Taking Action

Self-care Interventions: The path to Universal Health Care

Sep 30, 2021
Taking Action

Dear Diary,

I have been struggling with an eating disorder for the past few years. I am afraid to eat and afraid I will gain weight. The fear is unjustified as I was never overweight. I have weighed the same since I was 12 years old, and I am currently nearing my 25th birthday. Yet, when I see my reflection, I see somebody who is much larger than reality.

I told my therapist that I thought I was fat. She said it was 'body dysmorphia'.
She explained this as a mental health condition where a person is apprehensive about their appearance and suggested I visit a nutritionist. She also told me that this condition was associated with other anxiety disorders and eating disorders. I did not understand what she was saying as I was in denial; I had a problem, to begin with. I wanted a solution without having to address my issues.

Upon visiting my nutritionist, he conducted an in-body scan and told me my body weight was dangerously low.

I disagreed with him.

I felt he was speaking about a different person than the person I saw in the mirror. I felt like the elephant in the room- both literally and figuratively. He then made the simple but revolutionary suggestion to keep a food diary to track what I was eating.

This was a clever way for my nutritionist and me to be on the same page. By recording all my meals, drinks, and snacks, I was able to see what I was eating versus what I was supposed to be eating. Keeping a meal diary was a powerful and non-invasive way for my nutritionist to walk in my shoes for a specific time and understand my eating (and thinking) habits.

No other methodology would have allowed my nutritionist to capture so much contextual and behavioural information on my eating patterns other than a daily detailed food diary.
However, by using a paper and pen, I often forgot (or intentionally did not enter my food entries) as I felt guilty reading what I had eaten or that I had eaten at all.

I also did not have the visual flexibility to express myself through using photos, videos, voice recordings, and screen recordings. The usage of multiple media sources would have allowed my nutritionist to observe my behaviour in real-time and gain a holistic view of my physical and emotional needs.

I confessed to my therapist my deliberate dishonesty in completing the physical food diary and why I had been reluctant to participate in the exercise. My therapist then suggested to my nutritionist and me to transition to a mobile diary study.

Whilst I used a physical diary (paper and pen), a mobile diary study app would have helped my nutritionist and me reach a common ground (and to be on the same page) sooner rather than later.

As a millennial, I wanted to feel like journaling was as easy as Tweeting or posting a picture on Instagram. But at the same time, I wanted to know that the information I  provided in a digital diary would be as safe and private as it would have been as my handwritten diary locked in my bedroom cabinet.

Further, a digital food diary study platform with push notifications would have served as a constant reminder to log in my food entries as I constantly check my phone. It would have also made the task of writing a food diary less momentous by transforming my journaling into micro-journaling by allowing me to enter one bite at a time rather than the whole day's worth of meals at once.

Mainly, the digital food diary could help collect the evidence that I was not the elephant in the room, but rather that the elephant in the room was my denied eating disorder.

Sincerely,
The elephant in the room

For many Ghanaians and those in developing countries, where healthcare systems lack adequate human and financial resources, self-care remains crucial for maintaining physical and mental health. 

As a reproductive health and rights advocate, I have witnessed the stigma and fear surrounding unplanned pregnancy and HIV testing. No one wants to face judgment from their local pharmacists or community health center. But thanks to self-care interventions such as the pregnancy and HIV self-test kit, individuals can, in privacy, check their status without the anxiety of others knowing. 

Self-care interventions for health, despite their essential role, are largely untapped.

Given that an ideal, well-functioning health system is seldom reality, particularly in resource-constrained settings, there is the need to invest in self-care interventions. 

The United Nations benchmark to achieve Universal Health Coverage (UHC) by 2030 is just 9 years away. To accomplish this health objective, the intentional community and national governments must strive to prioritize self-care as a pathway to achieving UHC. That means individuals and communities must be empowered with the knowledge and ability to self-diagnose, prevent disease and maintain their health with or without the support of a healthcare provider. 


