Podcast Transcription
Tihut Mulugeta: I’m Tihut Mulugeta, a Self-Care Trailblazer Group member and project advisor for PSI’s RISE project in Ethiopia. Welcome to a special podcast on self-care for universal health coverage where we will focus on how self-care can be used to support young people engaging in health care. If you’re new to the self-care space, not to worry, you’re in the right place.
Here’s how it’ll work: I’ll walk you through an overview of self-care and then we will hear from two incredible youth leaders who are working at the forefront of this space. They’ll answer questions on the importance of self-care, how the health system can support self-care programming, and the potential promise that self-care holds in transforming our health care systems.
So, let’s get started! As I mentioned before, I am a member of the Self-Care Trailblazer Group—a global coalition dedicated to expanding the safe and effective practice of self-care so that individuals can better manage their own health, health outcomes are improved, and health systems are better equipped to achieve universal health coverage. But what do we mean when we talk about self-care?
The WHO defines self-care as “the ability for individuals, families and communities to promote, maintain health, prevent disease and cope with illness with or without the support of a healthcare provider.” What this means in practice is that people can use self-care to stay healthy and take charge of their own health care, significantly facilitated by health literacy, access to tools, commodities, and products. And for young people, self-care offers an opportunity to engage with the health system in an equitable, affordable, safe, private, and confidential manner, without fear of stigma or taboo.
With over half of the world’s population under the age of 30, we know that youth need to be included as crucial advocates and partners in order to reach UHC and ensure everyone has access to healthcare. And with me today are two youth advocates, who have been engaging in self-care advocacy as members of the SCTG.
Richard Dzikunu from Ghana is the Youth Officer with Tech for Health and Bea Okech of Kenya is the Content Development and Knowledge Management Assistant at Y-Act. Thank you both for joining me and taking the time to speak with me.
I’d love to start our conversation hearing a little bit about what self-care means to you, why you are advocates for self-care, and how you engage in self-care personally in your lives.
Beatrice Okech: Self-care to me means being able to use youth-friendly innovations to access sexual and reproductive health care without the shame and stigma that is often associated with it in my society. And that also links us to why I’m an advocate for self-care, because it provides young people the privacy and confidentiality to take charge of their sexual and reproductive health in our current contexts. How I engage in self-care is often through the use of online platforms or apps, such as the MyDawa app, in Kenya, where I’m able to access contraceptives and even HIV self-testing kits very easily with privacy and confidentiality. I also use the Flo app to check my menstrual cycle, which really helps me stay on top of my menstrual health. That is why self-care is so important to me on a personal level.
TM: Thank you, Bea, I think you’ve raised some interesting points considering young people empowering themselves and taking charge of their own health, as well as using different apps so that they can take care of their health.
Richard, what do you think about self-care, what does it mean to you, and why are you an advocate?
Richard Dzikunu: Based on the WHO definition of how people can take charge of their own health and manage their own healthcare with or without support of health professionals. Who would not want to take charge of their own healthcare, whenever you want? You can decide when and where to get a service from, without having to be shy about who is listening to you and getting to know about your condition, and who is trying to stigmatize or deny you of opportunities because of your condition. That’s why for me it is very important in the broader context that people, if given the opportunity, want to take charge of their own healthcare—where they are making decisions without dealing with any systemic social or cultural bias. That is why self-care is really important for me, and also for many other young people, because there are no barriers to deciding, and we can take our own initiative with or without support.
TM: That is very insightful. One word that captured me about your speech is about opportunities. So, young people and everyone deserves to have the opportunity to take care of themselves.
We know self-care can support people in all aspects of their lives, why do you think it’s especially important in the area of sexual and reproductive health in Kenya and Ghana?
