With focus on the vulnerable population, Nigeria faces several sexual, reproductive and maternal health (SRMH) challenges, limited capacity and resources in antenatal care, providing quality services for family planning, unintended pregnancy , unsafe abortion, combating sexually transmitted infections, including HIV, cervical cancer and other gynecological morbidities.
Improved awareness, operational and service – delivery issues need to be addressed to promote and increase safe, equitable access, uptake and the use of Self-Care intervention for advancing SRMH.
This means leveraging reviews on demand generation and social and behavioral change to ensure that health information on Self-Care is available, accessible, tailored to individuals needs and acceptable to potential users and communities.
Another area of intervention that requires attention is the criticality of awareness creation, advocacy, sensitisation of all stakeholders and ensuring that providers have adequate information to disseminate key messages freely.
Additionally, for far- reaching Self-Care supply products, strengthening the existing supply chain system, including through public private partnership, to ensure quality Self-Care products are available and accessible at all service points is seen to have potential of dramatically improving access to Self-Care benefits including reducing workload on health workers, increasing access to sexual and reproductive health and health service in a safe and private space and leveraging on innovations and digital platforms to access or deliver safe and appropriate health care services.
Also, scaling up Self-Care services through trained health care providers and integration of supervision, monitoring and data management into existing structures in Data Quality Assessment (DQAs) and National Health Management Information Service (NHMIS) will provide the country with robust data for decision making.
Addressing these specific necessities and normative guidance, and a safe and supportive enabling environment, Self-Care intervention will improve outcomes in reducing health disparities and increase equity.
In recent years, Nigeria has seen a mass exodus of health workers which has led to dearth of skilled workers in the healthcare sector. This necessitates the need for Self-Care interventions for SRMH to strengthen health, human rights and social outcomes.
The Federal Ministry of Health (FMOH) of Nigeria prioritised the development of self-care guidelines as a timely response to the COVID- 19 pandemic and a potential route to achieving universal health coverage (UHC).
In July 2020, guideline development process started, one year after the World Health Organisation (WHO) launched its consolidated guidelines for self – care in June 2020 and a coasted implementation plan was officially launched in March 2022.
Many Nigerians have made access to Self-Care through home, pharmacies, chemists, patient medicine stores, online stores, and community and health facilities. The supply of Self-Care products or provisions of services are available at all service delivery points with a few restrictions.
To accelerate progress towards achieving universal coverage of sexual, reproductive and maternal health- care service of Self- Care intervention by 30 percent users by year 2025, the work of initiatives, such as the FMOH in collaboration with WHO, Pathfinder International, White Ribbon Alliance Nigeria, Society for Family Health (SFH), Pharmacist Council of Nigeria and other critical stakeholders emphasising on the need for a National guideline on Self-Care would guarantee success.
According to WHO, Self- Care is the ability of individuals, families, and communities to prevent illness, promote health, maintain health and cope with ill health and disability, with or without the support of a health wellness provider.
This framework utilised the people- centered approach that recognised the promotional strategies for people’s participation in their health care presenting accountability and opportunity to reduce patient- health worker interaction or contact which allow low transmission of disease during outbreak or epidemics.
In line with this commitment, the FMOH and partners have systematically engaged and disseminated the Self-Care guideline in over 22 states namely Adamawa, Akwa Ibom, Bauchi, Bayelsa, Cross River, Edo, Enugu, Gombe, Kano, Kwara, Nasarawa, Niger, Oyo, Osun, Ondo, Ogun, Plateau, and River State .However, plans are on-going to carry out same advocacy and engagement visit in the remaining states of the federation.
Leveraging from the Nigeria response to WHO recommendation on Self-Care there were a series of in- country advocacy consultations between July 2019 and January 2020 on Self-Care.
“While significantly prioritising development of self- care, recalling that during the early stage of COVID-19 pandemic, the limitation of conventional health services was made obvious with the disruption of health service delivery in some health facilities, Self – Care intervention through community pharmacy and PPMVs were very helpful to sustain health services, ” said Remi Bajomo, director VVF and Reproductive Health, Ministry of Health.
Bajomo said: “Self-care has not been widely accepted but with the continuous advocacy and engagement, i can say that many people whom we have reached through advocacy and intervention work have embraced Self – Care.
“Ordinarily, Self-Care will reduce unnecessary overdependence on health facilities for services which individuals or families could provide for themselves.”
Jennifer Adebambo, country programme and advocacy lead at White Ribbon Alliance, (WRA) Nigeria that also advocates for self- care says self- care community advocacy campaign has improved quality maternal and reproductive healthcare for women and girls through the incorporation of their own voices for change.
”Self- care interventions for women across Nigeria, is not an indulgence but a life- preserving act. It is undoubtedly an innovative approach that plays a vital role in fostering equitable access to health services, promoting autonomy and agency of people, personal growth, resilience, and happiness. And by prioritising self-care, we are not only enhancing our own lives but also creating an environment where people can thrive, grow and live a satisfying life.
“At White Ribbon Alliance Nigeria, we strongly believe that the key to achieving Universal Health Coverage begins with Self-care. Hence, we are happy to join forces with the Media Agencies of Nigeria and partners to continue to explore innovative and concrete ways to promote Self-Care across the Country.
“We urge the media platforms to disseminate and raise awareness about self-care practice, share success stories and testimonials to inspire individuals to adopt self- care as part of their routine,” Adebambo said.
Self-Care requires an added explicit definition as a national public good in Nigeria. Other requirements are increased financing as well as accelerating planning and implementation.
Improving access to Self- Care by the six thematic areas; demand generation and SBC; service delivery; supply of products; supervision, monitoring and data management; advocacy and financing; and coordination and regulation would provide for more efficient self -care services value chain.
According to Amina Dorayi, country director Pathfinder International, Nigeria, who was represented by Sakina Amin-Bello, senior programme advisor, reproductive health at Pathfinder at a recent event held in Abuja, said that “standardising guidance on self-care for sexual reproductive and maternal health and creating an enabling environment would strengthen people-centered approach to health and well- being.
“Also showcase the efforts of various stakeholders including healthcare professionals, policymakers and community influencers as they come together to implement the national self-care.”