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BMJ Global Health (2021)
Self-care for family planning
20 Essential Resources
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Self-Care Trailblazer Group resources and series
Individual rights and choice have always been fundamental to the practice of family planning, especially the right to make and act on informed decisions about using contraception and having children. The concept of self-care has emerged as a natural fit for upholding choice within family planning. The World Health Organization (WHO) defines self-care as “the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a health-care provider.” Within family planning, self-care specifically refers to the ability of individuals, families, and communities to promote and maintain sexual health and prevent or space pregnancies, with or without the support of a health-care provider.
Products, information, and technologies for self-care can include: high-quality medicines, devices, tools to test and diagnose, and digital health interventions. This approach creates multiple benefits not only for women and girls themselves, but also potentially for health systems. When, according to the WHO, half of the world’s population do not have access to the healthcare they need, adequately supported self-care, including for family planning, will play a key role in ensuring the world can achieve universal health coverage (UHC).
As health systems grapple with the COVID-19 pandemic and other crises, the urgency of centering people as advocates for their own health, including their sexual and reproductive health, has never been greater.
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Map
Self care Trailblazer Group (2018)
Navigating Paradox in Self-Care
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WHO consolidated guideline on self-care interventions
World Health Organization (2021)
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Maintaining essential health services
World Health Organization (2020)
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KNOWLEDGE SUCCESS & PATH
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Background and considerations Normative guidance Conceptual framework
Policy advocacy Lessons learned and evidence
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Normative guidance
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Contributors
Design: Sophie Weiner
Writers: Caitlin Corneliess (PATH), Beth Balderston (PATH), Jennifer Kidwell Drake (PATH)
Technical input and review: Christine Bixiones (FHI 360), Alison Bodenheimer (FHI 360), Holly Burke (FHI 360), Katie Gray (Lwala Community Alliance), Anne Kott (Johns Hopkins Center for Communication Programs), Shanzeh Mahmood (Children’s Investment Fund Foundation), Tykia Murray (Johns Hopkins Center for Communication Programs), Manjulaa Narasimhan (World Health Organization), Sarah Onyango (PSI), Catherine Packer (FHI 360), Reana Thomas (FHI 360)
About Knowledge SUCCESS
Knowledge SUCCESS (Strengthening Use, Capacity, Collaboration, Exchange, Synthesis, and Sharing) is a five-year (2019-2024) global project led by a consortium of partners and funded by USAID’s Office of Population and Reproductive Health to support learning, and create opportunities for collaboration and knowledge exchange, within the family planning and reproductive health community. We use an intentional and systematic approach, called knowledge management, to help programs and organizations working in family planning and reproductive health collect knowledge and information, organize it, connect others to it, and make it easier for people to use.
About PATH
PATH is a global team of innovators working to accelerate health equity so all people and communities can thrive. PATH advises and partners with public institutions, businesses, grassroots groups, and investors to solve the world’s most pressing health challenges.
This collection was curated and published in October 2021. Resource links were active at the date of publication. Photos by: UNICEF/Njiokiktjien; PATH/Will Boase; WHO/Lushomo; Jahanpour for USAID Tanzania / Digital Development Communications; Pippa Ranger/Department for International Development; UNICEF Ethiopia; USAID/ StopPalu+; UNFPA Asia and the Pacific; The White Ribbon Alliance; Nsoedo O. Ndubuisi/IWHC; MCHIP/MCSP; WHO/Dorte Hopmans; ONE.org; PATH/Will Boase; PATH/Farmata SeyeI; KP STAR Project IntraHealth Namibia
Acknowledgements
This collection is made possible is made possible by the support of the American People through the United States Agency for International Development (USAID) under the Knowledge SUCCESS (Strengthening Use, Capacity, Collaboration, Exchange, Synthesis, and Sharing) Project. Knowledge SUCCESS is supported by USAID’s Bureau for Global Health, Office of Population and Reproductive Health and led by the Johns Hopkins Center for Communication Programs (CCP) in partnership with Amref Health Africa, The Busara Center for Behavioral Economics (Busara), and FHI 360. The contents of this webpage are the sole responsibility of CCP. The information provided on this webpage does not necessarily reflect the views of USAID, the United States Government, or the Johns Hopkins University.
