Key Messages:

At least 400 million people worldwide lack access to the most essential health services, and every year 100 million people are plunged into poverty because they have to pay for health care out of their own pockets. At the same time, new diagnostics, devices, drugs and digital innovations are transforming how people interact with the health sector.

There is an urgent need to find innovative strategies that go beyond the conventional health sector response.

Self care is “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health-care provider”.

The scope of self care in this definition includes

• health promotion;
• disease prevention and control;
• self medication;
• providing care to dependent persons;
• seeking hospital/specialist care if necessary; and
• rehabilitation, including palliative care.

Self-care interventions represent a significant push towards new and greater self-efficacy, autonomy and engagement in health for self-carers and caregivers. They could expand access to health services, including for vulnerable populations. People are increasingly active participants in their own health care and have a right to a greater choice of interventions that meets their needs across their lifetime, but also should be able to access, control, and have affordable options to manage their health and well-being.

Self-care interventions are a complementary approach to health care that forms an important part of the health system. Self care is also a means for people who are negatively affected by gender, political, cultural and power dynamics including those who are forcibly displaced, to have access to health services.

Promoting a safe and supportive enabling environment in which they can access and use health interventions when and where they choose to, improves autonomy and helps improve the health and well-being of these vulnerable and marginalized people.

The importance of self-care interventions for health policy, financing and systems has thus far been undervalued and its potential not fully acknowledged, despite the fact that people have been practicing self care for millennia.

Although self-initiated often means self-financed, there are promising indications that self-care could reduce indirect user/patient costs, and the risk of household financial distress. For self-care interventions to be sustainably financed, a combination of government subsidies, private financing, insurance coverage and partial out-of-pocket payments will need to be considered, based on need and ability-to-pay. Ultimately, the health system remains accountable for their outcomes, and should closely monitor their economic consequences for households and governments.

Self-care interventions offer strategies that promote active participation of
individuals in their health and an exciting way forward to reach a range of improved outcomes, including:

• increased coverage and access;
• reduced health disparities and increased equity;
• increased quality of services;
• improved health, human rights and social outcomes; and
• reduced cost and more efficient use of health-care resources and services. 

For most self-care interventions to remain safe and enhance access, health systems will need to provide different levels of targeted support. If not, self-care interventions may promote fragmented, consumerist approaches and undermine person-centred healthcare. While efficiency is an important objective of any health system, equity must be integral to the economic assessment of self-care, in terms of costs, benefits and financing. Globally, the social geography of illness is increasingly the social geography of deprivation.

There is a compelling argument for self-care as part of an integrated health system, allowing those who can manage their health to do so, while focusing health system resources on those who most need help – and who health systems are still failing.

Useful Links:

Link to related WHO news release:

https://www.who.int/news-room/feature-stories/detail/expanding-access-to-health-services-with-self-care-interventions

Link to Question-Answer on Self-care:

https://www.who.int/reproductivehealth/self-care-interventions/questions-answers-self-care.pdf?ua=1

Link to BMJ supplement on Self-care (Open Access) [The focus is on Sexual and Reproductive Health, though]:

https://www.bmj.com/selfcare-srhr

Link to ‘Self care for Health’ document by WHO SEARO (English) [PDF]:

Click to access B5084.pdf