What constitutes self-care interventions and practice? 

Self-care are all behaviors and actions that an individual can do to promote their own health and self-management of an illness. This could be a conscious action you take to promote your physical, mental, and emotional health.

Self-care intervention comes in different forms and approaches and must meet the users' health needs at all stages of the life course. The  WHO consolidated guideline on self-care interventions outlines three important components of self-care.  


1. Self-Management

This is one of the most common self-care practices we all know. Whether consciously or not, we have all practiced this type of self-care at some point in our lives. It includes self-medication, self-treatment, self-examination, self-injection, self-administration, self-use. 


2. Self-Testing

It is one of the self-care practices that has gained prominence in the past years. In the sexual and reproductive health rights field, pregnancy and HIV test kits are some of the best examples of self-testing practice. Other examples include self-sampling, self-screening, self-diagnosis, self-collection, self-monitoring. 


3. Self-Awareness

This includes self-help, self-education, self-regulation, self-efficacy, self-determination. Teamscope data collection application is one example of a health data platform that sends calendar forms in the form of reminders to individuals to fill in their health data. The application can also create custom messages for self-education. 



How can self-care health interventions help countries reach UHC? 

The main objective of Universal Health Coverage (UHC) is to ensure that everyone can access and receive quality healthcare without financial difficulty. Self-care supports this goal by increasing people's access to health services at a reduced cost. 

To understand the broader role of self-care to achieve UHC, we must first acknowledge the impending challenges in our health system and health workforce. The world suffers from a shortage of health workers. According to the World Health Organisation, if the current trends continue, a shortfall of 18 million health workers is projected in 2030, primarily in low- and lower-middle-income countries. 

The challenge calls for a more intentional and systematic approach to self-care interventions in low- and lower-middle-income countries to empower individuals to manage their health with or without the support of a healthcare provider. Self-care approaches, whether by self-testing, self-management, or self-awareness, should not be left to individuals or communities to practice on their own. It must be a national agenda with budget support. 


Tanzania is one of the countries leading a national agenda of self-care interventions. Their Ministry of Health, Community Development, Gender, Elderly & Children (MOHCDGEC) and other implementing partners have initiated partnerships with telecom companies to offer free and low-cost solutions for people to use their phones to support their own health.

The country has prioritized a more effective model of identifying people living with HIV who are currently unaware of their status and providing them with diversified testing options. The services allow individuals to send SMS messages to report self-test results and take HIV self-test at no charge. The purpose of using SMS-based reporting and tracking is to support HIV self-testing across hard-to-reach populations. 

This same self-management approach to self-care is also in use in multiple countries. In Benin, Malawi, Senegal, Uganda, and Zambia, women are trained on self-inject contraception to avoid unwanted pregnancies. Women in these countries have the freedom to self-manage their reproductive health at a private and convenient location of their choosing. In a pandemic where health services are interrupted, self-care remains the only solution for some women. 

These examples are the gradual but realistic self-care approaches that countries must adopt to achieve Universal Health Coverage and ensure that no one is left behind. There is the need to begin integrating self-care practices into long-term national health policies.

If appropriately used in the 21st century, data could save us from lots of failed interventions and enable us to provide evidence-based solutions towards tackling malaria globally. This is also part of what makes the ALMA scorecard generated by the African Leaders Malaria Alliance an essential tool for tracking malaria intervention globally.

If we are able to know the financial resources deployed to fight malaria in an endemic country and equate it to the coverage and impact, it would be easier to strengthen accountability for malaria control and also track progress in malaria elimination across the continent of Africa and beyond.

Odinaka Kingsley Obeta

West African Lead, ALMA Youth Advisory Council/Zero Malaria Champion

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Digital technologies and self-care 

The use of digital technologies in self-care is a great opportunity for low- and middle-income countries as they strive to harness new digital innovations to support self-care. 

A few months ago, I participated in a podcast series titled self-care: for youth, by youth. I shared my experience of how digital technologies are improving people's access to self-care at a reduced cost. 