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Background and considerations
Normative guidance
Normative guidance
Details
Global Health: Science and Practice (2020)
Contraception in the Era of COVID-19
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Details
SRH self-care in humanitarian and fragile settings
Conflict and Health (2021)
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Advocacy roadmap: Igniting a self-care movement for SRH
White Ribbon Alliance, Self-Care Trailblazer Group, PSI (2020)
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World Health Organization (2021)
WHO health topic page on self-care interventions
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Quality of Care Framework for Self-Care
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Digital Self-Care Framework
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Addressing contraceptive needs exacerbated by COVID-19
Contraception (2021)
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Sexual and Reproductive Health Matters (2020)
Self-care interventions for SRHR for advancing UHC
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Making Self-Injection Count (a workshop)
PATH-JSI DMPA-SC Access Collaborative (2021)
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Virtual training and supervision resources for contraceptive self-injection
PATH-JSI DMPA-SC Access Collaborative (2021)
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Self-Care Trailblazer Group and the Self-Care Academic Research Unit at Imperial College London (2021)
A new tool to map self-care policy and practice
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Economic and financing considerations
World Health Organization (2020)
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Ethical, legal, human rights and social accountability
World Health Organization (2018)
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Video
This article outlines how advancing integration of self-care into health systems is complex and requires recognition of multiple, simultaneous, and sometimes contradictory truths—which often present as paradoxes. Elements of self-care can be both contrary and true at the same time. For example, the "paradox of dependence" is present when a person self-injects contraception independently and is supported by quality monitoring and oversight that safely uphold her autonomy. Recognizing paradoxes in self-care is important for integrating self-care into health systems and healthcare decision-making, and ultimately, to maximize self-care’s contribution towards universal health coverage.
The authors emphasize that self-care should be integrated as a core component in health systems, not merely an add-on. This integration, in which systems recognize individuals’ and communities’ roles in coproducing health, can present obstacles stemming from the need for self-care to be both people-centered and system-centered. Among these obstacles is the wide array of ways self-care is understood that leave it open for interpretation between health systems and communities.
About BMJ Global Health
BMJ Global Health is an open access, online journal dedicated to publishing high-quality peer-reviewed content relevant to those involved in global health, including policy makers, funders, researchers, clinicians and frontline healthcare workers. BMJ Global Health adheres to the highest possible industry standards concerning publication ethics.
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This article raises considerations for program planners, as self-care requires careful calibration between opposing forces (i.e., paradoxes) and there are many ways to advance self-care in individuals’ lives and health systems. Recognizing these paradoxes is important for integrating self-care into health systems and to maximize self-care’s contribution toward universal health coverage.
Christofield M, Moon P, Allotey P., BMJ Global Health (2021)
Navigating Paradox in Self-Care
Why is it essential?
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Why is it essential?
The Self-Care Trailblazer Group (SCTG) spotlights the latest self-care events, information, and resources from the global self-care community. Resources and session recordings from the Self-Care Learning and Discovery Series and other events address family planning topics such as Self-Care Products from Innovation to Implementation, Building a community of Self-Care Champions, Self-Care and Universal Health Coverage, and more. This information is intended for anyone interested in self-care, including advocates, health providers, government representatives, implementers, community leaders, and others.
Established in 2018, the Self-Care Trailblazer Group (SCTG) was formed to support governments in institutionalizing self-care in sexual and reproductive health policy and practice. Since its inception, the SCTG has worked to increase self-care issue salience by coordinating its members and partners in evidence generation, global communications, advocacy, and shared learnings. The SCTG blog and resource library cover self-care comprehensively, including family planning and universal health coverage, advances in contraceptive technology, contraceptive supply, family planning in crisis settings, self-care methods for family planning, and more. The SCTG’s work is guided by its strategic plan that outlines its vision, goals, and objectives for 2015–2025. The Self-Care Learning and Discovery Series, hosted in 2021 by the White Ribbon Alliance on behalf of the SCTG, was an interactive virtual forum where participants exchanged ideas, experiences, and solutions on a variety of self-care topics—including family planning topics throughout the series.
About the Self-Care Trailblazer Group
The Self-Care Trailblazer Group (SCTG) is a global coalition of partners dedicated to advancing the evidence, practice, learning and policy landscape of self-care for sexual and reproductive health and rights.
Self-Care Trailblazer Group (2018)
Self-Care Trailblazer Group blog, resource library, and Learning and Discovery series
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Why is it essential?
This guidance is the established go-to resource for evidence-based self-care options for family planning. Several countries are in the process of adapting the resource to develop their own national self-care guidelines, including, but not limited to Nigeria, Senegal, and Uganda. It highlights the essential role people play in managing their own health and endorses self-care approaches in supportive health systems, particularly in settings with the fewest resources and least infrastructure.
Particularly through its online platform, the WHO normative guidance is considered a “living guideline” which will allow for continual review of new evidence and information, so that appropriate guidance can be issued in a timely manner and adopted and implemented by countries and programs. A summary of the guideline’s key facts is available, as is a series of training modules for health workers by the WHO Academy including training for pharmacists to provide over-the-counter contraceptives for self-care.
The 2021 version of WHO’s guideline on self-care interventions for health is an update of the original guideline launched in 2019 that consolidates both new and existing recommendations and is available both as a PDF and through an interactive online platform. Evidence-based self-care interventions included in the guidelines can help advance health equity worldwide—supported by high quality, rights-based programs and services. This release highlights people-centered primary health care, with emphasis on sexual and reproductive health and rights and noncommunicable diseases.
