#SelfCareIndex
#SelfCareIndex

Self-Care Readiness Index

What is the index?

The Index is an advocacy-centered research initiative. At its core, the Index was developed as a conversation starter. It is intended to serve as a practical tool to better understand and recognize what the enablers of self-care are and how to improve them. It also serves as a catalyst for further debate on the importance of self-care as an effective tool to improve the long-term sustainability and productivity of health care systems and aims to enhance individual health outcomes.

Which countries?

How were the countries covered by the Index selected?

In an effort to be reflective of global concerns and in line with broader policy conversations on issues such as universal health coverage and the management of non-communicable diseases, the Self-Care Readiness Index includes at least one country per each of the World Health Organization’s (WHO) six regions: Africa, the Americas, South-East Asia, Europe, the Eastern Mediterranean, and the Western Pacific.

The index is intended to serve as a practical tool to better understand and recognize what the enablers of self-care are and how to improve them.

The Self-Care Readiness Index Report

THEME 1

Self-care, as both a term and concept, is culturally relative and defined in a number of different ways.

THEME 2

Individual empowerment hinges on continued efforts to boost health literacy, having credible, consistent sources of information about self-care, and aligned healthcare providers.

THEME 3

Self-care legislation is common, but disjointed numerous government strategies, plans, and programs touch on self-care, but few call it by name or paint a coherent healthcare policy vision.

Methodology

Geographic Scope

To reflect the diversity of global health systems and approaches, the 2021 Self-Care Readiness Index covers 10 countries, including at least one from each of the World Health Organization’s six regions: Africa, the Americas, Southeast Asia, Europe, the Eastern Mediterranean, and Western Pacific. The specific countries were chosen in consultation with WHO experts with an eye to including both developed and less-developed self-care markets. We also selected countries that demonstrated adequate and accessible documentation on self-care policies and practices so as to facilitate primary and secondary research efforts.

With regard to the United Kingdom, there are effectively four different health systems in operation in England, Wales, Scotland, and Northern Ireland. Except where otherwise noted specifically, the UK findings in this report are based on research for England only.

Defining Self-Care

Using the WHO’s definition as a jumping-off point, self-care as defined in this report refers to a broad range of activities, practices, and products that individuals can adopt to improve their health and well-being. In particular, self-care involves making healthy lifestyle choices and avoiding unhealthy habits; making responsible use of both prescription and nonprescription medicines; recognizing symptoms of common illnesses and diseases; managing one’s own treatment of colds, coughs, and other minor ailments; and self-monitoring, self-testing, and self-management of health conditions. Self-care products may include nonprescription medicines, dietary supplements, vitamins, and simple medical devices and tests designed for home use.

Given this definition, the Self-Care Readiness Index is based on four key enablers – the broad elements needed to realize the full potential of self-care in a given health system: 1. Stakeholder Support & Adoption, 2. Consumer & Patient Empowerment, 3. Self-Care Health Policy, 4. Regulatory Environment.

Research approach

Each of the four enablers is supported by three or four measurable indicators of self-care readiness – which in some cases are broken down into even more concrete sub-indicators or proof points. For each indicator and sub-indicator, the research team gathered evidence through a combination of extensive desk research, expert interviews, and online surveys of healthcare providers and consumers.

The consumer survey garnered roughly 840 responses and the healthcare provider survey was completed by more than 1,200 doctors, pharmacists, nurses, and other skilled healthcare workers. Both surveys were distributed in English as well as in Chinese, Polish, Portuguese, and Thai, and the healthcare provider survey was also available in French.

All of the research for the Index was conducted in 2020, during the COVID-19 pandemic, which may have had an impact on the consumer survey responses, both in terms of awareness of self-care in general, and diet and exercise behaviors. Undoubtedly, the pandemic has shone a spotlight on the importance of self-care, gaps in healthcare systems, and the value of health literacy.

The World Health Organization defines self-care as; “the 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.”

