The Alliance, funded by Aidsfonds, conducted a series of policy analyses for the five countries above to better understand why self-care is critical to improve the sexual and reproductive health and rights (SRHR) and achieve Universal Health Coverage (UHC).
Kenya
Zambia
Tanzania
Uganda
Malawi
Prior to diving into the qualitative research, the reports from each country covers HIV numbers, age of consent, access to contraception, access to abortion, and criminalisation of LGBTQIA+ people – and what this all means from policy to practice.
The analyses assessed the policy landscape; lived experiences around UHC, SRHR and self-care; and the current limitations adolescent and young person’s (AYP) face in accessing the services they need – and used this process to develop a set of country-specific advocacy messages for partners in the five countries to take forward in the run-up to the HLM.
The HLM is the United Nations High-Level Meeting of governments, which happened in September 2023 in New York. Only the second HLM meeting on UHC, they met to agree on new commitments to realise UHC by 2030. In 2019, during the first-ever HLM on UHC, an ambitious Political Declaration was adopted to guide countries in their efforts to reform health systems, increase funding for health, and address barriers that prevent people from receiving the health services they need.
The COVID-19 pandemic demonstrated the devastating impact of weak health systems, underinvestment, and harmful policies and laws that prevent vulnerable, marginalised and stigmatised populations from taking care of their health.
This new HLM is critical to get world leaders back on track and agree on the need to invest in long-term, sustainable responses to ensure life-saving health services are guaranteed for everyone. In addition, there needs to be a continued push for sociocultural and economic change; intersectional, human-rights based and gender-inclusive approaches to health; inclusive engagement of civil society in the development, implementation and monitoring of health policies and funding; and empowering and equipping people to meet their own health needs, including through scaling up self-care interventions for realising sexual and reproductive health and rights (SRHR).
Self-care has never been more relevant than during the COVID-19 pandemic, where, globally, public health systems failed to meet the demands and needs of citizens. Governments increasingly stepped up self-care and digital health interventions to reduce the burden on public health systems and give people choices to access the services they need despite COVID-19- related service restrictions.
Solutions such as HIV self-testing, self-sampling for sexually transmitted diseases (STIs) and digital health information offer new options for people who are unable or willing to access clinic-based services. This is not just due to COVID-19-related limitations but also poverty, gender-based violence (GBV), (dis)ability and other vulnerabilities, as well as a lack of privacy and the related fear of stigma and discrimination that prevent adolescents and young people (AYP) in particular from accessing sexual and reproductive health (SRH) services in public clinics.
Self-care provides a crucial contribution to realising UHC, where UHC is defined by the World Health Organization (WHO) as all people having access to the health services they need, when and where they need them, without falling into financial hardship. The “where and when they need them” is the very essence of self-care, where this approach means people are not dependent on the availability of doctors, nurses or the capacity or accessibility of health clinics for all of their health needs. It also increases people’s autonomy, choice, and power in relation to their health.
For this reason, the partner organisations implementing the YouthWise and YouthCare projects in Malawi, Uganda, Kenya, Tanzania and Zambia are advocating for governments to commit to scaling up self-care in the 2023 UHC Political Declaration as a crucial component of health systems strengthening; self-care services and commodities must be included in national UHC plans and budgets.