A picture of a woman holding an HIV self test

Women at the centre of their health

Self-care offers an opportunity to empower patients to manage their own health.

The concept of ‘self-care’ might sound strange for a doctor and Women’s Health Advisor like myself to be discussing. But self-care is not just spas and meditation, but also a form of healthcare that’s been practised for centuries and is growing today. If you’ve ever taken an at-home pregnancy test, used a fertility tracking app or managed your asthma symptoms using a puffer, you’ve practised self-care. 

Self-care sits within a patient-centred approach to health, which means caring for people in a way that is meaningful and valuable to them. Right now, Doctors Without Borders is strengthening the patient-centred nature of our care to truly put patients at the core of our work. As the World Health Organization (WHO) highlights, this model of care sees people as active decision-makers in their health, rather than mere recipients of services. 

A picture of women holding condoms for distribution in Malawi
Sex workers receive condoms and lubricant during a health promotion session conducted discretely at a hotspot in Nsanje. 
Isabel Corthier/MSF

Self-care is an opportunity to improve patient-centred, and quality, care through empowering people with the knowledge, autonomy and choice to access safe, effective and timely care, with support from a skilled healthcare provider if and when they need it.

Under WHO’s debut self-care guidelines (2019) developed for sexual and reproductive health (SRH), self-care ranges from health promotion to disease prevention and control and self-medication, as well as other services involving medicines, devices, diagnostics and digital products, which are provided fully or partially outside of formal health services. 

Our teams have already been implementing self-care initiatives in several of our SRH programs, including self-injectable long-acting contraception Sayana Press™ in the Democratic Republic of Congo and a human papillomavirus self-sampling trial in our cervical cancer project in Zimbabwe. On International Women’s Day, 8 March, we are highlighting how self-care is especially valuable for women and girls who face significant barriers to healthcare. 

In places where people are cut off from health facilities due to remoteness, conflict, poverty or a lack of infrastructure or resources, self-care can help meet their health needs.

For women seeking SRH services such as contraception or safe abortion care, which are often highly stigmatised, self-care gives them the tools to care for themselves in the privacy of their home. It also helps women who face discrimination in the formal health system (because of their medical condition or identity) to have access when they may otherwise resort to unsafe care or none at all. Crucially, self-care promotes women’s agency to manage their own bodies.

A picture of a healthworker conducting an HIV test.
MSF counsellor educator Joan Chapema provides HIV testing services to a sex worker in her home in Dedza, as part of MSF’s outreach activities where an MSF community team comprising of a community health worker and counsellor provide discrete and confidential home visits.
Isabel Corthier/MSF

Evidence-based self-care is low risk and leads to good health outcomes when offered alongside traditional health services. In some contexts, women will choose self-care even when a trustworthy health provider is an option: it is important to provide the choice. As health workers, it is essential that we identify our biases, and our teams are driving training for our staff to help them integrate self-care options with existing models of care provided within facilities.

Self-care also hinges on meaningful engagement with communities. You can read more about how our teams are putting this into practice in this issue. On page 12 is a testimony from Fanny Falakeza, a Malawian sex worker and Community Health Worker who has supported her peers to learn about, prevent and self-manage a comprehensive range of SRH needs.

Fanny highlights the success of a patient-centred, self-care model, and the empowerment of her fellow sex worker community. On page 10, Mulikat, a survivor of the neglected disease noma, shares how she helps others facing noma to improve their quality of life alongside their medical treatment.

For approaches such as these to be effective, we need to gather perspectives directly from patients on how the care works for them. Our teams assist women across many different cultures and lived experiences, and we must ensure our care places all women, including those living with disability and adolescent girls, at the centre.
 

A picture of a woman washing clothes in Malawi
Homestead of Maria (not her real name) a sex worker, Dedza town centre, where women carry out daily chores and look after their children.
Isabel Corthier/MSF

COVID-19 has been devastating globally, but has also presented opportunities to bring healthcare to people using innovative and novel patient-centred approaches. High-income countries like my home, Canada have removed regulations to increase virtual and telemedicine access to safe abortion care; in Australia, telehealth access to abortion has been temporarily supported through Medicare.

Self-managed medication abortion facilitated by hotlines, abortion accompaniment models (phone-based support by trained volunteers) and web-based tele-abortion services—already used in places where abortion is stigmatised or criminalised—have enabled this lifesaving care to continue during COVID-19. 

There is potential for Doctors Without Borders to pioneer quality, patient-centred care for women in crisis-affected contexts, with self-care models facilitated through community-based programs and digital methods such as telemedicine, hotlines, SMS services, mobile apps, web-based platforms and peer-to-peer support. We can truly place women at the centre of care by trusting them to play a more active role in decisions that affect their own health and bodies.

 

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Patient and Staff Stories 15 April 2021