GlobalHealthAfrica

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Responding to the Needs of the Vulnerable: The State of Mental Health Care in Africa

In Community Health, Health Policies, Mental Health on May 18, 2014 at 12:28 am

In Africa, the problem of mental health and substance use disorders is particularly pronounced. GHA contributor, Diana Kingsbury, calls for governments and donors to increase their focus on mental health issues.

Among the many public health challenges that impact countries worldwide, mental health and substance use disorders continue to rank among the most persistent. These disorders are the leading cause of death and disability worldwide and account for about 23% of all years of life lost globally, according to the World Health Organization (WHO). For low- and middle-income countries, adequately addressing mental health needs is particularly challenging. Statistics show that 75-85% of individuals living with severe mental disorders in low-and middle-income countries are not receiving necessary treatment, compared to 35-50% in high-income countries.

Picketing in Cape Town, South Africa. Image by Halden Krog

Picketing in Cape Town, South Africa. Image by Halden Krog

In Africa, this problem is particularly pronounced. While the overall prevalence of mental health and substance use disorders across the continent is largely unreported, the lack of adequate services has been identified and is growing in relevance in the global health arena. The mental health care crisis within Africa is the result of several inter-related factors including a significantly understaffed mental health care workforce. For example, in the Niger Delta region of Nigeria, there is only one neuro-psychiatric hospital for the region’s four million inhabitants.

In Uganda, a nation of 33 million, there are only 33 psychiatrists. In Kenya, there are only 83 psychiatrists for a population of 40 million. In Ghana, there is only one psychiatrist available for 1.5 million people.

Across Africa, the burden of inadequate access to mental health care has resulted in lack of treatment, follow-up, and often inhumane treatment of the mentally ill. The additional burden of stigmatization often leaves individuals with mental disorders without any source of social support. Coupled with the significant social stresses that challenge the continent, such as poverty, food insecurity, conflict, and infectious disease, the risk of developing a mental disorder also increases. Very few prevention programs are currently in place to assist those at-risk in confronting these stresses. The limited availability of an appropriate mental health care system is a significant public health problem that needs to be addressed.

From a governmental perspective, there is limited infrastructure available to provide appropriate mental health care for those in need. It has been reported that 70% of African nations spend less than 1% of their health budgets on mental health and the majority of available funds are put toward psychiatric institutions and not community-based programs. Additionally, only 50% of African nations have a mental health policy, and if they do have a law, it is usually archaic and obsolete. In light of recent events in South Sudan and the disappearance of over 260 school girls in Nigeria, it is clear that in order to heal psychological wounds caused by violent conflict and social unrest, a commitment to building a mental health care system that can readily respond to the needs of the people should be of paramount importance.

Efforts that have been made to reverse current trends have proven successful. For example, former U.S. President Jimmy Carter’s “Carter Center” has established a mental health program in Liberia that seeks to train mental health care professionals within the country so that access to necessary mental health care services may be improved. As a result of the center’s efforts, mental health care access can be expanded to nearly 70% of the country. Organizations such as “BasicNeeds” also seek to break through stigmas associated with mental health disorders in the developing world, and create community supports that are vital to the integration and care of the mentally ill within the community. Through the work of non-governmental and philanthropic organizations, an organized effort to integrate mental health care into the primary care system, as well as an emerging focus on the mental health needs of the developing world, more attention has been brought to this issue. The relevance of adequate mental health care across the globe should not be underestimated.

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Spotlight: Organizations Making a Difference in African Healthcare

In Community Health, Healthcare, Medicine on April 22, 2014 at 3:25 am

Global Health Africa aims to spotlight organizations that are making a difference in African healthcare. In this post, GHA Blogger Udo Obiechefu sheds light on the work the Nigerian Healthcare Foundation accomplishes during its medical missions. 

Although much of the emphasis on improving health care in Africa is placed on governments and large scale international aid organizations, it is important to note the important work that is done by foundations and organizations who do not receive a large portion of the spotlight. These organizations, at times, are the primary source of medical treatment and attention for many Africans, young and old. In this piece, I speak with the Executive Director of the Nigerian Healthcare Foundation (NHF) in an effort to shed light on the work the organization accomplishes during its medical missions, gain a better understanding of the challenges they face, and provide insight into their operations.

Name: Ijeoma Obilo

Current title and years in current role: Executive Director (10 years)

Over the course of the NHF’s existence, important medical missions have been made by the foundation to Nigeria. What health care issues have been found to be the most prevalent?

The healthcare issues range from minute health check-ups to severe health complications that require surgery. We have seen it all. The majority of our patients do not have access to healthcare. They do not have the financial means to pay for medicine and health check-ups. So when the NHF arrives on the ground with our medical team and supplies, we go straight to work. On average, we treat almost 200 patients a day and provide them with food, necessities for their children, medicine and more.

health

As a follow-up to the first question, has there been any noticeable improvement in any key health outcomes over the course of the NHF’s missions to Nigeria?

