Transcription
[Music]
Good afternoon, ladies and gentlemen. We're about to start in a minute or so, so if you'd like to take your seats.
Hello again! How are you? Very nice to see you. Hello! I'm going to say hello to the member states.
Good afternoon, ladies and gentlemen, and welcome to this event on the occasion of the 76th World Health Assembly. A very warm welcome to all of you in the room with us. I know people are joining us online, so welcome to them as well.
I'd like to extend a special welcome to our colleagues from the World Health Organization who are here with us today.
I'm Shirley Gauche, and I'm delighted to be your host this afternoon as we examine the crucial role that self-care has to play in sustainable health systems.
Never has it been more vital that we address the increasing challenges facing national health systems. We have a rise in chronic conditions, an aging population, and of course, the COVID-19 pandemic, all of which have had an impact on overstretched resources and providers.
We're also striving to meet the global commitment to achieving universal health coverage. Well, against that background, there's growing recognition that self-care is an invaluable tool in strengthening the overall health ecosystem.
We've known for a long time that self-care practices have the potential to increase access to health care services, improve health outcomes, and reduce health care costs. Yet, self-care is often overlooked in national health care policies and strategies.
So today, we're going to talk about why that should change and why self-care should become a critical component of national health systems in order to achieve global health goals.
As you will hear from the Global Self-Care Federation and its coalition partners, a WHO resolution on self-care would provide a framework for its integration into future economic and health policies, promoting awareness, political commitment, and the mobilization of resources.
It would address issues such as training, quality assurance, monitoring, and evaluation, and it would support the realization of universal health coverage.
To discuss all of these aspects, we've brought together a fantastic set of experts to explore the huge benefits of including self-care in national health systems.
Let me quickly introduce them to you now:
- Manoj Raghunandan, Chair of the Global Self-Care Federation
- Dr. Slim Slama, Unit Head of NCD Management at the World Health Organization
- Kavaldeep Saini, CEO of IAPO, the International Alliance of Patients Organizations
- Dr. Mariette Eckstein, International Pharmaceutical Federation (FIP) and the Pharmaceutical Society of South Africa
- Dr. Manjula Nara Simmon, Department of Sexual and Reproductive Health and Research at WHO
- Dr. Austin L. Oster, Director of the Self-Care Academic Research Unit at Imperial College London
- Sandy Garson, Founding Director of the Self-Care Trailblazer Group
They will be answering questions and examining the role of self-care being integrated into healthcare systems, and they will also be taking questions from the floor. So I really urge you to have those ready because they are ready, able, and willing to be grilled by you a little later on.
But first, let's give a warm welcome now to the Federation Chair, Manoj Raghunandan.
[Applause]
Good afternoon! How's everybody doing?
Now, this is going to be a question and answer session. We just said that we're going to do grilling. If we're going to do grilling, we have to start with a hello.
Good afternoon! How's everybody doing? Excellent! Great! Thanks for being here.
First and foremost, I just want to thank our panelists for being here. What an incredible group of people! I'm sure that we're going to cut my talking down by quite a bit. I already gave them a warning that nobody really wants to hear from me; they want to hear from all the experts.
So first of all, thank you so much for making time. I know many of you. I was just talking to Dr. Slim; he has multiple speaking engagements, I think at the same time. So I really appreciate it, and Manjula, I think you have multiple engagements as well.
Thank you so much for making time to be here and for participating.
I thought maybe I'd just take a moment to tell you very quickly about the Global Self-Care Federation for those who are not aware. I was named the Chair of the Global Self-Care Federation just earlier this year, and I have to tell you, it's an incredible honor.
What a wonderful time to be named the Chair of the Global Self-Care Federation! We are in a unique moment as we see it from a federation standpoint as it pertains to the role of self-care in overall health care systems.
In my estimation, COVID-19 and the pandemic were the great accelerators of that. It was absolutely the great accelerator because we had a period in time where consumers and patients were relying upon themselves in those moments in order to care for themselves, adjudicate their own care, and provide for themselves.
During that time, we realized that in many cases, they could be successful at doing this.
At the Global Self-Care Federation, we represent associations and manufacturers in this industry who work closely with stakeholders to ensure, most importantly, that self-care is recognized.
We are not necessarily the pharmaceutical industry; we are the self-care industry. For some time, we've been trying to establish and recognize what self-care is, the value of self-care, and how it can be used properly.
So that is our job number one.
One of the things that we are really focused on over the course of the next three years is a key ambition, which was already mentioned: the WHO resolution.
We do believe that this has the potential for incredibly valuable impact, not just in developing markets. I think sometimes we think about what is convenient in developing markets, and absolutely we think there's benefit in developing markets, but we also believe that there's plenty of opportunity in our developed markets.
As a matter of fact, we just came from the AESGP conference in Paris. We were talking on a panel, and we got asked the question for our grilling on what would be the value for the European markets for a WHO resolution.
I said to them earlier in the day, we had just talked about how do we get harmonization and policy across the region. It's because we don't have a foundational layer of understanding of what is the right protocol for self-care within the overall healthcare ecosystem.
We also don't have the ability to have a great conversation with policymakers based on one approach for self-care overall.
Finally, we all know that things like healthcare literacy and education are going to play a big role in self-care. We firmly believe that if we get a WHO resolution, it'll allow us to have better and more impactful interventions in education, particularly in schools and during the younger years.
So we think there's value in this.
But the reality is, I heard somebody say this morning, "If you want to go fast, go alone. If you want to go far, do it together."
So we have established this coalition, which we are very, very proud of: the United for Self-Care Coalition, as you see it there with our logo.
