A Guide to Developing and Testing a National Self-Care Policy
- Posted
- Impact Area Self-Care, Self-care Trailblazer Group
In 2020, Uganda began the process of developing a national self-care guideline for sexual and reproductive health and rights, based on the World Health Organization (WHO)’s guideline on self-care, released in June 2019 and revised in 2022. The WHO guideline provides a people-centered, evidence-based framework along with normative guidance to support individuals, communities, and countries to put in place high-quality health services and self-care interventions.
Uganda’s goal was to advance these principles while ensuring that the national policy was well adapted to Uganda’s health system and cultural context. A traditional approach to creating policies involves stakeholder consultations, and inclusion of a monitoring component so the government can assess over time how the policy will affect the health system, then modify the policy during the next drafting cycle (or 5 years later) as needed. In this case, Uganda chose an innovative approach to policy development — “sandboxing,” which included rapid application and testing in one district, then modifying the policy before finalizing it.
How-to for Other Countries
Acknowledging the gap in documentation of approaches to health policy development, Samasha Medical Foundation partnered with USAID’s PROPEL Health project to create a how-to guide based on this work, titled “Localizing WHO Guidelines on Self-Care: A Practical Guide From Uganda.” The guide documents Uganda’s innovative approach and illuminates a guideline development process that may be helpful for other countries. It is organized by the five phases of the process, detailing the purpose and objectives of each phase, Uganda’s experience, lessons learned, and suggested activities and tools for other countries wishing to follow a similar process to develop national self-care guidelines. The lessons learned were developed to be relevant to other countries working towards a national self-care guideline and relate to both the policy creation and testing process and the self-care interventions themselves. The Government of Liberia is currently using this how-to guide to replicate the Uganda approach, with the expected result of national self-care guidelines adapted to the Liberia context.
Uganda’s Five Phase Approach
Uganda’s five-phase approach to developing, testing, and implementing self-care guidelines can help to ensure that a country’s self-care guidelines are supported by national and district leadership; fit within the existing health system; and are acceptable and appropriate to health workers, self-carers, and other stakeholders.
1. Government Ownership
As in the development of all new government policies and programs, in the first stage of developing national self-care guidelines, cultivating the support of national leadership and coalescing civil society and development partners around a common agenda are essential.
2. Establish a Self-Care Expert Group
The adaptation process began with the establishment of a Self-Care Expert Group (SCEG) chaired by the Ministry of Health’s Director of Clinical Health Services, with support from the Assistant Commissioner for Adolescent and School Health. A consultant from Samasha supported the guideline development process, facilitated meetings, and ensured all tasks stayed on course.
3. Conduct a Situational Analysis and Develop Draft Guidelines
It is important to have a complete understanding of how the guidelines will fit into the existing healthcare system and policies, what self-care options are currently available, and what the experience has been with self-care in the country. Situational analyses were conducted by the self-care consultant and by SCEG members. The drafted guidelines were strongly rooted in the findings from this analysis.
4. Sandbox the Guidelines in a Learning District
“Sandboxing” refers to piloting/testing reforms or innovations under real life conditions in a defined space within a defined time period. After developing the draft guidelines, the SCEG made the strategic decision to pilot test the draft guideline at the subnational level and use the lessons learned to inform revisions before national launch and scale-up. To pilot the guidelines in a real-life setting, the SCEG used the sandboxing approach in Mukono District, located in Uganda’s Central region.
5. Revise and Finalize the Guidelines
The SCEG incorporated lessons learned from the sandboxing activity into the guidelines before final government approval. The guidelines then received additional approval from relevant government agencies before being implemented nationwide.
The process to develop and test the guidelines was innovative and effective in creating a policy tailored to Uganda and also serves as a model for other countries looking to nationalize the WHO guidelines.
The Uganda SCEG is currently working to expand the existing self-care guideline from one that focuses on sexual and reproductive health and rights into one that covers a full range of health and well-being topics.
Authors
Dr. Moses Muwonge [email protected] (Samasha Medical Foundation)
Paschal Aliganyira [email protected] (Samasha Medical Foundation)
Rachel Yavinsky [email protected] (Population Reference Bureau)
