What is self-care?
WHO’s definition of self-care is the ability of individuals, families and communities to promote their own health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a health worker.
It recognizes individuals as active agents in managing their own health care in areas including health promotion; disease prevention and control; self-medication; providing care to dependent persons; and rehabilitation, including palliative care. It does not replace the health care system, but instead provides additional choices and options for healthcare.
What are self-care health interventions and who uses them?
Self-care interventions are tools which support self-care. Self-care interventions include evidence-based, quality drugs, devices, diagnostics and/or digital products which can be provided fully or partially outside of formal health services and can be used with or without health worker. Examples of quality, cost-effective self-care interventions include: over-the-counter availability of some contraceptive products, pregnancy tests, condoms and lubricants, HPV and STI self-sampling and HIV self-tests, and self-monitoring of blood pressure and blood glucose.
The users of self-care interventions are individuals and caregivers who might choose these interventions for positive reasons, which may include convenience, cost, empowerment, a better fit with values or daily lifestyles, or the intervention may provide the desired options and choice. However, they might also opt for self-care interventions to avoid the health system due, for example, to lack of quality health service or lack of access to health facilities. Self-care interventions fulfil a particularly important role in these situations, as the alternative might be that people don’t access health services at all.
Scope of the problem
Every year 100 million people are plunged into poverty because they have to pay for health care out of their own pockets. Furthermore, underserved and marginalized populations, often lack access to quality health information, services and products and face stigma and discrimination in healthcare. There is an urgent need to find innovative strategies that go beyond a conventional health sector response to address these challenges in accessing quality healthcare.
The COVID-19 pandemic has highlighted the unique and critical role that self-care interventions have played in mitigating disease and saving lives through personal self-care actions such as wearing masks and physical distancing, and prioritization at national levels of self-care interventions that people can use during period of lockdown. Self-care actions to promote own emotional resilience are also important for the well-being of health workers.
Challenges
Before recommending specific self-care interventions, it is important to have evidence that they are beneficial to health and cause no harm at individual and/or population levels.
Use of unregulated and substandard products, incorrect or unclear health information or lack of access to health workers and/or health facilities for guidance or management of side effects or complications are potential challenges which need to be addressed when promoting or generating demand for these interventions. Currently one of the biggest challenges is ensuring the products are available to those who need them and that they do not place added financial burden on individuals.
Assessing and ensuring an enabling environment in which self-care interventions can be made available in safe and appropriate ways must be a key initial piece of any strategy to introduce or scale-up these interventions. The enabling environment includes all the pieces, beyond health services themselves, that require attention to ensure that self-care interventions can be appropriately implemented. The elements of the enabling environment require action beyond the health sector, involving for instance, the education, justice and social services sectors, because self-care interventions are mostly accessed and/or used outside formal health services.
Global impact
Self-care interventions offer a strategy to improve universal health coverage, reach people in humanitarian situations, and improve health and well-being.
WHO’s conceptual framework on self-care interventions has core elements from both “people-centred” and “health systems” approaches, underpinned by the key principles of human rights, ethics and gender equality.
Self-care interventions can be connected with digital platforms and technologies and incorporated into the education of health workers for maximum scale and reach. Health literacy, including digital literacy is also important for the uptake of self-care interventions and provides the foundation on which individuals are enabled to play an active role in improving their own health.
In addition, in times of major disruptions to the normal functioning of national health systems, caused by health emergencies, self-care interventions can provide an important alternative to the usual health facility- or health worker-based services.
WHO response
WHO recognizes the value and potential contribution of self-care interventions within health systems, and the rapid advances being made in services, behaviours and information that can be initiated by individuals. The WHO consolidated guideline on self-care interventions and framework support and promote these innovative approaches as ways to accelerate attainment of universal health coverage (UHC) and the Sustainable Development Goals (SDGs). In addition, the framework and normative guideline are grounded in and advocate for a strengthened, comprehensive, people-centred approach to health and well-being, including for sexual and reproductive health and rights (SRHR); communicable diseases (CDS); and non-communicable diseases (NCD). WHO recommends self-care interventions through a holistic approach to the care of each person, taking account of their individual circumstances, needs and desires across their whole life course, as well as the environment within which they live.
The WHO global guideline is relevant for all settings. In implementing the global guidance, WHO regions and countries can adapt the recommendations to the local context, taking into account economic conditions, existing health services and healthcare facilities, and the needs and rights of underserved populations.