Mental Health in Zimbabwe
Mental health is something that is often easy to overlook, especially if you come from a low-income background. The intersection of mental health and poverty is one that interests many social scientists, yet it is a relatively new comparison. Several studies show that living in an impoverished setting makes one more likely to experience a mental illness, such as depression or anxiety. With many impoverished countries lacking the resources needed to provide substantial help for those affected by mental illness, programs like The Friendship Bench Project, who are working to improve mental health in Zimbabwe, are making a big impact.

Important Facts About Mental Health in Zimbabwe

  1. One in four Zimbabweans suffers from a common mental disorder (CMD), i.e. depression or anxiety.
  2. In a population of 13 million, there are only 11 psychiatrists and 20 clinical psychologists. That’s fewer than one psychiatrist per one million people.
  3. Only two of nine mental health institutions in the country have psychiatrists.

In a country with only eleven psychiatrists where one in four citizens have a CMD, it’s easy to wonder if there is anything being done to help improve mental health in Zimbabwe. That’s where The Friendship Bench Project comes in.

The Friendship Bench Project

During a Ted Talk, Dr. Dixon Chibanda, founder of The Friendship Bench Project and one of the eleven psychiatrists in Zimbabwe, explained why he started this project. Simply put, there just weren’t enough psychiatric resources in Zimbabwe to provide the aid for those who needed it. He decided to do something about it. He says that “One of the most reliable resources we have in Africa are grandmothers… there are hundreds of them… and they don’t leave their communities.” Using this knowledge, he came to the conclusion that these grandmothers can be trained to provide the necessary support for individuals who need it.

The Friendship Bench Project is an intervention of sorts that is based on problem-solving therapy where a patient and a trained community grandmother come together to identify issues impacting the patient and brainstorm ways of solving them. It is unlike conventional therapy in which the patient is diagnosed with an issue or symptom and is then treated based on their diagnosis.

Community grandmothers are trained to listen, to show empathy and are empowered with the skills needed to provide behavior activation and schedule activities. Technically, they are trained as lay health workers, but patients who go to see them recognize them only as the community grandmothers that they have always been. There are seen as someone to talk to, as someone who will listen. Together, over several sessions sitting on a park bench outside of a community health clinic, the grandmother and patient talk and work through the issues that are most affecting the patient.

The Impact of the Friendship Bench Project

A randomized clinical trial was conducted in order to see if these friendship bench sessions were working to improve the mental health in Zimbabwe. The trial split 573 patients into two groups: one group would receive psychological intervention from the community grandmothers while the other group (the control group) would receive the usual mental care from mental health professionals.

The trial found that patients who worked with the grandmothers displayed symptom scores (as measured on two symptom scales) that were lower than those who worked with doctors. This means that they had fewer symptoms of common mental disorders when they worked with lay health workers than when they worked with mental health professionals.

As of right now, there are 400 grandmothers working on 70 benches located throughout Zimbabwe, helping 35,000 people through The Friendship Bench Project. These women are changing mental health in Zimbabwe for the better. While The Friendship Bench Project is currently centered in Zimbabwe, it’s an innovative solution to combating mental health that could soon be used worldwide. In fact, Dr. Chibanda’s next goal is to do just that.

CJ Sternfels
Photo: Flickr

Using Technology for Decreasing Poverty in the Dominican Republic Via Technology
A promising program that is aiming to help to bring people in the Dominican Republic out of poverty is the Community Technology Center Program (CTC). This initiative is one key sign of the progress the country is making in improving health, promoting gender equality and decreasing poverty in the Dominican Republic. With more innovative programs like the CTCs, the country could continue to see significant progress in many areas of poverty reduction through education and access to technological resources.

What Do CTCs Offer?

Since its inception in 1998, the primary purpose of the CTCs is to offer technology resources for people to help in areas such as employment and education, thereby increasing financial stability. The CTCs are also working to achieve its mission connected to health by helping to prevent the spread of disease by offering people access to information about health. Currently, there are 87 centers, but there are plans to build more.

The CTC initiative works towards helping families living on a dollar per day to possess the tools to help themselves increase their financial stability. One of the reasons for the success of the CTC program is that it utilizes technology to help people at no cost, thereby bestowing to people the tools to have a say in their lives. In fact, the centers offer technology training for those who don’t know how to use the resources.

Empowering Women and Minorities

Assistance for women, the disabled, immigrants and others who have not had access to online information and technology is a top priority. One of the issues the CTC programs has been trying to address is women’s access and use of the Internet. At least “three-fourths of the female population don’t use the internet.” The CTC initiative is also working to expand women’s participation in technology and Internet access.

The part of the program, women on the net, also demonstrates the progress that the CTCs are making. Some of the areas of education the centers provide are programming, multimedia and telecommunications. By providing education in these areas, the goal is for participants to find jobs in technology. By 2013, 700 female participants had finished programs at various centers, learning computer literacy and technology.