Recommendations for the provision of high-quality services for family planning include:
- Over-the-counter access to emergency contraception, without a prescription
- Pregnancy self-testing available as an additional option to health worker-led testing for pregnancy
- Self-administration of injectable contraception as an additional delivery approach to deliver injectable contraception for individuals of reproductive age
- Oral contraceptive pills available without a prescription over the counter, with advance provision of up to one year's supply
- Consistent and correct use of male and female condoms, including with compatible lubricants
- Making lubricants available for use during sexual activity
- Self-screening with ovulation predictor kits for individuals interested in becoming pregnant
The new recommendations are accompanied by a series of good-practice statements on key programmatic, operational, and service-delivery issues that must be addressed to promote and increase safe and equitable access, uptake, and use of self-care interventions; and key considerations on specific topics to guide future research and guidelines processes.
About the World Health Organization
The World Health Organization (WHO) is the United Nations agency that connects nations, partners and people to promote health, keep the world safe and serve the vulnerable – so everyone, everywhere can attain the highest level of health.
World Health Organization (2021)
WHO consolidated guideline on self-care interventions for health and well-being
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Why is it essential?
This is a comprehensive listing of WHO’s self-care resources and updates on several topics including family planning and is useful for program planning and education among ministry of health decision-makers, program implementers, and health workers, among others.
This health topic page features a comprehensive collection of WHO self-care information and resources from WHO global experts on self-care in several health areas including family planning. The page includes including the WHO self-care conceptual framework, the self-care global values and preferences survey report, communication resources on family planning and self-care, videos on self-care interventions and family planning, and more.
About The World Health Organization
The World Health Organization (WHO) is the United Nations agency that connects nations, partners and people to promote health, keep the world safe and serve the vulnerable – so everyone, everywhere can attain the highest level of health.
World Health Organization
WHO health topic page on self-care interventions
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Why is it essential?
This guidance includes practical operational strategies that program implementers can employ in order to maintain essential health services during the COVID-19 pandemic, prioritizing self-care interventions, including for family planning, along with other approaches such as digital health services, task sharing, and outreach.
Countries are facing the challenge of increased demand for care of people with COVID-19, compounded by fear, misinformation, and limitations on movement that disrupt the delivery of health care for all conditions. This publication recommends practical actions that countries can take at national, subregional, and local levels to reorganize and safely maintain access to high-quality, essential health services in the pandemic context. When facility-based provision of sexual and reproductive health (SRH) services is disrupted, WHO recommends prioritizing digital health services, self-care interventions, task sharing and outreach to ensure access to medicines, diagnostics, devices, information, and counselling. The publication includes guidance for ensuring access to contraception, such as: If a woman’s regular contraceptive method is not available, making other contraceptive options available; relaxing contraceptive prescription requirements and providing multi-month supplies; and enabling pharmacies and drugstores to increase the range of contraceptives available and allowing for multi-month prescriptions and self-administration of injectable contraceptives.
About the World Health Organization
The World Health Organization (WHO) is the United Nations agency that connects nations, partners and people to promote health, keep the world safe and serve the vulnerable – so everyone, everywhere can attain the highest level of health.
World Health Organization (2020)
Maintaining essential health services: operational guidance for the COVID-19 context
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Why is it essential?
Promoting and prioritizing quality of care in self-care is essential to achieving the health care we want for tomorrow. This resource provides standards of care, grounded in evidence, that implementers and health systems can use to design, monitor and evaluate the quality of any self-care intervention.
This Quality of Care Framework for Self-Care is aligned with the World Health Organization Consolidated Guideline on Self-Care Interventions for Health and based on the globally accepted Bruce-Jain family planning quality of care framework. It is intended to help health systems monitor and support clients accessing health care on their own or in partnership with a health worker—without hindering clients’ ability to do so. A driving question for the development of this framework was, “If someone engages in self-care—on their own time and often in a private setting—how can quality of care be ensured?”
The framework is guided by five quality domains:
- Technical Competency
- Client Safety
- Information Exchange
- Interpersonal Connection and Choice (to engage in self-care)
- Continuity of Care
While grounded in family planning, the framework is applicable to a broader range of primary health care approaches to self-care. Within these five domains, forty-one standards comprise the framework and each can be adapted for any self-care intervention.
About the Self-Care Trailblazer Group
The Self-Care Trailblazer Group (SCTG) is a global coalition of partners dedicated to advancing the evidence, practice, learning and policy landscape of self-care for sexual and reproductive health and rights.
About Population Services International
Population Services International (PSI) is a global health organization with programs targeting malaria, child survival, HIV, and reproductive health. PSI provides products, clinical services and behavior change communications for the health of people in high-need populations.
Population Services International (PSI), Self-Care Trailblazers Group (2020)
Quality of Care Framework for Self-Care
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Why is it essential?
The COVID-19 pandemic adds new urgency to expanding self-care options for family planning; this is a key overview of critical considerations.