Enabler 1

Stakeholder Support & Adoption

The most important measure of a nation’s self-care readiness lies in its people’s attitudes and behaviors. To that end, we looked at three key stake-holder segments: healthcare providers, consumers (who are also often patients), and regulators and policymakers. We first considered the degree of trust and support for self-care among healthcare providers and patients/consumers respectively. Then we sought to measure the extent to which patients and consumers understand the complementary power of medicinal and non-medicinal approaches to self-care. Lastly, we looked for proof that regulators and policymakers have an understanding of self-care and its benefits for health systems as well as for individuals.

Based on our quantitative and qualitative analyses, stakeholder support and adoption was highest in the United Kingdom, China, and Thailand, and lowest in Poland.

1.1 Trust in and support for self-care among healthcare providers

1.2 Trust in and support for self-care among patients and consumers

1.3 Understanding of the complementary power of medicinal and non-medicinal self-care among patients and consumers

1.4 Understanding of self-care among policymakers and regulators

Indicator 1.1

The extent to which healthcare providers support, value, and adopt self-care products and behaviors, providing useful, accurate information to patients and recommending self-care products for prevention and first-line treatment.

As an objective assessment of whether self-care is part of continuing education for healthcare providers in each country, we examined the official agendas from the most recent congresses of the national associations for cardiology and primary care – specifically looking for sessions on self-care at those events. The United States ranked the highest on this measure, and information was spotty for many countries. As one cardiologist noted, even when self-care is part of the agenda, those sessions are often siloed in a specialized track on prevention and thus not widely attended.

Indicator 1.2

The extent to which members of the general public support self-care products and behaviors and view them as their preferred means for prevention and first-line treatment.

To measure consumer trust and support, we looked at social media coverage of International Self-Care Day (ISCD) in 2019 and 2020 and the prevalence of public campaigns on self-care in each country. This provides a good indicator of people’s awareness and support of self-care, and offers comparable data across the 10 geographies, which is otherwise scarce. Not surprisingly, both ISCD coverage and campaign intensity were highest in three countries with active industry associations focused on self-care (Brazil, South Africa, UK).

Indicator 1.3

Evidence that people choose to improve their health through self-care practices.

For this indicator, we researched proxies for healthy behavior in each country, such as consumption of fruit and vegetables and active membership in a sports or recreational organization. We also surveyed consumers about their exercise and dietary habits and their use of other self-care practices and non-medicinal products linked to healthy outcomes. Given the rising incidence of obesity and Type 2 diabetes around the world, it’s no surprise that most consumers surveyed say they engage in at least 30 minutes of exercise just two or three days a week at best – i.e., less than WHO’s guidelines for recommended physical activity.

Indicator 1.4

The extent to which policymakers and regulators are familiar with the term “self-care” and can articulate its health and cost-saving benefits.

For this indicator, we researched national legislative agendas and discussion records over the past two years to assess whether (and how often) self-care and different aspects of it (self-management, self-medication, health education) are a topic of discussion among policymakers. We also explored whether a government-approved framework or strategy on self-care exists and whether self-care is mentioned in key national health strategy documents – including those related to NCDs in general as well as more specific guidelines for diabetes or cardiovascular disease.

Enabler 2

Consumer & Patient Empowerment

Self-care delivers the greatest value when consumers and patients have a high degree of health literacy, understand the value of disease prevention and management, and feel confident and empowered to make their own health decisions. Studies show that lack of knowledge can result in misuse of valuable healthcare resources, such as unnecessary visits to hospital emergency rooms. While prevention is the gold standard, self-care delivers high value in terms of ongoing self-management of chronic disease – a critical benefit given the rising incidence of chronic disease in many countries around the world.

Governments could improve health literacy at scale by making it a public health priority, but they do not always have the incentives or resources to launch broad campaigns or elaborate programs.

2.1 Access to personal health data

2.2 Consumer health literacy

Indicator 2.1

The extent to which individuals can easily access their own health data, with self-care products and practices included in health records (paper and electronic) alongside details on prescriptions.

Providing access to electronic health records (EHRs) is a fundamental step toward empowering patients to practice self-care. This is no simple task, however; health systems must first overcome barriers related to privacy, security, interoperability, and data integrity – a challenge most easily accomplished when EHRs are connected to a single national system. Among our 10-country group, only China and France have “universal EHRs” i.e., systems based on standardized data and protocols that can be accessed, used, and updated by actors across the healthcare spectrum.

