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Beneath the rhetoric: Policy to reduce the mental health treatment gap in Africa

COOPER, Sara
2015

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In this paper I problematize knowledge on reducing the ‘gap’ in treatment produced by 14 national mental health policies in Africa. To contextualize this analysis, I begin with a historic-political account of the emergence of the notion of primary health care and its entanglement within decolonization forces of the 1960s. I unpack how and why this concept was subsequently atrophied, being stripped of its more revolutionary sentiments from the 1980s. Against this backdrop, I show how, although the 14 national mental health policies are saturated with the rhetoric of primary health care and associated concepts of community participation and ownership, in practice they tend to marginalize local meaning-systems and endorse a top-down framework heavily informed by colonial medicine. The policies thus end up reproducing many of the very Eurocentric assumptions that the original primary health care notion sought to transcend. More specifically, the paradigms of evidence-based research/practice and individualised human rights become the gatekeepers of knowledge. These two paradigms, which are deeply embedded within contemporary global mental health discourse, are legislating what are legitimate forms of knowing, and by extension, valid forms of care. I argue that a greater appreciation of the primary health care concept, in its earliest formulation, offers a potentially fruitful terrain of engagement for developing more contextually-embedded and epistemologically appropriate mental health policies in Africa. This in turn might help reduce the current ‘gap’ in mental health care treatment so many countries on the continent face.

 

Disability and the Global South (DGS), 2015, Vol. 2 No. 3

Facilitating disability inclusion in poverty reduction processes: Group consensus perspectives from disability stakeholders in Uganda, Malawi, Ethiopia, and Sierra Leone

MACLACHLAN, Malcolm
MJI, Gubela
CHATAIKA, Tsitsi
WAZAKILI, Margaret
DUBE, Andrew K
MULUMBA, Moses
MASSAH, Boniface
WAKENE, Dagnachew
KALLON, Frank
MAUGHAN, Marcella
2014

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This paper addresses the challenge of how to get disability on the development agenda in four African countries. We explored perceptions of what initiatives would most help in achieving disability inclusion in Poverty Reduction Strategy Papers (PRSPs), and identified factors that can either promote or hinder these initiatives. Stakeholders from Disabled People’s Organisations (DPOs), other civil society organisations (CSOs), development agencies, researchers and government ministries, participated in the Nominal Group Technique and Force Field Analysis procedures across Malawi, Ethiopia, Uganda and Sierra Leone. While each country had specific contextual factors, common ideas for promoting greater disability inclusion in PRSPs focused on policy action, the need for a stronger evidence-base, mechanisms for directly influencing the PRSP process, as well as strengthening central government and DPOs’ capacity in this regard. Common facilitators for these actions were seen as the existence of a national disability umbrella body, disability-specific legislation, named Ministries for Disability, ratification of the UN Convention on the Rights of Persons with Disabilities (UNCRPD), and the fact that disability was already mentioned (albeit inadequately) in some PRSPs. Common inhibitors included negative attitudes towards disability, poor capacity in DPOs and government ministries, poor policy implementation, little ‘domestication’ of the UNCRPD, little political will or consultation with people with disabilities, as well as aggregating disability with other vulnerable groups, a lack of research in the area and poor coordination between DPOs.

 

Disability and the Global South (DGS), 2014, Vol. 1 No. 1

Disability and the Global South (DGS), 2014, Vol. 1, No. 1

2014

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Articles include:

  • EDITORIAL :  Introducing Disability and the Global South (DGS): we are critical, we are open access!
  • Youth with Disabilities in Law and Civil Society:  Exclusion and inclusion in public policy and NGO networks in Cambodia and Indonesia
  • Performing the Stare in Indra Sinha’s Animal’s People  
  • Disability Sport in Sub-Saharan Africa: From Economic Underdevelopment to Uneven Empowerment
  • Does Africa Dream of Androids?
  • Mendicidad y discapacidad en la Ciudad de Buenos Aires: un síntoma de nuevas formas de  vulnerabilidad social
  • Facilitating Disability Inclusion in Poverty Reduction Processes: Group Consensus Perspectives from Disability Stakeholders in Uganda, Malawi, Ethiopia, and Sierra Leone
  • Disability, poverty and Education: perceived barriers and (dis)connections in rural Guatemala 

The health worker shortage in Africa : are enough physicians and nurses being trained?

KINFU, Yohannes
et al
February 2009

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"The health worker shortage in sub-Saharan Africa derives from many causes, yet the dynamics of entry into and exit from the health workforce in many of these countries remain poorly understood. This limits the capacity of national governments and their international development partners to design and implement appropriate intervention programmes. This paper provides some of this information through the first systematic estimates of health worker inflow and outflow in selected sub-Saharan African countries"

Mapping malaria risk in Africa

MAPPING MALARIA RISK IN AFRICA / ATLAS DU RISKE DE LA MALARIA EN AFRIQUE (MARA/ARMA)
December 2004

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This site presents maps of malaria risk and endemicity (the presence of malaria) in Africa, drawing on published and unpublished data, and through spatial modelling of malaria distribution, seasonality and endemicity. Many factors, especially endemicity, affect the choice of control methods. In the absence of such data it is impossible to rationalize the allocation of limited resources for malaria control. This site presents an opportunity to rethink endemicity and how we may map malaria risk in order to better support planning and programming of malaria control

The Africa campaign on disability and HIV & AIDS

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The Africa Campaign is a unifying umbrella under which disabled people's organisations, organisations of people living with HIV & AIDS, non-governmental organisations, AIDS services organisations, researchers, activists, and other citizens work collectively to achieve two main objectives: a coordinated response involving persons with disabilities in African countries to achieve inclusive national HIV & AIDS policies and programmes; and equal access for persons with disabilities in Africa to information and services on HIV & AIDS. This website contains information about the campaign and key documents

African Palliative Care Association

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Palliative care is seen as a vital component in the care of people with progressive, life-limiting illnesses (including HIV/AIDS). The Africa Palliative Care Association works to promote and support affordable and culturally appropriate palliative care throughout Africa, including to orphans and vulnerable children

African policy on disability and development

CENTRE FOR REHABILITATION STUDIES

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This website provides an insight into a three-year project to investigate the need for disability to be included on the agenda of national and international development initiatives. It offers some resources and links related to policy, disability and development, hosts a forum and highlights updated news and events. Details are provided for four country-specific case studies: Malawi, Uganda, Sierra Leone and Ethiopia. African policy on disability and development is a joint project between the Centre for Global Health, Trinity College Dublin, The Secretariat of the African Decade for Persons with Disabilities, and the Centre for Rehabilitation Studies at Stellenbosch University. This website is a useful resource for people who are interested in disability and development policy issues in Africa

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