The COVID-19 pandemic has exposed the vulnerability of global contraception provision, exacerbating barriers to access for reproductive health services and leading to suspension of clinical services and disruption of supply chains. Critical to combatting this crisis is the expansion of healthcare to include self-care approaches to de-medicalize contraception and increase individuals’ agency in determining what method they use, when they use it, and where they obtain it. This article maintains that the COVID-19 crisis has presented an opportunity to advance self-care in contraception provision as a way to avoid some of the most negative effects of the pandemic, and to sustain and increase use of contraceptive methods.
About the journal Contraception
The journal Contraception wishes to advance reproductive health through the rapid publication of the best and most interesting new scholarship regarding contraception and related fields such as abortion. The journal welcomes manuscripts from investigators working in the laboratory, clinical and social sciences, as well as public health and health professions education.
Addressing contraceptive needs exacerbated by COVID-19: A call for increasing choice and access to self-managed methods
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Why is it essential?
There has never been a more relevant time for effectively designed, implemented, and researched digital health in support of self-care. This resource offers practical guidance for family planning program implementers developing digital self-care interventions for people seeking services or information within the public or private sectors.
As health systems and people transition towards self-care to meet their health needs and shore up stressed healthcare systems, digital health services create new opportunities to increase individual agency, in turn accelerating the overall improvement of health outcomes. Recent developments in health practices that were once in the full control of healthcare professionals and can now be safely self-administered have created a shift in thinking about how individuals engage in self-care.
To support this evolution, this framework was developed to provide practical guidance for effectively designed, implemented, and researched digital health in support of self-care. This means ensuring that four key domains for quality digital self-care are considered when designing and implementing programs: user experience; data privacy and confidentiality; quality assurance; and accountability/responsibility.
A number of family planning digital interventions are highlighted in the framework, such as eCommerce platforms and a live chat feature for ordering family planning self-care commodities, and an eLearning platform to train healthcare providers learning to counsel clients on self-injectable contraceptives.
Digital health interventions are receiving increased attention during the COVID-19 pandemic, and this resource is a critical supplement to existing resources such as the High Impact Practice brief on Digital Health for Systems and the Digital Adaptation Kit for Family Planning.
About the Self-Care Trailblazer Group
The Self-Care Trailblazer Group (SCTG) is a global coalition of partners dedicated to advancing the evidence, practice, learning and policy landscape of self-care for sexual and reproductive health and rights.
About HealthEnabled
HealthEnabled is an Africa-based not-for profit that helps integrate proven life-saving digital health interventions into health systems. HealthEnabled also works with governments and implementing partners to develop and operationalize their digital health strategies.
HealthEnabled, Self-Care Trailblazer Group (2020)
Digital Self-Care: A Framework for Design, Implementation and Evaluation
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Why is it essential?
This paper raises important considerations for family planning program implementers, and aims to assist those working in crisis-affected situations to design novel service delivery strategies and technology approaches, accounting for programming, policy, and research considerations. Self-care interventions will only achieve their full potential when they are available and accessible, with quality, to all people—including the hardest to reach.
Recent crises have accelerated global interest in self-care interventions. This debate paper raises the issue of sexual and reproductive health (SRH) self-care and invites members of the global community operating in crisis-affected settings to look at potential avenues in mainstreaming SRH self-care interventions.
The paper starts with an exploration of self-care interventions that could align with well-established humanitarian standards, touches on the potential of digital health support for SRH self-care in crisis-affected settings, and discusses related policy, programmatic, and research considerations. These considerations underscore the importance of self-care as part of the care continuum and within a whole-system approach. Equally critical is the need for self-care in crisis-affected settings to complement other life-saving SRH interventions: self-care approaches do not eliminate the need for provider-led services in health facilities. The paper includes a preliminary list of SRH self-care interventions, including family planning approaches that ensure a range of long- and short-acting contraceptive methods and promote information and awareness of the availability of contraceptives.
About Conflict and Health
Conflict and Health is an open access journal documenting the public health impacts and responses related to armed conflict, humanitarian crises and forced migration. The journal provides a global platform to disseminate insightful and impactful studies. These span a broad range of public health topics including infectious disease prevention and control, nutrition, reproductive and maternal health, sexual and gender-based violence, mental health, non-communicable diseases, health systems, and ethics in conflicts and humanitarian crises.
Tran, N.T., Tappis, H., Moon, P. et al. Confl Health 15, 22 (2021)
Sexual and reproductive health self-care in humanitarian and fragile settings: where should we start?
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Why is it essential?
This short article provides concise guidance to help ensure continuity of contraception and reproductive health care to women and girls, including self-care, despite facility service interruptions during the COVID-19 pandemic.
This article emphasizes that in the face of facility service disruptions due to COVID-19, health care providers, particularly in low- and middle-income countries, should strive to maintain continuity of reproductive health care to women and girls as an essential service. When in-person encounters are limited, health care providers should adapt the way contraceptive services are provided by using telehealth approaches whenever possible for counseling, shared decision-making, and side-effect management, and should make adjustments to provision of contraceptive methods to ensure access.