Indicator 2.2

The extent to which a country’s government systematically strives to improve the health literacy of its people, and the extent to which consumers understand their own health, the risks, symptoms and treatments for common health conditions, and the role that self-care products and practices can play in both preventing and treating these conditions.

Most countries do establish basic health literacy through school health programs. The best-performing countries have comprehensive school curricula that cover most or all components of health literacy (e.g., chronic and noncommunicable diseases, nutrition, physical activity, sleep, hygiene, substance abuse, mental health, and sexual health).

Consumer Empowerment VIS-A-VIS SELF-CARE

% of consumer survey respondents who agree or strongly agree with these statements…

“I feel well-informed, supported, safe and empowered to undertake my own at-home care regimens for preventing illness.

“I feel well-informed and empowered to undertake my own at-home care regimens for managing my chronic and acute conditions.”

“I feel more educated and empowered to seek out self-care products and practices because of supportive campaigns and programs in my community.

Enabler 3

Self-Care Health policy

Building trust among stakeholders and increasing health literacy and digital access to personal health records are good first steps toward increasing self-care. But if healthcare leaders wish to leverage the full value of self-care, the right policy and regulatory frameworks need to be put in place. This section assesses countries’ current health policy vis-à-vis self-care: Do policymakers recognize the economic value of self-care? Are there incentives for patients and providers, respectively, to engage in and encourage self-care? And, given that many self-care practices are rooted in traditional and complementary medicine, in what ways (if at all) does the health system recognize and regulate traditional and complementary medicine (T&CM)?

3.1 Recognition of the economic value of self-care

3.2 Policies to promote self-care as affordable health solution

3.3 Provider reimbursement

3.4 Recognition and regulation of T&CM

Indicator 3.1

The extent to which policymakers recognize, discuss, and promote the economic value of self-care products and practices for health systems and the economy, including their potential for prevention, better resource utilization, and worker productivity.

To measure this factor, we looked for (1) evidence that policymakers consider the return on investment (ROI) of self-care for the healthcare system and (2) the degree to which national health policy focuses on value for money and patient outcomes. The economic case for self-care has been put forth by many national industry associations, typically with the focus on capturing savings by shifting from prescription to OTC drugs and by reducing doctor visits, thereby easing the burden on strained national healthcare budgets.

Indicator 3.2

The extent to which the health system uses policy mechanisms to lower the out-of-pocket costs of self-care products and practices for consumers.

Governments can use policy mechanisms such as tax credits, reimbursement for self-care products or counselling, and funding of patient education and behavioral change programs to encourage self-care as a means of reducing the burden on the healthcare system. For example, medical/health savings accounts and flexible spending accounts – which allow people to set aside pre-tax funds for spending on health needs, including some self-care products – are seen in South Africa and the US. But often these policy incentives are limited to consumers with private insurance.

Indicator 3.3

The extent to which a country’s health policy provides financial incentives for healthcare providers to counsel patients on self-care.

Remunerating healthcare providers for time spent advising patients on how to manage their conditions and discussing healthy lifestyle habits not only encourages such conversations but also is likely to result in better outcomes for patients and lower health costs in the long term.

To ascertain whether providers may seek payment for time spent discussing self-care with patients, we searched for relevant medical billing codes in each country. France, South Africa, and the US scored highest on this measure, with both medical practitioners and pharmacists eligible for reimbursement.

Indicator 3.4

The extent to which the health system recognizes and regulates T&CM.

Many of the healthcare providers we interviewed mentioned that their patients use TC&M as part of their self-care routines. At the same time, they expressed concern that their countries lacked formal oversight for T&CM in the form of policies, laws and regulations, national programs, and/or expert committees – thereby limiting opportunities to have constructive, inclusive discussions on the benefits and shortcomings of these treatments. Based on our desk research, T&CM seems to be gaining attention from healthcare policymakers and regulators, opening up a new potential domain of self-care. Brazil, China, South Africa, and Thailand appear to be at the forefront in terms of progress toward T&CM oversight and integration with the health system.

