Editorial

Miles to go: self-care medical interventions

India has some distance to cover before making self-care interventions freely available

Self-care, which mostly happens outside the formal health system, is nothing new. What has changed is the deluge of new diagnostics, devices and drugs that are transforming the way common people access care, when and where they need them. With the ability to prevent disease, maintain health and cope with illness and disability with or without reliance on health-care workers, self-care interventions are gaining more importance. Millions of people, including in India, face the twin problems of acute shortage of healthcare workers and lack of access to essential health services. According to the World Health Organization, which has released self-help guidelines for sexual and reproductive health, over 400 million across the world already lack access to essential health services and there will be a shortage of about 13 million health-care workers by 2035. Self-help would mean different things for people living in very diverse conditions. While it would mean convenience, privacy and ease for people belonging to the upper strata who have easy access to healthcare facilities anytime, for those living in conditions of vulnerability and lack access to health care, self-help becomes the primary, timely and reliable form of care. Not surprisingly, the WHO recognises self-care interventions as a means to expand access to health services. Soon, the WHO would expand the guidelines to include other self-care interventions, including for prevention and treatment of non-communicable diseases.

India has some distance to go before making self-care interventions for sexual and reproductive health freely available to women. Home-based pregnancy testing is the most commonly used self-help diagnostics in this area in India. Interventions include self-managed abortions using approved drugs — morning-after pills taken soon after unprotected sex, and mifepristone and misoprostol taken a few weeks into pregnancy — that can be had without the supervision of a healthcare provider. While the morning-after pills are available over the counter, mifepristone and misoprostol are scheduled drugs and need a prescription from a medical practitioner, thus defeating the very purpose of the drugs. The next commonly consumed drug to prevent illness and disease is the pre-exposure prophylaxis (PrEP) for HIV prevention. India is yet to come up with guidelines for PrEP use and include it in the national HIV prevention programme. Despite the WHO approving the HIV self-test to improve access to HIV diagnosis in 2016, the Pune-based National AIDS Research Institute is still in the process of validating it for HIV screening. One of the reasons why people shy away from getting tested for HIV is stigma and discrimination. The home-based testing provides privacy. India has in principle agreed that rapid HIV testing helps to get more people diagnosed and opt for treatment, reducing transmission rates.

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Printable version | May 21, 2020 10:56:57 AM | https://www.thehindu.com/opinion/editorial/miles-to-go/article28253593.ece

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