(Swamedikasi WHO 2009) PDF
(Swamedikasi WHO 2009) PDF
(Swamedikasi WHO 2009) PDF
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Printed in India
Contents
Page
5. Gist of presentations...................................................................................... 4
Country presentations ................................................................................. 11
Annexes
2. References .................................................................................................. 46
3. Agenda ....................................................................................................... 65
4. Programme ................................................................................................. 66
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1. Introduction and background
Self-care is a deliberate action that individuals, family members and the
community should engage in to maintain good health. Ability to perform
self-care varies according to many social determinants and health
conditions. In the series of international conferences on health promotion
held in 2006 from Ottawa to Bangkok, self-care was emphasized as the key
strategy for health promotion and disease prevention.
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2. General objective
The general objective of the consultation was to determine the way forward
in strengthening self-care for revitalizing PHC in Member States of the SEA
Region.
3. Specific objectives
The following specific objectives were set forth:
4. Inaugural session
The WHO Regional Director for the SEA Region, Dr Samlee
Plianbangchang, while inaugurating the regional consultation mentioned
that it was one in the series of follow-up actions emanating from the
Regional Conference on Revitalizing Primary Health Care, and reiterated
that PHC is the key to the attainment of the social goal of health for all, and
an important contribution by people of all walks of life to achieve the goal.
Good self-care or effective self-care depends on knowledge and
understanding of individuals, and depends on their ability to be in control
of their own selves.
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5. Gist of presentations
Dr Ilsa Nelwan, Regional Adviser for Health Systems, WHO Regional Office
for South-East Asia, introduced the working paper on “Self-care in the
context of Primary Health Care”. She said that self-care is health-related
decision-making and care undertaken by individuals, family and
communities and that the decision-making process depends on local
sociocultural aspects. She reiterated that studies and data showed the
potential of self-care to improve health-care effectiveness, including health-
care cost. The shift in epidemiology from infectious to chronic diseases, the
change in philosophy from cure to care and the escalating cost of medical
care demanded a new strategy to revitalize PHC in strengthening the health
system. Thirty years after the Alma-Ata declaration, the changing social,
political and cultural scenarios at global, national and local levels were
affecting health. Other challenges such as the current global financial crisis,
epidemiological transition leading to an increase in noncommunicable
disease mortality, widening inequity between and within countries that
threaten PHC values and a significant number of people in this Region
impoverished due to catastrophic health expenditure, will all aggravate the
situation further. WHO affirms that PHC is still an approach leading to
health equity and social justice. However, it has to be revitalized or
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The conceptual framework began with the equity issue. Health equity
is the most salient feature of PHC. To achieve an appropriate and equitable
level of health is a question of how the health system is organized at
different levels, financed and manned, so as to prevent barriers to access for
the whole population.
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upon the other positive features of self-care such as making people self-
reliant to make judgments related to factors having an impact on the health
of an individual, family and community, and seeking health-care from
professionals when appropriate. Self-care is a key to success in universal
health-care coverage. Further, she elaborated on the role of families and
communities in community-based care and components of community-
based care, physical care, nursing care, and physiotherapy, psychological,
spiritual and nutritional support. After explaining the benefits of
community-based care, she elaborated on the different roles of (i) Health
workers - provide technical support to patients, the family care-givers and
community health workers; (ii) Patients and family members: Family –
identify and meet care needs of the patients; Patient – perform self-care,
carry out the daily duties when possible and control disease; and
(iii) Community members - implement health-care activities at the
community level.
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knowledge of what they can do themselves and for which they need
support from health systems, prepare materials (manual with texts
supported by diagrams and illustrations), educate and train people with the
prepared material; carry out training periodically; continuously monitor and
evaluate the process and take corrective measures in order to improve the
processes. These tasks need to be carried out for a healthy population,
those with minor health problems, hospitalized patients (for post-
hospitalization care) and persons with disability. For doing these tasks, the
health system needs to be strengthened through continuous review and
reforms of policies (health and healthy public policies), structures, functions
and financing.
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Country presentations
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Challenges and limitations: Conflict situation in the north and the east,
district variations, and the global economic crisis.
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6. Group work
Two group work sessions were conducted viz:
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Best practices
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Pros
Self-medication might reduce the need for medicine. There would be
reduced burden on the government. Self-medication reduces
indirect/opportunity costs. Self-medication can provide psychological
support to chronic patients. It may pressurize medical practitioners to
behave more rationally and to regulate dispensing of drugs. Self medication
can safely use allopathic medicine vis-à-vis traditional medicine/home-
based therapies; self- medication can be safe if people are well informed.
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Cons
Inadequate knowledge about medicine including local culture barriers. Self-
medication may increase inconsistencies with rational use of drugs. It can
increase dependency on guidelines/set-thinking. It can be expensive if the
country depends on imported medicines. It might also delay treatment in
serious conditions.
Key strategies
(1) Policy and legislation for self-care are important for self-care
promotion.
(2) Networking among different players will improve collaboration
among health stakeholders and improve access to self-care.
(3) Information, education and communication for supporting self-
care promotion.
(4) Planning: Bottom-up planning to integrate the grassroot
initiatives supported by adequate resources through resource
allocation and resource mobilization.
(5) Interventions: Establish and strengthen the community-based
posts for launching SC interventions and for bringing the
community and the service providers closer. Strengthen the
capacity of community-based, private and nongovernmental
organizations.
(6) Research and studies on existing self-care practices.
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Recommendations
Member States should:
¾ Give serious consideration to including strengthening of self-care
as a programme in their efforts to revitalize PHC.
¾ Re-examine national health policies and strategies to strengthen
support structures, legislation and financing for self-care.
¾ Document existing local self-care best practices and conduct
operational research to develop evidence-based, effective self-
care practices.
¾ Establish a network of individuals and institutions for self-care
promotion.
WHO should:
¾ Advocate for strengthening self-care in the context of revitalizing
PHC.
¾ Provide technical support to Member States in their efforts to
promote effective self-care.
¾ Provide support to Member States in documentation, assessment
and evaluation and research on self-care practices.
¾ To develop common tools and guidelines.
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Annex 1
1. Introduction
Primary Health Care (PHC) is an approach for health development
envisioned in the Alma-Ata Declaration of 1978. PHC aims at equity in
health through accessible, affordable and quality health care for all with the
full participation of all people in the spirit of self reliance and self
determination. Health care is delivered through the health system, which
comprises all organizations, people and actions whose primary intent is to
promote, restore or maintain health. This includes efforts to influence
determinants of health as well as more direct health-improving activities. In
short, the health sector is not the sole owner of the health system. Hence,
the performance of the health system is influenced by other sectors beyond
health (1).
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The World Health Report 2008 entitled, “Primary Health Care – Now
More Than Ever”, was dedicated to the renewal of PHC. The report was
launched on 14 October 2008 at Almaty, Kazakhstan to commemorate the
30th anniversary of PHC (5).
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2. Conceptual framework
Health equity is the most salient value of PHC. It is generally used to
measure the performance of the health systems along with the level of
health using various indicators, such as life expectancy at birth and maternal
mortality ratio. To achieve an appropriate and equitable level of health is a
matter of how the health system is organized at different levels, financed
and manned, so as to prevent barriers to access for the whole population.
Health
Promotion
H H
Public Self Care
Disease E E
Health Prevention A A
L L
T
T
Primary Disease Individual
H
H
Control
S
Health S T
Family Y A
Care S T
T U
Self Community
S
E
Medical Medication M Level
Care and
Rehabilitation Equity
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Self-care should follow a continuum of care using the life cycle from
birth, childhood, adolescent, adulthood and elderly. In the reproductive
health programme, good results have been achieved by using adolescents
for behaviour change. With regard to level of care approach institutional
care, the focus should be on primary level of care where most illnesses can
be prevented in a cost-effective manner by any individual. The individual
will be the centre of self-care, supported by the family and the community.
3. Health equity
Attaining good health is one of the fundamental human rights as well as a
human investment for national development programmes. Health is
defined as a state of complete physical, mental and social well-being, and
not merely the absence of disease and infirmity.
The Health for All (HFA) movement was part of the Alma-Ata
Declaration on Primary Health Care adopted in 1978. HFA was to be
achieved by the year 2000. Even though HFA has not been achieved, it is
still vision or inspirational goal of health development. It is believed that this
could be achieved through revitalizing PHC
While equity and social justice are the salient values of PHC, the
recent global economic crisis will certainly worsen the inequity gap.
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IND-98
4. Health system
The physical infrastructure of health services in many countries of the
South-East Asia has expanded significantly since the 1980s, particularly at
the primary and first referral levels. Most countries have given priority to
upgrade the health infrastructure, particularly in rural areas. Practically all
Member countries have comprehensive networks of health facilities that
extend to the village level. The establishment of a primary care
infrastructure in rural areas, supported by a strong referral system,
intersectoral collaboration, and community participation are the
characteristics of the health systems development based on primary health
care in the Region.
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5. Self-care
Basically, when people feel there is something wrong or there is some
symptom, they will attribute that to some causes and then try to get well by
doing something to get rid of such symptoms. The ways in which they help
themselves is called “lay self-care”. How they practice self-care to get relief
from their ailments depends on what they believe are the causes of their
ailments. Before the era of modern medicine, there were many theories
explaining the causes of illness, for example, the imbalance of the
substances in the human body, karma, supernatural causes, including black
magic, evil spirits, luck, faith, etc. Therefore, self-care practices in many
societies include a wide range of options such as using herbs, body
massage, ointment, body heating, holy water, religious and cultural rituals
and ceremonies, spirit possession, and so on.
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addition to the usual care received in the setting. Results of the study
indicated that patients in the experimental group had significantly less
pain sensation and distress, used fewer analgesics, ambulated more,
had fewer complications, and had higher satisfaction with care than
patients in the control group. Since the experimental intervention was
based on Orem's and King's theories, these findings support the value
of application of these two nursing theories in practice (13).
(k) Kleinman in his study on health-seeking process in Taiwan reported
that 73% of total illness episodes in the preceding month were treated
in the family only, and 93% were first treated in the family. A study of
self-care behaviour in Northeastern Thailand employing a one-month
recall period, found 88% of all reported illnesses were minor ailments
and about 96% of these received self-care only. A study of self-
medication practice with modern pharmaceuticals for childhood
illnesses in a rural Filipino village found 38% of 422 illnesses in 51
children were self-medicated with modern pharmaceuticals and
another 42% were non-medication self-treatment (7).
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The definition of PHC also mentions that health care should be”… at a cost
that the community and country can afford”. It means that public health
services should be affordable, since affordability relates to the ability of an
individual or a family, community and country to pay for health care1. Thus
self-care also influences health care financing. The present status of
expenditure by countries in the Region shows that government health
expenditure is very small (about $3-$5/capita/year), even though, there is a
high proportion of population in developing countries categorized as living
below the poverty line. In the light of these challenges, the double burden
of disease creates a spiraling cost for individuals, the community as well as
for the whole country’s health care financing. Self-care related to health
promotion can reduce the cost of improving health and disease prevention
at personal, family and health care system levels, since self-treatment
accounts for a big chunk of the family’s health expenditure. Overall, the
benefits of self-care include lower costs for the entire health care system.
A big health challenge for the Region is the high rate of maternal and
newborn deaths. The Region accounted for 170,000 maternal deaths in
2005 and over 1.3 million neonatal deaths in 2004. Immediate and
effective professional care before, during and after delivery can make the
difference between life and death for both women and their newborns.
1
The maximum ability to pay has been estimated not to exceed 40% of non-food expenditure of an individual’s or
family’s income. Thus, any health expenditure within this limit is called affordable. Expenditure beyond this limit is
categorized as catastrophic expenditure that may impoverish the spender.
