{"id":5212,"date":"2020-10-01T18:33:17","date_gmt":"2020-10-01T18:33:17","guid":{"rendered":"https:\/\/kmtraining.org\/recap-of-webinar-on-reimagining-method-choice-in-the-era-of-self-care\/"},"modified":"2020-10-01T18:33:17","modified_gmt":"2020-10-01T18:33:17","slug":"recap-of-webinar-on-reimagining-method-choice-in-the-era-of-self-care","status":"publish","type":"post","link":"https:\/\/kmtraining.org\/fr\/recap-of-webinar-on-reimagining-method-choice-in-the-era-of-self-care\/","title":{"rendered":"Recap of Webinar on “Reimagining Method Choice in the Era of Self-Care”"},"content":{"rendered":"
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Particularly in the era of the COVID-19 pandemic, self-care has become more prominent in all areas of health care. For voluntary family planning, self-care means emphasizing contraceptive methods that are controlled and self-administered by women themselves. At the same time, not all methods are adaptable to self-care, and it is equally important that the voluntary family planning and reproductive health (FP\/RH) community ensure women and couples have a diverse choice of methods. Method choice ensures that they can make decisions about family planning that are voluntary, client-centered, informed, and supported.<\/p>\n

The \u201cReimagining Method Choice in the Era of Self-Care\u201d webinar examined the many ways in which self-care and method choice relate. Presenters shared country-level implementation examples and discussed recent innovations in products and practices that allow women and girls to have more active participation in their health.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n

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Watch Now: 3:38<\/a> – 8:30<\/p>\n<\/div>

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Introduction to Self-Care and Method Choice<\/h3>\n\n\t\t<\/div>\n\t<\/div>\n
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Patricia MacDonald, RN, MPH, Senior Family Planning\/Reproductive Health Technical Advisor at the Office of Population and Reproductive Health, USAID<\/span><\/p>\n\n\t\t<\/div>\n\t<\/div>\n

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Method choice in the context of self-care<\/h4><\/i><\/div>

Overall, women and couples have a broad choice of methods, many of which are women-controlled and self-administered\u2014for example, the Caya Diaphragm, vaginal rings, condoms, pills, and fertility awareness methods. In addition, technology has evolved for other existing methods\u2014for example, the DMPA-SC subcutaneous injection, also known as Sayana Press, which women in many countries can now self-inject. Not only can these methods be self-administered, but women can also obtain them through multiple delivery channels (for example, drug shops) that do not require a visit to a health facility. For some methods, multiple units\/packets can be supplied at one time, reducing the need for multiple contacts with health facilities or drug shops.<\/p>\n<\/div><\/div>

Self-care in the context of method choice<\/h4><\/i><\/div>

If we shift the context to method choice and show how self-care fits within that, we have a different perspective\u2014one in which all contraceptive methods have elements of self-care, even if they are not self-administered, but are provider dependent (for example, implants, IUDs, vasectomy, and tubal ligation). To understand this further, we can examine the Circle of Care Model<\/a>.<\/p>\n<\/div><\/div>

The Circle of Care Model<\/h4><\/i><\/div>

This model illustrates the connections between social and behavior change and service delivery\u2014and can help us find ways in which we can support self-care before, during, and after a healthcare visit. Self-care provides support \u201cbefore\u201d as clients seek information about contraception and take action to seek care. In the \u201cduring\u201d phase of self-care\u2014this can mean clients having the confidence during a healthcare visit to ask questions and ensure they are presented with the choice of methods that best fits with their own needs. Self-care \u201cafter\u201d care can include things like wound care, checking IUD strings, and seeking care from a provider when needed. Self-care also challenges the health system and health providers to help empower clients to choose a contraceptive method that meets their needs.<\/p>\n

\"Circle

The \u201cCircle of Care Model\u201d demonstrates social and behavior change along the service delivery continuum. (Source: Health Communication Capacity Collaborative, 2017)<\/p><\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div>

