Interesting! Can you provide some ideas about what the future of financing AI might look like, in a way that ensures (to the extent possible) equity?
PAGB published a report on Overcoming the Barriers to Self Care at the end of last year: https://www.pagb.co.uk/latest-news/barriers-to-self-care/
Very impactful data Donna
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Without wanting to open a giant can of wormsâŚIs the language of self-care a barrier? Despite the WHO definition, to many people self-care is a middle-upper class luxury for those with income to spend on yoga, meditation and mindfulness. To some âselfcareâ is a principle associated with the black feminist writer Audre Lorde who argued that caring for yourself was necessary to protect you from a society that was hostile to your identity. For others it implies a very individualistic approach to the relationship with your community and health system. How can we better communicate that self-care is something for everyone?
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It would be good to follow-up on this topic as we, at the World Economic Forum, are building a shared learnings platform that respond to the need to connect on priority topics to share learnings and best practices, exchange challenges, experiences and collaborate with each other. Letâs connect!
Totally agree with all these 4 points - as you can see from my essay! I donât need to repeat myself. But 1) economic savings as a)if we treat upstream before problem becomes bigger 2) we use AI to deliver our self care - in the form or our AI products - symptom checker, healthcheck, etc. This allows accessibility and affordability3) this accessiblity therefore creates to equality as reaches all those from rurual Rwanda to women home with kids in USA 4. and to engage the use with our self care products/coaching etc gives them empowerment to change lifestyle habits and change patient outcome
A1. COVID-19 showcased the importance of self-care for the health systems. Practicing responsible self-care is crucial in decreasing the burden on healthcare systems, particularly during this time of crisis. Self-managing symptoms through self-care will help to relieve the burden on health systems while helping individuals to alleviate mild symptoms.
And this goes beyond current crisis. By further integrating self-care into the health continuum we can improve health outcomes around the world, reduce costs, and ease the unsustainable burden currently placed on overstretched healthcare systems.
With an estimated shortage of 12.9 million healthcare workers forecast by 2035 and 1 in 5 of the worldâs population already living in humanitarian crises, there is a clear need for innovative strategies that go beyond a conventional health sector response. Self-administered care, with guidance from remote digital consultations is a practical, effective and feasible solution to this escalating issue.
@DaniellaF - Yes! Finding ways to operate in this time of disruption is key to not lose any momentume. HERproject has been digitizing its program to keep its presence in this time of social distancing to continue increasing the demand for health services and products.
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There are many silos of budgets & activities with different organisations or networks understandably focusing on their own perspective on how people, netwroks or society can self-care.
Self-care is about behaviour change, but we know that getting people to change behaviours once habits are set in is actually quite hard. Ideally, we can embed good self-care behaviours from a young age. Perhaps the most importnat barrier to self-care is perhaps lack of awareness by yong people on how to efectively self-care, so itâs crucial we get the messagin just right.
One of the key barriers to access is ensuring individuals are aware of self-care opportunities and know how to access them, use them safely and still link back to the health system when they need to. Thatâs a lot for us to get right! There are a myriad ways to increase awareness around self care and each needs to be tailored to the context. For example, US organization PATH led pilots in 4 African countries showing the most effective channels to increase demand for contraceptive, including self-injection are (1) interpersonal communication between health workers and patients and (2) radio dramas and programs
At the health systems level, we are huge fans of the WHOâs Consolidated Guidelines for Self-Care for SRHR! This provides such a valuable starting point to negotiate national barriers to self-care, including associated regulations. The MOHs in Ethiopia, Nigeria, and Uganda are already starting to develop national consolidated guidelines for self-care. There are 00âs of examples. In October this year, the Permanent Secretary of the MOH in Zambia issued a statement that supports private pharmacists and pharmacy techs to train women to self administer injectable contraception. These decisions unlock a myriad of barriers and create many opportunities. We are seeing the same changes here in the US where I am based, with a host of healthcare needs now allowed to be met via telemedicine. Not only does this enhance health care, it contributes to self care, and I am delighted Babylon Health here today as they are doing some great work. Dr. Afolabi, on this panel, may also be able to provide more detail about what this looks like in practice!
I have the same feeling about it
HERprojectâs experience highlights that access to healthcare is about more than geographic availability: itâs about ensuring that necessary health products and services are available, accessible, affordable, and acceptable to people. Our program employs supply-side strategy, which involves facilitating healthcare linkages from the workplace to external service providers to improve healthcare access for low-income women and men, as well as demand-side strategy, which involves reducing the barriers to access and participation. Letâs take family planning as an example.
In four agricultural workplaces in Kenya, HERproject asked low-income women workers about their access to modern family planning products. On the supply side of the equation, of the women workers surveyed:
- 97 percent of women reported that family planning products and services were available, with 82 percent reporting that modern family planning products were within walking distance.