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Diarrhoea
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Tuberculosis
The WHO South-East Asia Region carries over a third of the global burden
of tuberculosis, representing a case burden of nearly 5 million TB cases. In
addition, it is estimated that over half a million people continue to die of
tuberculosis each year in the Region.
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Malaria
HIV/AIDS
With an estimated 260 000 new HIV infections and 300 000 HIV-
associated deaths in 2007, HIV continues to be a major public health
problem in the Region.
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While access to services has increased since 2001, it is still low for
IDUs, (Men having Sex with Men (MSM), sex workers, and prisoners.
Coverage also remains low for VCT (Voluntary Counseling and Treatment),
PMTCT (Prevention from Mother to Child Transmission) and care and
treatment services (14).
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Region’s disease burden; 54% of the deaths in the Region during 2005
were NCD-related.
The main risk factors for major NCDs include: (a) tobacco and alcohol
use, (b) unhealthy diet (high in total energy, fat, salt and sugar, low in fruit
and vegetables) and (c) physical inactivity. These behavioural risk factors are
closely related to hypertension, overweight and high blood levels of glucose
and cholesterol.
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References
(1) World Health Organization. The World health report 2000: health systems: improving
performance. Geneva: WHO, 2000.
(2) Dean K. Health related behavior in health promotion: Utilizing concept of self-care.
Health Promotion International. 1995; 10(1): 35-40.
(3) Bhuyan KK. Health promotion through self-care and community participation,
element of proposed programme in the developing countries. BMC Public Health.
2004; 4: 11.
(4) World Health Organization, Regional Office for South-East Asia. Strengthening self-
care at home. New Delhi: WHO-SEARO, 1991.
(5) World Health Organization. The World health report 2008: primary health care - now
more than ever. Geneva: WHO, 2008.
(6) World Health Organization, Regional Office for South East Asia. Revitalizing Primary
Health Care: working paper. Paper presented at the Regional Conference on
Revitalizing Primary Health Care, Jakarta, Indonesia, 6-8 August 2008. New Delhi:
WHO-SEARO, 2008.
(7) Thavitong Hongvivatana. Self-care: emerging research challenge for primary health
care in developing country. A paper presented at the Thirteenth session of the South-
East Asia Advisory Committee on Health Research, Ulan Bator, Mongolia, 27 July – 1
August 1987. New Delhi: WHO SEARO, 1987.
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Self-care in the Context of Primary Health Care
(8) World Health Organization. The role of the pharmacist in self-care and self
medication: report of the 4th WHO consultative group on the role of the pharmacist.
Geneva: WHO-SEARO, 1998.
(9) Lorig KR, Holman H. Self-management education: history, definition, outcomes, and
mechanisms. Annals of Behavioral Medicine. 2003 Aug; 26(1): 1-7.
(10) Amorn CS. WHO and the development of public health in South-East Asia. In: World
Health Organization, Regional Office for South-East Asia. Sixty years of WHO in
South-East Asia: highlights: 1948-2008. New Delhi: WHO-SEARO, 2008.
(11) Kessaravan Nilvarangkul et al. Strengthening the self-care of women working in
informal sector: local fabric weaving Khon Kan Thailand (Phase I). Industrial Health.
2006; 44(1): 101-107.
(12) Robert L Parker et al. self-care in rural India and Nepal. Culture, Medicine and
Psychiatr. 1979 March; 3(1): 3-28.
(13) Somchit Hanucharurnkul. Effect of promoting patients participation in self-care on
post operative recovery and satisfaction with care. Nursing Science Quarterly. 1991;
4(1): 14-20.
(14) World Health Organization, Regional Office for South East Asia. Health situation in
South-East Asia region: 2001-2007. New Delhi: WHO-SEARO, 2008.
(15) Deressa W, Ali A, Enqusellassie F. Self treatment of malaria in rural communities,
Butajira, Southern Ethiopia. Bulletin of the World Health Organization. 2003; 81(4):
261-268.
(16) World health Organization, Regional Office for South-East Asia. Prevalence rate and
patterns of Epilepsy. New Delhi, WHO SEARO, 2008.
(17) World Health Organization, Regional Office for South-East Asia. Schizophrenia:
youth’s greatest disabler. New Delhi: WHO-SEARO, 2001.
(18) World Health Organization, Regional Office for South-East Asia. Conquering
depression. New Delhi: WHO-SEARO, 2001.
(19) World Health Organization, Regional Office for South-East Asia. Mental retardation,
New Delhi: WHO-SEARO, 2001.
(20) Chambers, Ruth. The role of health professional in supporting self-care. Quality in
Primary Care 2006 Sep;14(3):129-131.
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Health Promotion and Acceptable/Beneficial a. Family care giver seek a. Community members
Education a. Exercising information on basic listen/watch multiple mass
knowledge of the nature of communication channels
b. Taking adequate rest and minor illnesses that affect (radio, television or
relaxation family members, specifically newspaper) to promote self-
c. personal hygiene including the signs and symptoms and care at community level;
hand washing before and after what to do; b. The content of information
eating, after using the toilet or b. Family members requiring received shared with the
touching dirty objects; assistance and the family care general public does contain
brushing teeth; taking a body communicate clearly between conflicting messages;
bath themselves in order to c. Interpersonal communication,
d. Eating nutritious food, less in minimize suspicions and lack obtained through credible
fat and salt; drinking plenty of of trust; sources (such as local
clean water c. Family members maintain community health personnel
e. keeping a clear mind – Not confidentiality of information (such as nurses and medical
using alcohol or drugs, as a pre-requisite for effective doctors) used to disseminate
reducing emotional stress self-care. None of the family health messages to others.
through conflict resolution members discloses the cause d. Feed back mechanism
f. Breast self examination or nature of illness with other established to monitor the
(female) people outside the family effects of the SC initiatives
Regularly monitor vital signs - without the consent of the from community members;
Blood pressure, temperature family member receiving self-
care assistance; e. SC tips are disseminated
and weight through campaigns, books,
g. Recognize serious health d. In the case of food leaflets, audiotapes, videos,
problems and seek eek preparation, the family brochures as well as through
medical care quickly.; and if considers the nutritional needs traditional approaches to SC
had chronic conditions that of any family member on self-
care; f. Cultural relevancy is
require medical attention maintained in crafting and
h. Complying with prescribed e. The elderly are given more dissemination of messages;
medication regimen family and community support particularly the language used
in administering SC, therefore and age specificity.
i. Self-care of minor ailments
a family or community
such as stuffy nose, minor g. Community members monitor
member is assigned to
aches, cold, diarrhea, dry skin. closely and constantly specific
monitor.
population groups such as the
e. Family members resolve elderly, handicapped or young
conflicts within members of people under SC. The
the family and with neighbours community/family provide all
needed support.-physical,
emotional, psychological,
information.
