The core competencies for mental, neurological, and substance use disorder care in sub-Saharan Africa

Abstract

The 2010 Global Burden of Disease Study points to a changing landscape in which non-communicable diseases, such as mental, neurological, and substance use (MNS) disorders, account for an increasing proportion of premature mortality and disability globally. Despite evidence of the need for care, a remarkable deficit of providers for MNS disorder service delivery persists in sub-Saharan Africa. This critical workforce can be developed from a range of non-specialist and specialist health workers who have access to evidence-based interventions, whose roles, and the associated tasks, are articulated and clearly delineated, and who are equipped to master and maintain the competencies associated with providing MNS disorder care. In 2012, the Neuroscience Forum of the Institute of Medicine convened a meeting of key stakeholders in Kampala, Uganda, to discuss a set of candidate core competencies for the delivery of mental health and neurological care, focusing specifically on depression, psychosis, epilepsy, and alcohol use disorders. This article discusses the candidate core competencies for non-specialist health workers and the complexities of implementing core competencies in low- and middle-income country settings. Sub-Saharan Africa, however, has the potential to implement novel training initiatives through university networks and through structured processes that engage ministries of health. Finally, we outline challenges associated with implementing competencies in order to sustain a workforce capable of delivering quality services for people with MNS disorders.

The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa

“…The burden of mental and substance use disorders is set to grow by 130%, according to one estimate. 38 Researchers have proposed novel training initiatives to tackle the substantial shortfall in service provision and workforce in this area, 39 and a formal role for traditional practitioners remains largely unexploited.…”

Global Mental Health and systems of diagnostic classification: clinical and cultural perspectives

“…The latter could be considered an early parameter of an LYD and DALY increase (from 21.1 to 31.2 %), with more than 200 million people affected by back pain and Major Depressive Disorder. Gains in age and life expectancy resulted in an increase of prevalence of diseases and consequences, besides that of comorbidities (18,41,42). Literature reports on the reciprocal clinical interactions between mental disorders and chronic medical illnesses such as hypertension, diabetes, arthritis, cancer, bone marrow or immunological diseases have multiplied in the last decade (18,43).…”

“…Clinical research with a GMH outreach include themes of integrated care, special populations, risk factors, comorbidities, sub-threshold disorders and "functional im-provement" (75)(76)(77)(78)(79). Epidemiological studies regarding NMS disorders and gap treatments (41), and innovative service provisions of cultural consultations in general hospital settings, cost effectiveness and the institutionalization of use of research findings(80-82) are outstanding contributions. The best examples of public healthmental health proper are the inquiries into disasters (83) or about the troubles and tribulations of immigrant and refugee populations (40,(84)(85)(86).…”

The revolving door of mental, neurological, and substance use disorders re-hospitalization in rural KwaZulu-Natal Province, South Africa

“…The hospital oversees 17 fixed clinics, and services a large and predominantly rural sub-district population of over 200,000 mainly Zulu speaking individuals within an area of 1400 km 2 . The general population of the district as well as details about the Health Information System have been described in detail elsewhere 13,14 .…”

“…Despite evidence that mental, neurological and substance-use (MNS) disorders accounts for a substantial proportion of premature mortality and disability globally 1 , a deficit of services to treat the condition is a persistent challenge throughout sub-Saharan Africa 2 , including South Africa. While funding for mental health services is acknowledged to receive a disproportionately small proportion of health budgets across many developing countries 3 , policy-makers and researchers seldom focus on this regional and urban-rural resource inequity in an effort to address such conditions.…”