Thanks for sharing the report of the webinars on self-care by Richard Fitton. I am glad that WHO is taking a renewed interest in this area. In my opinion, WHO's 2001 document "Innovative care for chronic conditions" was one of the most transformative documents in this area. It had taken note that chronic conditions need a life-style change and periodic interventions by health professional cannot replace the central role of people in looking after themselves.
This document was followed by the "Building blocks" concept/strategy but I have a feeling that over the years it lost steam and was unable to become a bigger force in transforming health services. It had asked for health professionals to be involved in becoming sources of information and skills so that individuals could play a greater role in their self-care.
People involved in leprosy programmes had been aware of the importance of self-care to prevent new disabilities and to avoid worsening of existing disabilities since 1970s. A lot had been done including so much evidence gathering on the effectiveness of self-care in reaching this goal. There was also some work in applying similar strategies in disability prevention in lymphatic filariasis and diabetes, which is on-going.
The community-based rehabilitation (CBR) programmes since 1980s aimed at persons with different disabilities were initiated due to lack of health professionals in developing countries, especially in rural areas, with similar ideas. One of their strategies was to to simplify existing knowledge so that individuals and families can use that knowledge for self-care. During late 1980s and 1990s, Disability and Rehabilitation team of WHO had produced different manuals written in simple language and accompanied by a lot of illustrations. During my work in training and monitoring of CBR programmes in different countries, I remember collecting testimonies of individuals with disabilities such as spinal cord injury about the huge impact those WHO manuals had on their lives. These programmes (now sometimes called "community-based inclusive development" or CBID) also have accumulated some evidence in this area, though community
organisations involved in them are not very good at documentation.
From my work in disability related community programmes, I think that today a lot of individuals use internet and peer-group learning for sharing information and skills about self-care. For example, a couple of years ago, while running a training course on communication difficulties among children with development disabilities, my trainees had shown many examples of the parents who were sharing short videos about their children on platforms like YouTube, which were watched by parents in other countries and often adapted for use in their local contexts.
Thus, I think that it is important for WHO to take a leading role in promoting the best practices in self-care.
Dr Sunil Deepak
Schio (VI), Italy
HIFA profile: Sunil Deepak is a medical doctor with a long experience at international level in the areas of leprosy control, community health, and disability and rehabilitation programmes, especially in research, training and evaluation. For about 3 decades he worked with an Italian NGO AIFO and collaborated with the Disability & Rehab team of WHO as well as, with International Federation of anti-leprosy associations (ILEP) and International Disability & Development Consortium (IDDC). Then for a couple of years he was based in the north-east of India as head of regional centre of Mobility India. Now he collaborates as a volunteer with humanitarian organisations. sunil.deepak AT gmail.com