Enabler 4

Regulatory Environment

Regulations and processes governing the approval of new products and Rx-to-OTC switches, distribution, advertising, and pricing determine the ease of consumer access to self-care products as well as industry’s ability to drive innovation and adoption of self-care solutions. Overall, the US has the most supportive regulatory environment for self-care, marked by the transparency of its approval process for OTC medicines, broad retail access, and absence of advertising and price controls. France ranks last in the group because of its relatively strict rules on drug reclassification, access, advertising, and pricing. While some countries – notably China – are working to streamline the marketing authorization process for OTC products, there is room for improvement on the regulatory front in many countries.

4.1 Approval process

4.2 Drug reclassification

4.3 Access/distribution

4.4 Advertising and pricing

Indicator 4.1

The extent to which regulatory review of self-care products is transparent, efficient, and based on scientific evidence.

For each country we assessed whether the approval process and evaluation criteria for self-care products – specifically OTC medicines – are clearly described in writing, and whether this information is easily accessible to the public. We also examined whether the time from application to decision is largely predictable, and whether the regulatory agency tracks its performance with respect to predefined timelines. Lastly, we looked at whether applicants (sponsors) have opportunities to communicate with the regulatory agency at all stages of the approval process.

Indicator 4.2

Whether the process for switching drugs from prescription to over-the-counter status is well-defined, there are examples of such switches in line with global best practices, and innovation is rewarded with protection of proprietary product data.

The economic arguments for switching, including easing the cost burden on public health systems, have been laid out by numerous studies. From a self-care perspective, the rationale is that switching enhances consumers’ choice and access to treatment options without risking their safety or well-being. Since products being considered for switching are not novel and therefore not eligible for patent protection, data exclusivity offers an incentive for companies pursuing what may be a “costly, time-consuming, and often risky” switch project.

Indicator 4.3

The extent to which companies may distribute, and consumers may access, self-care products through a variety of channels, both in-store and online.

Here we examined whether (and, if so, where) consumers are free to browse and select products, without intervention or supervision; the highest scores went to countries where self-care products are available for self-selection in pharmacies and other retail outlets, including online.

Indicator 4.4

The ability of companies to advertise self-care products directly to consumers and to price products based on market forces.

Only the US imposes no restrictions on advertising and pricing of self-care products. Among the remaining countries, Brazil and Poland are the least restrictive and France is the most.

Brazil’s removal of all price controls on OTC products in 2020 should give rise to greater investment in innovation – not only in new molecules but also in products that have been on the market for years.

Self-care Readiness Index

Country Narratives

Brazil

Stakeholder Support & Adoption

Brazil’s Strategic Action Plan to Tackle Noncommunicable Diseases (2011-2022) mentions the importance of self-care and the rational use of medication for healthy aging, for the good management of cardiovascular diseases, and the importance of self-management for NCDs in general. However, concerns that people were not self-medicating in a safe way have have occurred despite national and local government campaigns emphasizing the risk of self-medication.

Consumer & Patient Empowerment

Despite considerable investment and efforts from the government side, Brazil has struggled to digitize medical records. In 2016, the Ministry of Health and the Ministry of Science, Technology and Innovation signed an agreement intended to stimulate the development of technological solutions in the Brazilian health system and set aggressive deadlines for implementation of the “Electronic Citizen’s Record” (PEC).

Self-Care Health Policy

Primary care is one of the main pillars of Brazil’s single-payer healthcare system – the Sistema Único de Saúde (SUS), which serves a diverse population of 212 million. While the COVID-19 crisis has raised awareness of the importance of self-care, our research and expert interviews suggest that policymakers tend not to “see the big picture” or appreciate the economic arguments for investing in self care education and programs.

Regulatory Environment

Brazil’s National Health Surveillance Agency (ANVISA) is responsible for the approval and supervision of food, cosmetics, tobacco, pharmaceuticals, health services, and medical devices, among others. The ANVISA website offers well-structured information on the approval process but no details on the evaluation criteria. An Analytical Information Portal provides key performance data, including the volume and speed of approvals. The agency also boasts multiple communication channels.

CHINA

Stakeholder Support & Adoption

In 2016, the Chinese State Council released “Healthy China 2030,” a 15-year blueprint to improve public health; a corresponding action plan was launched in 2019. As the plan outlines, the goal is to help everyone learn, understand, and master information and skills related to disease prevention, early detection, emergency rescue, timely medical treatment, rational drug use, and other aspects of health maintenance; to enhance health awareness; and to constantly improve health management capabilities – many of which are key elements of self-care.

