Strengthening Human Resources Through Development of Candidate Core Competencies for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary (2013)

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E Workshop Agenda Strengthening Human Resources for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: A Workshop September 4-5, 2012 Sheraton Kampala Hotel Kampala, Uganda Background: Sub-Saharan Africa (SSA) has one of the largest treatment gaps for mental, neurological, and substance use (MNS) disorders in the world. It is estimated that 4 out of 5 people with serious mental disorders living in low- and middle-income countries do not receive mental health services that they need. The ability to provide adequate human resources for delivery of essential interventions in MNS disorders has been identi- fied as a critical barrier to bridging the treatment gap. There is an over- whelming call for the development of a diverse, well-trained network of workers to reduce the treatment gap. The goal of the workshop is to bring together key stakeholders to examine the human resource needs for ef- fective delivery of treatments and improvement of the MNS health care workforce in SSA. The emphasis of the workshop will be on MNS disor- ders with the greatest disease burdens, focusing on depression, schizo- phrenia, epilepsy, and alcohol use. Meeting objectives: Participants will be invited to:  Assess the future needs of MNS health care workers based on provider type, treatment environment, and MNS disorder 91 

92 CANDIDATE CORE COMPETENCIES FOR MNS DISORDERS IN SSA o Examine human resource needs for effective delivery of treatments in a typical African district health care system o Consider core competencies and performance requirements necessary to improve human resource capabilities for MNS disorders (e.g., diagnosis, prescribing of medicines, and pa- tient monitoring)  Discuss potential mechanisms for task shifting and task shar- ing among human resources and across treatment locations  Explore education and training opportunities for acquiring and maintaining core competencies o Consider existing and potential partnerships for:  Developing programs to train current providers to reach core competencies  Implementing training programs  Consider tangible next steps for the dissemination of identified human resource core competencies and performance requirements DAY ONE 8:30 a.m. Welcome and background statement SEGGANE MUSISI (Master of Ceremony) Professor of Psychiatry Makerere University ALAN LESHNER Chief Executive Officer, American Association for the Advancement of Science (AAAS) Executive Publisher, Science 

APPENDIX E 93 8:35 a.m. Key themes from the 2009 workshop Mental, Neurological, and Substance Use Disorders in Sub- Saharan Africa: Reducing the Treatment Gap, Improving Quality of Care (with Q&A) EDWARD K. KIRUMIRA Deputy Principal of the College of Humanities & Social Sciences Makerere University 8:50 a.m. Human resources available for diagnosis and care of MNS disorders in sub-Saharan Africa: Review of the 2011 Mental Health Atlas (with Q&A) DANIEL CHISHOLM Health Economist World Health Organization 9:10 a.m. Why focus on depression, schizophrenia, epilepsy, and alcohol use? SEGGANE MUSISI Professor of Psychiatry Makerere University 9:20 a.m. Strengthening human resources through core competency development VIKRAM PATEL Professor of International Mental Health London School of Hygiene & Tropical Medicine 9:30 a.m. Charge to workshop participants PAMELA COLLINS Director, Office for Research on Disparities & Global Mental Health National Institute of Mental Health 

94 CANDIDATE CORE COMPETENCIES FOR MNS DISORDERS IN SSA 9:40 a.m. Welcoming remarks SHEILA NDYANABANDI National Coordinator, Mental Health Services Ministry of Health, Republic of Uganda 9:45 a.m. Keynote HONORABLE CHRISTINE ONDOA Minister of Health Republic of Uganda SESSION I: CORE COMPETENCIES FOR MNS DISORDERS Session Objectives: Discuss available human resources and their capabil- ity to provide appropriate care for MNS disorders in SSA. 10:00 a.m. Session introduction SEGGANE MUSISI, Session Chair 10:05 a.m. MNS disorder provider profiles (all participants)  Brief overview of provider types that commonly care for patients with MNS disorders, including a focus on country differences (introduction by panel moderator)  Provider perspectives o What are the challenges of caring for patients with MNS disorders in SSA? o What key points should participants consider when developing the core competencies? SOLOMON RATAEMANE, Moderator Head, Department of Psychiatry University of Limpopo Panelists MUTHONI MATHAI Psychiatrist, Kenya 