About Global Health: Science and Practice
Global Health: Science and Practice (GHSP) is a no-fee, open access, peer-reviewed online journal intended to be a resource for public health professionals who design, implement, manage, evaluate, and otherwise support health programs in low- and middle-income countries. GHSP fills an important gap in the scholarly literature for evidence and experience from global health programs implemented under real-world conditions, with specifics on the “how” of implementation—lessons and detail that are often buried in gray literature or not documented at all.
Nanda K, Lebetkin E, Steiner MJ, Yacobson I, Dorflinger LJ. Global Health: Science and Practice June 2020, 8(2):166-168
Contraception in the Era of COVID-19
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Why is it essential?
Advocates can ignite a broad-based movement in support of self-care; effectively paving the way for the thoughtful and deliberate integration of self-care into health policy, program and practice change. Just as self-care is about “putting the power in people’s hands,” this tool, which is also available in French,
was developed through a consultative people-centered approach to advocacy.
This advocacy roadmap is the result of a series of in-country advocacy workshops and consultations held with Indonesia, Kenya, Malawi, Nigeria, Senegal, Tanzania, and Uganda between 2019 and 2020. Participants included representatives from ministries of health representatives, nongovernmental organizations, civil service organization, and others. It is intended to reflect the wider thinking of the growing self-care community and to serve as a blueprint for collective advocacy action. Advocacy consultations emphasized sexual, reproductive, maternal, newborn, and adolescent (SRMNA) health and rights for all people as an important and relevant starting point for expanding self-care. Self-administration of injectable contraception and over-the-counter emergency contraception pills are featured as key family planning interventions for inclusion in a comprehensive self-care package. Participants also expressed a strong desire that, by 2030, self-care will systematically and measurably contribute to Universal Health Coverage (UHC), noncommunicable diseases, mental health, and primary health care (PHC) more broadly. Short-term advocacy objectives and activities must have an eye to this future.
About the Self-Care Trailblazers Group
The Self-Care Trailblazer Group (SCTG) is a global coalition of partners dedicated to advancing the evidence, practice, learning and policy landscape of self-care for sexual and reproductive health and rights.
About White Ribbon Alliance
White Ribbon Alliance is a global grassroots movement. We believe that every person and every effort counts to advance our mission for women’s health and rights. We were born from a group of “founding mothers” who raised their voices against the unacceptable treatment of women. Today, we celebrate the brave voices of change around the globe.
About Population Services International (PSI)
Population Services International (PSI) is a global health organization with programs targeting malaria, child survival, HIV, and reproductive health. PSI provides products, clinical services and behavior change communications for the health of people in high-need populations.
White Ribbon Alliance, Self-Care Trailblazer Group, PSI (2020)
Advocacy roadmap: Igniting a self-care movement for sexual and reproductive health
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Why is it essential?
Prior to this exercise, there had been no baseline or validated method for assessing adherence and implementation of the WHO Guideline's recommendation. This resource provides valuable insights on country progress and advocacy for self-care. The SCTG is also developing an accompanying policy dashboard to articulate the self-care policy status across a range of interventions in a growing selection of countries. The dashboard will be intended for use by self-care advocates, manufacturers, implementers and policymakers to track progress of self-care policies and to use the information to inform strategy development.
The purpose of this policy and practice mapping tool is to understand the extent to which countries are implementing the 24 recommendations outlined in the 2019 WHO Consolidated Guideline on Self-Care: Sexual and Reproductive Health and Rights (SRHR) in policy and practice. The tool was first applied in Kenya, Nigeria, and Uganda between 2020 and 2021. The study found that self-care policies and practices in all three countries were relatively advanced for perinatal health and family planning; while some were more nascent, including those for self-sampling for sexually transmitted diseases. The preliminary results are available in the Self-Care Policy Mapping Deck, while full manuscripts are under development. The SCTG is working toward a policy mapping tool that may be used for replication in other countries. To explore adaptation of this tool, contact secretariat@selfcaretrailblazers.org.
About the Self-Care Trailblazer Group
The Self-Care Trailblazer Group (SCTG) is a global coalition of partners dedicated to advancing the evidence, practice, learning and policy landscape of self-care for sexual and reproductive health and rights.
About the Self-Care Academic Research Unit at Imperial College London
The Self-Care Academic Research Unit (SCARU) is the first university academic unit dedicated specifically to the study of self-care. Imperial SCARU was formally launched at the 19th Annual Self-Care Conference in London.
Self-Care Trailblazer Group and the Self-Care Academic Research Unit at Imperial College London (2021)
A new tool to map self-care policy and practice
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Why is it essential?
While focused on Australia, this practical framework to achieve integration of self-care across health systems includes important insights and strategies that could prove useful for other countries looking to develop self-care policies and practice.
