Developing and implementing mental health policy in Zanzibar, a low income country off the coast of East Africa

Jenkins, Rachel; Mussa, Mahmoud; Haji, Suleiman A; Haji, Mohammed S; Salim, Ahmed Idha; Suleiman, Said; Riyami, Alya S; Wakil, Abdul; Mbatia, Joseph

doi:10.1186/1752-4458-5-6

Cited by 21 publications

(18 citation statements)

References 18 publications

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“…Such a strategy will need to include integration of mental health into the basic training of all health cadres and into post-basic training to develop a cadre of specialist workers, and into CPD of all health workers especially those in primary care. Such programmes have been described recently in Kenya 45 , Tanzania mainland 46 , Zanzibar 47 , and Egypt. 48 The next task would be to train health professionals within Somaliland to become mental health trainers so that the training programme can be sustained, and so that future students can receive supervision from within the region.…”

Section: Discussionmentioning

confidence: 99%

Use of interactive teaching techniques to introduce mental health training to medical schools in a resource poor setting

et al. 2013

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Objective: There are currently no practising psychiatrists in Somaliland. In 2007 the first medical students graduated from universities in Somaliland without mental health training. We aimed to pilot an intensive but flexible package of mental health training to all senior medical students and interns using interactive training techniques and to evaluate its effectiveness by assessing knowledge, skills and attitudes. Methods: Teaching techniques included didactic lectures, case based discussion groups and role playing. Informal feedback informed a flexible teaching package. Assessment tools designed specifically for this course included a pre and post course MCQ exam and an OSCE. Changes in students' attitudes were evaluated using a questionnaire administered before and after the course. In addition, a questionnaire administered following the course evaluated the changes students perceived in their knowledge and attitudes to mental health. Results: The MCQ improved from 50.7% pre course to 64.4% post course (p=9.73 E-08). Students achieved an average overall OSCE mark of 71%. The pre and post attitudes questionnaire was most significantly different for statements relevant to aetiology, stigma and the overlap between mental and physical health. The statement most strongly agreed with after the course was 'I now understand more about the overlap between mental and physical health'. Conclusion: Interactive teaching provided a learning experience for both students and trainers. On site and distance learning based on the teaching described here has widened the scope of the training possible in psychiatry and allowed the provision of regular teaching, supervision and peer support in Somaliland. However, the current lack of local expertise means that important issues of sustainability need to be considered in future work

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Section: Discussionmentioning

confidence: 99%

Use of interactive teaching techniques to introduce mental health training to medical schools in a resource poor setting

et al. 2013

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“…Reviews of mental health services in Zanzibar show that the majority of patients present to traditional healers before visiting mainstream practitioners and the Zanzibari ministry report that the use of their services is increasing in line with the population, due to scarcities of medication in the public sector [8]. In 2008 the Ministry of Health released the Zanzibar Traditional and Alternative Medicine Policy, recognising the potential benefits of regulating the practices of traditional healers and enabling a closer relationship with mainstream practitioners [9].…”

Section: Introductionmentioning

confidence: 99%

Establishing views of traditional healers and biomedical practitioners on collaboration in mental health care in Zanzibar: a qualitative pilot study