APPENDIX E 95 GERALD VITUS KIHWELE Nursing Officer Mirembe National Mental Hospital ANTHONY MULENGA ZIMBA Chair/Vice President International Bureau for Epilepsy–Africa Region SEBOLELO TSEEKE Senior Social Worker Sanca Eastern Gauteng, South Africa 10:30 a.m. Panel discussion with speakers and participants 11:00 a.m. Breakout I goals (all participants) Treatment environment and treatment role  Review and finalize treatment environment and treatment role columns  Are the treatment environments listed for each provider type correct? Are any missing?  Are the treatment roles appropriate for each pro- vider type? Are any roles missing? SEGGANE MUSISI, DISCUSSANT 11:20 a.m. BREAK 11:30 a.m. Breakout I: Treatment Environment and Treatment Role DEPRESSION – SYLVIA KAAYA, GROUP FACILITATOR SCHIZOPHRENIA – DAVID NDETEI, GROUP FACILITATOR EPILEPSY – ADESOLA OGUNNIYI, GROUP FACILITATOR ALCOHOL USE – SOLOMON RATAEMANE, GROUP FACILITATOR 12:30 p.m. LUNCH 1:30 p.m. Breakout II goals (all participants) 

96 CANDIDATE CORE COMPETENCIES FOR MNS DISORDERS IN SSA Core competencies: From diagnosis through treatment and care  Review and finalize core competencies for each provider type  Are the core competencies for these areas correct? Are any missing? VIKRAM PATEL, DISCUSSANT 1:50 p.m. Breakout II: Screening/Identification, Diagnosis, and Treatment/Care Core Competencies DEPRESSION – SYLVIA KAAYA, GROUP FACILITATOR SCHIZOPHRENIA – DAVID NDETEI, GROUP FACILITATOR EPILEPSY – ADESOLA OGUNNIYI, GROUP FACILITATOR ALCOHOL USE – SOLOMON RATAEMANE, GROUP FACILITATOR 3:45 p.m. BREAK 4:15 p.m. Breakout III goals (all participants) Continuum of care: Relationship roles and template commonalities  Review and finalize the relationship roles provid- ers have with each other  Discuss commonalities across the templates. Re- fine templates to highlight both commonalities and distinctions PAMELA COLLINS, DISCUSSANT 4:35 p.m. Breakout III: Relationship Roles and Template Commonalities SPECIALIZED PRACTITIONERS PAMELA COLLINS AND SOLOMON RATAEMANE, FACILITATORS 

APPENDIX E 97 NON-SPECIALIZED PRESCRIBING PRACTITIONERS WALTER KOROSHETZ AND SYLVIA KAAYA, FACILITATORS NON-SPECIALIZED, NON-PRESCRIBING PRACTITIONERS SEGGANE MUSISI AND DAVID NDETEI, FACILITATORS COMMUNITY AGENTS/LAY WORKERS VIKRAM PATEL AND ADESOLA OGUNNIYI, FACILITATORS 6:00 p.m. ADJOURN TO RECEPTION DAY TWO 9:00 a.m. Introduction ALAN LESHNER, Session Moderator Commonalities across disorders and shared provider roles  Where is there evidence of commonalities across the disorder templates?  What core competencies are shared among different provider types?  What are the relationship roles among differ- ent provider types?  How are relationship roles defined in these templates similar to or different from current practices? PANEL Specialized Practitioners Group PAMELA COLLINS AND SOLOMON RATAEMANE, FACILITATORS 

