Saturday, June 25, 2011

Break day - Friday June 24th - A plan for change?


In Khartoum wake up wandering how I am going to pay for the room but Zina to the rescue who sorts everything out. To the tremendously impressive National Musuem this morning then after a rest to the Omdurman Souk - tried to sell Sophie in exchange for camels but couldn't get a good price. Mahdi's tomb then pleasant pizza and fruit juice by the nile watching Sophie (not) feed cats.

More seriously conversation with Zina and colleague this morning about trying to sustain what we have started. Main problems identified by Zina include funding (Sudan apparently spends 3% of its spend on health care and virtually none on mental health) and strategies to get mental health care into primary care. The conversation reminded me of a research project I did 3 years ago teaching brief psychotherapy around New Zealand - the literature shows that training health professionals in new non-pharmacological interventions is not very successful with generally only about a quarter of health care workers using any new intervention after a workshop. The lessons I learned from this project that I think could apply in Sudan (and possibly elsewhere) are these:

The training

  1. Do a good initial training/workshop
  2. Follow up with "academic detailing" (supervision) of some sort - in other words after the workshop visit practitioners and talk to them about using the intervention in their practice (a Cochrane Review addresses this)

Make the system consistent with the goals of the training so everything "lines up"

For example in this case family doctors to do a psychiatric rotation (or write up a psychiatric case or some such); put psychiatric questions in their family doctor exam; explicitly put care of mental health in job descriptions; possible financial incentives etc.

Cerification - those who complete the course get accredited to do something extra that others are not allowed to do or opens other doors - for example would a "RCPsych Certificate in mental disorders in primary care (overseas)" enable family doctors to attract a different clientele in private practice?

Policy development

Then this all needs to be aligned with policy which means access to Ministers (maybe a meeting with senior figures from the College to lobby for increased attention to mental illness) and community development (includes media) so that communities press for policy change.

Funding

Until policy change leads to changes in funding priorites money will probably rely on charities/NGO to seed fund change. Could the major psychiatric colleges in the developed world raise a fund from members for mental health development - maybe a 2% annual levy on membership fees. There are probably also other charities and NGO's who would contribute if a compelling case could be made and philanthropists who may fund special (research) projects.

Technological opportunities

Technology offers two things - firstly new ways of delivering some teaching - secondly there is the opportunty for novel interventions in the developing world especially with interventions delivered by mobile phones which are ubiquitous (txt messages with health messages, reminders about medication etc). Such innovative interventions generate interesting ideas about partnerships with technology/phone companies in developing new health interventions in the developing world.

Those are my intial thoughts - any comments?



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