PROJECTS

VIEW PAST, PRESENT AND FUTURE CHAG PROJECTS

INTRODUCTION

CHAGThe Christian Health Association of Ghana (CHAG) is a recognised Implementing Partner and an Agency of the Ministry of Health (MOH) and works within the policies, guidelines and strategies of the MOH. Nonetheless, CHAG is autonomous and takes an independent position to advocate and promote improvements in the health sector and to promote the interest of its members and target beneficiaries. Over the past 50 years, CHAG has made significant contributions towards the achievement of the national health objectives. Importantly, in rural and deprived areas, CHAG has provided health services where hitherto the Government of Ghana had no facilities. As a network organisation, CHAG has a total membership of 302 Hospitals, Clinics, Health Centres, Polyclinics, Compound, Primary Health Care Centres and Training Institutions.

CONTEXT

It has been estimated that only 2% of people with mental illnesses have access to some form of care globally. This represents a treatment gap of 98%, thus a huge mental disease burden. CHAG is seeking to contribute to closing this gap in Ghana. Under the Health Sector Support Programme for Government of Ghana (HSSP), UKAID funded CHAG for a five-year (2013/14 – 2017/18) mental health programme. The broad aim of the entire project is to Improve the lives of persons suffering from mental illnesses in Ghana. Under this aim, the Project seeks to achieve the following:

  1. Reduce the incidence of and stigma towards persons with mental illness
  2. Increase access to treatment, care and support for persons suffering from mental illness
  3. Re-integrate treated mentally ill persons back into their communities and support them to be economically productive
  4. Integrate Mental Health Services into the primary health care system

CHAG This programme is in its fifth year of implementation and on course to achieving its key planned targets. For example, mental health services have been integrated into 218 CHAG Facility outpatient departments (OPDs) representing 72% coverage of CHAG Facilities. Various interventions since the start of the program have also been undertaken such as the provision of public address systems and rechargeable hand megaphones for some CHAG Member Institutions; training of Facility Managers including Principals from the CHAG Training Institutions on Strategic Planning and Resource mobilization to support the provision of mental health care services within their respective facilities; training of Community volunteers on basic identification and referrals for mentally ill persons within the communities; sensitization of various Islamic Communities – Sunyani, Abbosey Okai, Tamale, Madina and other places on mental health related issues including stigma; sensitization of the religious and clergy on mental health related issues including stigma and also to solicit their support for persons suffering from mental illnesses; airing of documentaries on mental health issues and the community approach to mental health reaching a wide number of the population of Ghana; training of community mental health officers and Clinical Psychiatric Officers at the School of Rural health and wellbeing – Kintampo among others.

GAPS IN MENTAL HEALTH PROVISION

CHAG According to the World Health Organization (WHO), the people who often suffer much of the burden of mental disorders are the poor, both in terms of the risk in having a mental disorder and the lack of access to treatment. The poor are constantly exposed to severely stressful events, dangerous living conditions, exploitation, and poor health in general and these contribute to their greater vulnerability of mental disorders. Our strategic locations in rural and deprived areas where these poor mostly reside in the country help us is providing mental health services relevant in removing the suffering from the poor who often bear a greater burden of mental disorders. Again, our location and community service provides the platform for implementing the global policy of decentralizing mental health and making it more community-based.

In spite of the achievements above there are still gaps in mental health service provision. The WHO World Health consortium for mental health has indicated that in low- and middle-income countries, less than 24% of people with severe mental disorders are on treatment. The situation may be higher in Ghana. There is no prevalence study of mental health in Ghana and the routine district management system, whilst improving, is not accurate in determining those being treated. The World Health Organization estimates that nearly two-thirds of people with a known mental disorder never seek help from health professionals. Stigma, discrimination and neglect prevent care and treatment from reaching people with mental disorders, says the WHO.

In 2016, after a review of the entire program taking into consideration the various interventions and successes chalked, it came to light that there were still gaps in the provision of mental health services and needed more attention. Again, the 2016 WHO AIMS report also revealed certain gaps that needed addressing. This report was commissioned by DFID locally in Ghana for the review of mental health services. These gaps identified included but not limited to:

  1. inadequate awareness on the mental health Act
  2. Inadequate funding for mental health services
  3. Lack of services for Adolescents and Children
  4. Unavailability of Psychotropic medicines at service delivery points
  5. Difficult access to community based clients for Community Mental Health Nurses among others

Consequently, in the same year, the various interventions initially earmarked for the project were revised to include new ones that sought to address some of the gaps identified. These interventions are;

  1. Establish 3 Daycare centers for Adolescents and young Children in 3 zones;
  2. Establish a revolving psychotropic medicines fund;
  3. Support community mental health nurses (CMHNs with transportation (216 motorbikes) to provide care to patients in the community;
  4. Step up advocacy to get increased attention of government for mental health care, particularly with regards to passing the LI and getting mental health services on the NHIS benefits package.

Similarly, CHAG further sought to scale up the various training and awareness activities in the existing programme to cover the 111 new CHAG Facilities and catchment areas for the following categories of people: Church Leaders (and Muslim Clerics as well as Traditional Leaders in the Brong Ahafo, Volta, Western and Greater Accra Regions), Prescribers, Management members/Facility Heads; use the new WHO Mental Health Gap Action Programme (MHGap) intervention guide to train prescribers. The expected outcomes are:

(1) Mental health service is integrated in all 100% CHAG Facilities including training institutions;

(2) Services are available for Mentally ill Adolescents and young Children in 3 zones in Ghana;

(3) Psychotropic medicines are available in 30% of CHAG Facilities at affordable prices;

(4) Two hundred and eighteen (218) Health Providers (CMHNs) have easy access to patients in the community;

(5) Incidence and Stigma towards Mentally ill Persons reduced by 30%. These activities would be executed in line with the existing programme and expected to be completed by March 31, 2018.

These motor bikes are therefore to support 218 Community Mental Health Nurses and Officers from the CHAG Network to adequately provide mental health care to their respective communities. They are LIFAN and BIJO models.

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