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Watch Now: 8:30<\/a> – 28:00<\/p>\n<\/div>

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Reimagining Method Choice in the Era of Self-Care<\/h3>\n\n\t\t<\/div>\n\t<\/div>\n
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Martha Brady, MS, Director of Sexual and Reproductive Health at PATH, who will leverage her work leading a global team of researchers and implementers to share the latest on self-care products and practices.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n

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What is self-care?<\/h4><\/i><\/div>

\u201cSelf care is the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a health-care provider.\u201d The scope of self-care is broad\u2014it includes health promotion, disease prevention and control, self-medication, providing care to others, seeking specialist care when needed, and rehabilitation\/palliative care. WHO published guidelines on self-care in the context of reproductive health<\/a> in 2019.<\/p>\n<\/div><\/div>

Emerging realities<\/h4><\/i><\/div>

While self-care is not a new concept, we are seeing growth in products and platforms that make self-care more feasible, well as healthier and safer. Self care has become more sophisticated and data-driven, which has led to more specialized, individualized medicine. There are now more digital solutions that help people access knowledge and resources and determine how to engage with self-care products and practices. When people are active participants in their own healthcare, with the use of digital self-management tools, their outcomes improve.<\/p>\n<\/div><\/div>

FP\/RH products and practices<\/h4><\/i><\/div>

FP\/RH products and practices include: self-administration of injectable contraception (DMPA-SC), HPV self-sampling for cervical cancer screening, over-the-counter provision of oral contraceptive pills, home ovulation prediction kits for fertility management, self-collection of samples for testing for sexually transmitted infections (STIs), HIV self-testing, emergency contraception, barrier methods of contraception (diaphragms, condoms), the contraceptive vaginal ring, fertility awareness mobile apps, pregnancy tests, and menstrual supplies.<\/p>\n<\/div><\/div>

What we know about FP\/RH self-care<\/h4><\/i><\/div>

Self care is appealing to many women\u2014particularly young women. We are also learning that self-care requires the knowledge and ability to access resources. Self care can be empowering and can increase autonomy and agency among women. In addition, self-care is linked to task-shifting: As individuals become more involved in their own care, the burden on the health system is reduced. Finally, we are learning of potential ways to link self-care to primary health care.<\/p>\n<\/div><\/div>

What we want to learn more about<\/h4><\/i><\/div>

The Self-Care Trailblazer Group has identified some themes needing more research and evidence\u2014from individual agency to provider behavior, health systems, and cost effectiveness and quality. There are also many questions related to method choice and self-care that are important to learn more about. Some of these questions are:<\/p>\n

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  1. How does self-care affect contraceptive method choice?<\/li>\n
  2. Do women (and men) make different contraceptive choices in the context of self-care?<\/li>\n
  3. What are the opportunities and the risks associated with self-care in terms of quality, cost, and equity?<\/li>\n
  4. What might a \u201cpackage\u201d of self-care interventions look like?<\/li>\n<\/ol>\n<\/div><\/div>

    Making self-care work in the FP\/RH space<\/h4><\/i><\/div>

    We are seeing an elevated interest in self-care, especially in the context of the COVID-19 pandemic. Many people are using telemedicine or digital health applications to find their way into health care, including contraception. Self care can help transform access to contraception, and is also a key component of achieving universal health coverage (UHC) more broadly. However, we need to make sure that self-care is working in harder-to-reach areas. We also need to ensure that self-care is person-centered and values autonomy, while still connecting people with the health system when needed.<\/p>\n<\/div><\/div>\n\t

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    \u201cSelf-care is more than products, technologies, and interventions. It is an approach, a practice, and a growing movement. The self-care movement is building, and this provides a great opportunity for the self-care and the method choice communities to work together.\u201d<\/strong><\/p>\n

    — Martha Brady<\/strong><\/p>\n\n\t\t<\/div>\n\t<\/div>\n<\/div><\/div><\/div><\/div>

