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2 Systems of Care for MNS in Sub-Saharan Africa
2 Systems of Care for MNS in Sub-Saharan Africa
Pages 21-42
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From page 21... ...
Known as the "treatment gap," it is defined as the proportion of people with a disease or condition who require treatment, but do not receive it. The gap tends to be much higher in developing versus developed countries and for rural versus urban populations.
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From page 22... ...
. Other agerelated MNS disorders on the rise in Tanzania, such as Alzheimer's disease and Parkinson's disease, are also poorly recognized by healthcare
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From page 23... ...
Workshop participants stressed that treatment gaps do not exist because of a lack of data on treatments. Substantial scientific data are available on the efficacy of treatments for MNS disorders.
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From page 24... ...
And this applies to more or less all professionals." Patel continued to explain, "The worst part of this story is that due to migration of professionals, the difference is widening rather than narrowing." In the lowest income countries, there are effectively no psychiatrists, psychologists, psychiatric nurses, or social workers available to treat patients with common mental health disorders.
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From page 25... ...
The absence of formal training programs and career paths in MNS disorders serves as a barrier. Many of the associated MNS disciplines are not represented in the medical universities that are affiliated with hospitals.
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From page 26... ...
However, the establishment of student loan reimbursement/forgiveness programs that require service in underserved communities would help incentivize individuals to seek MNS training and practice in their home country. Barriers to Treatment Access to Treatment Facilities Many barriers limit access to care for persons with MNS disorders in SSA.
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From page 27... ...
Financing MNS Assuming an accurate diagnosis is made, the patient then faces the challenge of paying for treatments and medicines. In low-income countries, health insurance is rare and care for MNS disorders is paid primarily out-of-pocket by families.
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From page 28... ...
The good news is that much is known about treating MNS disorders. Treatments are also broadly effective, and projects such as the Disease Control Priority Project have even modeled the cost-effectiveness for a range of treatments across many mental and neurological disorders (WHO, 2006c)
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From page 29... ...
Large, custodial mental hospitals should be replaced by community care facilities, backed by general hospital psychiatric beds and home care support, which meet all the needs of the ill that were the responsibility of those hospitals. This shift toward community care requires health workers and rehabilitation services to be available at the community level, along with the provision of crisis support, protected housing, and sheltered employment (WHO, 2001)
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From page 30... ...
Through the Ugandan system of training, mental health has been integrated into that Village Health Team manual so the Village Health workers recognize mental health illness. Ultimately, the hope is to change the perception of mental health illness in local Ugandan communities, which will be strengthened through collaborations BOX 2-1 Advantages of Community-Based Care • Social forces contribute to disease burden and health outcomes, and community-based care can address these forces.
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From page 31... ...
Kakooza-Mweisge believed that the need for integrated care was clear, especially given the complexity of the drug regimens to which patients with multiple issues must adhere. Because many HIV-related MNS disorders are related to seizures, often patients are put on antiretroviral drugs (ARVs)
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From page 32... ...
The babies had high rates of immunization coverage, as well as low rates of pneumonia, diarrhea, and other infections compared to those whose mothers did not receive the treatment, highlighting the importance of this program not only to the mothers but also their children. This type of evidence does not suggest that task shifting and an emphasis on community health workers translates into a healthcare system that no longer needs specialists.
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From page 33... ...
, it meant that chlorpromazine could be substituted for carbamazepine because they were out of it and they both ended with the letters "ine." As a result, the frequency of the in-person evaluations were increased to low high Long-Stay Facilities & Specialist Services Community Psychiatric Mental Services in FREQUENCY Health General COSTS OF NEED Services Hospitals Mental Health Services through PHC Informal Community Care Self Care high low QUANTITY OF SERVICES NEEDED FIGURE 2-2 The WHO's optimum mix of mental health services.
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From page 34... ...
As the Kenyan Ministry of Health worked to implement the plan, it found it did not have enough skilled health workers to treat the diseases it was seeing. It was decided to use existing health workers and train them to increase their skills so they could deal with the MNS disorders they were seeing in the field.
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From page 35... ...
The process has not been without challenges, but significant progress has been made. Rwanda Arguing for the mental health benefits of a broad commitment to general primary health care, Paul Farmer, cofounder of Partners in Health and professor of social medicine in the Department of Global Health and Social Medicine at Harvard University Medical School, spoke about the 1998 HIV Equity Initiative in Haiti that used community health workers to provide care in their communities.
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From page 36... ...
Workshop participants identified other strengths and weaknesses that traditional healers brought to caring for sufferers of MNS disorders. For example, strengths of traditional healers include the following: • Traditional healers live in the community and know the people they are treating and their families and their histories, and they are often very good at solving family, social, and neighborhood problems.
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From page 37... ...
They want to be able to believe in the treatment; it needs some legitimacy and traditional healers have legitimacy because they are traditional." Makerere University's Seggane Musisi noted that there was recent research evidence suggesting that, in MNS care, those patients who use both Western and traditional medicine did better than those who used either method alone. Treating traditional healers with respect is critical when approaching them for collaboration.
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From page 38... ...
The compounds can be analyzed to look at the active ingredients, check for efficacy, refine them, and even package and market them while retaining the traditional healer's intellectual property. Musisi emphasized the need to train, certify, register, license, integrate, and supervise traditional health practitioners for mental health care in primary health care and establish a formal health care category of Traditional Mental Attendants akin to the Traditional Birth Attendants of midwifery (Okello, et al.
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From page 39... ...
Mobile Health Technologies One tool developed for these health workers are applications and training modules that can be used on a mobile phone, providing decision trees and checklists, called Mobile Health. "A decision tree not only guides the health workers specifically to actions that they would perform, but also to specific information that needs to be imparted during the visit," explained Belkin.
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From page 40... ...
This would help address the issue of patients traveling for hours to a clinic only to find that it is closed or the medications they need are not there. Financing MNS Care in Sub-Saharan Africa Financing delivery of care to individuals with MNS disorders presents another challenge to the delivery of quality care.
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From page 41... ...
. The structure of the project is important -- village clusters are directly linked to the district hospitals, but the community health workers walking from home to home are the ones who truly bring patients into the healthcare system.
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From page 42... ...
. These data demonstrate the potential of this approach and the value it may hold for the purchase of drugs for MNS disorders.
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