BO: That really goes back to the type of context that we live in, and unfortunately, we live in a society where young people, especially young women, taking care of their sexual and reproductive health is still frowned upon. Self-care can give young people the agency to just take charge of their reproductive health, particularly in the area of access to contraceptives, and also dealing with STI’s such as HIV, we mentioned the self-testing kits for HIV. Even the broad spectrum of contraceptives, particularly the modern forms of contraceptives that we currently have on the market. It’s still such a huge challenge for young people, and especially young women, to seek these services out and to have the comfort to be able to cater to their sexual and reproductive health. This brings us back to the point that young people truly value their privacy, I believe that self-care is what they need to have the agency to cater to their sexual and reproductive health, even as we continue to make strides in youth friendly services and making health care facilities more available. In Kenya, the number of healthcare facilities available to the population is still very disproportionate. I think that self-care can really support all aspects, especially when it comes to SRHR and healthcare for many young people.
TM: Thank you so much, Bea. Like you said, young people value their privacy, and that’s true for most young people. They see self-care as a way to value their health and need youth-friendly services as they have different needs.
RD: When it comes to Ghana, the context is not much different than what my colleague shared in Kenya, young people, particularly girls, face challenges when having to access information and services when it comes to sexual and reproductive health. For me, between 2015 and 2017 when I was working in Ghana, we realized that getting access to information was always a challenge, and the fact that even when you can get information from a facility, it depends if that facility is youth friendly, if they will judge or question why you are asking about sex or contraception. If I can be at home and be able to access all of this information in the comfort of my room, on an application or dashboard and no one is judging or questioning me, then young people can feel empowered.
The age for sexual consent in Ghana is 16. At the age of 16, we presume that young people can have sex, however, the curriculum in our schools does not teach about the sexual and reproductive health side and you are not preparing them or providing them with any information or services so that they can make decisions on how to have safe sex, decisions around keeping their pregnancy or not, and all issues when it comes to their sexual and reproductive health.
This is where it becomes important for self-care. On one hand, young people have their rights, but they are not being provided with the services. With self-care tools they are able to make their own informed decisions. In a country like Ghana where teenage pregnancy is still on the increase, then that makes us ask some basic questions—why is it on the increase? Are people not getting access to information and services that they need? The services are there, but young people are not able to go because they are judged, stigmatized, and culturally, they feel shy to even talk about sex. These are all the challenges, but if you provide this information, for instance, through digital means—like in Ghana we have an online app where young people can basically go and get the information they need. In that case, they are managing their own health and getting information. Therefore, it is relevant when it comes to sexual and reproductive health, particularly in the context in Ghana and Kenya, where sexual health and rights seems to be a taboo to not talk about.
TM: Sometimes when people think of self-care, they think it’s easy, doesn’t need support from the government and health system, and that it’s free, but we know that’s not true. What do countries that want to support self-care need to do to advance self-care for sexual and reproductive health within universal health coverage?
RD: This is a very important point because we cannot discuss self-care without also discussing the challenges. Just like you said, self-care means basic care provided where people can access that care independently, with support. But when the infrastructure does not actually exist, where am I going to seek the care from? For instance, I can get information or be directed to a service from a mobile app, but if I go to the center and there is no service, then self-care is not complete. For self-care to be complete, we must invest in health infrastructure.
What are the things that young people need to have access to make their informed decisions? It’s different if there is a hospital or facility, but there are no health workers, and then there’s the instance where the facility does not exist at all—so even if you refer people to that facility, there is no way they can get a service. I think first investing in healthcare infrastructure is key, and here we are looking at primary health care services and investing in the health workers themselves. Again, when it comes to self-care, most self-care for young people is down to digital applications. My colleague from Kenya mentioned the application that she uses, and a number of the people in Ghana also use different applications. But who are the people using these digital applications? They are young people, who are educated, highly skilled in technology, and have the money to at least afford a mobile device where they can access this information. But there are young people who are not in school, who can neither read nor write, who do not know how to operate a computer or mobile phone. How do they access a counseling service if they are pregnant? It means that those who do not have the skills to use self-care tools are left out. That is why we also have to begin investing in digital skills, because there could be a digital application provided for self-care, but you need to have the means to have the skills to access those applications. For me, that is where a lot of investment should go to.
TM: I’d like to hear a little bit about the outcomes of self-care and sexual and reproductive health and rights. How have you seen either in your own life or with the people you’ve worked with or in communities how self-care has helped them access the health services they need, when and where they need them, without financial hardship?