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    Watch Now: 28:00<\/a> – 44:40<\/p>\n<\/div>

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    Introducing the Caya Diaphragm in Benin and Niger<\/h3>\n\n\t\t<\/div>\n\t<\/div>\n
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    Dorine Irankunda, MD, Clinical Advisor, PSI<\/p>\n\n\t\t<\/div>\n\t<\/div>\n

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    Quality of care framework<\/h4><\/i><\/div>

    The Caya Diaphragm program is guided by a quality of care approach to self-care. As self-care has become more prevalent and accessible\u2014and as the COVID-19 pandemic has acted as a catalyst for self managing health\u2014we must work to ensure quality of care in all self-care interventions. To help with this, the Self-Care Trailblazer Group<\/a> developed a quality of care framework for self-care to help health systems and clients accessing healthcare on their own. This framework can help programs recognize an individual\u2019s engagement in their own care, while ensuring quality, equity, and accountability.<\/p>\n

    \"Quality

    The \u201cQuality of Care for Self-Care\u201d framework includes 5 domains and 41 standards that can be applied to a broad range of approaches to self-care. (Source: Self-Care Trailblazer Group, 2020)<\/p><\/div>\n<\/div><\/div>

    About the Caya Diaphragm<\/h4><\/i><\/div>

    The Caya Diaphragm is a discreet, woman-initiated, reusable (for up to two years), one-size-fits-most device. It is a non-hormonal method that fits over the cervix to prevent pregnancy. With support from USAID, PATH and its partners developed the Caya Diaphragm through an interactive human-centered design process, which led to several design features that made Caya Diaphragm easy to use, especially for new users.<\/p>\n

    \"Caya

    The Caya Diaphragm is a new barrier method developed by PATH and its partners, with USAID support. (Photo credit: Reproductive Health Supplies Coalition)<\/p><\/div>\n<\/div><\/div>

    The Caya Diaphragm program in Benin and Niger<\/h4><\/i><\/div>

    In Niger, the Caya Diaphragm was presented with Caya gel. In Benin, it is being presented in tandem with cycle beads in some settings\u2014counseling will include the information that women could use cycle beads as a primary method, and Caya during fertile days. This is just being introduced now, but they will share learnings from this approach when available.<\/p>\n<\/div><\/div>

    Caya Diaphragm introduction<\/h4><\/i><\/div>

    To introduce this new contraceptive method, the Expanding Effective Contraceptive Options (EECO)<\/a> Project goes through 5 stages: regulatory assessment; consumer and market research; procurement and quality assurance; marketing, distribution, and service delivery, and monitoring and learning. Niger is at the last stage (monitoring and learning); in Benin, they are at the early stages (will start training soon). The device is being distributed in Niger via the public, private, and community health channels. The Caya Diaphragm program is working to ensure quality of care throughout the client journey\u2014and during all channels\u2014in obtaining the method.<\/p>\n<\/div><\/div>

    Quality improvement<\/h4><\/i><\/div>

    The Caya Diaphragm team completed a mystery study in October 2019 to evaluate the introduction program in Niger. One finding was that some clients were not able to practice insertion with a pelvic model. Also, some providers were not able to offer Caya (not all were trained).<\/p>\n<\/div><\/div>

    Key learnings from Niger<\/h4><\/i><\/div>

    The team has learned that the Caya Diaphragm is highly acceptable in the context of Niger\u2014and seems to fill a gap in the method mix by appealing to women who prefer non-hormonal methods or want a user-controlled method, and\/or have infrequent sex. They have also learned that users have an ongoing need for support as they use this method. Using a new self-care method can be confusing for some women. Ensuring a support system (especially via community health workers) is important to ensure proper use and continuation. Finally, the team has learned that buy-in from key opinion leaders is important for the success of Caya Diaphragm introduction.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div>

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    Watch Now: 45:00<\/a> – 1:01:05<\/p>\n<\/div>

