C
Agenda

Quality of Care Issues for Mental Health and Neurological Disorders in Sub-Saharan Africa: A Workshop


Tuesday, August 4, 2009

Workshop Agenda


Sheraton Kampala Hotel, Ballroom

Ternan Avenue

Kampala, Uganda


Background of the Workshop:

Neurological and mental health disorders are among the leading causes of global morbidity. More than 450 million people around the world are affected, and they account for 33 percent of years lived with disability and 13 percent of disability-adjusted life years lost. Recognizing both the importance of high-quality care for brain disorders and the economic limitation of most sub-Saharan African countries in diagnosing and treating these disorders, the workshop will explore areas where policies might improve care for mental health and neurological disorders for countries in this region. The Forum on Health and Nutrition of the Uganda National Academy of Sciences (UNA S) and the Forum on Neuroscience and Nervous System Disorders of the U.S. Institute of Medicine (IOM) will convene a joint workshop to address these issues.



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C Agenda Quality of Care Issues for Mental Health and Neurological Disorders in Sub-Saharan Africa: A Workshop Tuesday, August 4, 2009 Workshop Agenda Sheraton Kampala Hotel, Ballroom Ternan Avenue Kampala, Uganda Background of the Workshop: Neurological and mental health disorders are among the leading causes of global morbidity. More than 450 million people around the world are affected, and they account for 33 percent of years lived with disability and 13 percent of disability-adjusted life years lost. Recognizing both the importance of high-quality care for brain disorders and the economic limitation of most sub-Saharan African countries in diagnosing and treat- ing these disorders, the workshop will explore areas where policies might improve care for mental health and neurological disorders for countries in this region. The Forum on Health and Nutrition of the Uganda Na- tional Academy of Sciences (UNAS) and the Forum on Neuroscience and Nervous System Disorders of the U.S. Institute of Medicine (IOM) will convene a joint workshop to address these issues. 73

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74 MNS IN SUB-SAHARAN AFRICA, IMPROVING QUALITY OF CARE Audience: Policy makers from countries in sub-Saharan Africa, academia, clinicians (rural and urban practice), international stakeholders, local parishioners, and rising leaders in the area of brain disorders. Workshop Objectives: • Discuss opportunities that can be used to better ensure continuity of care and sustainability within a country’s healthcare system. • Identify resources that are currently available or could be made available, in cost-effective and efficient manners, to aid in im- plementation of treatments and prevention projects. • Emphasize the need for national, evidence-based policies ad- dressing quality of care and healthcare systems for mental and neurological disorders. Discuss how to facilitate collaborations among a variety of stakeholders, including policy makers and healthcare professionals. 8:00 a.m. Welcome PAUL E. MUGAMBI President Uganda National Academy of Sciences 8:05 a.m. Introductions ALAN I. LESHNER, IOM Neuroscience Forum Chair Chief Executive Officer, AAAS Executive Publisher, Science EDWARD K. KIRUMIRA, UNAS Health and Nutrition Forum Chair and Workshop Co-chair Dean, Faculty of Social Sciences Makerere University

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APPENDIX C 75 8:15 a.m. Workshop Objectives STEVEN E. HYMAN, Workshop Co-chair Provost Harvard University 8:25 a.m. Keynote Address: Task Shifting to Close the Treatment Gap for Mental and Neurological Disorders VIKRAM PATEL Professor of International Mental Health London School of Hygiene and Tropical Medicine 8:55 a.m. Moderated Discussion with Workshop Participants STEVEN E. HYMAN, Workshop Co-chair Provost Harvard University SESSION I: BURDEN OF MENTAL HEALTH, NEUROLOGICAL, AND SUBSTANCE USE DISORDERS IN SUB- SAHARAN AFRICA Session Objective: Review the prevalence and burden of mental health, neurological, and substance use (MNS) disorders in sub-Saharan Africa (SSA), including an examination of the economic and social impacts on communities and health systems. 9:10 a.m. Introduction and Session Objectives DONALD SILBERBERG, Session Chair Professor Department of Neurology University of Pennsylvania School of Medicine 9:15 a.m. Prevalence of Neurological Disorders in SSA, Economic and Social Impacts of Under- or Nontreatment of Neu- rologic Disorders

