As ministry of health commits to integration of quality mental services into its Primary health care system
By: Yusuf M Hasan
Somalilandsun- Health sector stakeholders are determined to arrest the huge prevalence of mental ill citizens.
To this effect pursuit is now to establish related data through needs assessment as a prelude to reliving stress on the few ill equipped mental health units with a home based care program
This was the unanimous decision taken during World Mental Health Week 2017 organized by the Somaliland Mental Health Support Organization -SMHSO in Hargeisa on the 10th October.
Participants at the function included the government represented by officials of the ministry of health, medical students from Franz Fanon University Hargeisa, representatives from international organizations, Religious and Traditional leaders, media, SMHSO staff members as well as ordinary citizens.
Themed Good Mental Health Services integrated into Primary Health Care, the WMD 017 activities included briefings by various sector professionals on prevalent status in Somaliland and planned strategies that would ultimately lead to realization of the integration.
Of interest was discussion led by a professional panel that ensued with participants chipping in with questions, comments and recommendations.
Panel discussions at a public function in Somaliland is novel and SMSHO introduction might ultimately change the norms where participants at such for as are not actual participants but listeners as if at a place of worship.
In Somaliland a joint study by GTZ and the national demobilization council conducted in 2002 revealed that 37% of the country’s 3.5m population are schizophrenic which is the highest in the world.
According to prof Eid Ali Ahmed the essence behind the Commemorations was not only to be seen as having been held, but actually stride forward with the objective of ensuring that those afflicted with mental health problems are availed avenues of recovery.
“To day a large number of our brothers and sisters are roaming the streets of our major cities, dirty, hungry and sometimes homeless as a result of mental instability” said Prof Eid adding that this is a very saddening picture that necessitates urgent corrective measures.
Eid a trained mental first aid responder said that apart from the need to integrate mental health services into primary health care, more urgent is the imperatives of raising awareness of the malady within local communities.
Said he, “Currently both relatives of mental ailing people and the general public consider them as beyond redemption thence neglected”
The British somalilander who has been much involved in the establishment of SMSHO said that this thinking has led to the now institutionalized system in which the few caring people put their ailing relatives in chains, beyond reach of corrective measures.
“It is our intent to end this practice through availing apt medical services that are humane and with the ultimate aim of rehabilitation” said Prof Eid Ali Ahmed adding that establishment of a home based care program is the ultimate goal.
Stress on the importance of home based care in which family and relatives tend the afflicted, under supervision by skilled ministry of health personnel Prof Eid was emphatic that this will not only be an impetus to integrating the unit into the primary health system but relieve current strain on the few institutions, not to mention the psychological impact, said to have been positively impactful where practiced.
Mr Hashi Abdillahi, the SMHSO chairperson-Somaliland Office who took the opportunity to elaborate on the key achievements the organization has realized since inception as well as the way-forwards said
“SMHSO has been supporting the mentally challenged people specifically at the public mental health Units of Hargeisa, Buroa and Borama hospitals operated by the ministry of health, its main partner in the country
Accordingly construction and equipping as well as pharmaceutical supplies, promotion of apt sanitation standards and capacity development through trainings, has been effected at the three mentioned mental health units”.
Mr Hashi highlighted that in 2016 they implemented a small project co-funded by Hub Cymru Africa in Wales and SMHSO, “The goal of the project was to improve mental health service to enhance quality of life and well-being of service users”
The project delivered a number of activities including providing practitioners and carers with awareness raising, capacity building and advocacy skills through well-structured training sessions held in the three regions of Awdal (Borame city), Togdheer (Burao city) and Maroodi-jeeh (Hargeisa capital city of Somaliland)
Mr Hashi added, “We are committed to double our efforts aimed at helping these voiceless and vulnerable groups that included the afflicted and the affected”.
In conclusion the SMSHO handed over the podium to the array of mental health experts at hand to guide events who were unanimous in the need for Somaliland to start and start fast initiatives geared towards not integration but implementation of deterrence measures towards identified causes leading to the high number of mental health cases.
According to the director mental health services at the Awdal regional hospital in Borame, Dr Abdirahman Garguurte, issues leading to mental health in Somaliland revolve around use of substances like Cannabis sativa (Hashish), Khat(a stimulant herb) as Tahriib (illegal immigration), stress and unemployment among many others.
Revealing that 25% of 2 billion global population suffers from one form of mental illness or another, Dr Garguurte stressed on the imperatives of all stakeholders streamlining mental health into regular activities.
