Self-care interventions for sexual and reproductive health: a strategic health systems investment.

Self-care interventions for sexual and reproductive health (SRH), including HIV self-testing, self-injected contraception and self-managed abortion, offer promising pathways to advance universal health coverage, particularly in low- and middle-income countries. While often framed as cost-saving measures, this paper argues that self-care should be understood as a strategic investment in health system performance. Drawing on costing and financing analyses and previous literature, we explore how self-care interventions can enhance efficiency, resilience and equity of health systems. We propose a costing framework that outlines cost components across development, implementation and scale-up, emphasising both system and individual-level considerations. We argue that sustainable scale-up of self-care requires diversified financing models, including tax-based funding, insurance mechanisms and reduced out-of-pocket costs for users. Successful integration also demands governance structures that prioritise quality, equity and continuity of care. By reframing self-care as a health system investment rather than a cost-containment tool, policymakers can better harness its potential to improve access, reduce burden on facilities and empower individuals in managing their health. Self-care interventions for SRH, when embedded within broader health system strengthening efforts, have the potential to be transformative for SRH outcomes and for progressing towards universal health coverage.