Yes, the improvements are shocking! Many of the children that visit our mobile site are malnourished and after just two weeks of the NHF being on the ground, you can visibly see the difference in the children and the adults. They gain weight and they look more healthy and vibrant. Not only do we provide medical care, we also provide 2-3 square meals a day to whoever comes to receive medical attention. We provide children and young people with school supplies and also provide nursing mothers with vitamins and baby essentials. We believe in treating the body, heart and mind.

What are some of the typical obstacles that arise during mission trips? How are they overcome?

Our mission trip is a truly inspiring and life changing experience for anyone who joins us. Some of the obstacles that often arise during our mission trips are being able to provide enough medicine for those that we treat. When the word spreads that the NHF has arrived, hundreds of people come daily from neighboring towns and villages to seek treatment. We want to be able to treat as many people as possible and to date have not turned anyone away, and we never will.

What is the reception like from the local government/community?

The community welcomes us with open arms! They are truly appreciative of our services and benefit immensely from our free health care services. We provide medication, hygiene necessities, treat ailments and more. They are receiving care from highly trained doctors, medical residents and health practitioners. At least we can attest that they are receiving care at least once a year because we exist. Hopefully we will be able to build a clinic so that we can see patients all year round and they can receive necessary health treatments. We look forward to partnering and collaborating with Imo State government on more initiatives.

What, in the opinion of the NHF, are the key issues facing Nigerian healthcare in the next 20 years.

Access to quality care which can be achieved through affordable and safe healthcare within Nigeria.

Community-Led Total Sanitation

In Community Health on September 23, 2013 at 9:29 am

Global Health Africa blogger-Ifeoma Ozodiegwu– shares her experiences in her work with an NGO in Zambia

ifeoma

September 4th 2013 was one of those lucky days for me!  I got to visit one of the communities where our Programme for the Awareness and Elimination of Diarrhoea (PAED) works in Zambia. Diarrhoea is the 3rd largest killer of children under the age of 5 in Zambia. One of the pillars of the PAED program is the promotion of practices that prevents diarrhoea-related illness and death. Community Led Total Sanitation (CLTS)  is a diarrhoea preventive practice that advances handwashing and the use of toilets to stop open defecation. The mission of the PAED Team  was to implement a Community-Led Total Sanitation (CLTS) effort in our destination, Kasenga, Chongwe District.  We made our way through several tarred and dusty roads to get there. On arrival, the locals welcomed us with delightful songs laced with clapping. As I watched the dedicated teams engage with the community, I learnt some very meaningful lessons.

ist kasenga

Transparent dialogue:

When identifying issues that exist within a community, it is important that as many community members as possible be part of the discussion. This was clearly demonstrated when community members took part in mapping their locality to identify homes with toilets and those without. All present formed a circle around two young men who used a stick to draw a map of Kasenga.  Stones marked homes and leaves were added if they had toilets. Despite my inability to understand Nyanja (the local language), it was evident that all community members were contributing to the process by pointing out any mistakes or omissions made by the amateur map-makers!

kasenga head

Walk of Shame:

Although “walk of shame” sounds negative in the context of community engagement, it does not have to be so. In this case, it means using the negative as a force for good.  After the mapping of Kasenga settlement was completed, the village headman led the community members and all present in a walk of shame. This 2km long walk took us to innermost part of the settlement to look for and collect fresh stool. Once these ‘deposits’ were found, they were brought back to our starting point for all to behold in their glory while we discussed the hazardous effects of open air defecation. One of the community facilitators led the discussion and using some food and water, she demonstrated how easy it is for human waste to contaminate food and drink and cause life-threatening diarrhoea to children and adults. For the exercise, she shared freshly prepared fish and some water amongst everyone and then placed the remaining food next to the faecal deposits and we watched as flies danced between them. For the water, she used a piece of stick to poke the faeces and put it into the can of water. Then, she asked if we would like some fish or water. The response was a unanimous “No”. The Community Champion then asked all to imagine what happens in homes where people defecate outside and a hen, for instance, could poke it with its beak or touch it with its feet and then match into the kitchen and touch prepared food that will be eaten by the household. Needless to say, it was disgusting to discuss food and drink in the midst of the excreta, but it had the desired effect and drove the lesson home!

Improvise:

One of the community facilitators demonstrated how to make a simple handwashing facility called Tip Tap using a leaking can filled with water and some dry sticks. This amazing equipment can be built by anyone outside their toilet. Instead of soap, community members were encouraged to use ash as a cleaning agent for their hands. This innovation will make it easy for communities to adopt handwashing as it costs next to nothing!

tip tap

Simple logic:

What followed after the collected waste was safely deposed of was a  lesson led by one of the facilitators on the monetary cost of illness that result from contamination of food or water by human waste. Using a long sheet of white paper and a marker, we all estimated and compared the cost of seeking medical care at a health facility versus the cost of building a local toilet. Unassisted, the inhabitants of Kasenga were able to come to the conclusion that the cost of medical care was much higher.

So what do you think? Leave a comment to let us know any lessons you are learning from your work in the community. Also do not forget to share this post! Just click on any of the social media icons 🙂

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