The availability of essential medicines for mental healthcare in Sofala, Mozambique

Abstract

ObjectiveWe assessed the availability of essential medicines for mental healthcare (MH) across levels of the public healthcare system to aid in future systems planning.DesignNon-expired MH medications were assessed in 24 public health facilities and 13 district warehouses across Sofala Province, Mozambique, from July to August 2014. Medication categories included: antipsychotics, antidepressants, benzodiazepines, antiepileptics and mood stabilizers, and anticholinergics and antihistamines.ResultsOnly 7 of 12 (58.3%) district warehouses, 11 of 24 (45.8%) of all health facilities, and 10 of 12 (83.3%) of facilities with trained MH staff had availability of at least one medication of each category. Thioridazine was the most commonly available antipsychotic across all facilities (9 of 24, 37.5%), while chlorpromazine and thioridazine were most common at facilities providing MH care (8 of 12, 66.7%). The atypical antipsychotic risperidone was not available at any facility or district warehouse. Amitriptyline was the most commonly available antidepressant (10 of 12 districts; 12 of 24 overall facilities; 9 or 12 MH facilities). Despite being on the national essential drug list, fluoxetine was only available at one quaternary-level facility and no district warehouses.ConclusionsEssential psychotropic medicines are routinely unavailable at public health facilities. Current essential drug lists include six typical but no atypical antipsychotics, which is concerning given the side-effect profiles of typical antipsychotics. Ensuring consistent availability of at least one selective serotonin reuptake inhibitor should also be a priority, as they are essential for the treatment of individuals with underlying cardiovascular disease and/or suicidal ideation. Similar to successful task-sharing approaches used for HIV/AIDS, mid-level providers could be retrained and certified to prescribe and monitor first-line psychotropic regimens.

Outpatient Mental Health Services in Mozambique: Use and Treatments

“…The first-generation antipsychotics trifluoperazine, fluphenazine, decanoate of fluphenazine, haloperidol, and chlorpromazine—all of which are on the national essential medication list (2)—were the most common treatment regimens for most types of organic disorders, as well as for psychoactive substance use, schizophrenia and delusional disorders, and intellectual disability. Most often, these first-generation antipsychotics were prescribed alongside promethazine—an unusual combination because promethazine is not a first-line treatment for prevention of extrapyramidal side effects in high-income countries nor is it recommended in the WHO Mental Health Gap Action Program (WHO mhGAP).…”

“…Psychiatric technicians are able to diagnose all categories of mental health conditions and treat them by using brief psychotherapy and all therapeutic categories of psychotropic medications. Psychotropic medications are generally available at facilities with trained mental health staff, although stock-outs are common, and certain essential medications are not available (2). …”

“…The hospital employs numerous specialists and serves all of central Mozambique, providing 26% of all outpatient mental health consultations in Sofala Province. Because it generally has better availability of mental health medicines (2) and specialists, it likely serves patients with more severe illness.…”

Medication challenges for patients with severe mental illness: experience and views of patients, caregivers and mental health care workers in Dar es Salaam, Tanzania

“…Emphasis has been put on the role for both psychosocial and pharmacological management of mental illnesses [ 2 ]. However, psychosocial management is almost non-existent and pharmacological therapy is the most common treatment method in many government-funded health facilities [ 3 , 4 ]. It is also important to note that psychosocial, together with biological treatments, have proven to be effective in low resource settings [ 5 ].…”

Access and rational use of psychotropic medications in low- and middle-income countries

“…Diazepam appears to be frequently available at a primary care level, whereas fluoxetine (or other selective serotonin re-uptake inhibitors (SSRIs)) is often missing from lists or is only available in secondary or tertiary centres (Padmanathan et al 2014;Raja et al 2015;Wagenaar et al 2015). Yet SSRIs such as fluoxetine are the first line recommended medications for depressive and anxiety disorders (Patel et al 2007b), two conditions which make the greatest contribution to the public health burden of mental disorders worldwide ).…”