This paper provides a framework for action to achieve integration of self-care across Australia’s health system, identifying outcome measures to indicate progress, and proposing three strategic priorities for self-care policy development: address structural health system issues to better enable self-care, embed self-care support for individuals across health services, and promote and support informed self-care and health behaviors for all individuals. The blueprint emphasizes that benefits associated with self-care cannot be achieved for the whole population through a singular focus on individuals’ health behaviors and lifestyle choices. Equal focus should be applied to enable and facilitate the provision of self-care support throughout the health system and broader community, including targeted approaches for individuals and groups requiring the most support.
About the Global Self-Care Federation
The Global Self-Care Federation is a federation of regional and national associations, and manufacturers and distributors of nonprescription medicines on all continents. We are a Swiss association based near Geneva, Switzerland.
Global Self-Care Federation (2020)
Self-care for health: a national policy blueprint
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Why is it essential?
This supplement features foundational literature on self-care for decision-makers, program planners, and advocates working in family planning, providing important background and evidence for interventions linked to the WHO’s consolidated self-care guidance.
This supplement focuses on self-care interventions for sexual and reproductive health and rights and includes analyses, systematic reviews, and opinion pieces, all providing an evidence base linked to the World Health Organization’s consolidated guideline and conceptual framework on self-care interventions for health. Several articles in the collection focus on family planning, including self-administration of injectable contraception, over-the-counter and pharmacy access to oral contraceptive pills without a prescription, and home-based ovulation predictor kits. Other topics include costs, benefits, and financing; humanitarian settings; and human rights and legal dimensions of self-care interventions for sexual and reproductive health.
About the United Nations Development Programme (UNDP)
As the United Nations lead agency on international development, UNDP works in 170 countries and territories to eradicate poverty and reduce inequality. We help countries to develop policies, leadership skills, partnering abilities, institutional capabilities, and to build resilience to achieve the Sustainable Development Goals. Our work is concentrated in three focus areas; sustainable development, democratic governance and peace building, and climate and disaster resilience.
About the United Nations Population Fund (UNFPA)
UNFPA is the United Nations sexual and reproductive health agency. Our mission is to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled.
About UNICEF
UNICEF works in the world’s toughest places to reach the most disadvantaged children and adolescents – and to protect the rights of every child, everywhere. Across more than 190 countries and territories, we do whatever it takes to help children survive, thrive and fulfill their potential, from early childhood through adolescence.
About the World Health Organization
The World Health Organization (WHO) is the United Nations agency that connects nations, partners and people to promote health, keep the world safe and serve the vulnerable – so everyone, everywhere can attain the highest level of health.
About the World Bank
The World Bank Group is one of the world’s largest sources of funding and knowledge for developing countries. Its five institutions share a commitment to reducing poverty, increasing shared prosperity, and promoting sustainable development.
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme - HRP (2019)
BMJ supplement: self-care interventions for SRHR
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Why is it essential?
Moving beyond the evidence for the role of self-care in health markets and health systems, this is a key resource for policymakers and program managers in thinking about how to operationalize integration of self-care options through different financing models and approaches.
Self-care interventions for health systems and users have the potential to increase choice if they are accessible and affordable, and to improve the efficiency of service delivery. This document discusses some of the evidence around efficiency, financing, and equity. Integrating self-care tools into health systems should take a societal perspective; costs, benefits and financing of self-care need to be considered to determine the equity and efficiency of self-care; self-care interventions must be supported by other health system interventions so that people who are less able to manage their own care are not excluded; and blended financing, including public subsidy, private-sector financing, and direct user payment, is needed—especially for interventions that need little support from health-care providers. Authors highlight the need to explore innovation in financing, including a total market approach across public, socially marketed, and commercial sectors, to ensure a sustainable supply of commodities and access for all population segments. The paper also addresses how several self-care approaches, including contraceptive self-injection, can have lower costs to users.
About the World Health Organization
The World Health Organization (WHO) is the United Nations agency that connects nations, partners and people to promote health, keep the world safe and serve the vulnerable – so everyone, everywhere can attain the highest level of health.
World Health Organization (2020)
Economic and financing considerations for self-care interventions for SRHR
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Why is it essential?
This report serves as a foundational overview of self-care and background on key issues related to human rights, gender equality, and social determinants of health, including important considerations for family planning program decision-makers, implementers, and advocates as they introduce self-care interventions.
This is an output of the WHO Department of Reproductive Health and Research’s expert consultation to discuss, debate, and synthesize emerging evidence on ethical, human rights, legal and social accountability considerations related to self-care interventions for SRHR. This meeting focused on exploring how self-care interventions might improve agency and autonomy among vulnerable populations, as well as factors that may inadvertently add to an individual’s burden or imply the abdication of responsibility from the health sector to provide high-quality services.