Our idea is to really work together on this concept of universal health coverage by establishing self-care as a critical part of that journey.
The reality is we have incredible partners from NGOs, research institutions, and a wide variety of expertise, which you'll hear from today in public health sectors that are united in this need to create a more resilient health system, a more efficient health system.
These partners have been engaged for the long haul. They have a ton of experience; some are on the panel, and some of you are here today.
I want to thank you for joining us. I want to thank you for being here. I want to thank you for contributing your time, your effort, and in many cases, also your resources in order to help us advance this topic, as that's critically important.
Listen, we're looking to create a common platform. That's what self-care is: where we can work together and work from all angles, really holistically, on this challenge in order to meet the needs.
I think what you'll hear through the course of the conversation today is there's not just one issue that we face; there's not just one region that needs help.
We really do need to attack this issue from multiple fronts in order to be truly successful.
So listen, self-care is not just a stand-alone concept; it contributes to many global ambitions.
Sometimes I think when you're on an industry association or particularly when you work for a company, there is the idea that you are just pushing an agenda. I think that's a real stigma that sometimes exists.
But the reality is we believe that self-care can have contributions across universal health care, the WHO triple billion initiative, the UN sustainable development goals.
There are multiple areas in which we believe self-care can have a positive impact.
The way that I like to think about it is a multiplicative impact. I'm an old math professor, so that's sometimes why I use those terms.
But it does have a multiplying impact if we're able to get this right through several different fronts.
We also think that it can serve many different initiatives and ambitions that exist across the UN and WHO as well if we're able to get it done well.
So when we think about healthy development, healthy aging, prevention, primary health care, oral health, all of these, I think, are goals that can be better developed through self-care and help us in the 2030 sustainable development goals that we have as well.
Without the Global Self-Care Federation and some of the work that we've been doing, I won't spend a lot of time here, but over the course of the last two years, we've done a lot of work to bring evidence.
This has been the key ask of us: What is the evidence for self-care? Why do I really need self-care? Why should I, as a government agency, care about self-care? Why do I need it to be written in my policy?
So we did two what I will call seminal pieces of work for our organization in order to help here.
One, we noticed as we went around the world, wherever we went, if we went to the U.S. and we talked to the CHPA organization there, they would talk about one dollar spent on health care would save seven dollars out of the health care system.
Just yesterday, when we were in Paris, we heard the ASGP talk about a study that says one Euro spent on self-care saves four dollars and thirty Euro in the system.
We really believe that there's actually a bigger global impact.
So we did a comprehensive study on the socioeconomic impact of self-care, the global impact.
Just one small fact for you to consider is that thanks to self-care globally, we saved 119 billion dollars in the health care system.
But we still have major health care cost issues that we face. If we were able to save 119 billion already in one year, we believe that there's potential to save so much more.
When we look at it, there's a potential of up to 179 billion dollars that can be saved in the health care system through properly adjudicated, properly provided self-care around the world.
We also look at productive days globally, and what we realize is that there are 40.8 productive days globally created through proper self-care.
These are for organizations that are looking at their healthy workforce, that are looking to have healthy populations that are contributing to their societies or contributing to their economic value.
You're creating billions of hours of more productive days if, in fact, you have this.
When we thought about it, we did a little bit more math, and it almost led to about 12 more working days per employee around the world when you have properly adjudicated self-care.
And it doesn't stop there. I mean, I'm sure as everybody here on the panel will talk about, there is a shortage of healthcare providers around the world, in developing or developed markets.
There is a shortage, and the reality is properly adjudicated self-care allows these healthcare providers to truly focus on the most important health issues.
If we look at the hours saved for physicians in just one year, and you divide all those hours by the population of the United States, it would give every single person in the United States five hours of dedicated care in the course of a year.
Every single person, five hours of dedicated care.
So as I talked about that multiplicative effect, as I talked about the amplifying effect that we can have, we thought that the global social and economic value of self-care study was comprehensive.
Obviously, from the Global Self-Care Federation, we're happy to share that.
Along those lines, we also thought it was important to understand, well, how ready are we for this?
It's very easy to say we need self-care everywhere; everybody should do it; it should be in policy; look at these great statistics.
But the reality is you have to have the environment for success. There are certain factors that are critical for us to be successful in adopting self-care.
We talk about health literacy; we talk about policy; we talk about availability; we talk about access.
We looked at several key countries to understand what is their readiness index. It literally is a numeric value of where they are on the readiness index and what needs to be done in order for us to be successful.
We believe that we can extend this study. We've already done two versions of it, where we start to extend to more and more markets so that we are providing for those markets, for those governments, a clear and comprehensive plan as to how do you get to a place where you can then realize a lot of this multiplicative effect that we've been talking about.
So from the Global Self-Care Federation, two very seminal studies that we think are important, and we think that they have a multiplier effect on the economy, productivity, quality of care, and most importantly, health outcomes.
So I'll finish just by saying this, and I'm sure in the room, or I'm hoping in the room, a lot of you are very well educated on where we are today.
But I was talking to Slim here on the panel earlier, and I said sometimes you feel like when you come to these events, you're preaching to the choir.
Maybe that is the case in this instance, but the reality is that choir can go out and sing.
The reality is this choir can go out and have a bigger impact.
So I ask all of you: the time is now. I think we have all the statistics. I think my colleagues here on the panel are going to tell you all the reasons why it's important.
My question for you is: What would need to be true for you to turn into a true advocate of this work?
What are the facts that you are looking for? What is the information that you need?
What will it take for you to not just be the choir but to become the soloist that amplifies this effect and allows us to be more successful in self-care?