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    Self-Care Through an Ecommerce Platform for Women\u2019s Health & Personal Care in Africa<\/h3>\n\n\t\t<\/div>\n\t<\/div>\n
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    Natacha Mugeni, MSc, Health Coordinator, Kasha Global, Rwanda<\/p>\n\n\t\t<\/div>\n\t<\/div>\n

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    About Kasha Global<\/h4><\/i><\/div>

    Kasha Global<\/a> is a direct-to-consumer platform built for users in low- and middle- income countries. They deliver personal health and self-care products.to urban and rural areas\u2014including hard-to-reach areas. Kasha started in 2016 in Rwanda, and expanded to Kenya in 2018.<\/p>\n<\/div><\/div>

    How Kasha works<\/h4><\/i><\/div>

    People can order and access information about Kasha in a number of ways\u2014via feature phones (internet not required), the Kasha website, a mobile app, or a call center (using call, text, or WhatsApp). Kasha provides a range of products\u2014from pharmaceutical products to personal care products. Related to reproductive health, their products include ovulation tests, pregnancy tests, family planning methods, and menstrual products. They offer free delivery via direct delivery (in urban areas), via pick-up points (in urban and rural points), and via Kasha agents (in urban and rural areas), most of whom are community health workers. Products in discreet packaging, and they offer affordable prices for low- and middle-income communities. Soon, they will be introducing DMPA-SC in Kenya, and are working on a home delivery pilot for ARVs in Rwanda.<\/p>\n<\/div><\/div>

    Access to health providers<\/h4><\/i><\/div>

    Kasha ensures confidentiality and minimizes contact with providers. At the same time, they link clients with providers for remote interactions and counseling sessions when needed. They also provide online live interaction sessions.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div>

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    Watch Now: 1:01:05<\/a>\u00a0– end<\/p>\n<\/div>

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    Question and Answer Session<\/h3>\n\n\t\t<\/div>\n\t<\/div>\n
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    During the last part of the webinar, panelists answered questions from participants. This session was moderated by Eric Ramirez-Ferrero, PhD, MPH, Technical Director of the Evidence to Action Project. Below is a summary of questions and answers (note that these are not actual transcriptions).<\/p>\n\n\t\t<\/div>\n\t<\/div>\n

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    Have there been any changes in government policy as a result of the interest in self-care?<\/h4><\/i><\/div>
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    \"camera\"Watch Now: 1:01:05<\/a> – 1:03:30<\/div>\n<\/div>\n

    Martha Brady:<\/strong> While self-care is not a new concept, programming for self-care is new. We have a few things underway, and a body of work around advocacy, working with a number of countries\u2019 Ministries of Health. This work aims to work with governments to determine how they are defining self-care in their context, and what specific policy advocacy asks there are within that. For example, task shifting to women self-injecting contraception is a clearer ask. There is increasing work on translating clients\u2019 self-care interests with policy makers. There are a number of civil society groups engaged in these self-care consultations at the country level. And regarding monitoring around self-care choices, this is a bold new world, and there are bright opportunities for understanding this as we go forward. It is a work in progress.<\/p>\n<\/div><\/div>

    Has there been any concern by young people in getting packages delivered? Would packages call more attention than going to a drug shop?<\/h4><\/i><\/div>
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    \"camera\"Watch Now: 1:03:30<\/a> – 1:06:25<\/p>\n<\/div>\n<\/div>\n

    Natacha Mugeni:<\/strong> We have pick-up locations at places where youth gather\u2014for example, youth centers or schools. Young people can choose any place for receiving packages, including in their homes or their friends\u2019 homes. We haven\u2019t had many complaints about delivery options. When we started, our users were mostly women. For RH products, at first, older people were most of the clients, as the prices were higher than young people could afford. Since then, we have partnered with the Packard Foundation to subsidize products in Rwanda\u2014young people have a coupon code. The coupon code is shared through youth ambassadors and youth centers\u2014so young people now only pay 10-20% of the cost. In general, subsidization has been key in driving young people to our platforms for RH products.<\/p>\n<\/div><\/div>

