Self-care: The Invisible Glue Holding Healthcare Systems Together
Self-care proved essential during the height of the COVID-19 pandemic, when millions of people around the world took testing and their health into their own hands to ease the strain on overwhelmed healthcare systems.

BERLIN, Germany — Last week, the World Health Summit in Berlin brought together experts, civil society, politicians, and international organizations from around the world to brainstorm solutions to the many threats facing healthcare systems today. 

Climate change, the looming health workforce crisis, and the increasingly distant goal of universal health coverage were all on the agenda. Panels and plenaries debated solutions like artificial intelligence, innovative financing mechanisms for global health, and the use of pharmaceutical innovation and digital technologies to further equity.

Yet the oldest solution in the book, self-care, received little attention. A panel organized by the Global Self-Care Federation (GSCF) and the World Health Organization (WHO), in a small conference room on the outskirts of the summit, was the only event to make it a focus.

That needs to change. Amid a widening health workforce crisis and a lack of universal health coverage for half the world, a broad alliance of public and private stakeholders are urging governments to recognize and develop self-care as a critical component of health systems. Their call is backed by a new joint statement on self-care launched at a World Health Summit, and signed by the WHO and three other UN agencies.

Formal care is only the tip of the iceberg

The global and economic value of self-care in data.

“When I think about the whole health continuum, I see an iceberg,” said Jurate Svarcaite, Director-General of the Association of the European Self-Care Industry, speaking on the panel. “The formal health system is what you see above the water, and self-care is what’s under. This invisible part of the iceberg is very difficult to visualize until you have the figures – and the numbers are really staggering.”

The self-care that people provide themselves and their families is essential to keeping even the most advanced healthcare systems afloat. Without it, the EU would need an additional 120,000 GPs, at a cost of $34 billion per year. Self-care allows physicians to focus on acute care by saving them nearly 1.8 billion hours per year globally, according to GSCF, a non-profit based in Geneva.

The impact of self-care in supporting health systems has grown significantly over the past 50 years and is set to accelerate further as over-the-counter pharmaceuticals become increasingly sophisticated, safe, and effective. 

Advances in over-the-counter medicines mean pharmacists can now empower patients by providing advice and treatment for a wide range of minor illnesses, such as coughs, colds, and skin conditions. This can help to reduce the burden on GPs and hospitals.

“Even in countries that have well-equipped and well-resourced health systems, I’ve never heard of a health system saying they have too many resources or too many healthcare professionals,” said Goncalo Sousa Pinto, Lead for Practice and Developmental Transformation at the International Pharmaceutical Federation.

“It is impossible to have sustainable health systems unless you revamp and you really invest in and strengthen primary health care – and self-care is really a way of responding to that challenge,” said Pinto. “It’s about prevention, it’s about early diagnosis, and it’s about reducing pressure on health systems so that patients that require more time in their health system can benefit from high-quality care.”

Self-care savings 

The COVID-19 pandemic demonstrated the essentiality of self-care in times of crisis. Healthcare systems would have collapsed, not just struggled, if millions of people around the world had not taken matters into their own hands.

“COVID really dropped the pin – all of us had to self-care,” said Svarcaite. “We were asked to stay home if we were sick, even if we caught COVID we just had to go to the pharmacy to get paracetamol for whatever symptoms we were feeling.” 

“We had to try not to go into the formal health system because it was caring for really, really sick people that needed the full attention of healthcare professionals,” Svarcaite added.

Self-care, enabled by enhanced health literacy, over-the-counter medicines, devices, and preventive care, can enable people to manage their health conditions and improve their productivity by up to 40.8 billion days globally, she said, referring to a 2022 report on self-care’s social and economic value. It is also often the only option for the nearly 4 billion people who do not have access to essential health services.

“There was not one country which had its health system saying ‘Hooray! We are ready, we can do the COVID, bring us more,’” said Svarcaite. “All health systems struggled, and it just shows that self-care is part of health system resilience.”

Self-care is not new, but it presents one of the highest impact ceilings and cost-benefit ratios to deal with some of the most intractable health problems of the future, such as climate change, conflict, displacement, and the health workforce crisis.

“We need to find new ways to deliver health and healthcare services,” Bente Mikkelsen, director of Noncommunicable Diseases at WHO, earlier told another World Health Summit panel focusing on the healthcare workforce. “For me, that can be the recommendation of self-care information.”

Self-care: A lifeline for sexual and reproductive health

Inequalities continue to be a fundamental challenge to global efforts to achieve universal health coverage, particularly for sexual and reproductive health and rights, according to the UN joint statement.

“Nowhere is the need for self-care more urgent than in sexual and reproductive health, where inequalities run deep,” said Dr Pascale Allotey, Director of WHO’s Department of Sexual and Reproductive Health and Research. 

