By Francis David Nsiyaludzu
A Nation with a good bill of health serves as a good predictor of increased productivity and a cornerstone for sustainable development. Zimbabwe, a country that has recently promulgated plans for transition to an upper middle class by 2030, could fully achieve this goal by giving priority to citizen health among other initiatives. In the face of a growing need for mental health services due to a plethora of factors and chief being the insurgent scourge of drug and substance abuse, it would be prudent to consider accelerating decentralisation of mental health services and expanding community-based mental health interventions that advocate for all levels of disease prevention.
The Zimbabwe National mental health policy (1999) articulates several key objectives. It highlights the benefits and significance of decentralisation of mental health services as one way of increasing access to metal health services, particularly in rural areas where mental health services are limited. Notable reports and desk reviews have shown that, Zimbabwe has a shortage of human as well as health care facilities for mental health. There is an estimated 18 psychiatrists (17 of them in Harare) or approximately 0.1 per 100,000 population. There are 917 psychiatric nurses (6.5 per 100,000) and 6 psychologists (0.04 per 100,000) There are only two psychiatric hospitals, two psychiatric inpatient units, and seven outpatient mental health facilities functioning in Zimbabwe.(WHO,2020)
Decentralisation of mental health services therefore, implies a collective commitment towards the structural as well as human resource mobilisation and towards the disbursement of responsibility and functions within the various levels of care. The current status quo that reflects a considerable shortage of both human and material resources, is an urgent call for routing towards decentralisation and ramping up of community –based mental health care services. This service paradigm could effectively reduce the country’s global burden of mental health, increase social -functionality and productivity.
A 2010 research conducted by Mangezi & Chibanda (Mental Health in Zimbabwe) points to a community- based approach as one of the several approaches that can assist to disburse mental health services. Devolution of mental health services through the expansion of Community –based mental health interventions would serve to increase access to care, domesticate mental health services, fight stigma, empower local communities, demystify mental illness, build mental health literacy, and promote the overall mental well-being of communities at grassroots level. This approach also serves to significantly reduce fiscal spending on the overall health –bill by actively promoting de-institutionalisation of patients and reducing the burden of care by the few health care workers and facilities in the sector.
The Zimbabwe National Mental Health Policy (1999) articulates clear and smart objectives that seek to comprehensively address mental health. It is the blue print towards achieving these set objectives. However, from a community practitioners’ perspective, one sustainable approach towards mental health care would be to prioritise and hasten prevention initiatives at community level, accelerate and pragmatise the process of decentralisation, increase community participation and instituting community- based mental health care. Investing in community –based mental health care initiatives, like day care centres, half-way homes, hostels, resettlement schemes, vocational training centres, community forums, awareness raising and health promotions among other initiatives as espoused by the policy can significantly mitigate mental health issues across communities. These community based initiatives will serve to rehabilitate patients, prevent relapse and entrench prevention at community level. This also augments service efforts that remain centralised and limited to few major urban centres. While commendable initiatives in the mental health sector continue to be pursued by our Government, like the decentralising of mental health services in some major urban centres, instituting the mhGAP training program for health workers at primary care facilities, refurbishment of some mental health facilities at central hospitals, building partnerships with civic organisations and other private players, accelerating the establishment of widespread community- based mental health services and facilities remains pivotal and can expedite and widen access to services at sustainable cost. Several civic organisations and other non –health sectors, bear witness to the efficacy of community –based mental health services and psycho-social support as a means to localise and ground services within communities. A community-based approach could be an effective and sustainable model for mental health care in the medium to long term. It is an approach that seeks to address, not only the presenting mental health issues, but also conduits attention to the root causes at an ecosystems level.
It therefore, remains prudent to move quickly in establishing community-based mental health initiatives at a macro-scale and in fulfilment of policy aspirations. The policy aspires for a decentralized service and integrated mental health services that are firmly established at all levels of care to satisfy the needs of the general public. (Mental Health Policy (1999). Developing a workforce that is intellectually and physically sound is essential if we are to reap the full benefits of our endowed country. Advocating for prevention-driven and community- based mental health initiatives that are global can be cost –effective and foster sustainable socio-economic development.
Francis David Nsiyaludzu is a Community Psychology intern and registered with the Allied Health Practitioners Council of Zimbabwe. Also a Researcher in areas of Youth and adolescent behaviour, offender rehabilitation and an Educator. Currently working as a Child Safeguarding Officer for the Catholic Diocese of Gokwe.