By providing assistance to people with disabilities, immigrants and non-legal residents, CTCs are helping to reduce poverty in often marginalized communities. One of the people the program has aided in employment, Julien Joseph-Josue, said the CTC program made him feel like “part of a family.” Joseph-Josue is a Haitian immigrant who received training to help his career as an interpreter.

The Success of the Program

The centers provide opportunities for learning and sharing in a community space as well as providing training in obtaining a job. Currently, the centers have achieved substantial progress in alleviating poverty in the Dominican Republic and have made significant strides in working to promote gender equality. The number of people CTCs has helped demonstrates this development. CTCs have helped develop the skills of around 40,000 people, 60 percent of these people being women, creating a more positive outlook.

Demonstrating a continual sign of progress the CTC program has made is the Bill and Melinda Gates recognition for the initiative for its innovation. The organization awarded the initiative The 2012 Access to Learning Award (ATLA), an award for organizations across the globe that offer access to technology. The CTC program obtained $1 million from this award. Furthermore, Microsoft will give $18 million worth of software to the initiative in accordance with its global citizenship effort to offer help in the positive developments from technology.

The technology that the program provides allows for access to information aiding in financial stability, health and decreasing poverty in the Dominican Republic. In addition, the CTCs have been shown to move the Dominican Republic further along on the path to achieving gender equality. With the continual effort of the initiative, hopefully, there will be more positive results in the effort to alleviate poverty in the Dominican Republic.

– Daniel McAndrew-Greiner
Photo: Flickr

Poor Mental HealthThe Mental Health Foundation has recognized poverty as a causal factor of mental health problems, but also as a consequence of mental health problems. Poor mental health and poverty often go hand in hand.

Causes and Effects of Poor Mental Health

Mental health issues arise from causes related to the social, economic and physical environments in which an individual lives. Poor mental health in a community is significant in the range of social health problems that contribute to reduced development. The effects include decreased community cohesion, low educational achievement, poor physical health, premature mortality and increased violence.

Recovery from both mental health problems and poverty requires timely, sufficient access to quality resources and care.  Incorporating principles and taking action in devastated areas will substantially improve the quality of life for individuals with mental and psychosocial disabilities. It will also improve development in the individuals themselves, as well as their families and communities.

The Work of Advancing Partners & Communities

Advancing Partners & Communities (ADC), a USAID-funded organization, recognizes the need to address mental health stability to repair impoverished communities. ADC understands that to address inequalities related to mental health and poverty, there must be a change in social arrangements. In order to transform an area’s social arrangement, the ADC has created community healing dialogues (CHDs) in areas of Sierra Leone that have been heavily affected by Ebola outbreaks.

The Ebola outbreak in 2014, as well as the recent outbreak in May of 2018, have left many countries with a sense of devastation and hopelessness.  Many people lost friends and family members, and survivors of the illness have been faced with discrimination and stigmatization. The immense disconnect between community members, as well as the heavy devastation that faces them, have affected the mental health of individuals and communities alike.

Community Healing Dialogues

The CHDs, a type of community-centered regeneration program, work directly with the distressed communities in an effort to change the divided social structure. The dialogues catalyze local action and build social capital, both of which are necessities in overcoming mental health instability and poverty.

The CHDs offer people, specifically survivors ostracized by their community, an outlet to voice their concerns, complaints and ideas for solutions. With the help of the CHD-trained facilitators, members of the community are able to move past stigmas and accept the survivors back into their midst.

By providing peer-support within the community, the CHDs work toward uniting people to build social capital. Social capital creates strong bonds within the community, allowing it to provide protection against health risks, resilience and support for its people, as well as access to social, psychological and economic resources. Conversation is key to building social capital, and social capital is key to developing a strong community.

Healing, for a community devastated by disease or an individual struggling with mental illness, begins with conversation. Assistance offered to people with poor mental health has the ability to impact the wellbeing of not only the individual but the entire community.

– Samantha Harward
Photo: Flickr

Empower Mali FoundationMali Presidential Candidate Niankoro Yeah Samake is promoting self-reliance through his Empower Mali Foundation. Samake spoke at a forum on the Brigham Young University-Idaho campus on May 17, discussing how consistent small actions focused on others can bring about great change.

To begin the change for his home village of Ouelessebougou, Samake ran for mayor when he noticed that the government wasn’t utilizing the taxpayers’ money effectively and was becoming more corrupt. Samake won the election by 86 percent and his first order of business was to get the community to trust the government again.

Members of the community started to pay their taxes and Samake showed them exactly where the money was going, where it was coming from and how much they had, unlike previous government rule. Those in Ouelessebougou were able to build a hospital, high school, have running water, electricity and solar panels. Within two years, Samake was able to move Ouelessebougou from the bottom five of Mali’s 704 districts to the top ten.

“The citizens were able to see the power of integrity,” Samake said. “They could see what could be achieved when leaders and citizens work together in an honest and productive way.”

Samake said that Mali needs a leader that would put them first, and he is running in Mali’s next presidential election.

Creating the Empower Mali Foundation

While he was a mayor, Samake created the Empower Mali Foundation to address the growing need in the areas of education, healthcare and access to basic necessities in the rural communities of Mali. The foundation’s goal is to have the issues of individual communities resolved by the community members themselves.