At the end of the day, for us, we really believe that this would lessen the burden on health systems.
It could truly change the health ecosystem around the globe, and more importantly, it can allow us to have a better impact on patients.
For any of you that have the opportunity to travel around the world, whether it's developed markets or developing markets, I was most recently in South Africa last year, and I spent some time there understanding that self-care just wasn't about reducing the burden of cost of care.
Self-care was the access to care for many in that country.
That's the job that we have.
So my ask of you is that the time is now. I think you're going to hear some pretty compelling information over the course of the next hour here.
You'll have a chance to meet and greet with some of these incredible folks and in the audience as well.
I know that there are brilliant minds that are here that can help us to be successful.
But I would ask: What would it take for you to fully get behind this cause?
What would it take for you to become an advocate?
And how can we all partner together to truly use self-care to have a positive impact on our health ecosystem, but more importantly, on the outcomes of our patients?
All right, so with that, we'll get started. Dr. Slim Slama is going to take the next agenda, or are we passing it off to our moderator?
Short video, then Dr. Slim Slama. Thank you.
[Applause]
So why do we want a WHO resolution on self-care?
We really want to see self-care recognized as a key contributor to the healthcare continuum.
Self-care spans over a wide spectrum of different actions, you can say, from detection of diseases, immunization, and prevention from minor ailments to actual management of non-communicable diseases.
The way we live our lives, the food we eat, the habits that we indulge in are major drivers of the diseases that we suffer from, and that's where self-care comes in.
We, as members of society, aren't merely passive recipients of health care but are actually generators of our own health.
We do need to achieve policy change. We need to achieve new service models. We need to build health literacy into all health interactions to enable people to participate in self-care with awareness and knowledge and to access self-care information that is quality assured for them.
Once you get a WHO resolution on self-care, you start to see a trickle-down effect. Member states start to adopt self-care in policy, and things flow down to the individual.
We recognize that this Congress has an opportunity to have the discussion as to how self-care can be integrated as a building block for universal health coverage, bringing self-care into the benefits not only of our individual health, our community itself, but also the health of our health systems.
As the WHO has said, self-care is one of the most special and unique opportunities that we have to dramatically change the healthcare ecosystem for everyone.
We have seen this, especially as we are able to reach communities that are otherwise marginalized and would not access health care, especially young people.
We're reaching LGBTI communities or even communities living in humanitarian situations.
We need to bring all actors together from the private and the public sector, and I see GSCF really as the convener of those groups.
A call to action for a self-care resolution is really to bring lots and lots of organizations on board, whether you're a key stakeholder in environment, health, consumer health, or health literacy.
We want your support and your buy-in.
So you'll be hearing from us. We're about to launch a special portal particularly for this resolution, so stay tuned.
[Music]
Thank you, and thank you, Manoj, for framing the benefits of self-care so comprehensively.
I think, as that video has alluded to, one area where self-care practices can make a significant and measurable difference is in the realm of non-communicable diseases.
Of course, reducing the burden of NCDs is one of the targets of the global health community.
So our next speaker is someone who knows the challenges of that only too well.
Please welcome Dr. Slim Slama, the unit head for NCD management at the World Health Organization.
Thank you.
Can I see it?
Thank you very much indeed, and I'm very thankful to the Federation for giving us the opportunity.
I have a couple of minutes, perhaps, to frame as well and contribute to the framing.
I think we can discuss during our presentation and further with the panel how we would come to a resolution on the path to a resolution.
But beyond that, I think it would be important to first have some element of framing.
I don't know if you can have the next slide.
Just to start to say that I spent 17 years of my life in this city as an internal medicine specialist.
I've been working in Geneva University Hospital for several years on chronic disease management, and then I moved to the region.
I'm happy to see some colleagues from the Eastern Mediterranean region. I spent an additional almost a decade in the EMRO region on NCD.
I think the first thing I learned from both is the humility to us.
What we want to do, and before being normative and prescriptive, is to listen.
To listen and to put people, not patients, at the center.
If my slides arrive, my first entry point was this.
I've seen that Jack is here, some of the colleagues, and Manjula have also contributed to this in WHO.
How do we move from a member state-driven organization, where we interact with ministries like today in deliberation at the UN Palais, to really bring back the main focus of people?
People that are living with chronic conditions, in particular lifelong.
They will spend most of their life on their own dealing with this, and the very minimum time they spend with the healthcare provider should be a dignified time, a time that they can be valued and supported.
I would like to bring some of the elements of the concept about self-care.
I think it's important that sometimes we agree on some elements of definition, but also understanding that definitions evolve.
As anything in policy and in global health, definitions should not be the limit, but also at the same time, it allows us to have a common ground on what we mean by self-care, by empowerment, and many of those concepts.
Here we are.
As I started, people power is something Jackie will be happy to see because this is my starting point.
In the last years in WHO, we started really to realize that we need to do another way of how we interact with people that we are meant to serve.
We started that journey by understanding and listening more to people across the world that are living with chronic conditions, with NCD, mental health, and logical conditions, involving them in biosaurus structure, understanding what are the perceptions, what are the language, what are their fears, how do we speak about it.
We did two major surveys on diabetes and survivorship in cancer to try to understand the perception of people that have those lived experiences.
They have claimed from the first time, the first consultation, that we have nothing for us without us.
I think it was a strong motto that we try to activate and mobilize people around this.
More recently, understanding the perspective from individuals across the globe that have lived experiences should be the starting point.
The resolution, the guidelines, whatever we do, come after.
But I think a clear understanding of what is at stake and how people can drive this change, putting them at the center, I think is a starting point.
As I said, patients with chronic conditions spend, on average, two hours per year with us as providers.
The rest of the time, they need to care for themselves.
How can we put the leverage on that point?
So people power, and you have seen it was very nice in your video as well, it's about advocacy and human rights.
It's about social justice.
It's about community engagement across a board of networks and health systems.
It's about exclusion or inclusion of marginalized communities that often are not the ones at the table.
It's about lived experiences, not as tokenism but as evidence and expertise.
People are experts over time.
Now, with the internet, with Google, every single time I used to have patients, they would come with what they found on the internet and would challenge us.
We need to accept this, and we need to actually be able to move with that new era of information and exchange.
Maybe the doctors have fallen down for their position, but actually, it's a more equal partnership that we are trying to establish.
It's about informed decision-making and health literacy.
Health literacy is not just about language; it's navigating systems and complex systems in a health system that we are living in.
But fundamentally, it's about power dynamics and power reorientation to us, individuals with experiences.
I think I would like to maintain this at the core of this discussion because then we go on very mechanistic approaches of self-care in managing or injecting or doing this and that.
It's an important component, but at the core, it's about the emancipation of people, a meaningful engagement in our definition of Diablo show.
I would like really to thank the colleagues from the global coordination mechanism.
We have Jack here as a representative who have been really at the forefront of those discussions with people with lived experiences.
It's really how we design and co-design, including decision-making processes through principles of respect, value, and dignity.
It's essential to achieve health for all.
We define meaningful engagement as a respectful, dignifying, equitable inclusion of individuals with lived experiences in a range of processes and activities.
In enabling environments where power is transferred to the people, a valued life experience as a form of expertise, as I mentioned, applying it to improve health outcomes.
It's not just for the sake of empowering; it also, when we mention self-care, is also to be able for people to benefit within the universal health coverage.
We forgot that financial protection and access to care have to benefit people.
People can say that yes, it changed my life because I have access to insulin, because I have been empowered, because I can say that yes, I'm entitled and I benefit from it.
It's something that is really important.
So health outcomes and metrics are also important, and I really allude to that.
There have been also some decades of work.
It's not something new per se.
As I said, the concept might evolve, but one definition, and a working definition that we have, and thanks to the colleagues from sexual and reproductive health that really have picked up this a couple of years ago, but I will mention also that there have been some work even before that that we need to recall specifically for chronic disease management.
Self-care is the ability of individuals, but also families and communities, to promote health, prevent disease, mental health, and cope with illnesses and disability with or without the support of health workers.
It's more than just the absence of disease; it's also about well-being, about being in a society and contributing positively.
I will let Manjula perhaps further develop later on the aspect of the work and the guidelines that have been put in place on self-care interventions, which is a sub-element also of what we are discussing here.
The self-testing, the self-management, the self-awareness is a contribution to this.
I would like to also refer to the research output about more and more evidence being generated about the efficacy of a range of self-care interventions, and I will allude to that in subsequent slides.
But I would like to also focus a bit more on self-care in the context of chronic conditions.
Sometimes, I mean, the word evolves, but they sometimes mean more or less the same.
Self-management in the context of people with lived experiences and chronic conditions is really how people, what do people do to be able to manage their disease and prevent complications, but also balancing their life and the illnesses in the daily challenges that they are facing in order to achieve the best outcomes.
Shift the perspective from illness to wellness, and the person with the chronic condition has three fundamental tasks.
One is really the medical aspect, managing life roles because we are impacted with chronic conditions, and this is something that we lost.
But also managing the psycho-emotional consequences of living, and this is very much of a neglected aspect.
It's not just about disease management; it's about also the psychosocial dimension of health and well-being.
The person living with a chronic condition can self-manage by gaining three elements, and I would just illustrate it later how this actually impacts on some specific examples with asthma, for instance, as an NCD condition.
It's about knowledge; it's about skills; it is about confidence.
Some of the work from the health community is really to bring those elements and support our communities to know about the condition, but also to have skills about how we manage them and have the confidence—the confidence to challenge us as doctors, but also the confidence to ask, the confidence to be able to say, "I know enough, and I'm competent to deal with my condition, but also to live my life and be inserted in a society."
Therapeutic education, and you have seen those different concepts, but they are somehow all converging towards something that is somehow similar.
It's an education and intervention, and it's drawing from behavioral science and health education about how to improve clinical outcomes carried out by health professionals to support patients to self-manage their chronic condition with the support of their families.
This document that you see in the middle is not new; it's from Pomona Collaborative Center, a few kilometers from here in Geneva.
Professor Assad was one of the pioneers in WHO to actually try to articulate that acute care model is not enough, and we need to move to chronic care disease management that really activates both providers but also people themselves.
The principle of therapeutic education has really been developed through evidence-based concepts and models from a number of disciplines.
It's not just being carried out by the healthcare community as well.
What is it for?
It's really to be able to set goals in life, action planning, taking decisions on the condition, but also sharing information with the patient about the condition, the risks, and how can they manage their condition.
It's about training and practical skills, including being able to anticipate the stress and the distress related to living with a chronic condition.
This is just a design that was coming from EMRO colleagues who painted this with us a couple of years ago.
These are real situations of people with chronic conditions, and what we want to achieve is to really develop the right competencies for both patients and healthcare professionals.
These competency profiles are really important to help self-manage the condition.
For health professionals, it's also to be able to deliver those educational activities that empower people.
I give you just a very concrete example.
I have this slide with asthma patients.
So what is the competency patient framework?
It would be about knowledge: What is asthma? What is an asthma episode? What are the triggers for attacks in asthma? What are the signs and symptoms?
These are simple, perhaps trivial elements, but many people are not aware of those conditions.
They live with this but without understanding really how these conditions are affecting them.
Then it's about skills: How to use an inhaler? How do you properly use an inhaler?
How do you use an inhaler in children when actually they don't know how to breathe, and you need to maybe use a spacer?
How to measure peak flow and measure actually your and monitor your condition?
How do you use the medication and take it properly?
We often put the blame on people about adherence and compliance, but actually, how do you empower them to maintain that control and keep healthy in diet and exercise, in emotional well-being?
Ability to assess any change and be able to prompt the system to seek for support when the situation changes.
As I mentioned, it's about confidence—confidence to manage the condition, confidence to manage different medications.
All these difficulties and the number of decisions that someone with a chronic condition has to take on a daily basis is huge.
But also confidence to ask for help and confidence also to disagree sometimes in the help that is provided.
We have the ongoing discussion, perhaps in WHO, what we are doing, and it's only one aspect because many of the colleagues across the department, I'm just referring to the work in the NCD department, with the quality center here in Geneva, we are reviewing in collaboration with many of the regions a review of concepts and self-management and therapeutic education.
The colleagues from Euro are building on that paper of 1998 to revisit this and develop a short guide.
We're also doing some research on the efficacy and evidence base, as we mentioned, of self-care and therapeutic education.
There have been a lot of requests across regions to develop a minimum curriculum for both patients and providers at the primary care level to be able to have training programs on therapeutic education and self-care.
This is just some element around the research output.
Next slide, please.
We have seen since the late '90s, and you can explain a bit why, an exponential increase in the number of publications.
This is just a problematic analysis of the number of publications on self-care in the last ten years.
It's also related to the fact that governments have accepted much more reimbursing some of those programs.
If you get funding for it, you get more publications; you might have more and more research done on it.
I think it's really important about how we operationalize self-care in systems is that it has to be recognized in the efficacy.
It has to have simple programs in place, and then it has to be reversed as part of the universal cash coverage schemes.
Effectiveness—we have a number of systematic reviews that show also that in terms of quality of life, but also on health outcomes across an NCD range and even beyond NCD for people with epilepsy, for instance, all the chronic energy conditions, it has an efficacy because the board—and this is one of the missing parts that we have—is that people seem to think that, "Yeah, it's a soft, it's good to have; it doesn't really show the impact."
Therapeutic education is about health outcomes that we can measure, and we can measure change over time.
I think I would stop with this.
Thank you very much.
[Applause]
Thank you very much indeed, Slim.
So we're going to jump straight into the panel discussion of the proceedings as we examine the arguments for including self-care in a WHO resolution.
I think I'm going to start with you, Kavaldeep.
We've heard a lot, haven't we, about the benefits that self-care brings to health systems and to communities.
What does it mean for patients?
I think everybody was here since childhood; we don't like hospitals.
No matter how bribing and confidently you're asking us into the lollipops and others, we don't like hospitals.
Secondly, as adults, we're much happier to take care of ourselves.
I think we have a pride, and we have found that taking care of oneself really depends upon having that efficacy, new self-care, and also efficacy is a product of your health education, health literacy, and more importantly, the confidence in that.
Though in current light, we would like to stay away from the hospitals.
We like to stay away and take care of ourselves first because in the long term, the number of hours we waste in units in hospitals is too much.
I can refer back to my patient's friends who said, "I've missed my daughter's weddings; I've missed this; I've missed that."
The number of hours I spent in hospitals has absolutely been too costly for me.
So from that aspect, it is then on the outcomes as well.
I think we are on outcome.
Yeah, part of that.
Lastly, to say that we always welcome political, legal, policy, and standards frameworks that we can rely on to help us create that ecosystem we want from patients: self-care first and health professionals second.
No matter—we all came out during the pandemic to cheer for health professionals; we know they're doing a good job.
Now it's time to take care of ourselves.
Thank you.
This all plays into the patient power that both Slim and Manoj were talking about.
Marius, as care providers, I mean, even in developed countries, it's really difficult to see your GP or your local doctor, right?
So how would community-level healthcare providers, particularly pharmacists, be impacted if greater self-care was integrated into healthcare systems?
Thank you. Good afternoon, colleagues.
I think we are all aware that in the healthcare system, most often, pharmacy and pharmacists are the patient's first point of call in any healthcare inquiry that they have.
So pharmacists could be exceptionally well-positioned resources to support the concept of self-care because we could assist patients with raising levels of health literacy as well as knowledge in the communities, which as a result could also result in increased levels of preventative care.
Of course, with a higher integration of self-care, you would also have a higher number of community-based healthcare workers, such as pharmacists.
But the demand will be higher because we could invest more in patients, assist them with increased levels of knowledge, and the patient can come and visit the pharmacy and out of their own have inquiries about self-care or minor ailments or just questions about the health game.
Pharmacists could then also have an expanded scope of practice.
I'm thinking about the concept of pharmacist prescribers, vaccination rights in pharmacies, and not in the hospital, for example.
But at the end, I see this as a win-win situation.
Firstly, the patient is encouraged to take a more active role in their health care, and the pharmacists could play an exceptional role in assisting that patient to equip them and to enable them to take up that active role.
It would take a lot more pressure on pharmacists, though.
What would it require? More training?
I think pharmacists are already well-trained; maybe not as optimally utilized as we could be in supporting the concept of self-care.
Thank you.
Thank you, Mariette.
Manjula, I know that there are already WHO guidelines when it comes to self-care, and you're a big advocate for greater integration of self-care within health systems.
Just give us a brief overview of what the WHO guidelines are when it comes to self-care interventions.
