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Tuesday
May072013

The mental health policies of Ghana, South Africa, Uganda and Zambia

Assessment of mental health policy in Ghana, South Africa, Uganda and Zambia: Faydi et al.  Health Research Policy and Systems 2011, 9:17

This month’s article is interesting but it’s quite ‘high level’, however, don’t worry as next month’s summary will be more topical and all about Ghana again.  This paper assesses the mental health policies of Ghana, South Africa, Uganda and Zambia. 

Before you read the summary bear in mind that as mental health professionals we’re all stakeholders in the mental health system and when it comes to producing policies we should make ourselves available and be willing to be fully involved.  However, we most of us are not experts on producing policies so we might need training.  We should identify who are our leaders on this and support their education as policy developers.   We should keep abreast of latest guidelines and be ready to adapt to new ways of working as policies evolve. As frontline staff , we know the needs of our patients and we should not be afraid to take up leadership roles to coordinate their care.  As you will see, the country policies inspected in this survey could have been better.  It’s in our hands to help improve this for the future.  In fact when the new Mental Health Act implementation comes on, which won't be long now, each Region and District will require mental health leads so some of you might need expertise in this sooner than you were expecting.

SUMMARY

Countries that would like to improve their mental health services need a mental health policy.  The World Health Organisation (WHO) has a Checklist to assess the strength of health policies and this research paper uses the checklist to assess the mental health policies of Ghana (1994), South Africa (1997), Uganda (2000-2005) and Zambia (2005).

The study notes that country level mental health policies would be expected to cover;

  • community based services
  • integration of mental health into general health care
  • promotion of mental health and rehabilitation
  • prevention of mental illness
  • protection of human rights
  • use of an evidence based approach

A key strength of the WHO Checklist is its generalizability as it takes into account best practice in low, medium and high income countries.

 The results were;

According to the Checklist, all the policies had quite a lot of weaknesses.  Common failings were;

Data to support the policy

  1. Those drafting the policies  relied too much on local knowledge rather than robust surveys.
  2. There was a lack of evidence and data overall .

Consultation and sanctioning

  1. Service users (patients) weren’t consulted enough.
  2. There wasn’t enough formal approval by senior health officials and government bodies despite them seeing the policies.
  3. There wasn’t enough political support.

Integration

  1. There was not enough linking of mental health policies to overall national policy and legislative frameworks.

Writing and content

  1. Not describing the key vision, values and principles.
  2. A lack of internal consistency of structure and policy content .
  3. No clear action plan and no one to make sure actions get completed.

Financing

  1. No clarity on who will finance the policy if it is put into action.

A positive point was a strong emphasis on community based care.

The recommendations were

  1. Key stakeholders (and policy makers) should take part in education on how to produce policies.
  2. Policies should be seen as dynamic and they should be kept amended and adjusted.
  3. Policies should be linked together and co-ordinated to prevent wastage of resources.

This is a link to the full article

These summaries are produced by;

Dr Olusola Awonogun, Specialist Registrar in Psychiatry, Hampshire, UK

Dr Mark Roberts, Consultant Forensic Psychiatrist, Hampshire, UK

Professor JB Asare, Psychiatrist, Accra, Ghana.