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

The authors have declared no competing interest.

This research received unrestricted funding from the Population Service International. The Funder did not have a role in study design or analysis. Austen El-Osta and Azeem Majeed are supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Northwest London. The views expressed are those of the authors and not necessarily those of the NHS or the NIHR or the Department of Health and Social Care.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study received a favourable opinion from Imperial College Research Ethics Committee (20IC6438). Participants consented to take part in the survey and personal interview

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All data produced in the present study are available upon reasonable request to the authors