Thank you for that question and for having me on this panel.
I'm in the Department of Sexual and Reproductive Health at WHO, and it's a unique department in that it hosts the special program, the UN special program for research in reproductive health (HRP).
The reason I'm saying that is the focus of the guidelines from WHO, which is sort of our bread and butter in terms of setting norms and standards, is very much to ground what we're seeing in available evidence.
So there are things that we know intuitively would probably be a good idea, but the guidelines, as we see them developed, were very much focused on what might be some of the priority aspects of health, including for sexual and reproductive health, but also for NCDs, as my colleague Slim was talking about, but other areas such as infectious diseases, you know, like HIV self-testing and other aspects.
The areas of work for the guideline was very much to look at putting people at the center of the work, and this has been mentioned several times by the panelists.
But we're not looking at people as patients; we're looking at people as clients or end users of self-care options.
So yes, some of them may be patients, but for the most part, people are healthy, and they are self-caring.
We're talking about looking at health care and the healthcare delivery differently to how it has been conceptualized so far, which is very hierarchical.
It's very much about the health system providing support to a patient, and we are looking at this guideline with a different angle, putting the people at the center, looking at what they might need in terms of key principles such as human rights, equity, gender considerations, and looking at a holistic approach to people's health.
So that life course approach becomes important, and again, this was touched upon as well.
If we have a good start early on in our life, we can then have healthy aging moving forward.
So what are those components that might be needed for—and we could call it self-care; we could call it self-managed care.
The terminologies can be quite different, but what are those elements of the safe, supportive, enabling environment that will be needed to take that health and well-being of individuals and communities forward?
So we look at things like how can we reduce the levels of violence, stigma, discrimination, coercion that many people face, even within health systems?
We look at what kind of education and support they might need, including psychosocial support and other types of support.
What kind of access to justice might people need?
What kind of training of health providers would be needed, including competencies and capacities of health providers to trust a patient or a client to be able to self-care?
There’s a range of how we can make sure that regulated products are available, including for over-the-counter, because in many instances, we've got substandard products available that people are accessing.
So there are a range of issues that will be needed in addition to simply a biomedical intervention.
We're not focusing on just the biomedical intervention.
Yes, it is about things like a pregnancy self-test or an HIV self-test or a self-injectable contraception.
There's a range of specific interventions that we do talk about, but mainly the guideline is focused on those elements of equity in access, those elements of the safe and supporting environment, but also about the accountability aspect.
Accountability of health systems remains.
It's not about putting additional burden on individuals and just saying, "Here it is; it is safe; this is efficacious; it's cost-effective; you're on your own."
It's really about that accountability aspect for health systems, also for donors, for governments, for the private sector, and for individuals as well, having accountability in managing the self-care.
But these elements of that self-care framework, which was developed by WHO, have informed the guideline, and it's a living guideline in that as new evidence comes on board, we will continue to expand that evidence base and those recommendations.
So currently, there are a series of commendations in there, good practice implementation considerations, both within primary health care and universal health coverage, which has also been mentioned.
But, you know, including things like training for health workers and other aspects of implementation, comprehensive guidelines.
We appreciate what you're saying about patients not being left on their own; they actually have a whole framework of support around them to make it more effective.
Yes, and it's a consolidated guideline.
So we're not saying we've just created this newly, and they're going to be evolved.
It's a living guideline, and we have built upon work that has already been taking place at WHO for many years.
So this is a consolidated guideline based on what has been existing on new evidence, and we will continue to talk about best practice.
Can you give us an example of best practice on self-care integration into international systems that you've come across?
Thank you for that question, and really, please be part of this panel.
Absolutely!
I think there are a number of examples I can cite, but before that, when we established the Self-Care Academic Institute in 2017, we wanted to grapple with what is self-care, the totality of self-care.
We are really keen to use the pillars of self-care, health literacy being the ignition, the key in the ignition, so to speak.
I think that's really important these days.
As we've seen from Slim and others, health literacy, mental well-being, physical activity, and otherwise.
In the UK, hypertension management, their blood pressure in their home setting.
So NHS England bought a quarter of a million blood pressure monitors that distributed these to patients, and patients are effectively self-caring.
So it is shifting, releasing pressure from primary care and releasing pressure from the health system.
I think we're all familiar with the many fantastic digital health apps and tools that we use, CPO, and really good med tech, and maybe even online symptom checkers that people are beginning to use.
There are dangers, of course, of people assuming that they have a condition or that they need an ambulance or otherwise, but they are already very good examples of best practice.
The big question is how do we democratize access to self-care interventions and best practice?
So we have the guidelines; we've got some anecdotal evidence; we've got a lot of work on NCDs and technology.
All of these are coming together now, I think, to create a movement.
Commendations to the Global Self-Care Federation and for this alliance to spearhead this with the WHO to try to really create and continue this movement to make a real difference.
I think to get that information to the people who need it.
So that's really my overview of some of the key.
And the last point I'll make is any recommendations or policy prescriptions should really come into the fold of the health system in the sense that they should be complementary, and they should be contextualized in a way that makes sense to people.
Because we have three microphones on the table, but it seems only one has been passed down the line.
Perhaps you could pass that one back up this way.
Sandy, you keep hold of that because I'm going to ask you a question about your particular field of expertise, which is sexual and reproductive health.
How does a self-care resolution play into that?
Thank you for that question.
First, I think we have to start out with the why it's important in the field of SRH.
Sexual reproductive health, by nature, is very personal, and as a lot of my colleagues have mentioned, it's marred by stigma, different societal barriers, barriers to access.
