{"id":4931,"date":"2020-03-30T19:35:19","date_gmt":"2020-03-30T19:35:19","guid":{"rendered":"https:\/\/kmtraining.org\/fr\/acceleration-of-self-care-in-the-time-of-covid-19\/"},"modified":"2020-03-30T19:35:19","modified_gmt":"2020-03-30T19:35:19","slug":"acceleration-of-self-care-in-the-time-of-covid-19","status":"publish","type":"post","link":"https:\/\/kmtraining.org\/fr\/acceleration-of-self-care-in-the-time-of-covid-19\/","title":{"rendered":"Acceleration of Self-Care in the Time of COVID-19"},"content":{"rendered":"
\n\t
\n\t\t
\n\t\t\t

This article, co-authored by partners at\u00a0PSI<\/em><\/a>\u00a0and\u00a0<\/em>Jhpiego,\u00a0<\/em><\/a>\u00a0explores the important issue of self-care in the context of the COVID-19 pandemic.<\/i><\/p>\n\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><\/div><\/div>

\n\t
\n\t\t
\n\t\t\t

What is the context?<\/i><\/h3>\n

The need for fundamental transformation in our health systems has never been more apparent. Already the world faces a shortage of 13 million health workers<\/a>. Now, in the context of COVID-19, our dependencies on a stretched health workforce are brought to the fore, demanding creative, urgent, and difficult solutions.<\/p>\n

People are asked to steer clear of COVID-19 hotspots such as hospitals and clinics, to use telemedicine or hotlines where they exist, to self-diagnose using symptom guidelines, and to self-medicate. Preventative and curative care jostle together, both equally important, both challenged to be delivered in tandem. World over, millions volunteered almost overnight to support continuity of health services, with clinicians coming out of retirement, and others lending their non-clinical expertise and labor. At individual, community, and health system levels, we are witnessing an overnight transformation in how people use and organize healthcare.
\n[ss_click_to_tweet tweet=”For COVID-19, self-care requires a carefully choreographed set of interactions between health workers and individuals to enable people to take greater control over their healthcare.” content=”For COVID-19, self-care requires a carefully choreographed set of interactions between health workers and individuals to enable people to take greater control over their healthcare.<\/strong><\/em>” style=”default”]
\nAs COVID-19 moved from outbreak to epidemic and now pandemic, and with the significant possibility that for the next 18 months we see episodic outbreaks of COVID-19, one immediate need\u2014and potentially lasting health system transformation\u2014will be learning what services and information can be provided with less dependency on health workers.<\/p>\n

These measures are both to protect heroic frontline health workers, but also to ensure the most effective healthcare can be provided at scale. In this context, self-care is not only occurring, but has rapidly become a critical answer in the health system response to COVID-19.<\/p>\n

What is self-care?<\/i><\/h3>\n

For the uninitiated, the World Health Organization (WHO) defines self-care<\/a> as \u201cthe 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 healthcare provider<\/b>,\u201d <\/em>and add in subsequent publications that “self-care interventions are among the most promising and exciting new approaches to improve health and well-being, both from a health systems perspective and for people who use these interventions.\u201d<\/em><\/p>\n\n\t\t<\/div>\n\t<\/div>\n\n\t

\n\t\t

Figure 1. Self-care in the context of interventions linked to health systems.<\/h2>\n\t\t
\n\t\t\t
<\/div>
<\/figcaption>\n\t\t<\/figure>\n\t<\/div>\n\n\t
\n\t\t
\n\t\t\t

Prior to COVID-19, self-care was already increasing in relevance for health systems. This is not self-care focused on general physical and mental wellness, although self-care does incorporate those broader and important considerations.\u00a0 This is self-care in the form of drugs, diagnostics, devices, and digital health, that\u2014paired with growing demand by individuals for participation in their healthcare\u2014has led to a greater configuration of self-led health care possibilities than ever before. Information, products, and services previously requiring the full participation of health workers have seen individuals take greater responsibility for their health care. Examples of this abound across the range of self-management, self-testing, and self-awareness (see Figure 1).<\/p>\n

