There’s more to self-care than scented candles or massages, it’s a key public health tool 

person doing at-home covid test
Self-care in public health means giving people good quality testing tools and medicines to manage their health.

By Tian Johnson, founder and strategist of the health advocacy non-profit African Alliance

There’s a new “It Girl” in the world of public health, and her name is “self-care”. This type of self-care is not about scented candles or massages. It’s about something far more radical: giving young people the power to protect and improve their own health without the help of health workers, according to the World Health Organisation (WHO). 

In practice, it means giving young people good quality testing tools and medicines, and then teaching them how to use them to manage their health. If you’ve ever used a self-test for HIV at home, you were practising self-care (the public health version). The pee-stick pregnancy test is another example. 

It’s not a completely novel concept. The WHO has used the term “self-care” since the 1980s. And women have, of course, been managing various aspects of their own health, and that of their loved ones for decades. 

What is new, though, is a sense of urgency among health advocates and international agencies that young people need self-care options. And they need it now. 

According to a joint statement by five of the world’s biggest development bodies (among them the World Bank and the United Nations Population Fund), self-care options could help governments improve their primary health care services. It could also ensure that young people get the care they need without putting their finances in danger. This goal is also called “universal health coverage” or UHC. 

Speaking of UHC, heads of state gathered in New York City late last year to gauge how close the world is to delivering free high quality health services for everyone. The results were horrific.  Most of the major goals from the 2019 meeting were missed. 

More people are bankrupting themselves to pay for emergency health care than in 2015. 

Governments also failed to get universal health coverage to 532 million more young people by the end of 2023. This deadline has now been pushed to 2027. 

These failures only make self-care options more urgent for public health. The work for self-care, captured in a series of reports by the pan africanist health rights NGO, the African Alliance, continues in communities around the continent. 

Here’s everything you need to know about this revolutionary public health trend.  

How does self-care help health systems? 

Self-care is not supposed to replace clinics and hospitals. 

There will always be instances that call for a trained team of health workers, but some of the simpler tasks are safe for young people to do themselves. Giving yourself a three-month contraceptive injection is one such example. 

It’s especially useful in countries where there aren’t enough doctors and nurses around, because it frees up health workers to help more young people. Cash strapped health systems are already shifting some tasks onto community health workers, but more hands are still needed. 

Self-care can also protect health systems from the dangers of public emergencies or humanitarian crises because young people won’t be as reliant on traditional clinics and hospitals for their everyday needs. 

How does self-care help patients? 

Self-care health tools can help young people who may otherwise face discrimination from health workers (say because their sexuality is not widely accepted).

Young people’s health suffers when they avoid clinics because they’re worried that they’ll be treated badly. The fear of judgement by health workers or fellow patients may result in someone letting an infection or illness go untreated, or they may avoid asking for preventive medicines such as contraception or HIV prevention pills. 

That’s why the WHO’s guidelines on self-care say the policy has the most benefits for groups that have a tough time in the clinics. These include young people who use, sex workers, young people with disabilities, survivors of abuse and migrants. 

Adolescent girls and young women also have a lot to gain since it can be difficult for them to get the contraception they need without judgement from older young people. 

Plus, young young people are just much happier when they have the agency to look after themselves. 

How do we know self-care is safe?

Young people may opt to get their self-care tools away from health facilities. So there is a chance that they could be offered tests, drugs or medical devices that haven’t been proven safe by a medicines regulator.

This is why health education will also be an important part of rolling out self-care widely. 

But beyond that, there’s growing evidence to show that young people are good at looking after themselves if they’re given the chance, and with the proper support from health workers. 

In Malaysia, for instance, a non-profit rolled out a pilot project that let women screen themselves for cervical cancer. That country was battling to find young people who may need cancer treatment because they were often too ashamed to go to a clinic. 

They would take the swab themselves, drop the sample off, get an SMS when their results are in, alongside information about where to get help if they test positive. Such tests only help if they lead to young people doing something about the results. 

The Malaysian project did just that. 

Just under 90% of the 4,000 women who participated in the study (who tested positive for cancer) went for a follow-up appointment at a clinic. They also told researchers that the home test is far more comfortable than the in-clinic option, and that they’d be happy to do it again. — Additional reporting by Joan van Dyk. 


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