Nearly 800 women die every day from preventable causes related to pregnancy and childbirth. 164 million women of reproductive age worldwide have an unmet need for contraception, one in three face sexual violence in their lifetimes, and over 1 million newly sexually transmitted infections are acquired every day. 

Self-care interventions, such as self-testing for pregnancy diagnosis, self-sampling for HPV and other infections, and self-management of medical abortion, can help to reduce these inequalities and empower women to make informed and independent choices.

“In so many places around the world, pregnancy self-tests are not available,” said Dr Manjuula Narasimhan, who leads WHO’s Sexual Health and Well-Being Unit. “If it’s not available at the pharmacy, it’s not available to that adolescent young girl asking ‘Am I pregnant? How do I find out?’”

WHO’s Sexual Health and Well-Being Unit Dr Manjuula Narasimhan speaks at the World Health Summit.

Pregnancy self-tests are a common and accessible means of contraception in high-income countries, but they are often unavailable or inaccessible to women in low-income countries. This can pose a significant barrier to women’s health and well-being, as early knowledge of pregnancy is essential for accessing timely and appropriate care.

In many low-income countries, pregnancy self-tests are not available in pharmacies or other retail outlets. They may only be available through health facilities, which can be difficult or impossible to reach for women who live in remote areas or who face stigma or discrimination.

“If the only way she can find out is to go to a clinic and do a blood test — likely in the local clinic where everybody knows her, and are wondering why she’s coming in — then that is a problem of equity,” said Narasimhan. “It is a problem of people having that ability, that agency, to be able to make informed decisions about their health.”

Health literacy: an essential pillar of self-care

The impact of self-care in supporting health systems has grown significantly over the past 50 years and is set to accelerate further as over-the-counter pharmaceuticals become increasingly sophisticated, safe, and effective.

Self-care can reduce the burden on healthcare providers. But self-care can only be effective when health literacy is well-integrated into health system strategies.

“Self-care is intrinsically patient-centric,” said Pinto. “But for these interventions by patients to be effective and to be the best options for patients, the pillar of health literacy and self-care literacy needs to be there. 

But health literacy is more than handing out pamphlets. It requires tailored awareness campaigns targeting the needs of local populations.

“Literacy is not just giving up a pamphlet and a brochure that they can read and many populations actually can’t read either,” said Dr Téa Collins, Platform Lead for Global NCDs at the WHO. “We need to be aware of the diversity of countries and the diversity of healthcare systems, knowing they are not all equipped to do things a certain way.

“There are also very different value systems because in different cultures there are different ways of managing health and disease,” Collins added. “We need to really consider and be culturally sensitive.”

A paradigm shift

Self-care panel underway at the World Health Summit in Berlin.

A shift towards self-care would require a paradigm shift in modern health systems, which are still largely based on top-down approaches to patient care.

“When we are talking about the medical model of care, particularly for those of us trained in this system, we are still gravitating towards this top-down approach,” said Collins.

A shift towards self-care would require a more collaborative approach to healthcare, with patients and healthcare providers working together to develop and implement care plans that are tailored to individual needs. It would also require a greater investment in health literacy and self-care literacy programs.

Self-care is not a magic bullet, but it is a critical part of the solution to the health workforce crisis and the broader challenges facing healthcare systems today.

A new joint UN statement recognizes the potential of self-care

The joint statement was issued at the World Health Summit by the World Health Organization and three other UN agencies.

As a next step, GSCF and its partners are calling on the World Health Assembly to adopt a resolution on self-care. The adoption of such a resolution would be a landmark moment for the advancement of self-care as a pillar of health systems.

“Self-care is an indispensable solution for realising Universal Health Coverage by 2030 and should be integrated into future health and economic policy, with a focus on affordability and access,” said Judy Stenmark, head of GSCF, which has been working in collaboration with WHO to advance self-care in policy agendas.

“A WHO Resolution on Self-Care would provide a comprehensive framework for governments, stakeholders, and the international community to strengthen self-care policies and interventions and would put us on a pathway to better health, well-being, and sustainable development,”  Stenmark noted.

The joint statement, released at the World Health Summit by WHO, the United Nations Development Programme (UNDP), the UN Population Fund (UNFPA) and the World Bank, outlines five priority areas for strategic investment and coordination, including:

  • Financing: We must implement innovative funding models that reduce costs, enhance efficiency, and build a more equitable system.
  • Expanding the health workforce: We need to expand the competencies of the health workforce to provide user-centred self-care options as part of high-quality primary care.
  • Fostering broad-based political will: We need to foster broad-based political will and accountability for integrating self-care across policies, programs, and sectors.
  • Strengthening regulatory systems: We need to strengthen regulatory systems to assure the safety and quality of self-care interventions.
  • Generating robust evidence: We need to generate robust evidence on the health economics and social impacts of self-care while respecting patient preferences.

“The statement represents a watershed moment,” said Allotey. “We really, really have a lot of work to do.”

Image Credits: Annie Spratt, CC.

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