Kwale Kenya - DETERMINANTS OF THE IMPLEMENTATION OF THE KENYA MENTAL HEALTH POLICY (2015 – 2030)

DETERMINANTS OF THE IMPLEMENTATION OF THE KENYA MENTAL HEALTH POLICY (2015 – 2030): A CASE OF KWALE COUNTY, KENYA

ABSTRACT

Mental Health is now globally acknowledged as a significant cause of human morbidity. It is postulated that by 2030 mental illness will be the largest contributor to the global health burden, if not properly addressed. In Africa, and by extension, in Kenya, various factors have been identified as being a hindrance to the achievement of reasonable mental health, among them being: lack of appropriate government policies to enable funding, manpower training, availability of relevant commodities and protection of the rights of mental patients.

The aim of this study was to evaluate what Kwale County has done, since the inception of the KMHP in 2015 to address mental health issues. A cross-sectional survey was carried out. Qualitative and quantitative data was obtained from 65 out of 76 health facilities targeted. Stratified and random sampling methods were used to get sample facilities. Structured interviews with in-charges of facilities or their assistants was used to obtain data. Obtained data was cleaned, organized and analyzed by Excel programme. Descriptive and inferential statistics were used to analyze the data. Generally, the descriptive analysis demonstrated general lack of awareness, among facility in-charges, on matters of health policy of the county, such as existence of KMHP (82%) and County budget allocation to mental health (97%). 71% were not involved in county policy formulation; and only 14% considered a budget allocation for mental health in their facility budget formulation. There was a severe shortage of trained mental health workers: 97% of the facilities reported having no trained mental health worker of any cadre. 66% of facilities have less than five trained health workers who attend to few (1 to 3) mental patients who come to the formal health system per month, besides other medical patients. Over 95% of health facilities do not have diagnostic technology such as Brain scan and EEG at their disposal; neither are they able to offer specialized mental services such as professional psychotherapy and socio-support therapy. 20% of health workers in the formal system are aware of CAM activities in their locality; 11 – 15% know at least one form of CAM practitioner (Diviner, Faith Healer of Herbalist). 62% of formal health workers think CAM treatment is not effective. Only 12% of the facilities reported receiving referrals from CAM practitioners; and almost none from the formal system to CAM. 55% of the facilities keep mental records manually and 45% in standardized reports. On testing specific independent variables against selected dependent variables under the four main hypotheses, all except one hypothesis were rejected in favour of the null hypothesis. Chi-square tests were performed for each pair of variables and the outcome was as follows: Involvement of facility in-charges in policy formulation at county level in relation to years of management experience - hypothesis rejected at 95% significance (X2 = 1.019, dof=1, p=0.653). Relationship between number of mental health workers and general health workers in facility - hypothesis rejected at 95% significance (X2 = 0.452, dof = 1, p=0.501). Relationship between availability of psychotropic drugs and number of mental patients seen - hypothesis not rejected at 95% significance (X2 = 4.249, dof=1, p=0.039). Relationship between staff training in health systems reporting and accessibility of mental health data - hypothesis rejected at 95% significance (X2 = 2,979, dof=1, p=0.084). Relationship between awareness of CAM activity and referral of patients from CAM - hypothesis rejected at 95% significance (X2 = 0.143, dof=1, p=0.705).

The general conclusion is that very little, if any, has been achieved in implementation of KMHP in Kwale County. There seems to be no association between what is going on in the facilities and what the county is doing to implement KMHP. The county needs to invest in advocacy and awareness creation for mental illness; train more health workers and equip health facilities to manage mental illness. More research is recommended to understand the role of CAM practice and the community’s views about the treatment of mental patients in the formal healthcare system in Kwale County.