RD: I have seen young people, some friends and colleagues, in the course of my life who have been able to access self-care tools, and it has helped them in different ways. For instance, as part of a project I did in Ghana, we are able to go to a number of schools in different regions in Ghana, we are able to speak to young girls, boys, provide information about reproductive health, and direct them to where they can get services. We also targeted young people who were out of school. For some of these young girls that got information and access to services, they were able to avoid pregnancy, stay in school and continue their education. Basically, the fact that they had timely access to information meant that they stayed in school and were able to make an informed decision. There were also young people who were pregnant and deciding if they wanted to keep it or not, then we were talking about comprehensive abortion care. Instead of taking the decision in their own hands, they were able to consult through health services or applications that gave them information on where to go for safe abortion services, avoiding death. We know a lot of stories of young people not making the right decisions because they don’t have all the information, and then they try to have an abortion and lose their lives. There are a lot of options, we’ve seen self-care tools providing timely information and services, enabling young people to make informed decisions and to use their education and become who they want to become and take their care into their hands.
TM: If you had to give advice to government officials deciding on how to improve SRHR and achieve UHC, what recommendations would you give them about self-care?
BO: For me, I think the starting point is to understand that self-care is not a replacement for primary healthcare, but rather a complementary element. The starting points would be funding and political will. When it comes to political will I think it is necessary because when we talk about actual implementation of interventions we need to start at the formulation and implementation of favorable policy frameworks that will incorporate self-care in our healthcare system to advance SRHR for UHC.
For instance, the WHO self-care guidelines of 2019 are a great place to start for government officials in Kenya to ensure that self-care is both accessible and in-step with formal health delivery systems. The best part is other countries like Nigeria and Uganda have made the first step towards this, and there is really a lot that we can learn from them in Kenya just to get the ball rolling in terms of ingraining self-care into our healthcare systems. When we talk about things like digitization of self-care practices, the subsidization of SRH services to increase their availability and access to vulnerable populations, we need to think about intentional financial investment from the government. And this is where we can also bring in the aspect of government in partnership with other stakeholders, such as the private sector and also civil society organizations (CSOs), just to increase the scope of self-care in our healthcare systems, particularly in places where access to facilities is not easy. For instance, there are places where many young people are not able to easily access a physical health care facility, maybe it’s 20 km away, sometimes even 50 to 100 km, and so accessing primary healthcare in that instance would really be a challenge. Incorporating self-care from the very start would really go a long way in addressing that challenge. When we talk about allocating resources towards self-care, I also just think about learning institutions as a starting point. My colleague Richard mentioned something about people needing that information. If we have comprehensive sexual education in our schools so young people know this is the type of information that is available, and in the event that I need support this is where I can get it, and this is where I can go to get services that look like this—I think that also empowers them to go out and take charge of their health. And, also, just thinking about learning institutions for the health care providers, I think that that would be a really great place to think about incorporating self-care. Once the health care providers are equipped with the necessary skills to provide guidance for other young people for self-care, that will help have it more ingrained in our healthcare system, which also requires a lot of investment—investment in the learning institutions, investment in the healthcare facilities, just to make sure there is always accurate and reliable information and also ensuring that services are constantly available so that we don’t find that young people are seeking contraceptives, but when they go to the actual facility or they try to use a digital app to access these services, they find that they are not in stock or available at the moment because of high-cost or high taxes, etc.. Just really bringing in the intentional financial investment and there is the aspect of political will, and multi-stakeholder partnerships which will really go a long way in incorporating self-care in our healthcare systems.
TM: Thank you for that Bea, I couldn’t agree more. And a big thank you to all who joined me as we explored ways for self-care to support young people around the world. If you’re interested in learning more about advocating for youth and continuing this conversation, you can join our youth workstream.
Our ultimate goal? To take all of your insights and answers and compile them into a comprehensive list of policy recommendations that can be shared with governments and the global community to include youth needs in self-care and healthcare policy!
Happy podcasting!