Consumer & Patient Empowerment

As part of its sweeping health system reform strategy, China introduced a national EHR system in 2009, and several provinces, including Beijing, Jiangsu, and Fujian soon began piloting IT projects to integrate data from various providers. The Chinese government actively communicates health information through television (including a daily health education show on CCTV) and digital channels such as WeChat and Weibo.

Self-Care Health Policy

“Healthy China 2030” does not explicitly mention the ROI of self-care, but the policy framework does focus on encouraging people to adopt healthy lifestyles, increasing health literacy, and facilitating early disease detection, diagnosis, and treatment. According to WHO, China has a “relatively complete policy system on traditional Chinese medicine” (TCM). Various national plans over the past decade have called for the “promotion of standardization and normalization of TCM”, and “Healthy China 2030” sets out a series of tasks and measures to that end.

Regulatory Environment

China’s National Medical Products Administration (NMPA) is responsible for regulating pharmaceuticals, medical devices, and cosmetics. The Provisions for Drug Registration outline the application process and the timeline for approval decisions for both prescription and nonprescription drugs. However, these provisions are buried in the NMPA website news stream, and performance tracking data is not readily available. Draft technical guidelines for OTC chemical drugs, if implemented, could mitigate this lack of transparency, as well as speed up and simplify the approval process by easing requirements for preclinical trials.

egypt

Stakeholder Support & Adoption

Egypt does not have a self-care strategy, and the Egypt Multisectoral Action Plan for Noncommunicable Diseases Prevention and Control 2018-2022 does not mention self-care as such. However, it does highlight the importance of a healthy diet and physical activity, and focuses on healthcare system changes needed to improve the management of NCDs. Based on our interviews, self-care is well understood by Egyptian healthcare providers, but they sometimes have difficulty convincing patients to practice self-care and, when pressed for time, rely on others to educate patients.

Consumer & Patient Empowerment

Though Egypt’s President declared 2019 as “the year of education,” there is still little evidence that health and hygiene are taught in public schools. Government use of WhatsApp to communicate health information predates the pandemic. In 2016, the Ministry of Health and Population launched WHO’s “health in a message” SMS service, which provides advice on living with diabetes and other medical information related to NCDs.

Self-Care Health Policy

While we found no evidence of policies acknowledging the economic value of self-care, the Egyptian government sponsors many screening programs, especially for women’s health, school-aged children, and communicable and noncommunicable diseases. These include the 2018-19 “100 Million Healthy Lives” campaign, which screened people nationwide for Hepatitis C and NCD risk factors. Some interviewees told us that the government is interested in programs that promote self-care, but it would need industry support.

Regulatory Environment

The Egyptian Drug Authority (EDA), which reports directly to the prime minister rather than to the Ministry of Health, oversees the regulation and approval of self-care products, including human medicines, medical devices, and food supplements. Drug product evaluation by the National Organization for Drug Control and Research (NODCAR) is a prerequisite for marketing authorization. The National Organization for Research and Control of Biologicals (NORCB) sanctions market authorization of biological products, including botanical drugs that may qualify as self-care products.

france

Stakeholder Support & Adoption

France’s National Health Strategy 2018-2022 does not explicitly refer to self-care, but it does mention many aspects of self-care: the importance of a healthy diet and physical activity, preventing the loss of autonomy, promoting sexual education and health, and following basic hygiene rules like hand washing and cleaning of public spaces. According to our healthcare provider survey, France is the country where HCPs trust and support self-care practices and products the least. Based on our research and interviews, patient education and empowerment are rarely discussed among healthcare providers and in medical curricula.

Consumer & Patient Empowerment

The French Ministry for Solidarity and Health asserts that its system of universal electronic medical records is highly accessible to patients. Patients can access their shared medical records on a web or mobile app and can add information, hide certain data, and control which health professionals have access to their records. According to a 2014 European Commission study, the terms “health literacy” and “empowerment” are not common in France, and there are no national or regional policies directly focused on these concepts.