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76 MNS IN SUB-SAHARAN AFRICA, IMPROVING QUALITY OF CARE DONALD SILBERBERG, Session Chair Professor Department of Neurology University of Pennsylvania School of Medicine 9:30 a.m. Barriers to Care for Individuals with Neurological Dis- orders in SSA ELLY T. KATABIRA Associate Professor Makerere University School of Medicine 9:45 a.m. Prevalence of Mental and Substance Use Disorders in SSA, Economic and Social Impact of Under- or Nontreatment of Mental Disorders and Substance Abuse HARVEY WHITEFORD Professor Department of Psychiatry and Population Health University of Queensland 10:00 a.m. Barriers to Care for Individuals with Mental and Sub- stance Use Disorders in SSA FLORENCE BAINGANA Research Fellow Makerere University School of Public Health 10:15 a.m. Moderated Discussion with Session Panelists DONALD SILBERBERG, Session Chair Professor Department of Neurology University of Pennsylvania School of Medicine 10:45 a.m. TEA BREAK

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APPENDIX C 77 SESSION II: CURRENT NATIONAL HEALTHCARE POLICIES Session Objective: Discuss current healthcare policies in place for MNS disorders in various SSA countries and describe what resources and in- frastructure investments were needed to implement these policies. 11:00 a.m. Introduction and Session Objectives OYE GUREJE, Session Chair Head, Department of Psychiatry University of Ibadan College of Medicine 11:05 a.m. Panel Discussion: National Healthcare Policies for Men- tal and Neurological Disorders (presentations 10 minutes each) World Health Organization THÉRÈSE AGOSSOU Regional Adviser for Mental Health and Substance Abuse WHO Regional Office for Africa, Brazzaville Uganda SHEILA P. ZARAMBA NDYANABANGI Principal Medical Officer, Mental Health Section Ministry of Health, Uganda . South Africa INGE PETERSEN School of Psychology University of KwaZulu-Natal

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78 MNS IN SUB-SAHARAN AFRICA, IMPROVING QUALITY OF CARE 11:45 a.m. Moderated Discussion with Session Panelists OYE GUREJE, Session Chair Head, Department of Psychiatry University of Ibadan College of Medicine 12:15 p.m. LUNCH SESSION III: EFFECTIVE HEALTHCARE SYSTEMS: LESSONS LEARNED Session Objective: Examine models for providing effective health care that may have used health systems, training programs, and dissemination of information. Discuss what can be learned from these models, how they can be expanded, and what can be applied rapidly in other SSA countries. 1:15 p.m. Introduction and Session Objectives CHARLES NEWTON, Session Co-chair Senior Clinical Fellow KEMRI-Wellcome Research Programme MICHELLE MCMURRY, Session Co-chair Director Health, Biomedical Science and Society Initiative Aspen Institute 1:25 p.m. Panel Discussion 1: Service Models (presentations 10 minutes each) • How was care for mental health, neurological, and/or substance use disorders integrated into the healthcare or information dissemination model? What challenges did you face when in- tegrating care for mental health, neurological, and/or substance use disorders into the service model?

