CHALLENGES OF MENTAL HEALTH CARE IN SUB SAHARAN AFRICA II

THE INTERGRATION OF TRADITIONAL APPROACHES TO MENTAL HEALTH CARE IN SUB SAHARAN AFRICA BY DR JM MBURU MBCHB,M.MED.{PSYCH}NRB RESEARCH 75.1% OF PATIENTS CONSULTED SPIRITUAL HEALERS  31.7% VISITED HERBALIST  71.4% HEALTH WORKERS HAD PATIENTS WITH DUAL CONSULTATION  {KURIA R.W.W,KABIRU E.W,MBURU J.M.2003} RESEARCH 90% CLIENTS OF TRADITIONAL HEALERS HAD VISITED MODERN PRACTITIONERS.(Njagi 1988)  80% RURAL FOLKS SEEN BY TRADITIONAL HEALERS (WHO,2001)  REASONS FOR DUAL CONSULTATIONS STIGMA  ETHINOMEDICAL BELIEFS  ACCESSIBILITY(QUALIFIED STAFF)  AFFORDABILTY(SERVICES,MEDICI NES)  MISDIAGNOSIS(DISSATISFACTION)  LEGAL PROVISIONS.  SOLUTIONS TO CHALLENGES INCLUDE MENTAL HEALTH IN TRAINING CURRICULUM IN INSTITUTIONS.  INTERGRATE TRADATIONAL HEALTH DELIVERY SYSTEMS WITH CONVENTIONAL SYSTEMS  COLLABORATION INSTITUTE OF PSYCHIATRY(WHO COLLABORATING CENTRE)  KENYAN MINISTRY OF HEALTH  KENYA PSYCHIATIC ASSOCIATION.  BENEFITS OF COLLABORATION OF WHO GUIDELINES TO MENTAL HEALTH .NATIONAL MENTAL HEALTH POLICY. ADAPATION BENEFITS OF COLLABORATION •EPEDEMIOLOGICAL STUDY ON MENTAL DISORDERS •PILOT OF MENTAL HEALTH TRAINING •INVOLVEMENT OF TRADITIONAL PRACTIONERS DEVELOPING PRIMARY CARE OF MENTAL DISORDERS IN KENYA STAGE ONE ACTIVITIES        MULITISECTORAL TEAM FORMED TRAINING DESIGN TEAM ASSEMBLED CURRICULUM DEVELOPED TRAINING PILOTED PROJECT STAFF APPOINTED STAKEHOLDERS BRIEFINGS PUBLICITY ;T.V,RADIO,PRESS, STAGE TWO ACTIVITIES 4 KENYA MEDICAL FACILITATORS TRAINED BY PROFFESSIONAL TEAM  2 PROJECT DEVELOPMENT STAFF COMPLETE 5 DAY ORIENTATION  STAGE THREE ACTIVITES  KMTC FACILITATORS TRAIN 18 RURAL HEALTH TRAINERS. STAGE FOUR ACTIVITIES DONE IN YEAR 2/3/4/5.        RHTC TRAINERS RETURN TO 6 REGIONS. BEGIN A ¾ YEAR PROGRAMME OF DELIVERY 24 COURSES PER REGION(8 PER YEAR+1 PILOT) 20 DELEGATES PER COURSE 4 DAY COURSE 150 COURSES 3000 STAFF TRAINED. STAGE FIVE OF ACTIVITIES DELEGATES TRAINED IN STAGE 4 WORK WITH:  FAMILIES  PATIENTS TRAIN:  COLLEAGUES  COMMUNITY HEALTH WORKERS  LOCAL TRADITIONAL HEALTH PRACTIONERS DELEGATES NUMBERS      4 FROM KMTC STAFF 18 SENIOR MOST TRAINING PROFESSIONALS FROM EACH(6) SITE 2784MOST SENIOR PRACTICING CLINICIAN, MINIMUM OF 1 PER PCC 72 MENTAL HEALTH COORDINATORS, ON