Of course, self-care, different self-care interventions can, while they're not the panacea, they can play a role in helping individuals test themselves for HIV, for example.
We know that about seven years ago, more than 30 percent of the people in the world who are HIV positive were unaware of their status.
But we've seen how self-care has come in and has helped individuals, such as men, MSM, or groups who would not use traditional testing services.
They're now utilizing self-care methods as a way to test themselves and be linked to treatment.
We know this.
Self-care can also play a role when it comes to contraception, whether it's self-managed abortion or using tools such as DMPA-SC, which is self-injection.
So seeing that self-care can play this role is very important.
But at the same time, we must realize that it's not going to happen on its own.
We need, as my colleague Manjula mentioned, there needs to be a framework around self-care.
There needs to be the right kind of policies, the right kind of funding, the right kind of programming around it.
Now, a lot of countries are already moving in this direction.
Some of them are moving there in terms of single interventions, such as HIV self-testing.
You have increasing countries such as Uganda, Nigeria, Senegal that are developing their own guidelines, which are based on the WHO recommendations.
But we need more countries to do this, and I see a resolution as a mechanism that really sends a strong signal to the global community that self-care is important and we need to move it forward.
It's a signal that there's buy-in from other countries, and as you mentioned earlier, it will have that trickle-down effect where it might spill over into policy, funding, and everything else that's needed in order to actually build an enabling environment for self-care.
Thank you.
Thank you, Sandy.
Just before I throw the questions open to the floor, I just want to come to you, Manoj.
Sandy's already answered part of this question, but we've heard how there are WHO guidelines on self-care interventions.
We've heard how some countries are already moving towards self-care.
Why then, in your opinion, do we need an actual resolution?
I think at the end of the day, we've made meaningful progress, and I think some of the examples that we've talked about across the panel are, in fact, meaningful progress.
But I think if we look at the outcomes and we look at the numbers, I don't think we're where we need to be yet.
If you look at the cost of health care, if you look at the overall impact of health care, there are still too many missed opportunities for us to have better outcomes, for us to have a more efficient health care system, and for us to create greater access and availability of self-care interventions to populations of people around the world.
You know, I love what Slim was saying about putting this consumer in the center of what we do.
I think if we put them at the center and we ask ourselves, have we achieved what we've needed to achieve?
The answer is still no.
And so with that being the case, I think a WHO resolution, all the reasons that you know Sandy mentioned, all the reasons that you heard in the video, whether it be the trickle-down effect that we believe that it could have.
I mean, I think if we look at national policy, we'd probably say we're still not yet where we need to be.
I think this independent support and voice for member states saying, "Hey, this is important," allowing us to go into ministers of health and saying, "Now that this is a resolution, what is the plan? Let's make a plan. How are we implementing in a policy? How can we help?"
I think all of that is still required in order for us to have the true impact that we want to have.
So if we follow Slim's advice and we put the consumer in the middle, if we look at their impact, if we look at their costs, if we look at their accessibility, if we look at their availability, until we decide that that's in a good position, I still firmly believe that the WHO resolution is very, very important for us to move forward and something that we absolutely need to pursue.
Hopefully, together with this coalition and partnership from the day at WHO, we will be successful here in the near future.
Thank you.
Thank you, Manoj.
So now I'm going to throw it over to you.
I would like to hear any comments, any questions, any queries, any concerns about the role of self-care's greater integration into health systems.
Our panelists are here ready to take questions.
I don't know if we have a microphone.
Yes, if you raise your hand.
Lady at the front here.
Hi, my name is Dr. Kimberly Green, and I work with PATH. I lead our primary healthcare program, and we have a very long history in self-care and partnering with WHO and the Trailblazers on the Federation.
I'm thrilled to see this conversation around self-care and really want to endorse the importance of bringing together that evidence and accountability piece because I think with a resolution, that will be critical.
I do think that we all—and I think many of us can agree to this—there are challenges in terms of the acceptability of a number of self-care technologies.
Because of the paradigm shift that requires the medical associations and having the evidence and the accountability through WHO and through other normative bodies is, I'd say, kind of the minimum requirements that will be needed for countries to move forward on a resolution.
So that's just a statement I wanted to make.
Secondly, I wanted to ask a question around telemedicine.
Because of course, with COVID, we saw an amplification of telemedicine, and that opened the door for a lot of creative and rapid approaches among people with chronic illness to get medicines to them, but also through diagnostics.
I can think of examples with HIV self-testing, for example, and PrEP to ensure that people who were taking PrEP could still test themselves and know that they were still HIV negative.
So now, as we've moved into another stage of the pandemic and with telemedicine maybe not being as readily available as before but still more prevalent, what do you see as the opportunities and also potential challenges with telemedicine plus self-care?
Great question!
Thank you.
Yes, the role of telemedicine when it comes to self-care.
Who would like to take that part of it?
Part of it sits with me because we have also in the unit and colleagues across the department digital health solutions for chronic disease management.
Of course, there are multiple—I mean, programmatic areas that also can benefit.
I don't use telemedicine and digital solutions because even during the pandemic, the mobile technologies in particular were much more used, whether in terms of messaging, in terms of also informing patients, being able to maintain the link, also the social link to it.
Telemedicine was one component, but telemedicine is much more so resource and the regulation, the risk that we see.
We also see that just came from India last week in Delhi.
The government of India was announcing 75 million people under treatment for diabetes and hypertension, and they were launching and asking us to support digital health initiatives to really create also the necessary requirements in terms of regulatory requirements, capital investment.
Totally, medicine has not been there even during the pandemic.
Despite what we see, I think many countries were not prepared to maintain essential services, even to use it for self-care, using telemedicine platforms.