2
Self care “behavioral outcomes” implemented at individual, family and community level
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Nutrition for Health and Eat healthy during pregnancy: Make vegetables and fruits an • Maintain a healthy body
Development • Increase food intake to provide essential part of every meal: weight
for the baby; • Include 1-2 vegetables or fruits • Be active
• Eat a nutritious diet to gain in every meal; • Eat a variety of foods everyday
weight at the recommended • Eat green, red, yellow, orange, • Eat cereals, preferably whole
rate; purple vegetables and fruits; grains, as the basis of most
• Iron-rich animal food include • Prefer seasonal and locally meals
red meat and eggs; available vegetables and fruits. • Eat more vegetables and fruits
• Vegetarians should consume • Limit consumption of fats and everyday
more iron-rich foods such as oils: • Eat legume-based dishes
whole cereals, soya beans and • For a healthy adult, use only 4- • Limit intake of fats and oils
green leafy vegetables. 5 teaspoon of oil in cooking • Limit intake of sugars
daily; especially sweetened foods
Give your baby only breast milk for
• Use at least two different oils and beverages
the first six months of life:
for cooking – soy, sunflower, • Limit salt intake
• Do not give your baby any
mustard or corn oil; • Consume milk/dairy products
other milk or water for the first
• Prefer low fat dairy products, daily (preferably low fat)
six months of life;
lean meats like chicken and • Eat fish at least twice a week
• Breast feed your baby
fish, nuts and seeds; (for non-vegetarians)
whenever the baby is hungry;
• Avoid processed foods made • Choose poultry and lean meat
• Continue to breast feed your
with hydrogenated fat or (for non-vegetarians)
baby up to 2 years.
margarine. • Drink lots of clean water, at
After six months, gradually increase least eight glasses of water per
Eat less sugar and salt:
age-appropriate and safe day for adults.
• Use less than 4 teaspoon of
complementary foods in the baby’s • Eat clean and safe food
sugar daily;
diet:
• Choose and prepare foods and
• Feed your growing child a
beverages with little added
mixed diet;
sugars;
• Gradually introduce soft
• Use salt sparingly while
cooked cereals, legumes, fruits
cooking;
and vegetables in your baby’s
• Consume less than 1 teaspoon
diet;
(5 gm) of salt per day.
• By 12 – 18 months of age, the
• Restrict intake of fried foods,
child should be able eat the
sweets and confectionaries.
family diet;
• Include a combination of milk
products, cereals, pulses, fruits,
green leafy vegetables, oils and
sugar, nuts and seeds in your
child’s daily diet.
Aim for a healthy weight:
• Aim for a Body Mass Index
(BMI) of 18.5 – 24.9 kg/ sq.m;
• Include more whole grain
cereals, whole pulses, fibrous
vegetables and fruits in the
diet;
• Restrict intake of fried foods,
sweets and confectionaries.
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Disability Prevention Preconceptual stage:- Habilitation and Rehabilitation • The community has to take the
and Rehabilitation • Avoid extremes of age for • Children with disabilities have responsibility for the full
conceiving a right to remain in the family integration of it’s disabled
• Check RH incompatibility of • Acceptance of the person with members on an equal basis
marriage partners disability as a valued member with others and this process
• In case of previous history of of the family is the first step in must begin with the birth of a
congenital disability in the rehabilitation disabled child The community
family, individual history of • If the child does not seem to must support the family ‘s
stillbirths, miscarriage, be developing in the same way efforts to accept, care for, and
maternal diabetes, or marriage as other children, in physical bring up the disabled child on
between close relatives, check development, hearing and an equal basis with other
with doctor for further communication, visual children Community –based
investigations. responses and mental rehabilitation is the best way to
• Ensure Rubella immunization alertness, then contact the ensure that all persons with
of teenage girls before health worker for advice If the disability are accepted,
conception child has a problem, and then included, and involved in all
• During pregnancy start training the child areas of mainstream
immediately as per the WHO community life.
Avoid: Community-based • All services, facilities, poverty –
• X-rays, Medicines that are not Rehabilitation guidelines. reduction programme
prescribed by doctor, exposure • Request for training in home- including social, cultural,
to Measles, Alcohol, smoking based rehabilitation services economic, civil and political
drugs and chewing of tobacco from health workers is to be life, needs to be accessible and
After delivery made ( please access WHO participatory for the persons
training manual in CBR for with disability
• Please check with health
worker if there are the different disabilities) • Opportunities and rights must
following signs in the newborn • Provision of age-appropriate be provided on an equal basis
baby:- intervention/ services for the with others.
