Until the next International Self-Care Day

An annual opportunity to put a spotlight on the benefits of self-care.

Bringing health policy forwards: making self-care an integral part of healthcare

In order to have a better healthcare future, we need to make an active shift towards new ideas and new ways of thinking.

Health policy can no longer be considered as an isolated, standalone entity. Social, economic, financial and innovation policy all directly impact the health of a population. And the inverse is also true – health policy can impact other policies.

In the current healthcare paradigm, self-care is still not perceived as an essential pillar of a comprehensive healthcare system. Accordingly, we see a lack of targeted policy measures that provide incentives at an individual or collective level to promote self-care as an integral part of healthcare.

Health for all needs to be reframed as a public policy objective by all governments and representative bodies, and we should strive to ensure that national and global economies and finance are structured in such a way to deliver on this ambitious goal. Investment in local and global health systems is an investment in the future, not a short-term cost.

The Covid-19 pandemic has fundamentally changed the outlook of the healthcare landscape as we know it, as well as the roles of the stakeholders involved. Two and a half years ago, we were scrambling to fund training for doctors and medical professionals on the differences between antibody and antigen testing. Today, our grandparents are well-versed in the nuances of lateral flow testing compared with PCR tests.

We saw that lockdown conditions demonstrate very clearly that with the right access to the right information, advice where needed, and the availability of quality products, patients were extremely capable of self-evaluation, self-triage, and self-care.

We need to invest for health
Health is a fundamental right. It cannot simply be considered an expenditure. Health is an investment. A healthy population must be the goal of economic activity.

There is a direct correlation that is accepted between health expenditure and GDP. Health for all has been defined as health and wellbeing within reach of every citizen of every country globally. To achieve a goal of this magnitude, we need to reconsider how we spend on healthcare.

When we focus merely on the minimum health spending required for economic functioning rather than on the strategic investments needed to improve health outcomes over the long term, we fail to foster healthy populations and resilient economies. When we aspire to achieve health for all, the minimum is not enough.

The Global Self-Care Federation’s (GSCF) recent report shows us that self-care is a critical part of healthcare, and severely underrated in the current healthcare status quo. This is especially true in low- and middle-income countries (LMIC).

Responsible use of OTC products relieves a healthcare burden. Self-care is the only treatment in regions where alternative care is not readily available.
Responsible use of OTC products relieves a healthcare burden. Self-care is the only treatment in regions where alternative care is not readily available.

The report showed that in high-income countries, self-care is seen as an alternative to the use of existing healthcare system facilities. The individual’s convenience, timesaving, loss of income and productivity through enhanced access to treatment are seen as the main advantages. On a societal level, the benefits of self-care result from relieving the burden on healthcare systems. These benefits, therefore, result from the responsible use of over-the-counter (OTC) products instead of consuming scarce resources, particularly physician time, in these healthcare systems.

In stark contrast to wealthier countries, where there is usually wider access to more healthcare, differing conditions exist in LMICs regarding health-related infrastructure and prevailing socioeconomic factors. In some of these regions, such as Sub-Saharan Africa and south-east Asia, self-care is not an alternative care option, but rather the only possible access to treatment for most individuals.

This highlights the need for self-care to be integrated into the new paradigm as we move towards universal health coverage and health for all. Achieving that is not possible without a reframing of how we think and how we invest for health.

What needs to change
In the drive to UHC, we need to fundamentally change the way we build and manage engagement with clinical services – enabling task shifting to more appropriately skilled, more accessible, and lower-cost resources. The lowest cost resource is the individual “self”.

Pharmacists can provide information and assistance, decongesting doctor-led services and increasing patients’ chances of receiving efficient treatment.
Pharmacists can provide information and assistance, decongesting doctor-led services and increasing patients’ chances of receiving efficient treatment.

Self-care must be seen as the first level of primary care, then escalating to community health workers, community pharmacists, nurse practitioners and then to doctors. Empowering individuals to self-care and increasing access to multiple tiers of primary care enables effective triage of patients, thereby decongesting doctor-led services, secondary and tertiary care sites – and increasing the likelihood that patients will receive faster and more targeted treatment for their needs.

We need to encourage disruptive innovations such as telemedicine, in both a clinician to patient format as well as a clinician to clinician format. Alongside this, we need innovation in diagnostics – encouraging point of care, retail, and even home diagnostics.

We need to recognise that the critical challenge is both to increase the proportion of the finance available for health, and to appropriately govern how it’s spent in a more directed and effective manner. Health for all can only be achieved through a realignment of finance (whether public or private).

We need to go beyond the current status quo and establish a new paradigm directing us towards health for all and universal healthcare. The finance of investment needs to be reoriented towards achieving health for all and foster innovation and disruption. We also need to refocus on longer term thinking. It will enable us to consider health as more of an investment, rather than just an expenditure.

The last two years have shown us that disruption and adjustment is possible. For us to have a better healthcare future, we need to make an active shift towards new ideas and new ways of thinking.

by Iain Barton

managing director and founding principal, Health4Development

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