01 Basangwa

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Published on January 11, 2008

Author: Reinardo

Source: authorstream.com

MENTAL HEALTH CARE IN UGANDA :  MENTAL HEALTH CARE IN UGANDA EMERGING CHALLENGES OF HIV/AIDS AND CIVIL STRIFES BY DR. DAVID BASANGWA CONSULTANT PSYCHIATRIST. Presentation outline:  Presentation outline Introduction HIV/AIDS in Uganda Civil strife Conclusion UGANDA:  UGANDA Located in East Africa Land locked Traversed by the equator Tropical climate Relatively fertile Tremendous mountain ranges,Lakes, Rivers and waterfalls. Political history:  Political history Got Independence 1962 Politically stable from then to 1971 ( Idi Amin Military Coup) Marked Chaos from then till 1986 (Current Government came into Power) 1971-1986 -massacres -Loss of skilled people -Collapse of institutions and services -Destruction of infrastructure and economy Vital statistics:  Vital statistics Population- 24 mill , predominantly rural-75% Ethnicity- Multiple Economy- poor -GDP 340.USD -Per capita expenditure on health 7-12 USD - 45% live the poverty line -Adult literacy -75% -Safe water coverage- 45% Health indices:  Health indices Measure UGA DEV IMR per 1000 live births 97 10 LIFE EXPEC 45 65 FERTILITY 6.9 3 MMR 1000 2 Per 100,000 live births Psychiatric morbidity:  Psychiatric morbidity No clear data available However, there is evidence of a growing problem Estimates:- 35% of general population suffer Psychiatric disorder. - 15% of these require treatment. Common disorders:  Common disorders Affective disorders Organic mental illness Alcohol/Drug related problems Schizophrenia Epilepsy PTSD Special feaures:  Special feaures General poverty Endemic diseases: - poor sanitation - Tropical diseases -HIV/AIDS Civil strife Beliefs and Stigma Illiteracy HIV/AIDS Epidemic :  HIV/AIDS Epidemic No. of people living with HIV/AIDS: Total 40m (34 – 46m) Adults 37m (34 – 43m) Children < 15 yr 2.5m (2.1 – 2.9m) People Newly infected with HIV/AIDS in 2003: Total 4.8m (4.2 – 6.3) Adults 4.2m (3.6 – 4.8m) Children < 15 yr 700,000 (590,000 – 810,000) Source: UNAIDS UPDATE DECEMBER 2004. Global figures:  Global figures Adults and Children estimated to be living with HIV/AIDS, END 2003 Region/Continent Estimates (000) North America 700 – 1,200 Caribbean 350 - 590 Latin America 1,300 - 1,900 Western Europe 520 - 680 North Africa & Middle East 470 - 730,000 Sub-saharan African 25,000 - 28,200 Eastern Europe & Central Asia 1,200 - 1,800 East Asia & Pacific 700 - 1,300 South & South East Asia 4,600 - 8,200 Australia & New Zealand 12 - 18 Total 34,000 - 46,000 Source: UNAIDS 2003 Progress Report on the Global Response to HIV/AIDS Epidemic. Prevalency among pregnant women (15-24) (2001):  Prevalency among pregnant women (15-24) (2001) Country: % HIV Prevalence: Botswana 32% Cameroon 12% Kenya 22% Malawi 18% Namibia 18% South Africa 24% Swaziland 39% Zimbabwe 18% Uganda 9% Source: UNAIDS 2003 Progress Report on the Global Response to HIV/AIDS Epidemic. HIV/AIDS IN AFRICA:  HIV/AIDS IN AFRICA Has multiple other problems - poverty -political instability -wars - refugees -civil strife - forced immigration (economic) HIV IN AFRICA contd:  HIV IN AFRICA contd Has biggest No. of HIV cases -total global-35m African population-600m with > 28m infected Economic growth fallen by 4% In some countries labor productivity has fallen by 50% (UNAIDS) 2/3 deaths in managerial sector are due to AIDS By 2020 nearly 25% of work force will be lost in sub-Saharan Africa. Challenges of HIV/AIDS IN UGANNDA:  Challenges of HIV/AIDS IN UGANNDA HIV/AIDS raises many challenges that touch all sectors of life - Human resource - Economy -Social -security -Health (mental health) HEALTH SECTOR:  HEALTH SECTOR Increased expenditure , 1-2% of GDP ( expenditure on health 6% GDP) High bed occupancy High budget on drugs and sundries High death rate Increased attrition rate for health workers. Challenges in Mental health care:  Challenges in Mental health care Burden generally increased 20-21% of patients attending the National referral mental hospital tested HIV+ve Common disorders:  Common disorders Adjustment reactions Depression Alcohol/drug