Published on March 7, 2014
Mental Health care in poor resource settings What can be done? An experience from Aceh Indonesia Marthoenis 3 course of NCDs Kobenhavn Universitet rd
The contents Situation of Aceh before 2004 Tsunami 2004 (Mental) health programmes Pasung Now
Aceh Current Population: 4,5 Million out of 237 millions in Indonesia 29 years military conflict One the poorest province in Indoenesia One of the lowest HDI in Indonesia
Tsunami 2004 Banda Aceh, Calang and Meulaboh were among the hardest area hit by tsunami 2004 In total; 170.000 died and 500.000 homeless
Tsunami 2004 Population Before the Tsunami was 4,271,000 (2004) and as of 15 September 2005 was 4,031,589 Infrasctructures and local government were collaps Main general hospital was destroyed
After the Tsunami MoU Heilsinski, December 15, 2006
Health care Reconstructions Building new hospital and health posts Training and re-training the health officers (nurse, midwife, GP) „Mental health programmes“
We have some 18.000 cases like this, how do we start?
Resources!: Some 500 CMH nurses Strong commitment from the local goverment BUT Regulation? Mental Hospital : Only one with 350 beds 6 Psychiatrists for 4.4 million population
12 10 8 Column 1 Column 2 Column 3 6 4 2 0 Row 1 Row 2 Row 3 Row 4
The Programme: Network between trained nurse Case finding Family of the patient Mental health cadre Referral system Local social health Insurance
The Barriers Saraceno et al 2007 Barrier 1: Low Political will Barrier 2: Resistence to decentralization Barrier 3: Difficulties in integrating Mental Health in PHC Barrier 4: weak Human resurce capacity and development Barrier 5: Mental health Leadership often lack of public health skills What is missing here?
Aceh Health Insurance (2010) Social health insurance to ensure all people have access to proper health care! Premium paid by the local goverment Problem Similar number of resource while the demand of health service is inreasing Moral hazard
Messages! Mental health is sooooooooooooooo much neglected But we can do something! Start from now Start from your self Start from a small thing
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