The field of self-care interventions is new, fast moving, and multi-disciplinary. There is a need to explore the way ahead in advancing the field so that self-care forms an integral part of health programs. In order to move this agenda forward, a comprehensive strategy is needed. This includes training health professionals on SRHR self-care interventions; providing education to potential clients; making self-care technologies available and accessible to potential users; promoting the use of digital and online resources to accelerate self-care; and providing research-based evidence for the formulation of policies and programs.

6.1 Training Health Professionals on SRHR Self-care Interventions

New approaches in training and education of healthcare providers are needed in order to institutionalize sensitive and effective use of self-care interventions. Healthcare providers include doctors, nurses, midwives, community health workers, and pharmacists, among others. Grassroots NGOs and community-based organizations (CBOs) are also important healthcare providers, especially for hard-to-reach communities.

It is important to revise curriculae of health professionals so that they are embedded in the principles of human rights, gender equality, increased user autonomy, and health literacy to empower and support confident decision-making. These training programs should focus on community-based curriculae with special emphasis on communication, compassion, and a person-centered approach to care; self-care interventions should be integrated into the curriculae for health professional education and training; training should be on holistic and integrated health care and sensitization to institutionalize empathetic attitudes which take into account the broader social, psychological, spiritual, and religious context of people’s lives. Issues of power and vulnerability to support increased autonomy and empowerment should be addressed. And innovative research, technologies, digital and online resources, interactive learning, and other innovative forms of training should be integrated to reinforce comprehensive learning of information and practical skills [1].

Training curriculae for professional development should mandatorily incorporate knowledge and sensitization about vulnerable and marginalized populations, serving to break existing stigma and discrimination. Preparatory curriculae for healthcare professionals should be equipped with knowledge about new interventions and opportunities that will serve the needs of the potential users of self-care. Healthcare providers need to be provided with adequate educational and communication training to address sexual and reproductive health issues of the vulnerable and marginalized communities. Training programs should be designed to enable teacher–student and patient–physician communications address the importance of healthy and sustainable self-care practices.

6.2 Education of Potential Users on Self-care

It is critical that appropriate and effective educational programs for the public and potential users of self-care interventions are initiated and sustained. Education programs and community interventions through workshops, dialogue and other means should address sexually dominant notions, stigma, gender inequality, and the overall perceptions of gender and sexuality. These programs should pro-actively and regularly involve stakeholders, most importantly, policy-makers, and community representatives.

Mass media platforms should work toward censoring regressive attitudes towards sexuality, gender fluidity, and gender equality and should ensure appropriate portrayal of communities. Alongside academic education, mass media has the potential for addressing the traditional psychology of people by providing exposure to the third gender in society. These messages could be more effective if they are reinforced by known and famous personalities who serve as champions for the cause.

As a part of the school curriculum, age appropriate comprehensive sexuality education should be undertaken. Moral education and moral policing of girls should not be the “sex education” in schools; it should include gender-unbiased delivery of factual information. Information should be provided to adolescents on SRH, contraception, and STIs. There is a need to organize educational campaigns and programs for addressing issues related to STIs particularly HIV/AIDS. These campaigns should address the impediments to SRH such as HIV non-disclosure and criminalization of consensual sex in MSM, FSWs, and transgender.

6.3 Self-care Technologies

The following self-care technologies, including drugs, devices, and diagnostics, are currently available: oral contraceptives, emergency contraception, contraceptive patch, self-injectable long-acting contraceptives, diaphragm, abortion with misoprostol, self-testing for STIs, HIV self-testing, pre-exposure prophylaxis, and post-exposure prophylaxis (PrEP) [1].

There is a need to develop educational programs for the community to provide information about the availability of these technologies and where they can be accessed as well as on their indications and contra-indications, side-effects, and follow-up schedules. Factors including privacy and confidentiality, empowerment, convenience, and access are viewed as important by potential users of these self-care technologies [2].

6.4 Digital and Online Resources on Self-care

Digital health is creating opportunities and challenges around how information and services can be accessed and delivered. Alongside the trends in digital health, advancements in self-administered family planning methods, self-testing, and screening for sexually transmitted infections such as HIV and HPV and self-administered abortions are leading to a new paradigm of self-care interventions in the field of sexual and reproductive health and rights with particular implications for women [3].

Digital health enables self-care in several ways. The first is as a stand-alone self-care intervention, for example mobile apps for better home-based care and risk assessment during pregnancy. The second is using digital technology in combination with self-care commodities such as instructional videos for more effective use of HIV self-testing kits. Third, at a health systems level, digital health offers the opportunity for better continuity of care through the use of shared health records accessible to clients and health professionals.

The combination of digital health and self-care is accelerating the movement toward person-centered health and shifting the center of gravity for many health-related activities from a clinical setting to people at home or in their workplaces. This takes the notion of task shifting in health to a whole new level by enabling people to directly access and use commodities and services that have previously been entirely in the domain of health professionals or administered in a health facility. Mobile apps and online ordering services have become new intermediaries with Internet drug stores and pharmacies [4].

