Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-10T07:57:39.626Z Has data issue: false hasContentIssue false

Development of a scalable mental healthcare plan for a rural district in Ethiopia

Published online by Cambridge University Press:  02 January 2018

Abebaw Fekadu*
Affiliation:
Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience and Centre for Global Mental Health, Health Services and Population Research Department, King's College London, London, UK
Charlotte Hanlon
Affiliation:
Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia and Centre for Global Mental Health, Health Services and Population Research Department, King's College London, London, UK
Girmay Medhin
Affiliation:
Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
Atalay Alem
Affiliation:
Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
Medhin Selamu
Affiliation:
Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
Tedla W. Giorgis
Affiliation:
Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
Teshome Shibre
Affiliation:
Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
Solomon Teferra
Affiliation:
Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
Teketel Tegegn
Affiliation:
Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
Erica Breuer
Affiliation:
Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Vikram Patel
Affiliation:
Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK, Centre for Mental Health, the Public Health Foundation of India and Sangath, Alto-Porvorim, Goa India
Mark Tomlinson
Affiliation:
Stellenbosch University and University of Cape Town, Cape Town, South Africa
Graham Thornicroft
Affiliation:
Centre for Global Mental Health, Health Services and Population Research Department, King's College London, London, UK
Martin Prince
Affiliation:
Centre for Global Mental Health, Health Services and Population Research Department, King's College London, London, UK
Crick Lund
Affiliation:
Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
*
Abebaw Fekadu, Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, PO Box 9086, Addis Ababa, Ethiopia. Email: abe.wassie@kcl.ac.uk
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background

Developing evidence for the implementation and scaling up of mental healthcare in low- and middle-income countries (LMIC) like Ethiopia is an urgent priority.

Aims

To outline a mental healthcare plan (MHCP), as a scalable template for the implementation of mental healthcare in rural Ethiopia.

Method

A mixed methods approach was used to develop the MHCP for the three levels of the district health system (community, health facility and healthcare organisation).

Results

The community packages were community case detection, community reintegration and community inclusion. The facility packages included capacity building, decision support and staff well-being. Organisational packages were programme management, supervision and sustainability.

Conclusions

The MHCP focused on improving demand and access at the community level, inclusive care at the facility level and sustainability at the organisation level. The MHCP represented an essential framework for the provision of integrated care and may be a useful template for similar LMIC.

Type
Papers
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
Copyright
Copyright © Royal College of Psychiatrists, 2016

Footnotes

This material has been funded by UK aid from the UK government. However, the views expressed here do not necessarily reflect the UK government's official policies.

Declaration of interest

None.

