In 2019, the World Health Organization (WHO) published the first Consolidated Guidelines on Self-Care Interventions for Health. Revised in 2022, these guidelines are essential for advancing access to self-care, but the work does not stop here – national governments need to find a way to adapt self-care guidelines to best meet the needs of their health systems and communities.
Fortunately, Uganda is up to the challenge.
For over four years, members of the Self-Care Expert Group (SCEG), led by the Uganda Ministry of Health and convened by PSI Uganda, worked together to adapt WHO’s self-care guidelines to the unique needs of Uganda. In October 2024, the Minister of Health of Uganda, Hon. Dr. Jane Ruth Aceng-Ocero, officially launched the country’s first National Guideline on Self-Care Interventions for Health and Well-Being at the Annual National Safe Motherhood Conference in Kampala. This milestone was the result of a collaborative effort among various stakeholders, including funding support from the Children’s Investment Fund Foundation, the William & Flora Hewlett Foundation, the United Nations Population Fund, the United States Agency for International Development and WHO. The Self-Care Trailblazer Group (SCTG) provided technical support and guidance to the SCEG throughout the guideline development process.
“Self-care is very essential for us as a country to realize Universal Health Coverage. The approach is important in strengthening our primary health care in alignment with our community health strategy. The self-care approach is also critical as we pay attention to addressing the social determinants of health through a multi-sectoral approach” – Hon. Dr. Aceng-Ocero.
The Uganda self-care guidelines include the following health priorities:
- Sexual health
- Reproductive health, including antenatal care and post abortion care
- HIV and sexually transmitted infection prevention
- Noncommunicable diseases (NCDs) including hypertension, diabetes, mental health, and nutrition
- Self-care for priority populations including adolescents, older people, and people with disabilities
Localizing self-care guidelines
Self-care practices are not new in Uganda – there are well-established and longstanding self-care strategies to address NCDs and sexual and reproductive health needs. However, as the availability of self-care products grows, providers and consumers need clear guidance on who should use them, how they should be used, and how they should be incorporated into the health system. By institutionalizing self-care in Uganda, the new guidelines aim to reduce stress on the health system, support individuals’ health agency, and improve health outcomes.
The self-care guideline development involved the following five-phase approach:
- Cultivating Government Ownership – At the onset, a group of development partners and civil society organizations, led by Population Services International (PSI), PATH, and WHO, approached the Ministry of Health to advocate for Uganda becoming one of the first countries to create national self-care guidelines based on the WHO guideline. The Ministry adopted the concept and permitted a phased approach to the development of the national self-care guidelines as a living document that would first focus on sexual and reproductive health and rights (SRHR) interventions before expanding to other health areas, mirroring WHO’s approach. The Ministry committed to providing leadership and stewardship during the development, piloting and scale-up of the guidelines.
- Convening a Self-Care Expert Group (SCEG) – To guide the development of the self-care guidelines, oversee the coordination of key stakeholders, and ensure self-care interventions are effective, the Ministry of Health
- Analyzing the Landscape – To develop a context-specific guideline, the national self-care consultant, with support from the SCEG, conducted a landscape analysis to understand the self-care interventions already being implemented across the country. PSI Uganda administered interviews among key stakeholders, including district leaders, implementing partners, and public and private sector providers to understand enablers and barriers to self-care. Using this information, the SCEG established priority health areas, listed above, to be included in the self-care guidelines.
- Guideline Testing – The SCEG pilot tested draft guidelines in Mukono district, located in Uganda’s central region, by implementing the guidelines in 18 health facilities (ten public and eight private) and training 15 national and subnational trainers to disseminate guidelines to providers and other stakeholders. Over a period of seven months (March-September 2023), the pilot tracked provider awareness of self-care, guideline implementation, and monitored its integration into the health system to determine the effectiveness of the draft guidelines. Through this pilot period we learned the importance of leadership and governance in integrating self-care into health systems, continued mentorship and support for providers, self-care commodity security, data recording and management, and financing of self-care. Provider engagement was a challenge because many health facilities and providers lacked awareness about self-care and its impact, indicating the guidelines should be paired with self-care awareness interventions. These insights informed updates to the final self-care guidelines.
- Revising and Finalizing the Guideline – Following the pilot phase, the SCEG and the self-care consultant synthesized key learnings, which informed the updated guidelines. The final guidelines were reviewed and approved by several Ministry levels representing all key priority health areas.
Following the official launch of Uganda’s self-care guidelines, the Ministry of Health will focus on guideline dissemination, implementation to scale self-care interventions, and self-care education to ensure interventions are accessible and effective. Priorities include integrating self-care into the pre-service curriculum for key health providers, stabilizing the self-care supply chain, integrating self-care reporting into the national health management information system, and supporting self-care access for vulnerable populations. PSI Uganda will support the government to strengthen partnerships, advocacy, and education for self-care interventions at every level of Uganda’s health system.
Together, we can implement and scale self-care that supports consumer choices, drives Uganda towards Universal Health Coverage, and transforms healthcare.
Learn more about localizing self-care here.
By George Kapiyo, Senior Technical Project Advisor; Precious Mutoru, Advocacy and Partnerships Manager and Victoria Torres, Associate Manager of Advocacy and Engagement, PSI
