Belgian Platform for International Health    ENG | FR

Be-cause health matters 14

Mental health voices from Africa: experiences and lessons learned

Workshop

Decentralisation of mental health care

For many African countries, most of the structures and competent personnel are located in the capital. This state of affairs raises the question of how accessible care is in the provinces and, how necessary it is to decentralise the provision of care throughout the country.

Burundi

Using Burundi as an example, Jean-Luc NKENGURUTSE provided data and the context. An East African country of almost 28,000 km², Burundi has a population of 12 million, 46% of whom are under 15 years old. Economically, the country is one of the ten poorest countries in the world, with a GDP of USD 246 per year per capita. At the epidemiological level, a study revealed that 4 out of 10 people in Burundi suffer from psychological disorders, including 8.9% anxiety disorders, 4.6% schizophrenia and 3.3% problems associated with trauma. (Mental health study by the Ministry of Health and the Swiss Cooperation in August 2019 in the provinces Ngozi, Gitega, Rumonge & Mairie de Bujumbura.) Faced with these high figures, there are only four psychiatrists in the country. There are many major constraints: poor mobility of trained professionals; insufficient human and financial resources; low involvement of community partners (local leaders, community actors); socio-cultural constraints (lack of the public’s knowledge, popular beliefs); few technical and logistical partners; insufficient and costly inputs, particularly psychotropic drugs.

Mental health care in Burundi

4/10
4 out of 10 people have psychological disorders in Burundi, including:
  • 8,9% of anxiety disorders
  • 4,6% of schizophrenia
  • 3.3% of traumatic problems
!

Only 4 psychiatrists in the country

In terms of addressing these acute needs, only the Kamengé Neuro-Psychiatric Centre (NPC) has the infrastructure, funds and staff necessary to offer high quality care. Thus, decentralisation experiments have been conducted in an attempt to overcome the lack of places and staff dedicated to mental health. The Kamengé NPC has opened two branches in the provinces, in Gitega and Ngozi, each with 50 additional hospital beds. With regard to the lack of training for health care teams, the NPC has gone further by decentralising care to smaller structures that are more widespread in the country. This begins with theoretical training for staff using the mhGAP guide. Then, "learning by doing" activities are carried out with qualified staff and local staff under observation. Finally, joint consultations are carried out by the local provider, under the supervision of the reference provider.

Watch the video of Mr. Jean Luc Nkengurutse (Burundi)

The discussion

As Jeanine KAMANA of the NGO Louvain Coopération in Bujumbura pointed out, efforts to decentralise psychosocial support were also being made by the humanitarian sector. She cited the example of the Izere mental health and psychosocial project which, in a few health districts in the north of Burundi, was actively improving the accessibility and quality of mental health care via three objectives: capacity-building for staff in public health structures (general hospitals and health centres); supporting the supply of psychotropic drugs in these structures; developing and strengthening community actions (awareness-raising, discussion groups and income-generating activities - IGAs) with local organisations and community health agents.

One participant commented on the VSLA (Village Savings and Loan Association) method, which is a self-managed savings group of 15 to 25 community members who meet regularly to save their money safely and take out small loans.

Jeanine KAMANA saw a link, while reminding us that her project is more of a tontine operation.

Watch the video of Mme Jeanine Kamana (Burundi)


Elvire SOSOHOUNTO launched the discussion and spoke as a discussant. She shared her experience as a psychosocial worker in Cotonou, Benin. She began by reminding the audience that in Benin, diseases could not be explained scientifically. They originate from a bad spell due to jealousy or some other magical cause. Whenever a family member shows signs of illness, the family does not have the reflex of taking them to a psychiatric centre, which is very expensive.

In the centre where she works, Elvire SOSOHOUNTO takes care of the links between patients and their families. This requires home visits to explain what mental illness is. This awareness-raising makes it easier to understand what the abandoned person is dealing with. The way the centre works is that the stable patients help the newcomers in their journey. There are workshops (sewing, welding) open to all and with the aim of contributing to the life of the centre. The centre doesn’t have a permanent psychiatrist; European psychiatrists only provide support once a year. Some patients are dropped off by their families directly at the centre, which also organises "raids" in the streets to recover people who have been mistreated and/or left to fend for themselves, if they have no support.

"[...] we managed to convince the Ministry of Health to produce guidelines in the Burundian health system: now we have guidelines that guide the different mental health stakeholders."

- INCONNU

The two speakers emphasised that at their different levels, these actions have, in addition to an impact on the populations supported, a repercussion in how mental health is addressed at the institutional and state levels, going in the direction of a better accessibility of care, in a logic of pro-activity.