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Ndyanabangi integrating mental health in primary care
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Transcript of Ndyanabangi integrating mental health in primary care
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