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APPENDIX C 79 Millennium Development Village Project GARY BELKIN Associate Professor Director, Program in Global Mental Health New York University School of Medicine Neurology in Africa: Service Models ALFRED K. NJAMNSHI Department of Neurology Yaoundé Central Hospital, Cameroon Patient Advocacy and Support Organizations OSMAN MIYANJI Board of Directors Chair The Kenya Association for the Welfare of People with Epilepsy Training Healthcare Workers Programs DAVID KIIMA Director, Mental Health Ministry of Health, Kenya Dissemination of Evidence-Based Resources JULIA ROYALL Chief, International Programs U.S. National Library of Medicine 2:15 p.m. Moderated Discussion with Panel 1 Discussants • What can be learned from these models and what can be applied rapidly in other SSA coun- tries? How can these models be expanded to be- come part of an effective national healthcare system? MICHELLE MCMURRY, Session Co-chair Director of the Health, Biomedical Science and Society Initiative Aspen Institute

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80 MNS IN SUB-SAHARAN AFRICA, IMPROVING QUALITY OF CARE 2:45 p.m. TEA BREAK 3:00 p.m. Panel Discussion 2: Disease Models (presentations 10 minutes each) • What were/are the challenges and opportunities in using disease models to improve diagnosis and treatment of mental health, neurological, and/or substance use disorders? Epilepsy Model CHARLES NEWTON Senior Clinical Fellow KEMRI-Wellcome Research Programme HIV/AIDS Model ANGELINA KAKOOZA-MWESIGE Department of Pediatrics and Child Health Makerere University School of Medicine Malaria Model DANIEL JAPHETH KYABAYINZE Clinical Epidemiologist Research Officer, Communicable Diseases Malaria Consortium, Africa 3:30 p.m. Moderated Discussion with Panel 2 Discussants • What can be learned from these disease models and what can be applied rapidly in other SSA countries? How can these disease models be lever- aged to improve quality of care for mental health, neurological, and/or substance use disorders? CHARLES NEWTON, Session Co-chair Senior Clinical Fellow KEMRI-Wellcome Research Programme

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APPENDIX C 81 4:00 p.m. Summary of Day One ALAN I. LESHNER, IOM Neuroscience Forum Chair Chief Executive Officer, AAAS Executive Publisher, Science 4:15 p.m. Discussion with Workshop Speakers and Attendees • Given the state of the disease burden, healthcare policies, and models, what can be learned from today’s discussions and how can these be ex- panded to become integrated into a national healthcare system? ALAN I. LESHNER, IOM Neuroscience Forum Chair Chief Executive Officer, AAAS Executive Publisher, Science EDWARD K. KIRUMIRA, UNAS Health and Nutrition Forum Chair and Workshop Co-chair Dean, Faculty of Social Sciences Makerere University 5:00 p.m. ADJOURN TO RECEPTION Lake Side Terrace Victoria Room Sheraton Kampala Hotel

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82 MNS IN SUB-SAHARAN AFRICA, IMPROVING QUALITY OF CARE Quality of Care Issues for Mental Health and Neurological Disorders in Sub-Saharan Africa: A Workshop Wednesday, August 5, 2009 Workshop Agenda Sheraton Kampala Hotel, Ballroom Ternan Avenue Kampala, Uganda 8:00 a.m. Welcome and Review of Day One STEVEN E. HYMAN, Workshop Co-chair Provost Harvard University EDWARD K. KIRUMIRA, UNAS Health and Nutrition Forum Chair and Workshop Co-chair Dean, Faculty of Social Sciences Makerere University 8:15 a.m. Keynote Address PAUL FARMER Cofounder Partners in Health Professor of Social Medicine Department of Global Health and Social Medicine Harvard Medical School 8:45 a.m. Moderated Discussion with Workshop Participants STEVEN E. HYMAN, Workshop Co-chair Provost Harvard University