98 CANDIDATE CORE COMPETENCIES FOR MNS DISORDERS IN SSA Non-Specialized Prescribing Practitioners Group SYLVIA KAAYA AND WALTER KOROSHETZ, FACILITATORS Non-Specialized, Non-Prescribing Practitioners Group SEGGANE MUSISI AND DAVID NDETEI, FACILITATORS Community Agents/Lay Workers Group ADESOLA OGUNNIYI AND VIKRAM PATEL, FACILITATORS 10:15 a.m. Re-imagining the health care system for MNS disorders  Provide highlights of critical and/or significant changes to provider core competencies as out- lined in the templates  How would the newly defined core competen- cies change the current system of care for MNS disorders?  What are potential challenges for integration of new core competencies into the current health care system? PANEL SYLVIA KAAYA, Depression Working Group Leader DAVID NDETEI, Schizophrenia Working Group Leader ADESOLA OGUNNIYI, Epilepsy Working Group Leader SOLOMON RATAEMANE, Alcohol Use Working Group Leader 11:30 a.m. BREAK SESSION II: OPPORTUNITIES FOR INTEGRATION INTO CURRENT TRAINING PROGRAMS Session Objectives: Explore successful mechanisms for strengthening human resources from other disease areas and countries. Examine current medical/health professional education programs in SSA for MNS disor- ders. Discuss potential opportunities and mechanisms to add-on compo- nents around MNS disorders to existing programs. 

APPENDIX E 99 11:45 a.m. Session introduction PAMELA COLLINS, Session Chair 11:50 a.m. Lessons about integration of new or revised core compe- tencies (with Q&A)  What was the mechanism for updating the core competencies?  What components have been critical to the launch of new training programs? In revision to current training programs?  What training tools have been most successful?  What were key challenges? How were they overcome? RUBEN SAHABO Country Director, Swaziland International Center for AIDS Care and Treatment Programs 12:10 p.m. Group discussion with speakers and participants  What opportunities exist to include MNS dis- orders in already-established training pro- grams for other disease areas?  What should be considered as critical compo- nents of a stand-alone training program for MNS disorders?  What steps would be important for implementation? 12:30 p.m. LUNCH 

100 CANDIDATE CORE COMPETENCIES FOR MNS DISORDERS IN SSA SESSION III: NEXT STEPS—BUILDING AND SUSTAINING COMPETENCIES Session Objectives: Explore mechanisms for integrating core competen- cies into the current health care system. Identify training priorities at multiple stakeholder levels for incorporation. 1:30 p.m. Session introduction VIKRAM PATEL, Session Chair 1:40 p.m. Training programs for MNS disorders (with Q&A)  What components have been critical in the launch- ing of these programs?  What training tools have been most successful?  Describe the process of adaption and field testing  What have been the successes and challenges? PANEL SHEILA NDYANABANGI National Coordinator, Mental Health Services Ministry of Health, Republic of Uganda DIXON CHIBANDA Psychiatrist, Zimbabwe TEDLA WOLDE-GIORGIS Ministry of Health, Ethiopia JEANNE D’ARC DUSABEYEZU Director, Unit of Drug Abuse Prevention and Treatment Ministry of Health, Rwanda 2:40 p.m. Panel discussion with speakers and participants  What opportunities exist to include newly identi- fied core competencies in already-established programs?  What are critical components of a stand-alone training program for MNS disorders? 

APPENDIX E 101 3:10 p.m. Next steps with workshop co-chairs  Identify tangible next steps for dissemination and possible integration of the core competencies  Who would be critical partners in continued ef- forts around this topic?  What mechanisms should be employed to dis- seminate the information?  What are key components of a training program based on the core competencies identified in the templates? 4:30 p.m. Closing remarks ALAN LESHNER Chief Executive Officer, AAAS Executive Publisher, Science PAMELA COLLINS Director, Office for Research on Disparities & Global Mental Health National Institute of Mental Health 4:45 p.m. ADJOURN