Digital self-care interventions, when designed well, have the potential to increase people’s self-awareness of their health needs and help individuals to self-manage their own health conditions. But using online services or platforms for self-care has to be safe and protect the users from harm. 



The 4 principles for digital health self-care   


Value for User 

A digital self-care tool should not become a burden on the user. It is vital for the end-users, who already face stigma and other challenges in accessing health, to find value in digital self-care tools. While financial profit is essential for designers and innovators of self-care tools, the well-being of users must remain a priority at all times 

Data privacy and confidentiality

In some instances, people turn to self-care tools because of the stigma and discrimination they experience while interacting with physical services and the fear of others knowing their health conditions without their consent. 

In the case of HIV and pregnancy self-testing, the privacy and confidentiality of a patient must be paramount. At any given time, self-care tools should ensure that individuals have autonomy and ownership over how their personal health information is used and disclosed to others. 

True ownership of personal data only occurs when we have the ability, without any person in between, to delete our data permanently and forever.

Quality assurance

As self-care becomes more prevalent and accessible, we must ensure the quality of care.

People using self-care interventions to manage their own health want to be assured that they can be supported or remedied if they make mistakes in their use of self-care products. 

To maximize quality, we must focus on improving the capacity of individuals to self-manage their care and another focused on reorienting the health system so that, as people become more engaged in their health, the health system is there to meet them.


Accountability and responsibility

Ultimately, we should all know that we are accountable and responsible for our own health. The use of self-care interventions means we have to choose what to do and what not to do. 

Having personal accountability and responsibility means you're fully responsible for your choices and action. We must always strive to gain the appropriate information to inform our choices and actions.


Conclusion

I believe that the future of healthcare cannot be without self-care. That is why we must consciously begin to integrate self-care interventions into everyday health practices. We can gradually control our own health management with the support of a well-functioning health system. However, this can only be possible if countries begin to see self-care as a national agenda and not an individual lifestyle

Self-care involves enabling environments for people to access healthcare. This means that for self-care to be complete, we must invest in healthcare infrastructure.

By putting in place national policies on self-care, there is the potential to strengthen national health institutions to maximize efficient use of domestic resources for health. It offers the opportunity to also improve access to healthcare services by reducing the pressure on the health systems. 

In all self-care interventions benefit the health system, and users can increase health choices as services can be accessible and affordable. The goal is to improve the efficiency of health service delivery for all people by making self-care options available at all times.

Dear Digital Diary,

I realized that there is an unquestionable comfort in being misunderstood. For to be understood, one must peel off all the emotional layers and be exposed.

This requires both vulnerability and strength. I guess by using a physical diary (a paper and a pen), I never felt like what I was saying was analyzed or judged. But I also never thought I was understood.

Paper does not talk back.Using a daily digital diary has required emotional strength. It has required the need to trust and the need to provide information to be helped and understood.

Using a daily diary has needed less time and effort than a physical diary as I am prompted to interact through mobile notifications. I also no longer relay information from memory, but rather the medical or personal insights I enter are real-time behaviours and experiences.

The interaction is more organic. I also must confess this technology has allowed me to see patterns in my behaviour that I would have otherwise never noticed. I trust that the data I enter is safe as it is password protected. I also trust that I am safe because my doctor and nutritionist can view my records in real-time.

Also, with the data entered being more objective and diverse through pictures and voice recordings, my treatment plan has been better suited to my needs.

Sincerely,
No more elephants in this room

Richard's avatar

Richard Dzikunu

Richard Dzikunu is a United Nations award-winning professional with a track record for influencing adolescent health policy and proven strategic communications, grassroots mobilization, coordination, and advocacy skills. He has over five years of professional experience leading successful youth-focused national and international campaigns. Since 2018, Richard has worked with youth groups to develop strategies that integrate digital technologies and data for Universal Health Coverage advocacy.

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