Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa Workshop Summary (2014) / Chapter Skim
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2 Challenge: Insufficient Demand
2 Challenge: Insufficient Demand
Pages 15-30
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From page 15... ...
• Development of national task forces composed of government officials and key stakeholders to advocate for and develop training and education plans for mental, neurological, and substance use (MNS) disorders.
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From page 16... ...
Gureje noted there are associated challenges related to low demand, including perceived quality of care; acceptability of seeking care (i.e., negative attitudes toward those with MNS disorders) ; cost of care and affordability of medicines; and overall awareness of the need for care by patients, families, and health care providers.
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From page 17... ...
They stressed the importance of increasing capabilities of providers around identification, diagnosis and treatment of MNS disorders. Providers in urban and rural settings that might be targeted for increased training included psychologists, medical doctors, nurses, and community health care workers.
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A study of 2,040 people in Nigeria found that more than 40 percent believe that some MNS disorders are due to supernatural causes and 30 percent believe in faith or spiritual treatments rather than medical treatments (Gureje et al., 2005)
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From page 19... ...
Cost and Affordability of Treatment The cost of care for MNS disorders directly influences the demand for medicines, said Gureje. Given the lack of universal health insurance coverage in most SSA countries, patients must pay out-of-pocket for health care expenses, even though 70 percent live below the poverty line in some countries (World Bank, 2014)
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From page 20... ...
Based on his experience, Gureje offered the following thoughts on how to improve access through increased demand. First, improve helpseeking through public education; enhance detection and treatment through provider training focused on improving skills and reduce negative attitudes toward MNS conditions; and reform the health system so that the few specialists available can spend more time providing supervision and support to first-line providers.
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From page 21... ...
BOX 2-1 Highlights of Lessons Learned from Example Programs: Insufficient Demand Country Programs National Health Insurance Scheme (NHIS) , Ghana • The establishment of the NHIS provided access and basic financial coverage to health care services for residents of Ghana.
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From page 22... ...
• Country-level prevalence data were needed to help accurately determine the demand for diabetes care and treatment. Schizophrenia • The simultaneous launch of awareness initiatives aimed at patients and families and training of primary health care providers increased demand.
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From page 23... ...
To address the need for increased and improved training and education of providers and managers about MNS disorders, several participants suggested that implementation of the mhGAP intervention guide and training modules might be a strong first step in addressing this challenge. A few participants suggested that national task forces composed of government officials and key stakeholders might be able to develop training and education plans aimed at addressing treatment gaps in care of patients with MNS disorders.
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From page 24... ...
The third barrier, limited access to prescribers by patients, was directly linked to low demand for essential medicines, according to many discussion participants. Collins indicated that a key opportunity identified by some participants was the reduction or removal of policies that limit the types of health care providers who can prescribe medicines and which medications they can prescribe.
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From page 25... ...
Success Inadequate Implementation of Increased Increased number Specialized MNS Use of health training and the mhGAP detection, of health care disorder trainers; information education of intervention guide diagnosis, and providers trained. primary care systems with health care and training intervention of Increased case providers; consideration providers and modules across MNS identification of pharmacists; based on funding managers about SSA countries.b,c,e disorders.b,c,g MNS disorders.
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From page 26... ...
Success Inadequate Cultivation of Development of a Active Policy makers; Consider need for training and champions within sustainable group participation by primary care articulating education of both government of government members of the providers; priority conditions health care and society to officials and key task force (e.g., community based on country providers and identify gaps in stakeholders to attendance at members; supply conditions and managers about addressing MNS comprise a meetings with chain evidence-based MNS disorders and train national task diverse representatives; medication needs. disorders.b,c,d,e,f,g,h,i health care force.
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From page 27... ...
Success A low perceived Integration of Increased number Increased demand Facility-based Consider the need for MNS- patient- and of patient for care and providers; impact on primary specific medical family-oriented education sessions treatment in health Ministry of health care care by patients training about per month focused care facilities. Health; advocacy providers due to and MNS disorders in on MNS Reduced groups; increased families.a,b,c,d,e,f,g,h,i health care disorders.
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From page 28... ...
Success A low perceived Integration of Increased Increased Community-based Consider country need for MNS- training about education on MNS identification of organizations; differences in specific medical MNS disorders disorders for faith cases. Increased faith-based levels of care by patients into existing leaders, referrals to a organizations; literacy.b,d and community-based complementary health care facility Ministry of families.a,b,c,d,e,f,g, programs.b,c,d,e,g and alternative for treatment and Health; advocacy h,i health care care.
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From page 29... ...
Success Limited access to Reduce or remove Increased number Increased Ministry of Country-based prescribers by policy limitations of providers able to number of Health; Ministry regulations on patients.a,b,c,d,e,g on which types of prescribe certified of Finance; patient prescribing health care medications. prescribers.
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