Self-Care Health Policy

Several studies show that the French government does not pay attention to the economic value of self-care and self-medication. However, the French government funds many programs on nutrition, physical activity, and diabetes management. One example is Activité Physique Adaptée, a program to help people with NCDs play sports and stay healthy. Under this program, healthcare providers can write a prescription for a wide range of physical activities and other healthy practices such as going to the gym, Nordic walking, swimming, yoga, and qigong.

Regulatory Environment

The French system for granting marketing authorization to nonprescription medicines follows the European rules (proof of quality, safety and efficacy). According to industry sources, the process for Rx-to-OTC switches is defined in legislation and based on an active pharmaceutical ingredient. In recent years, however, there have been more reverse-switches (i.e., OTC-to-Rx) prompted by safety considerations (precaution principles). Legal experts say France has some of the Europe’s most restrictive access policies: all drugs, whether prescription-only or OTC, may only be sold in pharmacies and dispensed by pharmacists or pharmacy technicians.

nigeria

Stakeholder Support & Adoption

Nigeria’s National Policy and Strategic Plan of Action on Prevention and Control of Non-Communicable Diseases, launched in 2013, mentions aspects of self-care, including self-examination to prevent breast cancer and self-measurement of blood pressure for people with diabetes. The National Health Promotion Policy stresses the importance of empowering people to manage their health, but it does not mention self-care as such or the importance of self-management of diseases. According to our consumer survey, Nigerians rely heavily on traditional and complementary medicine practices or products as part of their self-care regimens.

Consumer & Patient Empowerment

Several academic studies suggest that health literacy in Nigeria is low. The population faces major health issues exacerbated by inadequate information, particularly in areas of nutrition and reproduction. According to WHO, only 70% of Nigerian children enroll in primary schools nationwide. The 2013 National Policy on Education mandates general health and physical education at each level (primary, junior secondary, and senior secondary). However, lack of specificity suggests a less-than-comprehensive school health curriculum.

Self-Care Health Policy

Nigeria lacks adequate resources (both human and financial) for health promotion interventions and activities. In our interviews with HCPs, we heard that government support for health promotion initiatives and self-care activities is nonexistent, and providers often take the initiative to organize patient support groups. NGOs sometimes support these groups, as well as local screening and education on self-management of diabetes and cardiovascular disease. While Nigerian HCPs do talk about self-care with their patients – especially self-management of NCDs – they cannot seek reimbursement for the time spent on those activities.

Regulatory Environment

The National Agency for Food and Drug Administration and Control (NAFDAC) is responsible for approving the sale of drugs, medical devices, herbal medicines, etc. in Nigeria. Information on the NAFDAC website is easily accessible and clearly spells out the application/registration process and timeline for approval. The site does not reveal evaluation criteria, however; nor does it track performance vs. timelines.

POLAND

Stakeholder Support & Adoption

Based on what we heard during our interviews, policymakers in Poland are generally not supportive of self-care; they put heavy emphasis on the dangers of OTC and complementary products. Our interviews suggest that Polish healthcare providers who work with patients with cardiovascular disease and diabetes have a good understanding of the benefits of self-care, self-monitoring, and self-management. The importance of patient education and empowerment tends to be well understood, though HCPs would like to see more support from the government in this regard.

Consumer & Patient Empowerment

According to a 2016 index of European health literacy, Poland ranked close to the average among the eight EU countries studied, with roughly 55% of those surveyed having excellent or sufficient levels of general health literacy. Conversations with several interviewees, as well as academic analyses, however, suggest that Polish health literacy could be improved. For example, a study of the occupational health system argues that the “low level of health literacy among both employers and employees lies at the forefront of a passive approach towards the safeguarding of workers health” and recommends the design of a Polish tool for assessing health literacy.

Self-Care Health Policy

Healthcare reform is ongoing, with discussions on how to make the system more outcome-based and efficient. In 2016, the Polish Ministry of Health embarked on a far-reaching reform program aimed at improving access to care and care coordination, improving efficiency, and reducing duplication. The National Health Programme 2016–2020, the basic document defining Polish public health policy, calls for investing in disease prevention, with a focus on reducing smoking and alcohol consumption. But it does not include specific actions related to self-care (e.g., self-management of NCDs, self-medication and self-monitoring, health literacy).

