Constraints affecting the administration of mental health services in Zambia: With special reference to manpower training and utilization

Abstract

Zambia's mental health services date back to 1962 when Chainama Hills Hospital was opened. Before this period, Psychiatric services in this country were primarily part of the prisons service. However, nearly 26 years later the mental health service has only achieved about 15% coverage of the at-risk population in the country such as students, detainees, prisoners, unemployed etc.One explanation which has been given for this lack of coverage of the at-risk population is that mental health workers are being utilized on general medical work as well as on mental health work.This study is therefore an attempt to discover whether mental health workers are actually being utilized on general medical work, and if so, the degree to which they are deployed on general medical work.The study is also intended to find out whether general health workers too are being assigned to do mental health work.In addition, we also want to find out the factors (other than training) which have led to such a situation.The study is conducted in three provinces of Zambia and covers 23 mental health facilities {50% of all mental health facilities in these three provinces). The interviewee population consists of 46 mental health workers, general health workers, 18 supervisors, 3 provincial medical officers and 2 deputy directors of medical services responsible for planning and development; and medical care administration. This is based on random sample of 113 health personnel out of 208 population:The eclectic approach - combining the Historical, Sociological and Psychological approaches - is used during the collection and analysis of primary data. The findings of the study reveal that forty per cent of mental health workers' training programme is devoted to general medical work as compared to only three per cent of general health workers' training programme devoted to mental health work.Mental health workers are involved in general medical work more regularly than their counterparts the general health workers, involvement in mental health work.In terms of career anchorages, there is a widespread agreement among the respondents that mental health workers are given poor facilities,are rarely visited and have fewer opportunities for promotion to administrative positions within the Ministry of Health and that the Central Administration is not responsive to the needs of mental health workers in the country.This appears to result in frustrations and low morale among mental health workers.As a result of this negative assessment by the majority of the respondents about mental health workers' professional position, we recommend that organizational changes be made at the national (Ministry), provincial, district, hospital (institutional) and community levels to ensure the proper control and coordination of mental health services in the country.Thus,there ought to be a Deputy Director of Medical Services (Mental Health) at the national level and mental health worker(s) at each provincial, district, hospital and community levels. There is also a need to develop a polyvalent health worker capable of dealing with a variety of health problems facing the country.