Self-care key to the attainment of universal health coverage

Blood test. [iStockphoto]

A triple challenge characterises Africa’s health landscape. First, Africa grapples with a disproportionately high disease burden given that it bears over 23 per cent of the global disease burden, yet it is home to just 16 per cent of the global population and accounts for just one to three per cent of global healthcare spending.

Second, the problem posed by the high disease burden is exacerbated by the restricted fiscal space for health with government health expenditures averaging 1.8 per cent of Gross Domestic Product (GDP), falling short of the five per cent threshold needed to attain Universal Health Coverage (UHC).

Third, the incidence of non-communicable diseases on the continent is at an all-time high. The net effect of these challenges is that Africa’s health outcomes, such as maternal and infant mortality, lag behind the rest of the world.

It is critical for the health system to develop sustainable, long-term responses that ensure that everyone has access to life-saving healthcare, even in the context of pandemics such as Covid-19. To achieve UHC, governments and donors must make significant investments in health systems, as well as continue to push for socio-cultural and economic change, an intersectional, human rights-based, and gender-inclusive approach to health, and more effective and innovative ways to empower and equip people to meet their own health needs, especially through approaches such as self-care.

Self-care is an approach to advancing health wherein people themselves take health actions towards the better health of themselves, their families or their community. Self-care enables people to protect their own health, prevent disease, and treat illness, both with and without the support of a healthcare provider.

Self-care solutions can help in the attainment of UHC through improving equitable access to healthcare and ensuring the resources in the health system are used effectively and efficiently. Self-care interventions could help countries in efforts to achieve UHC by lessening the workload for health workers, and reaching people who either can’t access or don’t want to come into health facilities.

Self-care can be used in areas such as health promotion; disease prevention and control; self-medication; providing care to dependent persons; and rehabilitation, including palliative care. Self-care has the potential to enhance access to and coverage of healthcare while lowering reliance on facility-based services and the overburdened health workforce.

When patients use medical devices or commodities without the assistance of a health provider (e.g., HIV self-testing and self-injectable contraception), they can take care of their health needs at home with more privacy, which is appealing to many people. Some self-care alternatives have the potential to lower financial and opportunity expenses for clients by eliminating or reducing time spent seeing a health practitioner.

There are numerous examples of how self-care, when properly implemented, can help individuals manage their own health. Self-care can help minimise the number of people who are not reached by traditional testing services and improve the number of people who are aware of their health status by offering access to self-testing options in areas such as HIV and diabetes.

Another example of how self-care allows patients to self-screen for symptoms and assess if they need to see a healthcare provider is the Covid-19 symptom checklist. Self-testing has especially been advanced through the development of digital technologies that provide more options for self-directed prevention, treatment, and care than ever before. These are just a few examples of self-care strategies that might help people manage their health.

To achieve benefits from self-care, it must be integrated as a key component of health systems. This integration requires systems to be reoriented to recognise individuals’ and communities’ role in co-producing health, and should be structured in a way that allows for interventions to be both people-centered and system-centered.

If self-care is completely integrated into the health system, concerns about it being dangerous, giving health systems a ‘pass’ on institutional accountability, increasing disparities, or shifting responsibility onto self-care users themselves will be adequately addressed.

Finally, it is imperative to build the health information systems of the African continent. The recent growth of new medical and digital technology has opened up a plethora of options for incorporating self-care into health systems.

The advancement in information and communication technology, if properly harnessed, can greatly contribute to efficiency and effectiveness of self-care promotion. It would help people choose the right information for effective self-care.

These digital configurations, when combined with behavioural and educational interventions that encourage self-management of health, raise self-care to a cutting-edge solution for providing a wide spectrum of healthcare to a large population.

Solutions that expand access to healthcare and eliminate supply-side constraints are especially appealing to health systems and consumers in the context of the Covid-19 pandemic. Promotion of self-care provides an opportunity to fast-track the attainment of UHC.