Regulatory Environment

The Polish Office for Registration of Medicinal Products, Medical Devices and Biocidal Products (URPL) oversees licensing of drugs and medical devices. According to law, the approval process for medicinal products takes 210 calendar days, but evaluation criteria and performance tracking information are not publicly available.

Poland’s Rx-to-OTC switch process is not formally defined. However, Poland is reportedly one of the “most progressive” OTC markets in Europe, often leading the way in switches. While advisory meetings are not possible ahead of filing switching applications, URPL staff are available during the evaluation of a switch through a dedicated contact point.

South Africa

Stakeholder Support & Adoption

South Africa’s NCDs Plan (2013-2017) states that “there is a need to fully integrate non-communicable diseases into the re-engineering of primary health care in South Africa with the view to increasing community-based prevention, screening, and self-management.” Our desk research revealed that most South Africans do not follow a healthy diet, despite numerous government campaigns in recent years. Based on our interviews, this is the result of large inequalities that hamper access to healthy food, and to the healthcare system overall.

Consumer & Patient Empowerment

South Africa’s National Health Promotion Policy and Strategy 2014-2019 provides a framework, “to integrate health promotion into all health programmes to allow people to increase control over their health and to make healthy choices.” And in its Strategy for the Prevention and Control of Obesity in South Africa 2015-2020, the government states that, “it is our responsibility to empower people to make informed decisions in this regard and to ensure that they have access to healthy food by raising awareness and increasing the availability of effective initiatives and interventions.”

Self-Care Health Policy

Private health insurance plays a large role in South Africa, but work is under way to put a universal health insurance system in place. Currently, of South Africa’s 60 million people, about 16% (mostly white and wealthy) have private insurance. This group is served by 70% of the nation’s doctors and accounts for almost half of all spending on medical care. The remaining 84% of the population rely on crowded, underfunded government hospitals and clinics. Doctors in South Africa’s private system operate under a fee-for-service model and have wide discretion in how they treat patients, which encourages interventions.

Regulatory Environment

The South African Health Products Regulatory Authority (SAHPRA) regulates all health products, including orthodox medicines (drugs), biological products, medical devices and in vitro diagnostic products, and T&CM. In partnership with the Self-Care Association of South Africa, SAHPRA is building an online directory of all Schedule 0, 1, and 2 registered OTC medicines. This mobile-friendly directory will make it easy for consumers and healthcare professionals to access drug information and is targeted to launch in May 2021.

thailand

Stakeholder Support & Adoption

Although “self-care” may not be a familiar term or part of the formal healthcare lexicon in Thailand, interviewees say that Thai people typically practice self-care on a daily basis. It is common for people to self-diagnose minor illnesses and to access household remedies, OTC medicines, and other safe, non-controlled drugs prior to consultation with healthcare professionals.

Consumer & Patient Empowerment

An update to Thailand’s 2008 Core Curriculum included good physical and mental health, hygiene, and preference for physical exercise as an important goal. Health and physical education used to be part of the national test taken by students at the end of general primary, lower secondary and upper secondary levels but this was removed in 2015. Since 2003, the Thailand Ministry of Education has partnered with the Thai Health Promotion Foundation, an autonomous government agency, to encourage healthy behaviors, particularly among young people.

Self-Care Health Policy

According to some of our interviewees, Thai policymakers understand the link between self-care and good health, but we found no explicit evidence that the ROI of self-care figures in government policy decisions. Thailand has had a tax-funded universal health insurance scheme in place since 2002. A fee-for-service model dominates but there are some indications of a move away from that system. A majority of respondents to our HCP said that they can bill for self-care.

Regulatory Environment

The Thailand Food and Drug Administration (FDA), under the Ministry of Public Health, oversees the regulation of drugs, medical devices, cosmetics, and other products. According to Dr. Suchart, the current lead time for approval is 135 working days for self-medication in the generic medicine category. He also told us that Thai FDA “tracks approval lead time of every single application in every step as a key performance indicator.” However, information about lead times does not appear on the FDA website, and other sources say the process takes longer.

