The government last week signed four bills into law that seek to support its Universal Health Coverage plan.
The Digital Health Act will promote the digitisation of health services and telemedicine, the Primary Healthcare Act will strengthen preventive health services, especially through community health promoters, the Social Health Insurance Act proposes to replace the National Health Insurance Fund with three new funds, the Social Health Insurance Fund, Primary Health Care Fund and Chronic Illness and Emergency Fund and; the Facility Improvement Finance Act to restrict funds raised in public health facilities.
Of interest that further strengthens the implementation of the recently domesticated WHO Guidelines on Self-Care Interventions for Health and Wellbeing (2021) by the Ministry of Health are the Digital Health Act and Primary Health Care Act.
The National Guideline for Self-Care Interventions in Reproductive Health (2023) provides a contextualised reference on an emerging ground of accelerating Universal Health Coverage and access safely by empowering all in need of reproductive health care to actively own and contribute to the achievement of the highest standard of reproductive health that is personalized.
It provides regulation for the previously weakly regulated self-care domain and outlines specific areas requiring urgent adjustments within the health system to ensure realisation of reproductive health self-care in Kenya that promotes Sustainable Development Goals 3 and 5 as well as several international commitments that Kenya has ratified.
Priority areas identified in the new guidelines are self-care in maternal and neonatal health, family planning and infertility and cross-cutting reproductive health issues including sexually transmitted and other reproductive tract infections and cancers, and sexual gender-based violence among others.
The new guidelines which were domesticated from the WHO Guidelines, are anchored on several laws, policies and guidelines that seek to improve reproductive health outcomes in the country.
The Kenya 2010 Constitution guarantees under Article 43 on the right to health that “Every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care.”
Article 27 on equality and freedom from discrimination, Article 28 on human dignity, Article 31 on privacy, Article 35 on access to information and Article 46 on consumer rights further provides constitutional provisions for self-care.
Parliamentary legislation such as the Health Act defines telemedicine as “the provision of health care services and sharing of medical knowledge over distance using telecommunications and it includes consultative, diagnostic, and treatment services”, and under Section 6 asserts that every person has a right to reproductive health care.
Policy frameworks such as the National Reproductive Health Policy 2022-32, the Kenya National eHealth Policy 2016-30, the Kenya Primary Healthcare Strategic Framework 2018-2024 and Ministry of Health guidelines such as the Kenya Essential Medicines List (2019) and the National Tele-Mental Health Guidelines (2021) among others provided a framework for reproductive health self-care.
The guidelines will also be implemented alongside existing documents and strategies such as the Universal Health Coverage plan, Health Sector Standards and Norms, the Kenya Essential Package for Health, the County Specific Reproductive Health Strategies among others and managed and coordinated by the Health Sector Intergovernmental Consultative Forum as provided by the Health Act.
Self-care interventions do not replace the need for healthcare providers, but empower 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.
However, the healthcare provider remains at the centre of self-care to provide information for informed choice, teleconsulting and providing services in case of referrals.
According to WHO, self-care recognises individuals as active agents in managing their own health and recommends a range of self-care interventions for health promotion including self-management, self-medication, self-treatment, self-examination, self-injection and self-administration.
Self-care interventions have the potential to expand choice, empower individuals and communities to manage their health and well-being, strengthen the efficient use of domestic resources for health and improve primary healthcare contributing to the achievement of universal health care.
This will reduce stress on the already overburdened health systems, where the ratio of healthcare providers to the population is only 13.8 per 10,000 population, a need that became extremely eminent during the COVID-19 pandemic when the importance of self-care interventions was more evident.
However, for self-care to be feasible as an alternate means of accessing healthcare and decongesting facilities, investments in health literacy programs and their integration into health systems, appropriate measurement of self-care’s contribution to health outcomes and research and evidence generation to deepen understanding of the complexities, challenges and potential need to be supported.
Lessons learnt by the Self-Care Trailblazer Group, a multi-stakeholder global self-care movement with over 300-member organisations with representation from over 85 countries across the world, recommends several strategies to effectively institutionalise reproductive self-care into policy and integration into national health systems.
Some recommendations include having the Ministry of Health lead in-country self-care agenda, active stakeholder engagement in the implementation of self-care guidelines through a national technical working group of diverse multi-sectoral stakeholders, continuous learning and evidence generation to guide the design, implementation and scale-up of self-care approaches, engagement of youth advocates and existing community groups to drive demand and ensuring the availability and affordability of sexual and reproductive health supplies among others as key to institutionalising self-care in reproductive health.
The Ministry of Health, through the Division of Reproductive and Maternal Health has begun implementation of the new guidelines on reproductive health self-care interventions by developing training manuals for healthcare providers, which is awaiting finalisation.
In order to further advance self-care in Kenya, in line with the new guidelines, development of training packages for community health promoters, training of healthcare providers and community health promoters in the counties, incorporation of self-care indicators into data reporting tools, and integration of self-care into existing healthcare services among others need to be prioritised.
This calls for a multi-sectorial collaboration with stakeholders drawn from the Ministry of Health, devolved health systems and the private sector to ensure the operationalisation and implementation of the reproductive health self-care guidelines for complementarity.
Stakeholders, especially from the private sector where Reproductive Health Network Kenya belongs, need to create combine efforts and take advantage of the new Digital Health Act and the Primary Healthcare Act by working closely with the Ministry of Health to support the institutionalisation of the National Guideline for Self-Care Interventions in Reproductive Health (2023) into health systems.
Nelly Munyasia is the Executive Director, Reproductive Health Network Kenya