Assess the Capacity of Health Centre IVs to Manage Mental Health Problems :

Abstract

According to the Mental Health Gap Action Programme (MHGAP), mental disorders account for 14% of the global burden of disease; 75% of which are in Low Developed Countries (WHO, 2008). In Uganda, common mental disorders can be detected in 20% to 30% of all outpatient visits common in community health centres (Kigozi et al, 2005). Although it is recommended that majority of cases of mental health problems identified within community be recognized and treated within Community Health Centres, research by Holdaway (2003) shows that up to 50% of patients who present mental health problems fail to have their symptoms recognized by a general medical practitioner. The implications of this are many and present themselves in terms of human social cost and economic cost. The study assessed the capacity of Health Centres IVs to manage mental health problems as a basis for improved mental health service delivery within community Health centres in Uganda. The study uses a case study of Health Centre IVs in Wakiso district as a generalizeable study area representing urban, semi-urban and rural characteristics. The focus of this study is primarily on the capacity of Health Centre IVs, based on their jurisdiction as the main point of referral in each health sub district, to manage mental health problems. The objectives of the study were to identify existing forms of care available for mental health problems, to analyse the capacity of primary health care workers to effectively manage cases of mental health problems and to describe existing mechanisms for resourcing the treatment of mental health problems by 2011. A cross sectional study design was chosen as applied to the case study of Wakiso district. A total of 33 respondents were interviewed. The District Health Officer, Mental Health Focal Person, Psychiatric Clinical officers and Nurses were taken as purposive samples. The health care workers were drawn from Health Centres IVs including Buwambo, Kasangati, Namayumba, Ndejje and Wakiso. Findings show that clinical treatment of mental health problems was the primary form of care provided by 70% of the Health Care Workers followed by psychological care provided by 80.65% of which 75% use counseling as for delivering psychological services to patients. There was limited understanding of techniques such as Cognitive Behaviour Therapy (14.29%), Narrative Exposure Therapy (14.81%), Motivational Interviewing (18.52%) and Group Therapy Sessions (14.81%) which are important for the effectiveness of any counseling interventions. In spite the government effort to recruit Psychiatric Clinical Officers and Nurses on the staff teams at the five Health Centres, the findings show a high propensity for mental health referrals by approximately 89% of health care workers which contests the capacity of the health care workers to manage mental health problems. In addition, of the cases referred, 27.59% of them are made to the resident mental health specialist at each Health Centre IV which denoted limited involvement of general health care workers in treatment on mental health problems. The main source for resourcing mental health care is facilitated by the Government of Uganda with undocumented proportions of out of pocket expenditure by patients and care givers. Although it is evident that resources such psychotropic medicines are well stocked represented by 85% of all health care workers, constraints at the health centres are responsible for limited admissions, follow up and provision of psycho-education services to clients. In conclusion, although efforts have been made to improve the capacity of Health Centre IVs to manage mental health problems, it is important to integrate such efforts with quality control mechanism which can be done through establishment and implementation of effective monitoring and evaluation mechanisms.