An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia
An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia
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DOI：
10.1186/1478-4505-9-17
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发表时间：
2011-04-08
影响因子：
4
通讯作者：
Flisher, Alan
中科院分区：
文献类型：
--
作者：
Faydi, Edwige;Funk, Michelle;Flisher, Alan
背景资料：到2005年，非洲区域约有一半的国家制定了心理健康政策，但人们对非洲和全球心理健康政策的质量知之甚少。本文报告了加纳，南非，乌干达和Zambia.Methods的精神卫生政策的评估结果：世界卫生组织精神卫生政策检查表被用来评估最新的精神卫生政策，在每个国家。评估由一个专门组成的国家委员会和一个独立的世卫组织小组完成和审查。对每个国家评价的结果进行了讨论，直到达成共识。每项政策都涉及社区服务、将心理健康纳入一般保健、促进心理健康和康复。只有南非和乌干达的政策涉及预防问题。在政策制定中使用证据的情况差别很大。主要与精神卫生部门进行了协商。只有赞比亚的政策提出了明确的愿景，而四个国家中有三个国家阐明了价值观和原则、建立精神卫生协调机构的必要性以及保护有精神卫生问题的人的人权。没有一份报告包括政策的所有基本要素，也没有具体说明执行工作的资金来源和数额。非机构化和提供基本精神药物的问题没有得到充分解决。宣传、增强用户和家庭的能力以及部门间合作没有得到充分处理。只有乌干达充分概述了心理健康信息系统、研究和评价，只有加纳全面处理了人力资源和培训需求。没有一个国家制定了相应的精神卫生战略计划，以便制定和实施具体的战略和活动。结论：可能影响政策对各国精神卫生系统影响的六个差距是：政策的结构和内容缺乏内部一致性，关键的国际概念肤浅，缺乏作为政策方向基础的证据，政治支持不足，精神卫生政策在国家总体政策和立法框架内的整合程度不高，缺乏财政针对性。为解决这些问题提出了三项战略，即加强主要利益攸关方在公共（精神）卫生和政策制定方面的能力，创造一种包容性和动态政策制定的文化，以及采取协调行动优化现有资源的使用。
Background: Approximately half of the countries in the African Region had a mental health policy by 2005, but little is known about quality of mental health policies in Africa and globally. This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia.Methods: The WHO Mental Health Policy Checklist was used to evaluate the most current mental health policy in each country. Assessments were completed and reviewed by a specially constituted national committee as well as an independent WHO team. Results of each country evaluation were discussed until consensus was reached.Results: All four policies received a high level mandate. Each policy addressed community-based services, the integration of mental health into general health care, promotion of mental health and rehabilitation. Prevention was addressed in the South African and Ugandan policies only. Use of evidence for policy development varied considerably. Consultations were mainly held with the mental health sector. Only the Zambian policy presented a clear vision, while three of four countries spelt out values and principles, the need to establish a coordinating body for mental health, and to protect the human rights of people with mental health problems. None included all the basic elements of a policy, nor specified sources and levels of funding for implementation. Deinstitutionalisation and the provision of essential psychotropic medicines were insufficiently addressed. Advocacy, empowerment of users and families and intersectoral collaboration were inadequately addressed. Only Uganda sufficiently outlined a mental health information system, research and evaluation, while only Ghana comprehensively addressed human resources and training requirements. No country had an accompanying strategic mental health plan to allow the development and implementation of concrete strategies and activities.Conclusions: Six gaps which could impact on the policies' effect on countries' mental health systems were: lack of internal consistency of structure and content of policies, superficiality of key international concepts, lack of evidence on which to base policy directions, inadequate political support, poor integration of mental health policies within the overall national policy and legislative framework, and lack of financial specificity. Three strategies to address these concerns emerged, namely strengthening capacity of key stakeholders in public (mental) health and policy development, creation of a culture of inclusive and dynamic policy development, and coordinated action to optimize use of available resources.