APPOINTMENT 72 DISTRICT HEALTH MANAGERS AND SOCIAL WORKERS(ALL IN POST) COURSE CONTENT. SKILLS •DIAGNOSIS •MANAGEMENT AND CRITERIA FOR REFERRAL •10 COMMON MENTAL DISORDERS •MENTAL HEALTH •ASSESMENT COURSE CONTENT ROLE OF • TRADITIONAL HEALTH PRACTIONNERS. •VOLUNTEER COMMUNITY HEALTH WORKERS COURSE CONTENT DATA COLLECTION  CASE REGISTERS FOR OUTREACH AND FOLLOWUP.  RELAPSE PREVENTION  PLANNING FOR MEDICINES.  MONITORING AND EVALUATION GENERIC MONITORING AND EVALUATION WITHIN THE PROJECT.  RANDOMISED CONTROL TRIAL EVALUATION STUDY.  GENERIC MONITORING EVALUATION OF IMPACT OF TRAINNING  VALIDATION OF COURSE CONTENT  MONITORING OF DELIVERY AGAINST PLAN.  EXIPENDITURE.  RCT EVALUATION PHASE 1.  TRAIN INTERVENTION GROUP  SELECT CONTROL GROUP  FOLLOW UP ASSESMENT 6 MONTHS AFTER TRAINING FOR BOTH GROUPS.  THUS ASSEING IMPACT.  THE OTHER ½ DOESN’T  . RCT EVALUATION PHASE 2  ½ INTERVENTION GROUP GETS SUPERVISION .  ASSESMENT OF SUPERVISION DONE ON BOTH GROUPS. PHASE 3.  CAN TRAINED NURSES AND CLINICAL OFFICERS DELIVER RELEVANT KNOWLEDGE TO COMMUNITY HEALTH WORKERS AND TRADITONAL PRACTIONNERS? OUTCOME OF THE PROJECT  INTERGRATION OF MENTAL HEALTH PROVISION INTO PRIMARY CARE CENTERS. GAINS      INCREASED COMPETENCE OF NURSES AND CLINICAL OFFICERS. NO UNNECESSARY REPEAT CONSULTATIONS INCREASED EFFICIENCY,SHORT QUES. REDUCTION OF SOCIOECONOMIC BURDEN INTERSECTORAL RELATIONSHIPS(POLICE PATIENTS ETC) MEASURABLE RESULTS     2,784 NURSES AND CLINICAL OFFICERS TRAINED. AT DISTRICT LEVEL TRAIN,72 DISTRICT MENTAL HEALTH CO-ORDINATORS,72 DISTRICT HEALTH MANAGERS,72 DISTRICT SOCIAL WORKERS. 18 RHTC TRAINERS TRAINED. 4KMTC FACILITATORS TO DEVELOP RHTC TRAINERS MEASURABLE RESULTS AT COMMUNITY LEVEL 1 PATIENT GROUP SET UP IN EACH OF 72 DISTRICTS  1 TOPIC LOCAL BASED TRAINING  CMHW AND THP TRAINED BY NURSE AND CLINICAL OFFICERS  PUBLICITY RADIO,TV.  FINALYEAR FIVE ACTIVITIES        FINAL COURSE COMPLETED KMTC FINALISE CORE MENTAL HEALTH IN CURRICULUM EVALUATION COMPLETED NATIONAL CONFERENCE ALL MATERIALS /EQUPMENT TRANSFERRED TO KMTC END OF PROJECT REPORT TO NUFFIELD FOUNDATION POST PROJECT FUNDING. KMTC CONTINUE TRAINING STUDENTS USING THE COURSE CONTENT  KMoH ,BID FOR TREASURY TO SUPPORT THE PROJECT  KPA PROMOTE STRATEGIC APPROACHES TO MENTAL HEALTH. 