Contextual Adaptation and Implementation of WHO Guideline on Self-Care Interventions for SRH in Kenya, Nigeria and Uganda

Background

Self-care interventions for sexual and reproductive health and rights (SRHR) are critical to advancing individual wellbeing and achieving universal health coverage. This study assesses how three countries - Kenya, Nigeria and Uganda - have adapted and implemented the World Health Organization (WHO) Guideline on Self-Care Interventions for SRHR within their national policy and practice landscapes.

Objectives

The primary objective was to develop and pilot a novel policy mapping and implementation analysis tool. Secondary aims included using a mixed-methods approach comprising policy document review, surveys and interviews to evaluate the contextualisation and uptake of WHO recommendations at the country level.

Methods

We designed a Policy Mapping and Implementation Matrix (PMIM) to assess alignment with 24 WHO SRHR self-care recommendations. Data were collected from 316 stakeholders through surveys and interviews, and 47 policy documents were reviewed. Findings were synthesised using a Red-Amber-Green (RAG) matrix to assess implementation across the guideline’s five domains.

Results

Implementation varied by country and recommendation. Family planning and infertility services (Category 2) showed the strongest uptake, while areas such as unsafe abortion management and STI self-sampling (Categories 3 and 4) were less consistently addressed. Kenya demonstrated broad alignment through multiple policies, while Nigeria and Uganda showed promising progress, particularly with the development of dedicated national self-care guidelines. Key barriers included supply chain challenges, low health literacy and legal constraints; critical enablers were provider training and task shifting.

Conclusion

This study introduces a novel, pragmatic framework for assessing national self-care policy and practice. It highlights the importance of contextual adaptation rather than mechanical adoption of global guidelines. While study limitations are acknowledged, the methodology offers a replicable approach for monitoring and strengthening self-care integration in diverse settings.

Key points

• Little is known about how countries are contextualising and adapting WHO Guideline on Self-Care interventions

• We present the first iteration policy mapping and implementation analysis tool and findings from three countries where there is an emergent self-care movement

• A key driver for contextual adaptation of the WHO Guideline includes the development of national guidelines and self-care advocacy groups

• The extent that the policy landscape supported self-care practices for SRHR could be used to objectively prioritise policy and advocacy opportunities in each country