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APPENDIX C 83 SESSION IV: DEVELOPING FEASIBLE HEALTHCARE SYSTEMS Session Objective: Explore feasible strategies to improve care for mental health, neurological, and substance use disorders given the current finan- cial and resource constraints. Discuss opportunities that can be used to better ensure continuity of care and sustainability within a country’s healthcare system. Identify resources that are currently available or could be made available to aid in implementation of treatments and prevention projects. 9:00 a.m. Introduction to the Session MARCELO CRUZ, Session Co-chair President Global Network for Research on Mental and Neurological Health Ecuador EDWARD K. KIRUMIRA, Session Co-chair Dean, Faculty of Social Sciences Makerere University 9:10 a.m. Traditional Healers and Epilepsy Treatment ROY BASKIND Division of Neurology Department of Medicine University of Toronto 9:25 a.m. Continuity of Care, Sustainability, and Standardization OYE GUREJE Head, Department of Psychiatry University of Ibadan College of Medicine

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84 MNS IN SUB-SAHARAN AFRICA, IMPROVING QUALITY OF CARE 9:40 a.m. Partners in Health PAUL FARMER Cofounder Partners in Health Professor of Social Medicine Department of Global Health and Social Medicine Harvard Medical School 9:55 a.m. Moderated Discussion with Session Panelists MARCELO CRUZ, Session Chair President Global Network for Research on Mental and Neurological Health Ecuador EDWARD KIRUMIRA, Session Co-chair Dean, Faculty of Social Sciences Makerere University 10:25 a.m. TEA BREAK SESSION V: IMPROVING THE PRESENT, LOOKING TO THE FUTURE: DEVELOPING EVIDENCE-BASED HEALTH POLICIES S ession Objective: Explore the greatest opportunities for improving evidence-based health policies, leveraging resources, and developing meaningful collaborations between various countries and healthcare net- works. 10:40 a.m. Introduction to the Session FLORENCE BAINGANA, Session Chair Research Fellow Makerere University School of Public Health 10:45 a.m. Panel Discussion: Opportunities for Improving

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APPENDIX C 85 Evidence-Based Health Policies Lesotho MATHAABE CECILIA RANTHIMO Acting Director, Mental Health Services Ministry of Health and Social Welfare, Lesotho Kenya DAVID M. NDETEI Director African Mental Health Foundation Rwanda YVONNE KAYITESHONGA Coordinator, Mental Health Department Ministry of Health, Rwanda Neurology Perspective MARCELO CRUZ President Global Network for Research on Mental and Neurological Health Ecuador WILLIAM B. P. MATUJA Consultant Neurologist Department of Neurology Muhimbili University College of Health Sciences Muhimbili National Hospital Psychiatric Perspective FRANK NJENGA President African Association of Psychiatrists and Allied Professions 11:45 a.m. Moderated Discussion with Session Panelists

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86 MNS IN SUB-SAHARAN AFRICA, IMPROVING QUALITY OF CARE FLORENCE BAINGANA, Session Chair Research Fellow Makerere University School of Public Health 12:30 p.m. LUNCH SESSION VI: NEXT STEPS Session Objective: Identify practical next steps by which to facilitate collaborative activities among stakeholders that are aimed to improve the quality of care of mental health, neurological, and substance use disorders. 1:30 p.m. Closing Remarks: Where Do We Go from Here? EDWARD K. KIRUMIRA, UNAS Health and Nutrition Forum Chair and Workshop Co-chair Dean, Faculty of Social Sciences Makerere University ALAN I. LESHNER, IOM Neuroscience Forum Chair Chief Executive Officer, AAAS Executive Publisher, Science 2:00 p.m. Moderated Discussion with Session Panelists and Attendees What next steps were identified during the workshop that could (1) better ensure continuity of care and sus- tainability within a country’s healthcare system; (2) aid in implementing treatments and prevention projects; (3) better emphasize the need for national, evidence-based policies; and (4) facilitate collaborations among a variety of stakeholders, including policy makers and healthcare professionals?

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APPENDIX C 87 ALAN I. LESHNER, Moderator Chief Executive Officer, AAAS Executive Publisher, Science EDWARD K. KIRUMIRA, Moderator Dean, Faculty of Social Sciences Makerere University 3:00 p.m. ADJOURN PAUL E. MUGAMBI President Uganda National Academy of Sciences

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