By Davina Canagasabey, Senior Technical Advisor—Primary Health Care, PATH

 From PATH’s perspective, how does self-care advance universal health coverage (UHC)?

PATH prioritizes self-care as a critical component as standing up strengthened and resilient primary health care (PHC) systems as the pathway for achieving UHC, aligned with the joint Constituency Statement on PHC and self-care at the 76^th World Health Assembly.

Making services more accessible, affordable, and equitable is essential for UHC, and requires shifting away from hospital-based health systems towards differentiated care models that meet individual and community needs. Self-care, by enabling and empowering self-management and self-monitoring, offers another option for how people can choose to access health care. By enabling service differentiation and task-shifting, self-care plays a powerful role in reducing pressure on constrained health systems with human resource shortages, especially when coupled with digital applications and messaging systems that help connect people to information and support they may need.

PATH’s Primary Health Care program has promoted self-care across health issue areas, ranging from supporting self-management of chronic diseases, like diabetes, as well as HIV; increasing access to diagnostics and awareness of health status through self-testing; and facilitating uptake and continuity in prevention services, including HIV pre-exposure prophylaxis (PrEP), self-sampling to prevent cervical cancer, and family planning through contraceptive self-injection. PATH also works with countries to adapt appropriate digital health tools that connect individuals to services, allowing them to make informed decisions about their health.

What does PATH see as the connection between self-care and pandemic preparedness and global health security?

Self-care and pandemic preparedness are fundamentally intertwined through PHC. Effective PHC necessitates health systems with the capacity to effectively respond to disease outbreaks and maintain essential health services during times of crisis, such as during an emerging health threat or response to a growing epidemic or pandemic. A resilient PHC system can also serve as the first line of defense and backbone of effective pandemic preparedness and response efforts, and self-care—as a critical element of PHC—plays an important role in effectively responding to emerging health threats and maintaining essential services.

In responding to an emerging health threat or ongoing pandemic, self-care can facilitate detection and management or prevention of illness:

• Detection: Share information to enhance communities’ understanding of signs and symptoms of emerging health threats and knowledge or when and how to access screening or diagnostic services for people who believe they may have symptoms.
• Management and prevention: Support risk communication and infection prevention and control efforts by sharing information to raise awareness of how a threat is transmitted and strategies to mitigate onward transmission and protect oneself, household members, and others from infection.

The COVID-19 pandemic highlighted the role self-care innovations played in enabling countries to maintain essential services as national systems and resources were leveraged to respond to the COVID-19 pandemic. For example, contraceptive self-injection allowed women to continue preventing unintended pregnancies through self-injection at home, and self-testing allowed people to access screening at a location of their choosing (instead of a health facility), relieving pressure on overloaded health systems while also reducing travel that increased potential exposure to COVID-19. COVID-19 pandemic restrictions also created opportunities to decentralize services outside of traditional health delivery settings, particularly accelerating a shift towards private sector and virtual platforms for information-sharing and consultations and telemedicine, for example, using social messaging platforms (such as WhatsApp, Viber SMS) or Skype to hold clinical consultations for people living with HIV, tuberculosis, and non-communicable diseases or counsel on appropriate prevention services, such as PrEP and/or family planning.

Tell us more about an example of this work in action

There is a wealth of examples from COVID-19 of how self-care drove impactful COVID-19 response and adaptations, both in responding to the COVID-19 pandemic and in maintaining access to essential health services.

To share an example of self-care supporting the COVID-19 response, through the Unitaid-funded, PSI-led HIV Self-Testing Africa (STAR) Initiative, PATH focused on decentralizing access to COVID-19 diagnostics by leveraging professional-use rapid diagnostic tests as a self-test to expand delivery outside of public sector platforms, working to understand the acceptability, feasibility, and effectiveness of through various distribution channels across Brazil, India, and Uganda. In Brazil, findings from an evaluation of serial self-testing for COVID-19 at contact tracing programs at family health PHC clinics showed self-testing to be acceptable and feasible, with 94% completing the entire self-testing process correctly and participant self-test interpretation matching a health professional’s interpretation 100% of the time. Participants also reported general compliance with public health guidelines, with participants experiencing a COVID-19 symptom self-reporting mask-wearing in public at least 60% of the time, and those self-testing positive with COVID-19 reporting as more likely to self-isolate and take preventive precautions, suggesting the process of self-testing and accompanying infection prevention and control counseling empowered individuals to take preventive and protective measures.  

Self-testing and self-monitoring were also instrumental in maintaining access to care for communicable and noncommunicable diseases during COVID-19, from HIV and hepatitis C to diabetes and hypertension. In Vietnam, through investments by the United States Agency for International Development, PATH engaged private-sector pharmacies and e-commerce to deliver self-care packages, including HIV self-testing and PrEP, through prolonged waves for COVID-19. PATH has been applying lessons from applying self-care through private-sector channels to support Vietnam’s response to mpox since 2023, working with community-led social enterprises and private clinics to conduct online social media campaigns, telephone hotlines, virtual learning platforms, and individual/group-based virtual information-sharing sessions on mpox signs and symptoms, accessing mpox screening and care services, and self-care strategies for protecting oneself from and preventing transmission of mpox.