Montevideo, 6 November 2024. Self-care interventions are among the most promising approaches to address the challenges of accessing affordable, acceptable and quality health services today. By recognizing individuals as active agents in managing their health, self-care interventions in sexual and reproductive health offer opportunities to strengthen primary health care as part of comprehensive and integrated care across the life course.
An innovative workshop organised by the World Health Organization (WHO) and the Pan American Health Organization (PAHO) took place in Bogotá, Colombia, from 23-25 October 2024 to address the concept of ‘self-care’ in sexual and reproductive health and its implications for potentially accelerating the reduction of maternal mortality. Interventions recommended by WHO were identified, which are already successfully implemented in the region and others that could begin to be developed. With the participation of representatives from the Ministries of Health of 12 countries in the region that were prioritised in the need to accelerate the reduction of maternal deaths, a toolkit developed by WHO and PAHO for the implementation of self-care was presented.
Self-care as a tool for maternal mortality reduction
The director of PAHO's Latin American Centre for Perinatology - Women's and Reproductive Health (CLP/WR), Suzanne Serruya, said that these interventions are in line with the Strategy for Accelerating the Reduction of Maternal Mortality presented by PAHO director Jarbas Barbosa in June this year. ‘It is necessary to adopt a preventive, health-promoting, life-course approach, with models of care centred on women, families and the community, where self-care plays a predominant role,’ she said.
The director of CLP/WR recalled that there is great inequality in the region and that maternal mortality affects mostly women in vulnerable situations. ‘Self-care can reduce gaps in access and equity that disproportionately affect the most underserved people and communities.
The workshop was attended by representatives of the ministries of the 12 priority countries identified in the Strategy to Accelerate the Reduction of Maternal Mortality, PAHO focal points linked to health services and sexual and reproductive health, technical teams from the ministries and representatives of civil society and academia.
Global challenges
Manjulaa Narasimhan, head of self-care at HRP, a unit of WHO's Department of Sexual and Reproductive Health and Research, recalled that one in five of the world's population is currently living in a humanitarian crisis, where health systems are challenged to provide essential services. Sexual and reproductive health conditions are among the leading causes of death and disease among women of reproductive age worldwide. "Self-care is an opportunity It is important that people know their rights, are empowered and have the ability to manage aspects of their own health. We need to strengthen institutions, be more efficient and more innovative’.
The growing number of events associated with climate change; armed conflicts; the forced displacement of people; the displacement of migrants, sometimes in very precarious conditions; the lack of health professionals, particularly in some areas where people in vulnerable situations live, were some of the challenges identified.
Self-care favours access to health, reduces the overload on health services, promotes the use of telemedicine and new technologies and, above all, empowers people by focusing on their own needs.
Violeta Ross, a member of the World Council of Churches in Geneva, Switzerland, and an HIV-positive herself, emphasized the evolution of health technologies. "There is now HIV self-testing. When I was diagnosed, it didn't exist. Science has come a long way in the field of health and users have the opportunity to access interventions that were previously unthinkable. That's why it's important that communities participate, know and get involved. I welcome these kinds of meetings,’ she said.
The activist also pointed out that there is resistance on the part of health teams because ‘there is a false idea that this competes with what the health systems are doing. But no, self-care interventions are complementary. It's more about facilitating access’.
Self-care in the Americas
PAHO's Sexual and Reproductive Health Advisor, Rodolfo Gomez Ponce de León, pointed out that interventions such as home pregnancy tests, HIV and HPV self-testing, self-monitoring of blood glucose and blood pressure, emergency contraception and subcutaneous auto-injectable contraception, among others, are examples of self-care practices. "Self-care strategies are already being implemented in the region, although they are not always identified as such. This meeting was useful to shed light on some of the successful practices that are already being developed. It is important that countries learn about these practices, identify what is useful for each reality, and manage to incorporate them into their plans and strategies’.
Before the end of the third day of the workshop, participants were asked to evaluate the experience, highlighting what they could apply in their own countries. Among the ideas that emerged were: to continue reflecting and sharing the ideas and concepts that were presented with the health sectors in their countries in order to continue moving forward; to show existing evidence on the subject in order to debunk myths that are still present; to include self-care as a tool to contribute to the reduction of maternal mortality; to provide self-care inputs to communities and incorporate aspects of gender and interculturality; to work on the empowerment of individuals, families and communities; to establish strategic alliances to continue moving forward and deepening the existing transformations; to promote the use of self-care as a tool to contribute to the reduction of maternal mortality; and to establish strategic alliances to continue moving forward and deepening the existing transformations.
In short, self-care interventions promote the active participation of people in their health care and facilitate self-determination, self-efficacy, autonomy and commitment to health. Person-centred self-care reinforces the role that each individual has in managing their own health, putting people's health and well-being at the centre of all interventions.