abuse Organic mental syndromes Various Neuro-psychiatric manifestations Responses to the HIV/AIDS Epidemic:  Responses to the HIV/AIDS Epidemic Government commitment Open policy Massive education Multi-sect oral approach (GOV , NGOS and CIVIL SOCIETY) Care for people with HIV/AIDS Government commitment:  Government commitment Political will Put resources Started – National ACP roles- Mobilize resources - implement activities - research -policy formulation ACP strategies:  ACP strategies Mass media campaigns Health education net work District aids mobilization project School health education project Behavior change strategy Involvement of PLWAs Condom promotion Community based care Strategy contd:  Strategy contd Improved blood transfusion services Security sector Advocacy strategy – for social and political support NGO involvement Multisectoral approach:  Multisectoral approach Saw creation of UAC- 1992 A statutory body under office of President to –develop HIV/AIDS control policies -resource mobilization -monitor and coordinate activities Composition:  Composition 10 key Ministries ACP NGOs CBOs Religious organizations Achievements of ACP:  Achievements of ACP Increased awareness Reduced stigma Capacity building at community and District levels Stigma associated with drug abuse Other strategies:  Other strategies PMTCT of HIV/AIDS Management of STDs VCT Use of ARVs Treatment of opportunistic infections On going approaches:  On going approaches Behavior change approach (ABC model) Create more awareness Provide services- eg VCT, STD Friendly condom distribution Vulnerable groups Life planning skills for adolescents Give information that motivates children to make responsible life decisions Mental health care strategy:  Mental health care strategy Decentralization of mental health care Integration if MHC into General health care Training of staff at all levels - In-service training -Pre service training Involvement of other players -NGOs, Civic organizations, media, traditional healers, counselors. Civil strife:  Civil strife A common problem Africa Uganda has experienced various forms of war since we attained independence (1962) Stability was attained 1986 when current Govt came into power Pockets of instability in the Northern and North eastern (LRA) Effect of civil conflict and wars:  Effect of civil conflict and wars Massive displacement of persons (IDPs) Abduction of children and Adults Rape Body disfigurements Gunshots and landmines Destruction of property and livestock Erosion of moral and social values Psychosocial/Medical consequences:  Psychosocial/Medical consequences Increased cases of PTSD Alcohol/drug abuse Depression Suicidal and homicidal tendencies Violence and aggressive tendencies among children Interventions:  Interventions Political level -Promotion of good governance -Democratization of political institutions -open dialogue with aggressors -Amnesties -Ensure good neighbourliness Health sector level:  Health sector level Strengthening Mental health services through: -Development of a new Mental health programs ( continually updated) -Formation of a NHP and HSSP ( emphasises Integration of services) -Delvery of MH as part of the Minimum health care package at PHC level) Other services:  Other services Provision of infrastructure for MHC Human resource development Provision of services in an integrated form including counseling. Provision of rehabilitation services A center to offer specialized trauma management , and also to serve as a teaching and resource center. NGO level:  NGO level A number of them exist Well coordinated and have joint planning meetings Offer counseling services, conflict resolution strategies, medical care, community development programs etc Do research Conclusion:  Conclusion Government and the Ministry of health recognize the high BD caused by both HIV/AIDS and civil strife. Specific and deliberate measures have been put in place to address these two important causes of disease burden We are however still faced with challenges mainly posed by the limited resources (Mwebale ):  (Mwebale ) Thank you

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