• Delayed birth cry, Preterm and specific problem(if there is • Public places, transportation,
low birth weight, blue colour delay in physical development schools, healthcare facilities,
of baby, low or high muscle then simple exercises for workplaces, parks and
tone of baby, very small or motor development is to be common places of community-
very large head-size, lack of given) The child is to be activities, to be made
response from baby to noise stimulated and talked to accessible to persons with
and visual stimuli especially during daily living disabilities
activities like toileting, eating • Persons with disabilities have
etc. the same rights as every other
• Provision of other member of the community
rehabilitation services
including assistive devices to
increase development,
mobility, hearing and speaking,
and independence
• Inclusion of person with
disability in all family activities
• Ensure access to health,
education, play, food, hygiene
clothes and other amenities at
par with siblings
• Make home environment
caring, accessible, inclusive,
and participatory
• Respect the inherent dignity of
the person with disability
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Essential Drugs and • Knowing when to self • Encourage of appropriate self- 1. SC in medicines means taking
Medicines medicate or not care with medicine correct drugs as well as not
• Avoid over medication Support patients on correct use of taking incorrect drugs
long-term medication (DM, 2. Making appropriate self
Hypertension, Rub) medication legally available
3. Information & education on
appropriate use of medicines
in self-care
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• Stimulate foetal growth and • Aware of danger sign and • Make arrangement before the
development through relaxing discuss with skilled birth time of delivery to ensure that
music, communication by attendant when it occurs for families with pregnant women
heart with the foetus, monitor immediate actions/referral. will be attended by skilled
foetal movement (after 4-5 • When necessary, arrange for birth attendant at childbirth.
months gestational age). immediate referral with the • Implement referral plans,
• Use of ITN in malaria-endemic skilled birth attendant and ask when necessary.
area when sleeping. her to accompany. • Encourage midwife to make
• Assist mother in taking a good visits as schedule to
During childbirth:
care of herself and the postpartum mothers and their
• Ask for a skilled birth attendant newborn and facilitate newborns.
(midwife/nurse or doctor) to contacts with skilled birth • Assist in referral, when there is
assist childbirth and ensure a attendant for essential care. a need to refer mother/
clean environment for labour.
• Provide an emotional newborn to a higher health
• Ensure sufficient intake of meal environment that allows the facility.
and fluid, maintain a peaceful mother and her newborn live a
mind and avoid exhaustion. healthy and happy life within
• Ensure empty bladder before the family.
labour, proper breathing during • Aware of danger signs and
labour and choose an refer immediately when there
appropriate position for labour. is one in mother or newborn.
• Skin-to-skin contact with the
baby immediately after birth,
preparation for breastfeeding
and initiate bonding.
Postpartum/post-natal:
For the mother:
• Personal hygiene, including
breast, perineum and vaginal
care.
• Awareness on danger signs,
including lochia monitoring.
• Initiate breastfeeding within
half an hour after birth and to
give colostrums to the baby
and continue to breastfeed
exclusively up to 6 months.
• Good nutrition, sufficient rest
and maintain a peaceful mind.
• Established bonding with
newborn, early stimulation of
child development.
• Regular postpartum check-ups,
including postpartum FP
service.
• Use of ITN in malaria-endemic
area when sleeping.
For the newborn: • Promote good RH practices in • Advocate for good RH and
• Avoid hypothermia, i.e. by the family. gender-sensitive practices.
skin-to-skin contact with the • Promote gender-sensitive • Address RH problems in the
mother, cover newborn with practices in matters related to community and discuss it for
appropriate/warm clothes and RH. possible actions at community
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Self-care in the Context of Primary Health Care
head cap and avoid bath • Support women and men at level and ask for support from
immediately after birth. reproductive age in the family the health and relevant sector
• Immediate breastfeeding (see to meet their RH needs in an – both public and private.
above) and maintain adequate appropriate manner.
breast milk intake.
• Clean cord care and overall
care of newborn.
• Awareness on danger signs.
• Regular neonatal check-ups:
after birth at least once in the
first 3 days and then once
afterwards within the first
week and once afterwards
within the first month.
Immunization should be
started.
Related to reproductive health:
• Personal hygiene/cleanliness,
including during menstruation
for women at reproductive
age.
• Practices that reflect healthy
images of boyhood/manhood,
i.e. responsible practices in
interactions with girls or
partner.
• Safe sex and good knowledge
of basic RH information.
• Delay the age of marriage to at
least 20 years.
• Healthy timing and spacing of
childbirth.
• Regular breast check up and
Pap smear.
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Noncommunicable • Learning on, generating • Ensuring smoke free • Ensuring smoke free
Diseases motivation and developing environment at home environment in workplace and
skills for and practicing healthy • Introducing healthy dietary public places
behaviours related to diet and practices (purchasing healthy • Establish community
physical activity products, applying healthy infrastructure promoting
• Quitting tobacco consumption cooking practices) physical activity (safe
• Periodically checking blood • Introducing family practices sidewalks, bicycle lines, parks,
pressure and body weight (also promoting physical activity playing grounds etc.)
blood glucose and lipids if in (family walks, games) • Facilitate local production of
high risk group) • Provide home care to patients and access to inexpensive
• Complying to non- and with NCDs fruits and vegetable
pharmacological treatment of • Emotional and financial • Discourage consumption of
NCDs (if present) support to family members aerated soft drinks and junk
• Requesting prescription of low- requiring chronic treatment food especially among children
cost generic medicines (if at all • Ensure home rather then • Community information
required) health facility-based palliative meetings on NCDs and their
• Seeking initial advice at PHC care in terminal stage of illness risk factors
rather then secondary/ tertiary • Establish facilities to measure
health care institutions and provide advice on major
NCD risk factors
• Establish self-help groups to
provide psychological, social
and medical support to people
affected with chronic diseases
in the community
• Promoting healthy behaviours
at schools and workplace.
