Implementation of the WHO 2021 self-care guidelines: findings from policy and market landscaping from Malawi and Mozambique

Abstract Background To support countries’ promotion and scale-up of self-care, the World Health Organization (WHO) launched the Consolidated Guideline on Self-Care Interventions for Health: Sexual and Reproductive Health and Rights in 2019, further revised in 2021. This study aimed to understand the extent to which WHO’s 2021 self-care recommendations are implemented in Malawi and Mozambique and to explore barriers, facilitators, and recommendations to provide critical insights for self-care design, implementation, and scale-up. Methods The study employed a modified version of the Self-Care Trailblazer Group’s self-care policy mapping toolkit with an additional market landscaping component. The mixed-methods study included a desk review of gray and published literature, a market landscape, e-surveys, and key informant interviews to understand the implementation of the WHO self-care guidelines and barriers to self-care scale-up, and stakeholder workshops to validate findings. Quantitative data were analyzed descriptively using STATA software and qualitative data was analyzed using a mix of deductive and inductive coding in Dedoose software in Malawi and pragmatically by analyzing themes across transcripts in Mozambique. Results We surveyed 47 stakeholders in Malawi and 23 stakeholders in Mozambique and conducted 22 key informant interviews in Malawi and 9 in Mozambique. We found that Malawi has made more progress in integrating self-care products and services into policy while Mozambique is still building momentum with variations across health areas. Key barriers to expanding self-care options included lack of knowledge and awareness in the general population about self-care products and services and lack of funding to expand self-care offerings. In Malawi, stakeholders recommended the use of communal outlets for self-monitoring of blood pressure, addressing issues of family planning stockouts, and generating evidence on self-sampling for sexually transmitted infections and human papillomavirus. In Mozambique, stakeholders recommended raising women’s confidence to use self-injectable contraceptives, addressing social norms related to safe abortion, and expanding self-sampling for the human papillomavirus. Conclusion Our study findings confirm that Malawi has a more advanced market for self-care while Mozambique is still building momentum. We also show how an adapted policy mapping tool can be used to understand the extent of self-care policy and product availability, identify barriers to implementation, and define a minimum package of self-care recommendations.