The report provides an overview of self-care interventions for sexual and reproductive health and rights (SRHR), frameworks to understand accountability of the health sector and user autonomy, and a life-course approach to SRHR. It highlights that the development of WHO normative guidance, equity in access to, and uptake of, quality health interventions that are based on human rights, gender equality and social determinants of health is essential. A particular focus on changing vulnerabilities across the life course of individuals, rather than a focus on specific vulnerable or key populations, is also considered important. In addition, for self-care interventions for health (including SRHR), it is also relevant and important to consider ethics, the law and social accountability, as well as the application of life-course and person-centered approaches.
About the World Health Organization
The World Health Organization (WHO) is the United Nations agency that connects nations, partners and people to promote health, keep the world safe and serve the vulnerable—so everyone, everywhere can attain the highest level of health.
World Health Organization (2018)
Ethical, legal, human rights and social accountability implications of self-care interventions for sexual and reproductive health
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Why is it essential?
With an abstract available in English, French, and Spanish, this survey adds to the evidence base for making self-care people-centered and feasible in the context of health systems and raises important considerations for family planning program implementers introducing self-care interventions. For example, results underscored the urgent need to reduce stigma and discrimination and increase access to and improve knowledge of self-care interventions for SRHR, including family planning, in order for countries to advance UHC and achieve global development goals.
Implementation of self-care interventions within the context of human rights, gender equality, and a life course approach offers an opportunity to advance toward universal health coverage (UHC) through health service delivery systems, the health workforce, and governance and legislation. Considering that more than 200 million women in developing countries lack access to modern contraceptives and 300,000 women die each year from cervical cancer worldwide, a rights-based introduction of just two interventions—self-injectable contraception and self-sampling kits for human papillomavirus—can have a significant impact for women and girls in low- and middle-income countries by providing them with additional choice and options to prevent or delay pregnancy and reduce morbidity and mortality from cervical cancer. Given the myriad of self-care interventions available or in the development pipeline, to date there has been insufficient research exploring perceived benefits and concerns for laypeople and healthcare providers. This paper outlines results from a cross-sectional web-based study aimed to elicit perspectives on self-care interventions for SRHR to inform World Health Organization guidelines. This online global values and preferences survey provided lay persons' and healthcare providers' perspectives on access, acceptability, and implementation considerations.
About Sexual and Reproductive Health Matters
Sexual and Reproductive Health Matters (SRHM) promotes sexual and reproductive health and rights globally through our open-access journal and advocacy.
Narasimhan M, Logie CH, Gauntley A, Ponce de Leon RG, Gholbzouri K, Siegfried N, et al. Sexual and Reproductive Health Matters. 2020;28:2.
Self-care interventions for sexual and reproductive health and rights for advancing universal health coverage
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Why is it essential?
Self-care data is often missing in routine family planning measurement and evaluation. Programs need an accurate measure of uptake of new options and self-care approaches to better understand the needs of women and adolescents, help ensure a contraceptive method mix and quality of care, and influence policy and procurement planning across development and humanitarian settings.
Data has the power to convey the lived experiences of women and adolescents, highlighting the importance and potential of expanding choices to reduce unmet need for contraception. Held in March 2021, this virtual convening prioritized the use of routine family planning data in policy and programming, spotlighting DMPA-SC self-injection to catalyze discussion, learning, and country action—not only for this contraceptive option, but for broader family planning and self-care initiatives. Session topics included using routine data from health management information systems in policy and programming, integrating self-care methods into national health information systems, total market approach and the private sector, and running effective data use meetings, and more.
About the DMPA-SC Access Collaborative
Led by PATH and John Snow, Inc., the DMPA-SC Access Collaborative provides data-driven technical assistance, coordination, resources, and tools to ensure that women have increased access to DMPA-SC self-injection as part of an expanded range of contraceptive methods, delivered through informed choice programming.
PATH-JSI DMPA-SC Access Collaborative (2021)
Making Self-Injection Count: A workshop on family planning data availability and use
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Why is it essential?
Rolling out self-care options, including for family planning, within countries is the next frontier for progress in leveraging this approach to advance toward UHC. This paper articulates key insights that can help other countries considering self-care guideline development, including recommendations for institutionalizing self-care into policy and health systems.
Several ministries of health have expressed interest and commitment to scaling up self-care in light of the COVID-19 pandemic and in response to the World Health Organization’s guideline on self-care interventions for health. This case study summarizes how the Federal Ministry of Health in Nigeria and the Ministry of Health in Uganda pioneered national guidelines for self-care in 2020—among the first national self-care guidelines in the world—as the first step toward adopting self-care as an approach to achieve universal health coverage. Self-care interventions for family planning were integral to both countries' guidelines, which includes methods such as contraceptive self-injection, over-the-counter oral contraceptive pills, ovulation predictor kits, and condoms.
About the Self-Care Trailblazer Group
The Self-Care Trailblazer Group (SCTG) is a global coalition of partners dedicated to advancing the evidence, practice, learning and policy landscape of self-care for sexual and reproductive health and rights.