• Ensuring equitable access to
essential preventive and
curative health services
• Ensure access to low-cost basic
medicines
• Introduce social insurance
schemes to provide financial
protection against catastrophic
health expenditures
• Promote partnerships among
sectors: local authority, NGOs,
civil society, health facilities
• Ensure adequate access to
emergency services
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Self-care in the Context of Primary Health Care
HIV/AIDS • Seek awareness of health • Provide home care including • Community information
information, disease basic and chronic care to meetings
prevention, care and treatment HIV/AIDS patients • Door-to-door visits in the
• Avoid risk to HIV/AIDS, e.g., • Provide love, compassion, community by local volunteers
sex with casual partners and social and emotional bonds • Build life skills and impart
sex workers, injecting drug use between family members to knowledge about sexually
• Practice healthy lifestyles persons living with HIV/AIDS transmitted infections,
including: • Provide care of children, including HIV/AIDS, through
– Healthy nutrition orphans and elderly affected youth peer approach and the
– Exercise for health by HIV/AIDS voluntary participation of
– Meditation • Generate income to help young people and other local
– Routine health check up people living with HIV/AIDS community members
• Use preventive measures, e.g., • Establish self-help groups to
condom for unsafe sex, needle provide psychological, social
and syringe exchange for drug and medical support to people
use affected with HIV/AIDS in the
• Attend antenatal care for community
pregnant women • Combating stigma and
• Compliance to drugs in discrimination against people
treatment of AIDS and affected by HIV/AIDS in the
opportunistic infections community
• Using Buddhist ethics as their
guideline, monks teach
villagers how to avoid high-risk
behavior, help to set up
support groups, train people
with HIV/AIDS in handicrafts,
take care of AIDS orphans and
AIDS patients.
• “HIV-friendly" temples
encourage people to
participate in community
activities. They also provide
training in meditation as well
as grow and dispense herbal
medicines in collaboration
with local hospitals.
• Establish referral system for
care and support of people
living with HIV/AIDS to the
nearest health and social
facilities
• Participate in social and
resource mobilization
campaigns on HIV/AIDS for
self reliance
• Partnerships among sectors:
local authority, NGOs, civil
society, health facilities
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Tuberculosis • Early diagnosis and treatment • Motivate to take anti- TB drugs • Create awareness among the
to the nearest health facility daily as prescribed by the community on signs and
having cough more than 3 health facility; symptoms of TB;
weeks; • Compliance with the treatment • Refer suspects having cough
• Regular intake of drugs as prescribed by the health more than 3 weeks for
prescribed by health facility in facility; diagnosis and treatment to the
front of a health worker; • Supporting the patient with nearest health facility;
• Consult with health worker if care, taking him/her to the • Provide Directly Observed
the symptoms persists or got doctor on time. Treatment to the TB patients;
worse; • Refer TB patients to doctor if
• Promote others having cough any adverse effects arises due
more than 3 weeks for to drugs;
diagnosis and treatment. • Participate in social
mobilization campaigns on TB.
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Self-care in the Context of Primary Health Care
Water, Sanitation and • Always drink safe water (boiled • Always provide safe water • Protect water sources of the
Health or filtered if not sure of the (boiled or filtered if not sure of community from
safety of the water source) its safety) to all family contamination.
• Cover water storage containers members. • Advocate the need for latrines
properly, to avoid re- • Inculcate a habit of covering in each household and initiate
contamination as well as water storage containers at declaration of open defecation
mosquito breeding. home to avoid re- free communities.
• Boil water for one minute prior contamination as well as • Advocate the importance of
to its use in the preparation of mosquito breeding. hand washing by everyone in
infant formula. • Ensure that no one from the the community especially
• Do not defecate in open air family defecates in open air mothers/care givers who are
especially near water sources. especially near water sources. responsible for cooking food
• Wash hands after defecation, • Ensure that each member of and feeding children.
before cooking, after wiping the family washes hands after
children faeces and before defecation, before cooking,
eating food or feeding after wiping children faeces
children. and before eating food or
• Aways dispose children faeces feeding children.
in the latrine • Keep drainage systems around
the house clear to avoid
stagnation of water and
mosquito breeding.
• Ensure a practice of disposing
children faeces in the latrine.
• Ensure that the household
latrines are clean after use.
Adolescent Health and 1. Healthy eating • You should provide your son • Advocacy and support for food
Development • Eating a sufficient amount and or daughter with good role supplementation with
a wide variety of healthy foods models. Prepare healthy meals nutritious foods to adolescents
is important for you to grow for yourself and all the family. especially those who are from
and develop normally. • Talk to your son or daughter poor segments of the
• You should eat lots of rice/ about healthy foods and population, street children etc.
cereals and noodles, as well as healthy eating. • Participation and support for
lots of fruits and vegetables. iron and folic acid tablets once
You should also have some a week for control of anaemia
meat in your diet as well as where nutritional anaemia is a
milk, yoghurt or cheese. public health problem
• You should limit the amount of • Support to mid day meal
food you eat which contains a program in schools
lot of fat or sugar.
• While it is important that you
eat enough so make sure that
you grow, it is important that
you do not eat so much that
you become overweight as this
is not good for your health.
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3. Sexual activity • As your son or daughter grows • Promote safety of sex through
• Many adolescents, including and develops from childhood advocacy messages include
older adolescents, have not into adolescence, provide delay sex and practice
started having sexual them with information on an abstinence, be faithful and use
intercourse (i.e. the insertion of ongoing manner about their condoms consistently and
the penis into the vagina, changing bodies and about correctly for safe sex
mouth or anus). The decision sex. Ask them if they have any • Support availability of good
to start to have sexual questions or concerns. Show quality condom in the
intercourse is an important them that you are open to talk community to adolescents as a
one. Wait till you feel ready to to them about this subject. right of the adolescents
do so. Do not begin because • Explain that sexual feelings are • Assist in provision of accurate
other people want you to do normal, but that having sex information about safe sex to
so. should be a well-thought adolescents through
• Even if you have already had through decision. community based
sexual intercourse in the past, • Explain that abstaining from organizations
it is important that whenever sex is the only completely sure • Provide support to
you have sex you feel ready way to prevent pregnancy and organizations government and
and comfortable about this. sexually transmitted infections. non government in the
• Talk to your friends, parents or • Talk to your son or daughter programs that address the high
other trusted adults about how about how to prevent risk groups like men having sex
to make decisions about sexual pregnancy and sexually with men, injection drug users
activity, and about how to transmitted infections, even if • Support for timely referral of
resist pressure from others to you have stressed the adolescents for medical
have sex. importance of abstaining from termination of pregnancy,
• As far as you can, avoid being sex till they are ready. Explain voluntary testing for HIV and
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Self-care in the Context of Primary Health Care
with people or in places where that while there are different treatment of STI
you could be forced to have options for contraception, only
sex against your will. condoms, if used properly, can
• Be aware that there are ways reduce the risk of both
of having and giving sexual pregnancy and sexually
pleasure that carry no risk of transmitted infections.
becoming pregnant or getting a • Discuss the pressures that they
sexually transmitted infection. could face to have sex before
This includes kissing, caressing being ready for it. Discuss how
and touching/rubbing genitals. they could resist such
(Contrary to popular belief, pressures.
handling your genitals does not • Encourage them to seek help
lead to any negative effects). from a health worker for
• If you decide to have sexual advice and support if and
intercourse, always use a when they need to do so.
condom from start to finish.