Mobile health is better.
We have also a Be Healthy mobile initiative in WHO for years with ITU, and we use it across.
I mean, I have behind you Vinayak, one of my colleagues for M cessation for tobacco.
We have it for cervical cancer; we have it for oral health more recently.
We are trying now to revisit the expense that we have about mobile health technology, but it's only one aspect of it.
I think the telemedicine part would require much more refinement about how the requirements are in place because we might also create—and we are creating—a digital divide already between those who can afford that, have the infrastructure, and the regulatory mechanism to put in place, and those who cannot.
Thank you.
Manjula, do you want to add to that?
A quick comment: there is also guidance on telemedicine that just came out from that department, led by Tamrat, our colleague, who has been leading that.
During the COVID pandemic, the again, based on the evidence, it came out the operational guidance from WHO on maintaining essential health services, including for sexual reproductive health and other NCDs and other areas.
The two areas that were prioritized were self-care interventions and digital health interventions.
Those links were made early on due to COVID.
But you asked about some of the concerns or, you know, that could happen.
One of the things we did see is issues related to data safety.
And again, it's always, you know, technologies always seem to benefit those who have power, who have education, who have wealth.
And those who fall through the cracks are those who are disadvantaged by many of the technologies that could be self-care interventions.
It could be telemedicine; it could be other things.
But we have seen that access to mobile phones or, you know, who has access to the data, how it's being used has been something that, you know, there has been a rise of sort of, you know, violence and gender-based violence or intimate partner violence linked to this.
So there are some concerns.
I think that's why we have to keep coming back to what the evidence is saying and what we can or cannot see and always be nuanced that we're not here to sort of just advocate in sort of in a blanket form all of self-care to everyone.
So those were just my thoughts.
Thank you.
Thank you, Manjula.
Thank you.
I'm aware that we are running very short of time.
Let's take one more question from the floor.
Yes, hi.
My name is Naoko Kozuki from the International Rescue Committee.
My organization works in the humanitarian space, but importantly, it's low-resource, high-mortality, high-burden context where we work.
I'm wondering if the panelists can speak on what special considerations you have for those locations because essentially, some of the conversations of exciting innovations that were mentioned are really not applicable.
But that's where the self-care need is the highest, I believe.
So it would be great to hear from the panel around considerations and maybe exciting areas that you've seen to tackle self-care in those areas.
You see everyone's fighting to answer that question now.
Who wants to take that question first?
Mariette?
Thank you, and thank you so much for that question.
It's certainly so important.
So if I can tap into the example that Dr. Tedros used this morning, and he explained a certain concept by saying it's like a bird with two wings.
I see the drive in terms of a resolution in this case for self-care as the one wing, and the other wing is the implementation of universal health coverage.
We need to take these two forwards together because at the end, when you look at the self-care context and the role players in it, you want that to be a sustainable vision.
If it all does not come together, then we offer maybe for a very short time or in certain countries or a very fragmented service to our patients, and we don't realize the goal that we have in mind.
So I think whatever the approach is, and my colleagues have said it already, is we need to make sure that the implementation is going together with the vision that we have.
Because at the end, we want it to be sustainable.
We want to see an upliftment.
We want to see that goal that we have in mind, and we can only do that when we all are moving forward in the same direction.
Okay, one last comment from the panel, and then we will have to bring it to a close.
Go ahead, Manjula.
So that's an excellent question, and actually, two months ago, we held an international consultation around what self-care interventions can mean in fragile and humanitarian settings with colleagues from IRC and others.
What we saw at that meeting, and evidence was presented from all the regions of WHO and in many different settings, high metal, low income, and what we did see is the value and the role of self-care interventions within each of those spaces if it was given with adequate approaches related to equity.
Because people definitely need the interventions; they do need the health care; they do not have access to it.
But there are concerns, such as when you go crossing across a border if you're a migrant crossing a border, if the language has changed, they don't have access to some of the information, the policies at border control where migrants are crossing perhaps, and all of their medicines, whether even if they were self-caring, are taken away from them.
What are the policies, the care, the information that needs to be given that provides that equitable access to those who are burdened during humanitarian and fragile settings?
So it's actually—the meeting report is about to come out, so watch the space.
We did discuss this quite in great detail.
Thank you.
Thank you.
Please keep it short and shortly.
I'm so glad you mentioned this because we are working with the refugee and the internally displaced communities.
Please refer to firstly Healthcare Endanger ICS project.
It has been there for a long time; they've got guidelines out to work with.
And the second guideline I'm very proud as a lawyer in human rights society I was working on is the Sphere guidelines on humanitarian work.
Please have a look at that Sphere guidelines; they guarantee you seamless care and self-care.
Long, so that with mobile technology, we can track a patient traveling from one border to the other and have seamless care.
And for all belligerent communities, it's not one big superpower or a small power for everybody, even kind of non-conformist blizzard groups, you know, small little groups.
Thank you.
As you can see, our panelists are a font of knowledge, and they will be very happy to meet with you on a one-to-one basis after we bring this session to a close.
But we are short of time, and I think that the speakers have done a great job of explaining why incorporating self-care into health systems will have multiple benefits for individuals and society.
I think it's a very strong call for collective action to have a global compact at WHO level.
Thank you very much indeed for listening.
We appreciate your attention.
Please give a final round of applause to our fantastic speakers.
Please join us for a networking reception to mingle, and we're going to have a reception here till—oh, where is it?
Downstairs!
Downstairs, please join us downstairs for a reception.
Thank you.
Thank you to our moderator too.
I was trying to say thank you to them.