Integration of mental health in PHC in Uganda: Opportunities, challenges and collaboration

A

Presentation by

Dr. Sheila Ndyanabangi

Principal Medical Officer, Mental Health

Introduction• 1935- 1954 – Mental Health services started with

Asylum care in Hoima• 1954 – Services introduced at Mulago National

Referral Hospital with four 4 bed Regional Units• 1965- Butabika National Mental Referral Hospital

(1000 beds)• 1995 – MH Programme at MoH• 1999/200- National Health Policy and HSSP I MH

part of minimum package

Mandate integration of MH at all levels of care

Methodology• 2001- 2005 & 2008 conducted Country

Profile of MH services in partnership with WHO collaborating centre at King’s College London

• 2008 – Conducted a situation analysis during MHAPP Research Project in partnership with DFID funded consortium

Evaluation of Mental Health Policy, Plan and Legislation using WHO checklists

Strengthens and opportunities for integration of mental health

• Global support – World Report 2001• Favorable National Policy that prioritized

integration of MH • Inclusion of MH in HSSP I• Decentralized system of government

Opportunities • Integrated guidelines i.e. Planning Clinical Management guidelines Essential drug list Integrated planning and support

supervision guidelines Annual performance reports Annual work plan• Review of other general policies and laws• Training institutions for psychiatric Nurses

and PCos

opportunities cntd• Family members and relatives provide people

with mental illness with food, clothing, bed side care and financial support

• All regions attach value to positive mental well being and many people seek care for MH problems

• Mental health care being free at public health facilities and subsidized at most NGO Hospitals

• An In- Service training programme to build capacity of general health workers exists

Findings ctd

• Strong political will, translated in acquiring loan and grant from ADB for MH totaling USD 25million over 10years

• Mental health conditions included in HMIS. Provides opportunity to collect countrywide data

Weaknesses and challenges• Big population of vulnerable population

including refugees, former IDPs, orphans due to HIV/AIDS, the poor who need special attention

• Recurrent political turmoil, natural disasters and endemic diseases such as malaria and parasitic diseases

• Lack of understanding of the concepts of mental health, causes and nature of mental illness

Weakness ctd• Some communities still have high levels of

discrimination and stigma• Minimal programmes for suicide and

homicide reduction• In spite of increased availability of MH

services people still go to traditional and religious healers because of false beliefs

• The current legislation for MH is outdated and inadequate and formulating the new law is bureaucratic

Weaknesses • The current staffing structure does not provide

adequate staffing numbers and multidisciplinary teams

• Low budget for MH services with concetration on curative services and limited efforts on health promotion and disease prevention

• Poor facilitation of health facilities for activities such as supervision and outreach

• Low health worker wages de-motivating• No formal mechanism for intersectoral

collaboration with inadequate participation in care by other relevant sectors such as police, social welfare, education etc.

Collaboration Collaboration is a major principle of MH Policy.

Examples of collaboration in Uganda:• Interasectoral collaboration with Planning,

Human Resource, HP&E, Quality Assurance and the Resource Centre

• MoH holds a stakeholders’ forum annually which includes other relevant Government sectors, NGOs, User support groups, Training Institutions, National Referral Hospitals, Prisons and Armed Forces MH staff.

Collaboration ctd• International collaboration and National partners

including WHO, UNODC, Basic Needs, Transcultural Psychosocial Organization, Peter C. Alderman Foundation

• Partner in resource mobilization, policy development and service delivery especially psychosocial services

• Collaboration in research includes WHO collaborating centre at King’s College London, DFID funded research projects e.g. MHAPP and PRIME evaluation of models for integration of MH

Priorities for strengthening integration of MH

• Strategic plan to identify activities to reach vulnerable populations

• Build capacity of MH services to respond to emergencies and conflict situations

• Scale up public education for understanding concepts of MH and mental illness

• Set up programmes for suicide and homicide prevention

Priorities ctd• Develop a strategy for streamlining the role

of traditional healers in MH• Advocate for quick enactment of the Mental

Health Act• Lobby for hastening of restructuring exercise

to increase number of staff and multidisciplinary team

• Develop mechanisms for increasing funding to MH by government and other partners

Priorities ctd

• Strengthen intrasectoral and intersectoral collaboration

• Strengthening existing partnerships and establishing more international partnerships and collaboration