilizing resources for that. And I think the environment is good for us to do that.

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Dr. Sarah Onyango

Dr Sarah Onyango is the Senior Technical Advisor, Self-Care at Population Services International (PSI) and provides guidance and leadership for PSI’s technical, research and programmatic self-care portfolio. She is also the Project Lead & Secretariat Director of the Self-Care Trailblazer Group (SCTG) - a coalition of more than 900 individuals and 300+ organizations dedicated to advancing the practice of self-care to achieve universal health coverage. She also co-leads SCTG’s Evidence and Learning Working Group (ELWG). Sarah is a health professional with significant expertise in sexual and reproductive health and rights and has led international SRHR organizations and programs at the country, regional and global levels with industry leaders such as Ipas, Planned Parenthood Global, USAID, and IPPF. She also worked with the Ministry of Health in Kenya and has served as a representative at WHO, UNFPA, FIGO, the IBP Consortium, and other international fora. She is a medical doctor and holds a Master’s in Public Health and an MA in Health Research.

Aïssatou Thioye

West Africa Knowledge Management and Partnerships Officer, Knowledge SUCCESS, FHI 360

Aïssatou Thioye est dans la division de l'utilisation de la recherche, au sein du GHPN de FHI360 et travaille pour le projet Knowledge SUCCESS en tant que Responsable de la Gestion des Connaissances et du Partenariat pour l’Afrique de l’Ouest. Dans son rôle, elle appuie le renforcement de la gestion des connaissances dans la région, l’établissement des priorités et la conception de stratégies de gestion des connaissances aux groupes de travail techniques et partenaires de la PF/SR en Afrique de l’Ouest. Elle assure également la liaison avec les partenaires et les réseaux régionaux. Par rapport à son expérience, Aïssatou a travaillé pendant plus de 10 ans comme journaliste presse, rédactrice-consultante pendant deux ans, avant de rejoindre JSI où elle a travaillé dans deux projets d’Agriculture et de Nutrition, successivement comme mass-media officer puis spécialiste de la Gestion des Connaissances.******Aïssatou Thioye is in the Research Utilization Division of the GHPN of FHI 360 and works for the Knowledge SUCCESS project as the Knowledge Management and Partnership Officer for West Africa. In her role, she supports the strengthening of knowledge management in the region, setting priorities and designing knowledge management strategies at the FP/RH technical and partner working groups in West Africa. She also liaises with regional partners and networks. In relation to her experience, Aïssatou worked for more than 10 years as a press journalist, then as an editor-consultant for two years, before joining JSI where she worked on two Agriculture and Nutrition projects, successively as a mass-media officer and then as a Knowledge Management specialist.