Prior to the outbreak of COVID-19, health systems from Uganda and Nigeria were working on plans to take the 2019 WHO Consolidated Guideline for Self-Care Interventions in Health for Sexual and Reproductive Health and Rights<\/a> and other self-care interventions to scale. This specific WHO guideline recognizes that many evidence-based practices within the SRHR space could be promoted to enhance self-care, and recommends measures such as HIV self-testing, HPV self-sampling, and self-administered injectable contraception all be available at scale.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n\n\t

\n\t\t\n\t\t
\n\t\t\t
<\/div>
<\/figcaption>\n\t\t<\/figure>\n\t<\/div>\n\n\t
\n\t\t
\n\t\t\t

Why is self-care important in the context of COVID-19?<\/i><\/h3>\n

Within a COVID-19 response, self-care is how we help one another, and what keeps our health systems from complete collapse. It appears in our efforts to self-screen through AI-powered websites<\/a> where we check how common our symptoms are in relation to COVID-19, or in those WHO WhatsApp alerts<\/a> used to self-educate. It\u2019s the promise of home self-testing (tantalizingly close), and all we do to care for ourselves and our household when someone falls ill.<\/p>\n

This sudden and rapid reliance on self-care isn\u2019t how we imagined it\u2014haphazard and driven out of crisis rather than thoughtful health system design. There will be people now managing their health in ways that they should not, cannot, be expected to do alone. In this messiness exist dangers and pitfalls, such as the general public and physicians purchasing and using chloroquine and hydroxychloroquine after recent reports suggested they may be able to treat COVID-19, but with insufficient evidence or reflection on the consequences. The safeguards (financial protection, safe and quality care, adequate support from a health worker when needed) have not been fully established.<\/p>\n

But crises don\u2019t wait for us to get it right, as much as they reveal how previously we could have done things differently, better. This leaves us in a transitional moment, where the rapid transformation happening cannot be ignored. Within the lens of outbreak response itself, self-care plays an important function. Self-care will also remain important for the many healthcare needs that carry on regardless of COVID-19. And it will play a critical role in the health systems that exist once the pandemic has subsided.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n\n\t

\n\t\t\n\t\t
\n\t\t\t
<\/div>
<\/figcaption>\n\t\t<\/figure>\n\t<\/div>\n\n\t
\n\t\t
\n\t\t\t

What does advancing self-care look like?<\/i><\/h3>\n

Self-care can mean better, more accessible, participatory, affordable, quality healthcare. In the case of the emergency contraceptive pill or acetaminophen when available over the counter, such self-care will require minimal or no interaction with a health worker. However, frequently, for COVID-19 and many health interventions, self-care requires a carefully choreographed set of interactions between health workers and individuals to enable people to take greater control over their healthcare.<\/p>\n

As the WHO guidelines also highlight, self-care is not a binary phenomenon of healthcare worker versus person-led healthcare, rather it\u2019s far more dynamic. For example, the HIV self-test may be taken alone but requires referral into the health system for result verification and treatment, if needed. HPV DNA self-sampling allows a woman the control and privacy to collect her own specimens for screening for cervical cancer, but the health system will review the results and assist clients to interpret and act on them, including treatment when applicable. Self-injected DMPA-SC and oral PrEP for HIV prevention might require an initial contact with a pharmacist, clinician, or lay health worker, but are largely used autonomously thereafter\u2014with support provided at intervals to counsel through any adverse effects and adapt regimens or switch methods as needed. The nature of these interactions will vary by intervention, by population, and across people\u2019s lifetimes.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n\n\t

\n\t\t\n\t\t
\n\t\t\t
<\/div>
<\/figcaption>\n\t\t<\/figure>\n\t<\/div>\n\n\t
\n\t\t
\n\t\t\t

What can we do?<\/i><\/h3>\n

During the COVID-19 outbreak and beyond, a health system that optimized self-care would therefore consider the following:<\/p>\n