Health systems are under growing pressure. An estimated 4.6 billion people lack access to essential health services, while 1.6 billion are pushed into or deeper into poverty by health costs. At the same time, development assistance for health is declining and many low- and middle-income countries face debt and increasingly constrained public budgets.
Against this backdrop, a new series of UNU-CPR policy papers examines an underutilized opportunity: publicly financed, supported, incentivized and regulated self-care. Self-care enables individuals, families and communities to promote health, prevent disease, diagnose conditions and manage illness, with or without direct support from a health worker. When properly integrated into health systems, it can expand access while improving efficiency, strengthening household financial protection and contributing to economic growth.
The main paper, Self-Care Pathways to Universal Health Coverage and Financing Equitable Development, sets out three mutually reinforcing pathways through which self-care can generate returns: reducing health-system costs and pressures; reducing out-of-pocket expenditure and strengthening household financial security; and supporting productivity and economic participation.
But these benefits are not automatic. Policy recognition has advanced faster than financing and implementation, and poorly designed approaches risk transferring costs and responsibilities from health systems to individuals, weakening safety and regulatory oversight, or excluding people already facing barriers to care. The paper argues that the challenge is therefore to finance, institutionalize and govern self-care at scale – embedding it in development finance strategies, Universal health Care (UHC) policies, benefit packages, budgets, reimbursement and service-delivery systems while strengthening evidence, measurement and accountability.
Two companion papers explore how this approach can work in priority areas. Cardiovascular Self-Care: Pathways to Equitable Health, Financial Protection and Economic Returns examines opportunities for improving self-care, including home monitoring, medication adherence and health-promoting behaviours. With cardiovascular disease as the world's leading cause of death, supported self-care can extend prevention and long-term management – but must be backed by medicines, referral pathways and primary-care capacity.
Financing Maternal Health Self-Care: Benefits for Health Systems and Households focuses on the critical periods between clinical contacts, examining how sustained access to information, supplements, monitoring, community support and referral can improve the value of maternal health investments while protecting women and households from additional costs and generating intergenerational returns.
Together, the papers make the case for moving self-care from the margins of health policy towards systematic integration within UHC and health and development financing strategies.