    How do men fit into self-care? And do you have male users of the products at Kasha Global?<\/h4><\/i><\/div>
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    \"camera\"Watch Now: 1:06:25<\/a> – 1:08:26<\/div>\n<\/div>\n

    Martha Brady:<\/strong> Men can be users of self-care\u2014it\u2019s not an exclusive domain of women. For example, many men are using HIV self testing. Is there something different about self-care that men will or won\u2019t approve of? We don\u2019t know, but this is an area that needs to be explored more, so we can understand how partners of a female self-care partner would feel about self-care.<\/p>\n

    Natacha Mugeni:<\/strong> We do have a number of male users. Most purchase condoms. Male condoms are the most popular in Kenya, and men often purchase them. Men also purchase lubricants through our company.<\/p>\n<\/div><\/div>

    What are the contraindications and side effects of the Caya Diaphragm?<\/h4><\/i><\/div>
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    \"camera\"Watch Now: 1:08:26<\/a> – 1:09:26<\/div>\n<\/div>\n

    Dorine Irankunda:<\/strong> The Caya Diaphragm is a barrier method. There is no hormone in the device, so there are really no contraindications or side effects. It can be used safely by everyone. But we always highlight the fact that it doesn\u2019t protect against HIV, so women should use additional protection (condom) if there is a risk for HIV.<\/p>\n<\/div><\/div>

    How do we envision that FP self-care can be integrated with other types of self-care for self-care packages?<\/h4><\/i><\/div>
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    Martha Brady:<\/strong> There are discussions around self-care packages in some countries. Contraception would be in this package. But some of this depends on how countries articulate self-care in their context\u2014what do they mean by \u201cself-care,\u201d and what do they want to include in that? This is driven by context, and the trailblazers group is working on this.<\/p>\n<\/div><\/div>

    It is interesting that many Kasha agents are community health workers (CHWs). Do they leave their roles as CHWs to devote themselves to Kasha more?<\/h4><\/i><\/div>
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    \"camera\"Watch Now: 1:11:10<\/a> – 1:12:06<\/div>\n<\/div>\n

    Natasha Mugeni:<\/strong> Being a Kasha agent is not a full-time job, and is on commission basis. They don\u2019t leave their CHW jobs, but this is something that gives them an advantage and opportunity to reach more people in the community. They show people how to communicate and use the Kasha platform, but it isn\u2019t their full-time job.<\/p>\n<\/div><\/div>

    What type of monitoring of clients and evaluating their method of choice is done? In other words, how are we doing monitoring and evaluation in terms of self-care?<\/h4><\/i><\/div>
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    \"camera\"Watch Now: 1:12:06<\/a> – 1:13:20<\/div>\n<\/div>\n

    Martha:<\/strong> In order to monitor and evaluate clients on self-care, we need to have an active program on this topic. We\u2019re still new to this, but we do need to have M&E built into country work as they go forward with self-care so we can learn more about these self-care interventions.<\/p>\n<\/div><\/div>

    Natacha mentioned linking pharmacists to physicians if prescriptions are needed. Do you have more plans to link your program up with health services\u2014clinics, etc?<\/h4><\/i><\/div>
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    \"camera\"Watch Now: 1:13:20<\/a> – 1:15:05<\/p>\n<\/div>\n<\/div>\n

    Natacha Mugeni:<\/strong> We have a nurse in-house now, as well as a digital tool. We also have a forum where women can go and discuss side effects, learn about contraceptive choices, and share experiences. This is now live in Kenya, and will expand into Rwanda. And we want to expand referrals to others\u2014beyond doctors and clinics, we often get requests for lawyers and other professionals\u2014so we want to make sure our platform is as useful as possible.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div>

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    Selected tools and resources mentioned during the session:<\/h2>\n\n\t\t<\/div>\n\t<\/div>\n
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