About PSI Delivering Innovation in Self-Care (DISC) project
Driven by deep consumer insights, DISC supports women to take more control over their sexual and reproductive health. By doing so, women become active participants in their health systems and critical new partners for health providers. In Nigeria and Uganda, we work in close partnership with women and their providers, increasing informed demand as well as local innovation and capacity for self-care as a cornerstone of sexual and reproductive health care, starting with self-injectable contraceptives.
Self-Care Trailblazer Group and PSI Delivering Innovation in Self-Care (DISC) project (2021)
Developing national self-care guidelines in Uganda and Nigeria: Supporting achievement of universal health coverage in partnership with empowered consumers
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Why is it essential?
These are practical tools to support health workers and clients in successful contraceptive self-injection and could be used as a model for other family planning self-care interventions.
Quality training and supervision of both health workers and clients is key to successful self-care). In its self-care guidance, the World Health Organization emphasizes that “health workers should receive appropriate recurrent education to ensure that they have the competencies, underpinned by the required knowledge, skills and attitudes, to provide self-care interventions based on the right to health, confidentiality and non-discrimination.” Once community health workers, midwives, and other health care providers are trained, are better equipped to counsel clients on their self-care. Particularly during the COVID-19 pandemic, more programs worldwide have renewed interest in virtual training and support approaches to keep family planning self-care initiatives moving forward, even among health workers in remote settings and with limited technological capacities. PATH has developed a DMPA-SC eLearning course and videos to train health workers and clients, as well as remote and in-person supportive supervision tools for use in health facilities that offer family planning services. While these resources are focused primarily on contraceptive self-injection, they offer a model that could be utilized for other self-care approaches.
About the DMPA-SC Access Collaborative
Led by PATH and John Snow, Inc., the DMPA-SC Access Collaborative provides data-driven technical assistance, coordination, resources, and tools to ensure that women have increased access to DMPA-SC self-injection as part of an expanded range of contraceptive methods, delivered through informed choice programming.
PATH-JSI DMPA-SC Access Collaborative (2021)
Virtual training and supervision resources for
contraceptive self-injection
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Why is it essential?
Resources are grouped into five categories:
Background and considerations
Conceptual framework
Population Services International (PSI), Self-Care Trailblazers Group (2020)
Conceptual framework
HealthEnabled, Self-Care Trailblazer Group (2020)
Policy advocacy
Haddad et al. Volume 103, Issue 6, June 2021, Pages 377–379. Contraception.
Policy advocacy
Policy advocacy
Policy advocacy
Policy advocacy
Policy advocacy
Policy advocacy
Lessons learned and evidence
Lessons learned and evidence
Lessons learned and evidence
Lessons learned and evidence
Background and Considerations
Normative guidance
Conceptual framework
Policy advocacy
Lessons learned and evidence
Guttmacher Institute (2020)
BMJ supplement: self-care interventions for SRHR
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme - HRP (2019)
Policy advocacy
Self-care for health: a national policy blueprint
Global Self-Care Federation (2020)
Self-Care Trailblazer Group and PSI Delivering Innovation in Self-Care (DISC) project (2021)
Developing national self-care guidelines in Uganda and Nigeria
Policy advocacy
Several ministries of health have expressed interest and commitment to scaling up self-care in light of the COVID-19 pandemic and in response to the World Health Organization’s guideline on self-care interventions for health. This case study summarizes how the Federal Ministry of Health in Nigeria and the Ministry of Health in Uganda pioneered national guidelines for self-care in 2020—among the first national self-care guidelines in the world—as the first step toward adopting self-care as an approach to achieve universal health coverage. Self-care interventions for family planning were integral to both countries' guidelines, which includes methods such as contraceptive self-injection, over-the-counter oral contraceptive pills, ovulation predictor kits, and condoms.
About the Self-Care Trailblazer Group
The Self-Care Trailblazer Group (SCTG) is a global coalition of partners dedicated to advancing the evidence, practice, learning and policy landscape of self-care for sexual and reproductive health and rights.
About PSI Delivering Innovation in Self-Care (DISC) project
Driven by deep consumer insights, DISC supports women to take more control over their sexual and reproductive health. By doing so, women become active participants in their health systems and critical new partners for health providers. In Nigeria and Uganda, we work in close partnership with women and their providers, increasing informed demand as well as local innovation and capacity for self-care as a cornerstone of sexual and reproductive health care, starting with self-injectable contraceptives.
Self-Care Trailblazer Group and PSI Delivering Innovation in Self-Care (DISC) project (2021)
Developing national self-care guidelines in Uganda and Nigeria: Supporting achievement of universal health coverage in partnership with empowered consumers
Rolling out self-care options, including for family planning, within countries is the next frontier for progress in leveraging this approach to advance toward UHC. This paper articulates key insights that can help other countries considering self-care guideline development, including recommendations for institutionalizing self-care into policy and health systems.
Self-Care Trailblazer Group (2018)