Solera-Deuchar

Mussa

Ali³

et al. 2020

Int J Ment Health Syst

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Background: This qualitative pilot study aimed to establish views of traditional and biomedical practitioners towards collaboration between the two sectors on the treatment of people with mental illness in Zanzibar, Tanzania. Methods: Six traditional healers (known as "waganga" in Swahili) and six nurses working in government secondary mental health services were invited to participate in a series of focus group discussions (FGDs). Two sets of FGDs took place approximately seven weeks apart. In each set, FGDs were conducted with traditional healers only, nurses only, and finally nurses and traditional healers together. FGDs were conducted in Swahili, audio-recorded and then translated to English by an independent translator and coded thematically using NVivo software. Results: All participants expressed that they were in favour of collaboration between traditional and biomedical practitioners on mental healthcare. Opinions varied regarding what form this collaboration should take. For many nurses and healers, there was acknowledgement of the role of the other group in providing treatment for people with mental illness, with support for the idea of bi-directional referrals between the two sectors. For some nurses, the value of collaboration would be purely in the education of traditional healers in the recognition of mental illness, with subsequent referral to biomedical services. For some traditional healers, the idea of collaboration seemed to appeal in part because of a perceived opportunity to learn additional skills from biomedical practitioners. Both categories of participant expressed a belief that patients possessed by a jinn (a spirit) or those that had been bewitched needed treatment by traditional healers. On the other hand, those with what participants considered to be "mental illness" needed treatment at the hospital clinic. However, some nurses felt that that traditional healers might be able to provide helpful treatment for mental illness, as well as those suspected to be affected by jinn or witchcraft. There was agreement on the need to establish clear referral pathways between the two service providers. The creation of an office for traditional healers at the hospital was an area where there was disagreement among participants. Conclusions: We conclude that there is a positive view of collaboration among traditional healers and nurses who participated, and a willingness to work towards actual collaboration. The results suggest that views vary as to what form this collaboration should take, with opinions differing between nurses, as well as between traditional healers. Additional work is needed in order to further explore the nature of potential collaboration and extend the research to the wider population of traditional and biomedical practitioners in Zanzibar, to include primary health care workers.

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“…It provides for comprehensive health services, including mental health, as a human rights entitlement [10]. Kenya is also a signatory to international rights conventions which provides state protection of the human and legal rights of people with mental illness and disabilities, their property, and their treatment [13][14][15]. Kenya has adopted the World Health Organization's Global Mental Health Action Plan 2013-2020.…”

Section: Introductionmentioning

confidence: 99%

Using the WHO-AIMS to inform development of mental health systems: the case study of Makueni County, Kenya

Mutiso

Musyimi

Gitonga

et al. 2020

BMC Health Serv Res

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Background: In order to develop a context appropriate in mental health system, there is a need to document relevant existing resources and practices with a view of identifying existing gaps, challenges and opportunities at baseline for purposes of future monitoring and evaluation of emerging systems. The World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) was developed as a suitable tool for this purpose. Our overall objective of this study, around which research questions and specific aims were formulated, was to establish a baseline on mental health system as at the time of the study, at Makueni County in Kenya, using the WHO-AIMS. Methods: To achieve our overall objective, answer our research questions and achieve specific aims, we conducted a mixed methods approach in which we did an audit of DHIS records and county official records, and conducted qualitative interviews with the various officers to establish the fidelity of the data according to their views. The records data was processed via the prescribed WHO-Aims 2.2 excel spreadsheet while the qualitative data was analyzed thematically. This was guided by the six domains stipulated in the WHO AIMS. Results: We found that at the time point of the study, there were no operational governance, policy or administrative structures specific to mental health, despite recognition by the County Government of the importance of mental health. The identified interviewees and policy makers were cooperative and participatory in identifying the gaps, barriers and potential solutions to those barriers. The main barriers and gaps were human and financial resources and low prioritization of mental health in comparison to physical conditions. The solutions lay in bridging of the gaps and addressing the barriers. Conclusion: There is a need to address the identified gaps and barriers and follow up on solutions suggested at the time of the study, if a functional mental health system is to be achieved at Makueni County.

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Developing and implementing mental health policy in Zanzibar, a low income country off the coast of East Africa

Cited by 21 publications

References 18 publications

Use of interactive teaching techniques to introduce mental health training to medical schools in a resource poor setting

Use of interactive teaching techniques to introduce mental health training to medical schools in a resource poor setting

Establishing views of traditional healers and biomedical practitioners on collaboration in mental health care in Zanzibar: a qualitative pilot study

Using the WHO-AIMS to inform development of mental health systems: the case study of Makueni County, Kenya

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