- 96 percent of women reported that family planning products were affordable.
- 76 percent of women reported using family planning products.
Yet of those not using modern family planning products, nearly 20 percent said that they would want to use it. We found that the âacceptabilityâ dimension of access is key to understanding women workersâ demand for family planning products. Our data suggest that family planning remains a taboo topic.
For more info, feel free to check our blog here.
Since the start of the COVID-19 pandemic in March, more than 60 million claims have been filed for unemployment insurance in the US. In this country, when people lose their job, they also lose their ability to access healthcare. Even with health insurance, the healthcare system can be costly. For those who are uninsured or underinsured, the out-of-pocket expense can be even more debilitating. The healthcare system can support the creation of self-care, though the barriers to cost must be removed. At a minimum, this requires a shift to a system that ensures universal health coverage. It also requires reducing the cost of care (both primary and specialty). In the former case, the benefits to receiving these services vastly outweigh the consequences of delay to both individuals and society as a whole.
Thereâs more information on our self care survey on the PAGB website here: https://www.pagb.co.uk/latest-news/pagb-self-care-survey/
A2. Some enablers are to be considered to overcome barriers to self-care.
- Harness the power of technology and digital engagement: According to the International Telecommunication Union, there are over 5 billion wireless subscribers; over 70% of them reside in low- and middle-income countries. Digital health is transforming our lives and is a powerful tool in the way we manage our health and wellbeing. It increases accessibility and reaches population in different areas. For example, during the current pandemic crisis, rural India has seen 10% more usage than in urban areas which has an opportunity to move to over 220 million rural internet users.
- Have the self-care approach as part of public health policies and programs: reforming the traditional healthcare system is crucial and policy makers should help and support the transition to a self-care population model. Policy makers should play a role in making sure that everyone has access to self-care information, measures and tools but also have a supporting role in this journey.
- Evidence on return on investment to self-care is still to be documented and this is where data could play a major role to build a stronger economic case for stakeholders.
Q2. Difficult question indeed
As I have focused on MMS from a research point of view, I will apply that lens here for a start point.
For all health initiatives and medical progress, there is always an evidence base of research that grows until it becomes demonstrated it has a positive effect, and has improved efficiency and efficacy compared to existing approaches. That is used to feed into health strategies that are budgeted and included into current policy and law.
This seemingly simple approach in which academics show policy makers the truth and they turn it into law, is not how things work in reality. Ministries of Health have many competing priorities, and all are important. Funds need to be carefully allocated and it will nearly always be insufficient, while already existing approaches may not work so well but are already stablished and probably not exempt of deficiencies themselves. Many agencies, corporates and civil society groups are pushing for their area of interest and the discussion becomes crowded with information and misinformation. It can be very difficult to get heard given each topic is highly important.
A key here is how to empower accessible self-care that is science-based and truly helps improve overall health.
The healthcare system cannot be entirely responsible for ensuring self-care. The regulatory environment also plays a role. One of the biggest challenges in the US is the separate funding mechanisms for healthcare and social services. Evidence suggests that for every dollar spent on healthcare in the US, mere cents are spent on social services. In Scandinavian countries, a dollar spent on healthcare means two dollars spent on social services. The disparate funding streams make it challenging to create a holistic and integrated system. Negotiating this barrier requires a whole of government approach predicated on leadership and political will.
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A great report about Self Care in Australia that Pierre told me about (https://www.vu.edu.au/sites/default/files/state-of-self-care-in-australia-mitchell-institute.pdf) highlights the challenge that âthere are now a plethora of self-help and self-management resources that have become available in the market. Much of the information available for self-care or self-management is unspecific, appears to be unqualified and there are concerns that it might be wrongâ. It goes on to talk about the need âto develop quality assurance or a âtrusted brandingâ process to reassure consumers about the safety and integrity of the information provided through these resourcesâ. Are you aware of any efforts like this happening?
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Any major changes require, focusing for example in MMS: new expertise in country, involves supplying micronutrient powders, advocating for the adoption of relevant policies, counterpart coordination and collaboration, enforcement of new laws, creating demand and behaviour change strategies to reach target populations, and ensuring that programmes are rigorously monitored and evaluated with a strong supply chain that prevents stock disruption. It requires funding at all levels and can take several years to roll out to maximum coverage even in the case of a self-care approach.
The process (with endless glitches) then looks more like this, in my experience:
Evidence generation (sometimes over decades of discussions and research) â eventually more evidence is needed â acceptance of demonstrated approaches as standard and recommendation/guidelines produced by WHO/UNICEF â lobby and advocacy at international and national levelâ counter advocacy â more advocacy â policy making (can take years) â health strategy, costed plan and implementation (can take a few years to reach required coverage).