Why Africa's health sector needs to embrace self-care

In recent years, an increasing number of development practitioners have proposed that self-care is a cost-effective solution to various health challenges.

The WHO’s Self-Care for Health initiative promotes self-care as a key component of health systems, especially for managing non-communicable diseases. On the margins of the Seventy-Sixth World Health Assembly in Geneva, Switzerland, the Business Council for International Understanding and the Global Self-Care Federation convened a round-table on self-care on May 28, 2024.

The World Health Organisation (WHO) defines self-care as activities by individuals, families, and communities to promote health, prevent disease, maintain well-being, and cope with illness and disability.

Self-care includes making healthy lifestyle choices such as a balanced diet and regular exercise, avoiding unhealthy habits such as smoking, adhering to prescribed medication regimens, recognising symptoms of common illnesses and seeking timely medical advice managing minor ailments, and self-monitoring using medical devices suitable for home use like those for checking blood glucose levels and blood pressure.

Why is self-care important? People with higher health literacy tend to enjoy better health. Such individuals make better decisions about preventing diseases, treating minor illnesses, managing chronic conditions, and knowing when to see a doctor.

They have more constructive conversations with healthcare providers and need fewer hospitalisations. By embracing self-care, individuals can practice preventive measures like hand washing, undertake disease screenings, reduce complications, and improve overall health outcomes without relying solely on healthcare professionals.

African countries stand to benefit from incorporating self-care practices into national primary healthcare strategies. The continent needs to embrace self-care to enhance the efficiency and sustainability of health systems amidst diverse and growing populations, increasing life expectancy, rising chronic diseases, constrained fiscal spaces, and climate change threats.

When applied at scale, self-care can significantly contribute to advancing universal health coverage and achieving the 2030 Sustainable Development Goal on health. A 2018 Diabetes Care study found that improved self-care among diabetes patients could reduce healthcare costs by up to $4,000 per person per year due to fewer hospital admissions and complications. Additionally, a 2020 WHO study estimated that improving self-care could reduce healthcare costs by up to $1.2 trillion globally by 2030.

According to the Global Self-Care Federation, embracing self-care in Africa can also lead to substantial economic benefits because healthier individuals contribute more effectively to the economy. The WHO estimated that a 10 per cent reduction in mortality from heart disease and stroke could reduce economic losses by $25 billion per year in low-and middle-income countries.

To move the conversation on health care forward, a good beginning point is for stakeholders to engage in reviewing the self-care index to draw insights to guide action. The Self-Care Readiness Index 2.0 is a tool developed by The Global Self-Care Federation and supported by the WHO to examine the key enablers of self-care for improving healthcare systems.

The index covers countries from WHO regions and focuses on four enablers, namely stakeholder support, consumer capacity, health policies, and regulatory environments. The index aims to inspire new approaches to self-care and healthcare system improvement.

Consider the case of Kenya. In 2022, the country had an overall self-care readiness score of 2.4 on a scale of 1 to 4 (where 1 means not self-care ready and 4 means exceptionally self-care ready). It scored 2.2 on stakeholder support, 2.3 on consumer capacity, 2.4 on self-care policy, and 2.5 on the regulatory environment.

For a country like Kenya, opportunities for advancing self-care based on this index include the following:

First, Kenya has high stakeholder support for self-care among healthcare providers but lower levels among the general public and policymakers. Therefore, the country needs to include self-care in primary healthcare guidelines and enhance self-care instructions in disease-specific guidelines for conditions like diabetes and high blood pressure. Collaborative approaches involving healthcare providers and patients in the development of care plans can contribute to strengthening stakeholder support.

Secondly, to improve consumer capacity, Kenya can leverage the widespread use of mobile phones and local radio and deploy over 100,000 community health promoters and thousands of community groups to educate citizens on self-care, including disease management, lifestyle changes, and self-monitoring techniques. Embracing technology such as mobile apps and telehealth services can fast-track self-care practices by communities and democratise access to health information, boosting health literacy. The adoption of a self-care resolution at the World Health Assembly 2025 will boost efforts to scale-up self-care.

Third, Kenya’s Health Policy (2014-2030) calls for empowering households to take responsibility for their health and well-being and participate in managing local healthcare systems. The country can benefit by translating this policy intention into action by investing in consumer education on self-care.

Fourth, to improve the regulatory environment, the Health ministry needs to work with regulatory agencies to facilitate scaling up access to self-care products and devices in the country through approval reclassification guidelines and provide an environment for incentives to reward innovation and allow direct-to-consumer advertising for self-care solutions.

-Dr Ndirangu is the Country Director at Amref Health Africa in Kenya. Mr Wakoli is a Family and Reproductive Health Programme Specialist at Amref Health Africa in Kenya