In Gabile region where the mental health unit was established a year ago, over 500 new cases of affected persons have been registered, “of which 275 are taking drugs at a regularly basis” said Dr Mukhtar Bashir, the local Hospital’s Director of mental health services.
Breaking down the various types of mental health problems coming within his domain, Dr Mukhtar revealed that schizophrenia at over 30% is main followed by Bipolar 17%, Depression14% and epilepsy among others.
Thanking the Samo-Kaal NGO for facilitating construction of the Gabile mental health although service unit which has a capacity of 45 inpatient beds, the medic said that though his facility is function major constraints exist.
Said he, youth Samo-Kaal continues to support us we are in urgent need of equipment and trained staff”
In Toghdeer Region where thousands of residents suffer from mental problems, just like the rest of the country, the major constraint to rehabilitation is lack of awareness among the populace.
According to the SMSHO regional office in Burao treating mental illness is neglected because most people believe and wrongly at that, that once somebody loses his mental faculties, nothing can be done, thence the abject refusal to pursue medical treatment
Stressing that Burao town might be home to largest number of mental disturbed citizens in the country, the SMSHO Toghdeer regional Director Mawlid Mohamed said “in order for their activities to be impactful measured negating lack of awareness within the public must be implemented and urgently”
In the meantime the large numbers of Ilaajs (religious treatment centers) has despite not being regulated, termed as highly effective in alleviating the communal strain on handling cases of mental illness.
This is according to the executive director of USA based, Acceptance and Change in health organization, Dr Salah Ahmed who told participants that the combination of modern, traditional and religious modes of treating mental based diseases has been found to very effective.
Urging for a nationwide mental health services policy , Dr Salah said that full cooperation between the three different treatment methods should be gradually incorporated “thence patients can be availed preferred mode of medication anywhere anytime.
“A successful incorporation shall Inshallah, facilitate the housing of the three different types of treatment at a single facility” said the US trained medic
According to the acceptance and Change in Health Org the prevalent instance in which an ILaaj or ministry of health mental unit is available in one place and not in another shall be negated and to the benefit for of all.
Concurring with the sentiments expressed by Dr Salat On the part played ILaajs in mental health treatment Sheikh Mahmud Dubaad said that the cooperation existing between religious and traditional healers with Ministry of health does not only complement properly but assuages nationwide strain.
According to the Sheikh who is one of the most influential clerics in Somaliland, empirical knowledge indicate that any given mental ill person responds to either of the three treatment types.
“While we are in pursuit of improving standards at the religious based mental health centers, we are also encouraging the standardization of services and fees” said Sheikh Dubaad
On the expressed intent to introduced a home based care program supervised by skilled practitioners, the cleric said that this will hasten the realization of the WMD 2017 theme of “Good Mental Health Services integrated into Primary Health Care” in Somaliland.
In conclusion Sheikh Mahmud Dubaad confirmed that Religious leaders shall not only support but take affirmative action towards realization of any and all policies and strategies established towards improvement of mental health services in Somaliland
Upon presentation by the various professionals at hand, the next phase of events turned to a panel discussion with subsequent Q&A from the public.:
Allied to the WMHD 2017 theme the debate Titled Good Mental Health Services integrated into Primary Health Care the discussion was chaired by Prof Eid Ali Ahmed with panelists as
1.Dr Abdirahman Garguute, director Borame hospital mental health services
2. Dr Mukhtar Bashir, director Gabiley hospital mental health services.
3. Dr. Mustafe Husein director mental health ministry of health
4. Dr Ahmed Askar Director Hargeisa group hospital
5. Dr Salah Ahmed, director of USA and Somaliland based, Acceptance and Change in Health Organization and
6. Dr. Ayaanle Suleiman dean associate of collage of medicine and health science at UoH
In his address the Director of Hargeisa group hospital Dr Ahmed Askar who is in charge of the biggest public mental health unit in the country , said that the Impact had of SMSHO activities in the country are not exemplified by constructions, supplies or equipments etc only but facilitation of events like the WMD that helps put the Somaliland health sector in global limelight.
Stressing on the many challenges faced by fledgling mental health services which he acknowledge had been left behind while others health sectors were established from ground and nurtured, Dr Askar who hailed the support of international and local stakeholders, urged others to follow suit more so on emulation of work done by the Somaliland mental health support organization
Bringing events to conclusion the director mental health ministry of health Dr. Mustafe Husein revealed that government efforts are now geared towards needs assessment prior to formulation of a policy that shall ultimately integrate mental services into the Somaliland primary health care system.