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Ethiopia
Period
October 2010 - October 2013
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Ethiopia

Ethiopia: Scaling Up Public Care for Those with Mental Illness

“Through integrating mental health into public health care the WHO global mental health Gap Action Programme supports the delivery of quality mental health services to the people of Ethiopia, while focusing on priority disorders and vulnerable groups.”

KESETE BERHAN ADMASU
Federal Ministry of Health, Government of Ethiopia

The Context

In Ethiopia the threat of mental, neurological and substance abuse disorders (MNS) is high, with prevalence rates at 12-17% but unfortunately very few financial resources are allocated to address this issue. Currently only 1.7% of the government’s health budget is directed to mental health.

As a result, the country lacks mental health specialists outside the capital and the services provided for MNS disorders are of very poor quality. In many cases these conditions expose the affected to neglect, disability and violations of their human rights.

Our Project

The MhGap Program is the World Health Organization’s action plan for people suffering from mental disorders in low and middle-income countries. The program seeks to bridge the gap between what is required to treat priority mental health disorders and what is actually available. The priority conditions include: depression, psychosis, bipolar disorders, epilepsy, developmental and behavioral disorders in children and adolescents, dementia, alcohol use disorders, drug use disorders, self-harm/suicide and other significant emotional or medically unexplained complaints.

Our partner’s main focus is to promote the integration of mental health into primary health care by strengthening the service delivery system and expanding the coverage of services into selected regions of the country.

Our Partners

World Health Organization (WHO)
Italian Government
Federal Ministry of Health of Ethiopia
European Union

Our Activities

To achieve the goals of the project, the WHO is supporting the government in establishing the policy directives, the trained human resources and the tools that are required to create an infrastructure for the provision of adequate mental health care.

Policies:

A government-appointed task force is developing a consensus-based action plan to issue necessary guidelines for the service provision’s organization and the establishment of a mental health information data system.

Training:

  • The same task force has developed WHO training material adapted for the local situation.
  • Master trainers are preparing mental health specialists to train and supervise general health workers.
  • Mental health specialists also train non-specialists to identify and treat major mental health disorders.

Tools:

  • The task force will ensure the availability of the necessary equipment and medicines to treat MNS disorders at the primary level of care.
  • Supervisors, health officials and WHO staff will monitor the delivery of mental health care through visits, audits and the development of a health information system.

Community awareness:

To ensure that the people affected by the disorders benefit from the new services, a specific training for community-based health extension workers, is also being implemented.

Our Results So Far

WHO Ethiopia estimates that since the beginning of the project, about 800 people suffering from mental, neurological and substance use disorders have received assessment and treatment within the frame of mhGAP.

The planning phase for the mhGAP project involved conducting a situation analysis in 19 selected facilities of the four pilot regions of Amhara, Oromia, Tigry and SHHPR, and developing an action plan for project implementation. The mhGAP materials, including the intervention guide and training curriculum, have been adapted to the Ethiopian context in consultation with a group of core members who represent the collaborating partners for the mhGAP project.

The implementation phase of the mhGAP project has involved conducting mhGAP Base Course and Standard Course trainings for non-specialized health workers in all identified facilities of the four selected regions. Supportive supervision ensures that the mhGAP guidelines are being used at facility level, and a mentorship program has been initiated to further support the mhGAP-trained, non-specialized health workers, in their day-to-day provision of mental health service. This method has been extremely successful in improving the self-confidence of health care workers.

Today, 94 non-specialized health workers have completed the mhGAP Base Course training, and 51 others have gone on to attend the mhGAP Standard Course aimed at covering all the MNS disorders. In addition, 76 health professionals received the mhGAP Training of Trainers and Supervisors and monthly supportive supervisions are conducted by regional supervisors for all trained non-specialized workers.

In the 6 months from March to August 2013, a total of 592 cases were detected and treated or referred in the four pilot regions of the project. Of all the different cases, 58.9% were Epilepsy, 15% depression and 17.5% were alcohol disorders or other significant or medically unexplained complaints. Of the patients treated, 84.3% were over 18.

Another encouraging result is that the majority of psychotropic medications are now available in most clinics. To continue bridging the gap from region to region, we are negotiating with the Pharmaceuticals Fund and Supply Agency.

Efforts towards integrating mhGAP into the Health Management Information System are also taking place.