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Be-cause health matters 14

Mental health voices from Africa: experiences and lessons learned

Mental health in Africa: an overview of the situation and needs

Talking about mental health in Africa requires thorough knowledge of the contextual conditions related to it: the needs, the epidemiological data, the obstacles, the human resources present on the ground. For this purpose, Florence BAINGANA, who covers the entire African continent for the WHO, sketched a pragmatic and current picture of the mental health sphere in Africa.

Mental, neurological and psychoactive drug abuse disorders

First of all, it was noted that mental, neurological and psychoactive drug abuse disorders are very present in sub-Saharan Africa, and this has been the case since well before the Covid-19 epidemic. Mental disorders rank 6th in the WHO figures, and if neurological disorders are added (notably epilepsy) this diagnostic category rises to 3rd place (excluding the "other" category).

Watch the video of Mme Florence Baingana

Suicide figures are alarming, as are those related to addictions. Suicide rates are higher in Africa than in the rest of the world. The WHO gives the number of 18 estimated deaths by suicide per 100,000 African men (1st in the world) and 5.2 per 100,000 African women (2nd in the world); giving an average of 11.2 deaths by suicide per 100,000 inhabitants in Africa (1st in the world). The same applies to minors, where alcohol consumption among 13–15-year-olds is alarming in many sub-Saharan areas: 42.3% in Zambia, 39.3% in Benin, 23.5% in Namibia, 20.6% in Botswana, 14.6% in Kenya, 14.5% in Liberia, 12.8% in Uganda and 10% in Sierra Leone.

Cumulation of several types of disasters

Finally, it should not be forgotten that some countries have experienced several types of disasters, such as Ebola in Guinea, the eruption of Mount Nyiragongo in North Kivu in the DRC, and prolonged conflicts, to which must be added the third wave of the Covid-19 pandemic, which, according to the WHO, has severely affected all 47 countries in the region. Infections have been particularly high in South Africa (71,617 positive cases as of June 6, 2021), Kenya (51,677 cases), Algeria (36,671 cases) and Ethiopia (20,419 cases).

In addition, the WHO reports that public financial resources for mental health and the number and types of mental health care providers remain minimal and in some African countries non-existent.

Reduced budget and personnel

The funds used for mental health in Africa are low: US$ 0.1 per capita per year compared to the world average of US$ 2.5. The American continent is at 11.8 US dollars and Europe reaches 21.7 dollars allocated to mental health for each inhabitant.

There is a severe lack of trained personnel. Indeed, in Africa there is less than one mental health professional (0.9) per 100,000 people. This is far below the global average of 9 professionals per 100,000 people. Moreover, this figure of 0.9 professionals per 100,000 Africans hides great disparities in certain types of professions: for example, there are no speech therapists/logopedists or specialists in paediatrics/child psychiatry. Some positions such as social workers or psychologists are almost non-existent, and for the most statistically represented positions (psychiatrists and the category of "untrained mental health personnel") they represent a presence of only 0.7 professionals per 100,000 individuals.

"These mental health disorders are increasingly common"

- Florence BAINGANA

F. BAINGANA also shared data on the distribution of public spending on mental health by category of care in low-income countries, which include most of the countries on the African continent. In these countries, existing financial resources are used on average 80% for psychiatric hospitals, 10% for day hospitals and other forms of hospitalisation, and only 10% for outpatient care and primary health care services. In middle- and high-income countries, the share of health budgets allocated to psychiatric hospitals has fallen to 50% and 30% as a result of the policy of reducing hospitalisation in favour of outpatient and community care.

For all these reasons, the WHO recommended in the 148th session of the Executive Board (20/01/2021) two areas of improvement, namely: