Be-cause health matters 14

Speaker 1: Adelin N’situ

First, Adelin N'SITU gave an institutional overview of the mental health response in the Democratic Republic of Congo (DRC). With its 2.345 million square kilometres, 26 provinces and 519 health zones, the National Mental Health Programme (NMHP) ranks mental health as one of DRC’s 12 primary health care components.

Leadership in mental health care is exercised at each level of the care pyramid and at the organisational level, which is the Ministry of Health, Hygiene and Prevention at the central level, and the provincial coordination of the provincial health divisions (DPS) at the intermediate level. At the operational level, curative, preventive and promotional mental health care and management are provided at the community level and in the care structures of the pyramid, in accordance with the primary health care philosophy.

The major challenges remain, on the one hand, the motivation of health care workers and their financial stability, which is the guarantee of this; and, on the other hand, obtaining community participation through the voluntary work of grassroots community organisations and the social workers of the health care structures (health committee, development committee, health zone community relays).

In conclusion, Adelin N'SITU indicated that it was important to call upon national leaders to prioritise health in general, and mental health in particular, in contrast to the current situation where the priority was being granted to humanitarian emergencies. Without strong political commitment through the ratification of a national policy, resource mobilisation would be difficult to achieve.

Watch the video of Adelin N’Situ

Speaker 2: Eugène Rutembesa

Eugène RUTEMBESA then looked at the case of Rwanda. Tracing the history of mental health in the country through a few key dates, the speaker highlighted the boom in mental health projects and awareness. After the genocide, the country was in an emergency situation and the main concern was dealing with the psychological trauma the population had endured. From 1998 onwards, mental health care was fully integrated into the health care system at hospital level. The community approach and decentralisation of mental health and psychosocial support were then implemented systematically. It showed in particular the good cooperation between the state body (Ministry, hospitals, public hospitals) and numerous local NGOs which specialise in issues as diverse as providing support for women who have been victims of rape and their children or the reintegration of former genocide perpetrators.

RUTEMBESA concluded by saying that after having lived through it, it had been necessary to invent, imagine and create in order to contain the terrible suffering generated by the genocide. The political will, the humanism that came from all corners to support this resilience overcame the inhumanity suffered during the genocide perpetrated against the Tutsis.

Listen to the audio clip of Eugène Rutembesa

The discussion

Achour AIT MOHAND launched a discussion after having spoken as a discussant. He revisited the issues of leadership and governance, which are often not thought about upstream and thus have to be discovered on the ground. A proponent of greater openness and dissemination of mental health programmes, he mentioned the multiplicity of "entry points" in this respect. Referring to the example of the Rwandan genocide, which led to considerable progress, Achour AIT MOHAND cited the case of Algeria, which, in order to combat the consequences of terrorism, has had to diversify and adapt its range of mental health services.

He urged the various stakeholders in the field to take part in this process of reflection, while stressing the importance of political commitment. In his view, a more global vison of mental health could allow for better representation of the field to institutional supports, which are too mainstream and exclusively summarised in psychiatric structures.