• If you have had sexual
intercourse without any
condom or other form of
contraception, it is possible
that you may be pregnant or
have a sexually transmitted
infection, including HIV. You
should seek help from a health
worker as soon as possible.
Most sexually transmitted
infections can be treated with
simple medicines. In some
cases, pregnancy and HIV can
be prevented.
• If you suspect that you may be
pregnant, or have got a
sexually transmitted infection,
seek help from a health
worker.
4. Emotional well being • Make every effort to • Organize and support social,
• Adolescence is a time of communicate with your son or cultural and sports activities
enormous change in one’s life. daughter. Encourage them to that help the adolescents to be
These changes can be stressful. share their hopes and able to relax
• Spending time every day doing expectations, fears and • Support peers groups to reach
things that you enjoy, being concerns with you. Show out to adolescents and help
with people whom you life interest in their activities and the adolescents who feel
and doing some physical viewpoints. Show that you depressed, angry or aggressive
activity can help to prevent care for them through your to overcome them.
and reduce stress. words and actions. Let them • Identify adolescents who
• Feeling anxious, sad or angry know that you will always be persist to have these problems
from time to time is normal. there to support them when and support them in accessing
Talking to friends, your parents needed. Encourage them to mental health services
or other trusted adults can be contribute to family and
helpful. They can give you community activities.
comfort and support, and help • Talk to your son or daughter
you to think things through about health ways of dealing
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5. The use of tobacco, alcohol • Talk to your son or daughter • Prevent access to alcohol,
and other substances. about the dangers of using tobacco and other substances
• Do not be pressured into using tobacco, alcohol or other through community decision
tobacco, alcohol or other substances. Do this in early making and action. These
substances by people around adolescence. Do not wait till should not be accessible near
you, or by images in the their use has started. the school and community
cinema, on television, etc. • Discuss with your son or places
• Talk to your friends or parents daughter the influence that • Accurate knowledge about
about drugs you may have peers and media have on their ill effects through schools
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Self-care in the Context of Primary Health Care
seen or have been offered. young people initiating and peer groups
You should discuss how you substance use. Explain to them • Adults and influential people
could avoid using these the importance of deciding in the community to be role
substances. what is best for themselves. models. Such people should
• If you do use alcohol or other • Make clear what your abstain from tobacco, alcohol
substances that can impair expectations regarding their and other substances
your judgement, avoid driving behaviour are. Provide a good • Arrange for referral of
a car, motorcycle or bicycle role model through your own adolescents who are
while under the influence of behaviour. emotionally disturbed and are
these substances. • Be watchful for sign of taking on to these habits
• If you have started using substance use by your son or
alcohol or substances, seek daughter. If and when you
help from your friends, your notice them, discuss the
parents or and adult you trust. matter, and together seek help
• If you do use alcohol, or other from a health worker.
substance that impair
judgement, do so with a
friend. Avoid using drugs when
alone. You are more likely to
overdose and die if you take
drugs alone. You are more
likely to be a victim of crime or
violence when using drugs if
you are not with friends.
6. Unintended injuries • Discuss with your son or • Promote the use of helmets
• There are several things that daughter, the risks and and resolve to prevent
you could do to reduce the consequences of injuries. adolescents from driving cars
chance that you will be killed Teach them what they could or motor cycles
or hurt as a result of an injury: do to reduce the likelihood of • Advocate the dangers of
• Road traffic crashes: injuries. Clarify your driving after drinking alcohol
When driving a car always expectations of their • Arrange transport and referral
use a seat belt. When behaviour, and demonstrate of injured adolescents
riding a motorcycle or good behaviour through your • Organize promotional events
bicycle, always use a own example. to inform the adolescents
helmet. They may feel • Road traffic crashes: Talk to about safety on the roads
uncomfortable and may your son or daughter about the
not look attractive to you, importance of not
but they save your life. driving/riding if they are under
Learn and respect the the influence of alcohol or
traffic rules as a bicycle or other substances. Help them
motorcycle rider or a car make a plan for what to do in
driver. case the driver of their
Never drive or ride if you car/rider of their motorcycle
have been consuming has consumed alcohol or other
alcohol or other substances substances. Talk to them about
that affect your thinking. the importance of paying
Never get into a car or on attention to traffic as a driver
a motorcycle if the driver- or as a pedestrian, especially
rider has been consuming when poor light, rain or fog
alcohol or other hinder visibility.
substances. • Drowning:
Never drive or ride when (a) Encourage your son or
you are upset. daughter to learn to swim.
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Injury Prevention • Build safety practice behavior • Family members’ training on • Promote “injury watch” to
for prevention and control of identification of injury risk and identify important causes and
injuries through education and hazards at household level; their risks for community
training; • Family members’ training on interventions.
• Should be informed age “First Aid”; and • Community care: mobilize
specific common injuries and • Family safety rules to apply whole community to develop
their risk factors – and disciplined. community-based injury
– Infant – suffocation and prevention activities e.g.
falls community swimming learning
– < 5 years – drowning, program, day-care centre for
burn, falls etc. children of working mothers
– 5-10 years – drowning, and formation of peer-support
falls, road traffic accidents group, fencing of water
etc. resources and covering wells
– 15-45 years – road traffic etc.
accidents • Training of community
• 60+ years - falls volunteers on “Emergency
• Change traditional perception Trauma Care” and “Referral
of injuries as an “inevitable” System”.
event by dissemination of • Introduction of injury
information on injury prevention and control
prevention interventions. curriculum in the existing
education system.
All these activities could be done
under the umbrella of “Safe
Community” concept.
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Self-care in the Context of Primary Health Care
Annex 2
Agenda
(1) Inauguration
(8) Key strategies, best practices and main activities for strengthening self-care in the
context of Primary Health Care
(10) Closing
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Annex 3
Programme
08:00–09:00 Registration
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Self-care in the Context of Primary Health Care
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Self-care in the Context of Primary Health Care
Annex 4
List of participants
Bangladesh India
Ms Quamrun Nahar Khanam Dr S.K. Sikdar
Joint Secretary Assistant Commissioner (FP)
Ministry of Health & Family Welfare Ministry of Health and Family
Dhaka Welfare
New Delhi
Dr Kazi Shahadat Hossain Email: sk.sikdar@nic.in
Line Director
National AIDS/STD Programme Ms Vandana Krishna
Dhaka Secretary & Commissioner (FW)
Public Health Department
Dr Md Amirul Hasan Government of Maharashtra
Associate Professor Mumbai
National Institute of Preventive and Email: acc_w@maharashtra.gov.in
Social Medicine
Dhaka Dr Suranjeen Prasad Pallipamula
Chief in Need Institute
Dr A.M. Zakir Hussain Ranchi
Former Director Email: suranjeen@gmail.com;
Primary Health Care and Disease Control Cinijhk@gmal.com
Government of the People’s Republic of
Bangladesh Professor Ritu Priya
Dhaka Adviser-PH Planning
Email: amzakirhussain@hotmail.com National Health System and Research Centre
New Delhi
Dr Sultana Khanum Email: ritu_priya_jnu@yahoo.com
International Public Health Consultant
(Former Director, Department of Health Dr J.P. Gupta
Systems Development WHO/SEARO) President
Dhaka Apothecaries Foundation
Delhi
Bhutan Email: Jpgupta35@gmail.com
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Self-care in the Context of Primary Health Care
Mr Noppadon Pumyim
Nepal Health Technical Officer
Mr Rakesh Thakur Northern Regional Training Center for
Senior Public Health Administrator Primary Health Care Development
District Health Office Department of Health Services Support
Mahottari Ministry of Public Health
Nonthaburi
Mr Narendra Man K.C. Email: npumyim@yahoo.com
Member
Sawal Community Service Nepal Dr Prapim Buddhirakkul
Pyuthan Department Head
Community Nursing Department
Dr Suniti Acharya WHOCC for Nursing and Midwifery
Executive Director Development
Centre for Health, Policy, Research Chiang Mai University
and Dialogue Chiang Mai
Kathmandu Email: prapim@mail.nurse.cmu.ac.th
Email: sunitiacharya@yahoo.com
Dr Phitaya Charupoonphol
Mr Khem Bahadur Karki Dip. Thai Board of Epidemiology
Director Dean and Associate Professor
Society for Local Integrated Development Mahidol University
Kathmandu Faculty of Public Health
Bangkok
Sri Lanka (President, SEAPHEIN)
E-mail: deanph@mahidol.ac.th
Dr H.P. Haritha Aluthge
Medical Officer (Health) Professor Dr Somchit Hanucharurnkul
Ministry of Health Office Department of Nursing
Deraniyagala Faculty of Medicine
Ramathibodi Hospital
Mr P. Balawardane Mahidol University
Provincial Health Education Officer Bangkok
PDHS Office Email: rashk@mahidol.ac.th
Anuradhapura
Dr Supachai Kunaratanapruk
Dr N.T. Cooray Executive Dean
Former Director Medical College and Health Science
National Institute of Health Sciences Departments
Kalutara Rangsit University
E-mail: coorayn@mail.ewisi.net; Bangkok
coorayn@hotmail.com Email: supachaikuna@yahoo.com
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Dr Somchai Peerapakorn
National Programme Officer
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Member States in the South-East Asia Region agree that primary health care is the right
approach to strengthen the health systems, taking into account the social determinants of
health for achieving the MDGs, and ultimately to achieve equitable health for all. The
PHC approach encompasses four principles: universal coverage; community
participation; multi-sectoral collaboration; and use of appropriate technology. Self-care
embraces all of these principles and translates community participation through
community empowerment that necessitates involvement of other sectors beyond health.
Use of appropriate information and communication technology is essential in
empowering the community. Finally, self-care will ease the burden of the overstretched
health systems, reduce cost and increase its effectiveness, all of which facilitate efforts in
achieving universal coverage.
The regional consultation on “Self-care in the context of PHC” was held from 7-9
January 2009 in Bangkok, Thailand. The objectives were to determine the way forward
in strengthening self-care for revitalizing PHC in countries of the Region, specifically to
review the regional and countries’ current policy and practices on self-care, to identify
best practices and challenges for self-care and to identify key strategies for self-care.
The regional consultation concluded with the following recommendations: For
Member States – (1) Give serious consideration to including strengthening of self-care as
a programme in their efforts to revitalize PHC; (2) Re-examine national health policies
and strategies to strengthen support structures, legislation and financing for self-care; (3)
Document existing local self-care best practices and conduct operational research to
develop evidence-based, effective self-care practices; and (4) Establish a network of
individuals and institutions for self-care promotion. For WHO – (1) Advocate for
strengthening self-care in the context of revitalizing PHC; (2) Provide technical support
to Member States in their efforts to promote effective self-care; (3) Provide support to
Member States in documentation, assessment and evaluation and research on self-care
practices; and (4) To develop common tools and guidelines.
The consultation also suggested the way forward to enhance community
participation and self reliance in health, with the improved role of the health work force
to empower the community in a comprehensive understanding of health to improve
social and economic productivity.