United kingdom

Stakeholder Support & Adoption

The Department of Health and Social Care, which oversees care and the National Health Service (NHS) in England, defines self-care as, “the actions people take for themselves, their children and their families to stay fit and maintain good physical and mental health; meet social and psychological needs; prevent illness or accidents; care for minor ailments and long-term conditions; and maintain health and wellbeing after an acute illness or discharge from hospital.” Based on our interviews, healthcare providers in England generally trust and support self-care practices, and they told us they strongly encourage prevention and self-monitoring among patients and encourage self-treatment of minor ailments.

Consumer & Patient Empowerment

The UK government launched the National Program for Information Technology, then described as “one of the world’s biggest IT projects,” back in 2002, with the goal of implementing electronic patient records to reduce the burden on medical professionals. It was eventually closed down in 2011. NHS England supports a half-dozen apps focused on self-management of long-term conditions such as asthma, Chronic Obstructive Pulmonary Disease (COPD), and diabetes. For example, “Changing Life” is a lifestyle coaching program designed to help people with Type 2 diabetes lose weight, eat better, and move more. This app is free but requires a GP referral; others require a user fee.

Self-Care Health Policy

Health policy in the UK is strongly influenced by a paternalistic approach – that everything is paid for and that patients should go to their local GP and hospital as first points of call – which runs counter to the essence of self-care. With this mindset ingrained in UK society since 1948, and before, the shift toward policies encouraging people to prioritize self-care could take years to bear fruit. The NHS Long-Term Plan puts emphasis on self-management of long-term conditions like diabetes and calls for pharmacists to support patients in increasing medication adherence as well as for a shift from prescription medicine to OTC drugs in order to reduce costs. A 2018 report from the Local Government Association stresses the economic benefit of increasing self-care and profiles how city and county councils are helping people look after themselves.

Regulatory Environment

The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for granting marketing authorizations for medicines (both prescription and nonprescription) and medical devices as well as traditional herbal registrations in the UK. The MHRA section of the gov.uk website offers detailed guidance for drug applicants, including information about different application types, approval processes, and fees. In addition to providing detailed contact information, MHRA explicitly encourages sponsors to contact agency staff before submitting their application, and provides relevant email addresses and telephone numbers throughout its application guidance pages.

United states

Stakeholder Support & Adoption

In the US – as well as in Canada and parts of Europe – the phrase “self-care” has been so overused by lifestyle gurus and marketers that it means both everything and nothing. Blowing your diet by binge-eating ice cream or French fries, having a glass of wine or to ease stress at the end of a hard day, or pampering yourself with a spa treatment or bubble bath? The fact that these types of self-indulgent activities are often cited in feature articles, advertising, and social media under the umbrella of self-care makes the task of assessing stakeholder support for self-care as defined in this report a challenge.

Consumer & Patient Empowerment

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, the US invested heavily in a project to digitize health records in 2009. The US Department of Health and Human Services (DHHS) published the National Action Plan to Improve Health Literacy in 2010, in response to several studies identifying limited health literacy as a widespread public health problem. Since 2010, the DHHS has produced several resources to help make health information more accessible, including the Health Literate Care Model for providers and “Health Literacy Online,” which helps organizations create intuitive online sources of health information.

Self-Care Health Policy

While the pandemic has heightened public awareness of the need for self-care, there is little evidence that US policymakers are conversant with the economic benefits, despite industry efforts to illuminate them. The Department of Health and Human Services’ “Healthy People 2030” plan talks about influencing outcomes and cites 23 leading health indicators that impact major causes of death and disease in the US. The aim is to help, “organizations, communities, and states across the nation focus their resources and efforts to improve the health and well-being of all people.”

Regulatory Environment

Comprehensive information for all categories of self-care products (OTC drugs, medical devices, dietary supplements) can be found on the website of the US Food and Drug Administration (FDA). The section on OTC drugs outlines two different approval processes: one for drugs developed under the New Drug Application (NDA) process and another for well-established ingredients in drugs under the OTC drug monograph process. According to the FDA, an OTC monograph is “a ‘rule book’ of conditions for each therapeutic category that describes the active ingredients, uses (indications), doses, route of administration, and labeling for an OTC drug to be considered ‘generally recognized as safe and effective’.”

The Self-Care Readiness Index Report