6.5 Research-Based Evidence for Policies and Programs

Research and analysis of self-care reported in this volume on men who have sex with men (MSM), transgender, female sex workers (FSWs), and long-distance truck drivers starkly underscores the serious paucity of research on these vulnerable and marginalized communities. There is a need to build on this research as well as to undertake research on other vulnerable, marginalized communities such as substance users, poor urban slum children and adolescents, poor rural women, migrants, and disabled persons. Research on these vulnerable communities would provide the evidence needed for the formulation of policies and the design of programs to address their multiple health, education, employment, and legal needs.

Self-care practices for vulnerable communities have special relevance as these communities remain unserved due to the serious barriers that they encounter in availing services from the formal health system. A major barrier is the stigma and discrimination that they face when accessing health care from formal healthcare providers from both the public and private healthcare systems. Research on their self-care perceptions, sources of information, barriers, motivations to practice self-care, and what they do when self-care fails would provide important insights for promoting self-care among these communities.

There is a clear need to systematically study self-care practices so that effective policies and programs can be formulated to address the needs of the general population as well as those of vulnerable and marginalized communities. As the design of these policies and programs has to be tailored to the needs of the communities they serve, it is critically important that research-based evidence on these communities is made available. Thus, it has been possible to design and scale-up self-care interventions for FSWs in several contexts because research to empower and mobilize this community provided insights for ensuring consistent condom use, thereby significantly reducing the incidence of HIV and other STIs in this community. Migrant FSWs are a specially vulnerable group for which interventions are not available because research-based evidence is needed to design and implement appropriate strategies.

Policy advocacy was employed over long years to legalize consensual sex among men. There is evidence that MSM are not a homogeneous group. There are several individual groups of MSM. For program strategies to be effective, they must be tailored to the needs of individual groups of MSM for which research-based evidence is required.

Self-care by consistent condom use by long-distance truck drivers, an important bridge population for the transmission of STIs/HIV, led to decreased prevalence of infection and its spread. This was an outcome of a program designed to make highways “safer.” Safer highways meant increased exposure to HIV prevention interventions and consistent condom use by truckers with non-regular female sex partners.

Strong policy advocacy made it possible to acknowledge the legal rights of transgender. Policy advocacy undertaken jointly by NGOs, lawyers, researchers, and the community itself made it possible to convince policy-makers to recognize their special needs and to frame appropriate laws for the transgender community. These laws have enabled transgender to get voting rights and procure identity cards that specify their self-perceived sexual identity. In April 2014, the Supreme Court of India passed a landmark judgment reaffirming individuals’ rights to choose their identity as male, female or third gender. This Supreme Court judgment in its verdict also instructed the central and state governments to develop inclusive social welfare schemes and ensure greater involvement of the transgender community in policy formulation.

However, accessing formal health and education services and employment opportunities remains difficult for the transgender community primarily because of the stigma and discrimination that they face in society. Thus, despite small wins, there remains a long road ahead to address the needs of marginalized and vulnerable communities. It is, therefore, important to prioritize research for obtaining the evidence for designing policies and programs. These efforts must be continued and sustained to promote sexual and reproductive health and rights and prevent HIV among vulnerable and marginalized communities.

A dynamic and flexible research environment driven by a collaborative ethos is required for undertaking future research. This research should include the contribution of the users of self-care.

Some of the elements of research undertaken in India may provide important leads for conducting research on marginalized and vulnerable communities in other countries. Future research must focus on the development and delivery of self-care interventions. The following are some research questions that need to be addressed: Is stigma and discrimination a driver for the use of self-care interventions within the healthcare system? Will a specific healthcare intervention improve coverage, reduce out-of-pocket expenditure, and be responsive to current and emergent population needs? Are health workers supportive or resistant to self-care interventions? Studies on self-care interventions for SRHR should advance knowledge on a holistic approach to health and well-being by reducing disparities and vulnerabilities and advancing universal health coverage (UHC).

To better understand the effects of self-care interventions in people’s lives, implementation strategies need to be linked to clear outcomes. Successful mainstreaming of self-care interventions will therefore require monitoring and evaluation earlier on. While monitoring and evaluation is common practice for program implementation of focused health interventions such as the number of ante-natal visits for maternal health or use of anti-retrovirals for HIV treatment, it is far less common in domains where policies and programs are aimed at an organizational change. Introduction of quality self-care interventions is a true paradigm shift in the way health care is delivered. Its potential to bridge people and communities through primary health care to reach UHC is underexplored. Moving forward, researchers, policy-makers, and practitioners can consider the participant narratives regarding the need to consider both the heterogeneity of self-care interventions of SRHR and the needs and lived experiences of diverse populations. These lay persons’ and healthcare providers’ perspectives underscore the urgent needs to increase access, reduce stigma and discrimination, and improve knowledge for self-care SRHR interventions to increase UHC in order for individuals and communities to realize their SRHR and for countries to achieve the Global Development Goals [5].