References

1 Alem, A, Kebede, D, Fekadu, A, Shibre, T, Fekadu, D, Beyero, T, et al. Clinical course and outcome of schizophrenia in a predominantly treatment-naive cohort in rural Ethiopia. Schizophr Bull 2009; 35: 646–54.Google Scholar
2 Fekadu, A, Kebede, D, Alem, A, Fekadu, D, Mogga, S, Negash, A, et al. Clinical outcome in bipolar disorder in a community-based follow-up study in Butajira, Ethiopia. Acta Psychiatr Scand 2006; 114: 426–34.CrossRefGoogle Scholar
3 Jablensky, A, Sartorius, N, Ernberg, G, Anker, M, Korten, A, Cooper, JE, et al. Schizophrenia: manifestations, incidence and course in different cultures: a World Health Organization Ten-country study. Psychol Med Monogr Suppl 1992; 20: 192.CrossRefGoogle ScholarPubMed
4 Kohn, R, Saxena, S, Levav, I, Saraceno, B. The treatment gap in mental health care. Bull World Health Organ 2004; 82: 858–66.Google Scholar
5 Patel, V, Maj, M, Flisher, AJ, De Silva, MJ, Koschorke, M, Prince, M et al. Reducing the treatment gap for mental disorders: a WPA survey. World Psychiatry 2010; 9: 169–76.Google Scholar
6 Giel, R, Harding, TW. Psychiatric priorities in developing countries. Br J Psychiatry 1976; 128: 513–22.Google Scholar
7 Federal Democratic Republic of Ethiopia Ministry of Health. Health Sector Development Program IV 2010/11 – 2014/15. Federal Ministry of Health, 2010.Google Scholar
8 World Health Organization. mhGAP in Ethiopia: Proof of Concept 2013. Falcon Printing, 2013.Google Scholar
9 Federal Democratic Republic of Ethiopia Ministry of Health. National Mental Health Strategy 2012/13–2015/16. Johns Hopkins University/TSEHAI – Ethiopia, 2012.Google Scholar
10 Lund, C, Tomlinson, M, De Silva, M, Fekadu, A, Shidhaye, R, Jordans, M, et al. PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Med 2012; 9: e1001359.CrossRefGoogle Scholar
11 Hanlon, C, Luitel, NP, Kathree, T, Murhar, V, Shrivasta, S, Medhin, G, et al. Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries. PLoS One 2014; 9: e88437.CrossRefGoogle ScholarPubMed
12 Kebede, D, Alem, A, Shibre, T, Negash, A, Fekadu, A, Fekadu, D, et al. Onset and clinical course of schizophrenia in Butajira-Eth iopia – a community-based study. Soc Psychiatry Psychiatr Epidemiol 2003; 38: 625–31.Google Scholar
13 Negash, A, Alem, A, Kebede, D, Deyessa, N, Shibre, T, Kullgren, G. Prevalence and clinical characteristics of bipolar disorder in Butajira, Ethiopia: a community-based study. J Affect Disord 2005; 87: 193201.CrossRefGoogle Scholar
14 Awas, M, Kebede, D, Alem, A. Major mental disorders in Butajira, southern Ethiopia. Acta Psychiatr Scand Suppl 1999; 99: 5664.Google Scholar
15 Bekry, AA. Trends in suicide, parasuicide and accidental poisoning in Addis Ababa, Ethiopia. Ethiop J Health Dev 1999; 13: 247–61.Google Scholar
16 Alem, A, Kebede, D, Jacobsson, L, Kullgren, G. Suicide attempts among adults in Butajira, Ethiopia. Acta Psychiatr Scand Suppl 1999; 397: 70–6.Google Scholar
17 Fekadu, A, Alem, A, Hanlon, C. Alcohol and drug abuse in Ethiopia: past, present and future. Afr J Drug Alcohol Stud 2007; 6: 3953.Google Scholar
18 Tekle-Haimanot, R, Forsgren, L, Ekstedt, J. Incidence of epilepsy in rural central Ethiopia. Epilepsia 1997; 38: 541–6.Google Scholar
19 Almu, S, Tadesse, Z, Cooper, P, Hackett, R. The prevalence of epilepsy in the Zay Society, Ethiopia – an area of high prevalence. Seizure 2006; 15: 211–3.CrossRefGoogle ScholarPubMed
20 Social Research Unit, Community and Social Development. A Handbook for Conducting a Community Assessment. The City of Calgary, 2002.Google Scholar
21 Breuer, E, De Silva, MJ, Fekadu, A, Luitel, NP, Murhar, V, Nakku, J, et al. Using workshops to develop theories of change in five low and middle income countries: lessons from the programme for improving mental health care (PRIME). Int J Ment Health Syst 2014; 8: 15.Google Scholar
22 De Silva, MJ, Rathod, SD, Hanlon, C, Breuer, E, Chisholm, D, Fekadu, A, et al. Evaluation of district mental healthcare plans: the PRIME consortium methodology. Br J Pyschiatry 2015, in press (doi: 10.1192/bjp.bp.114.153858).CrossRefGoogle Scholar
23 Wig, NN, Suleiman, MA, Routledge, R, Murthy, RS, Ladrido-Ignacio, L, Ibrahim, HH, et al. Community reactions to mental illness. A key informant study in three developing countries. Acta Psychiatr Scand 1980; 61: 111–26.Google Scholar
24 Alem, A, Jacobsson, L, Araya, M, Kebede, D, Kullgren, G. How are mental disorders seen and where is help sought in a rural Ethiopian community? A key informant study in Butajira, Ethiopia. Acta Psychiatr Scand Suppl 1999; 397: 40–7.Google Scholar
25 Smith, J, Firth, J. Qualitative data analysis: the framework approach. Nurse Res 2011; 18: 5262.Google Scholar
26 Shibre, T, Kebede, D, Alem, A, Negash, A, Kibreab, S, Fekadu, A, et al. An evaluation of two screening methods to identify cases with schizophrenia and affective disorders in a community survey in rural Ethiopia. Int J Soc Psychiatry 2002; 48: 200–8.Google Scholar
27 World Health Organization. mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings. WHO, 2010.Google Scholar
28 Thornicroft, G, Tansella, M. Are community mental health services relevant in low- and middle-income countries? Epidemiol Psychiatr Sci 2014; 23: 115–8.Google Scholar
29 Kigozi, F, Ssebunnya, J. The multiplier role of psychiatrists in low income settings. Epidemiol Psychiatr Sci 2014; 23: 123–7.Google Scholar
Supplementary material: PDF

Fekadu et al. supplementary material

Supplementary Figure S1

Download Fekadu et al. supplementary material(PDF)
PDF 136 KB
Submit a response

eLetters

No eLetters have been published for this article.