This foundation wants each community within Mali to become self-reliant. The communities initiate the demand for projects and also contribute through cost, land or labor. By being involved, community members are more likely to maintain their project and become self-sustainable.

Empower Mali Foundation works in five main sections:

  • Education
  • Healthcare
  • Clean Energy
  • Clean Water
  • Leadership Training

Education

At 31 percent, Mali has one of the lowest literacy rates in the world. Many Malian villages don’t have the adequate funding for schools or training for teachers. The foundation focuses on resources in school construction and repair, school supplies, adult literacy, job skills training and technology skills.

Healthcare

The average life expectancy for a citizen of Mali is 52 years. This can be due to many different diseases in the area, and the fact that there isn’t adequate training for doctors in more rural parts of Mali.

The Empower Mali Foundation focuses on providing additional health care training, arranging and implementing healthcare expeditions and supplying hygiene kits to communities in need.

Clean Energy

Less than one percent of Mali has access to electricity. The majority of Mali citizens rely on wood and charcoal burning fires to supply energy to their village. The Empower Mali Foundation focuses its resources on the installation of solar panels.

Clean Water

The second leading cause of death in low-income countries is diarrheal diseases. This is because of poor sanitation and no access to clean water. More than one-third of Mali does not have access to clean water. To address this, the Empower Mali Foundation is focusing its resources to install water tanks and water pumps, dig wells and cover current water sources.

Leadership Training

Many people locate in rural Mali don’t have enough information on what local governments do for them. Along with little communication, the poor level of skills and capacities of the duty-holders restrict the full involvement of the people.

The Empower Mali Foundation wants to focus its resources on training local leaders for success by arranging governance summits between local leaders in Mali and other countries. The foundation also wants to implement local participation in order to teach youth to better understand and engage in the local governance process.

The Empower Mali Foundation has completed many projects such as the donation of school kits, hygiene and dental kits and the successful installation of the first electricity-generating playground in Ferekoroba.

The Empower Mali Foundation’s projects take steps to make communities in Mali more self-reliant and sustainable. It is continuing to pursue its goal to raise Mali out of poverty, one community at a time.

– Victoria Fowler
Photo: Flickr

Poverty in Africa Is Key to the Future of the ContinentA recent report published by the ONE Campaign entitled ‘The African Century‘ shows the urgent necessity of the international community to pay attention to development on the African continent. With Africa’s population set to double by 2050, the authors of the report have stated that taking action on poverty in Africa is key to future of the continent and of the globe.

Although population growth is rapid and expansive on the continent, the flow of international aid into Africa has been stagnating and decreasing in recent years. Since 2012, the three most significant forms of financing for African countries—official development assistance, domestic revenue and direct foreign investment—have been steadily decreasing; they are now at their lowest aggregate level since 2009. Since 2012, although its population has increased by 15 percent, the combined resources available for development in Africa have nominally decreased by 22 percent.

The authors of the report emphatically underline that the international community must start taking action on poverty in Africa as soon as possible. Alleviating poverty in Africa is key to the future of the continent, one which is uncertain right now and might present very serious challenges. With the population increasing to an estimated 2.5b billion by 2050, and 50 percent of them being 25 years or younger, there is a great risk of further destabilization of the region and massive waves of migration. According to estimates, by 2020 Africa’s unemployed population will equal that of Germany’s entire population, and 50 years from now that number might increase to 310 million, or half the employed population of continental Europe.

Donors who used to largely finance aid and development on the continent have been largely using aid budgets in the pursuit of short-term foreign policy interests rather than in fighting poverty. This shortsightedness might prove catastrophic. As a young population grows up in conditions of extreme poverty, conflict that resonates around the globe might be unavoidable. This is why the authors of the ONE report so emphatically claim that taking action on poverty in Africa is key to the future of the continent and the world. In its conclusion, the report calls for a renewed partnership with African countries, which include the doubling of investments in education, employment and empowerment “to support a programme of economic and policy reform across the continent”. Hopefully, the international community will heed this call and think in the long term in order to avoid catastrophe before it manifests.

Alan Garcia-Ramos

Photo: Flickr

Social Ecological ModelPeople do not act in isolation, which is why it is important to understand the ways they interact with their communities and environments, in order to determine why they do what they do.

One way of measuring these networks of interactions is the Social Ecological Model. This model, developed by sociologists in the 1970s, studies how behaviors form based on characteristics of individuals, communities, nations and levels in between. In examining these intervals and how they interact and overlap, public health experts can develop strategies to promote wellbeing in the U.S. and abroad.

The Social Ecological Model is broad in scope. Each level overlaps with other levels. This signifies how the best public health strategies are those that encompass and target a wide range of perspectives. A public health organization may struggle to promote healthy habits in a community if it does not take into account how other factors play into the behavior of the community as a whole.

Different organizations use variations of the Social Ecological Model organizational hierarchies in a given society. The Centers for Disease Control and Prevention (CDC) sometimes uses a four-level model, while UNICEF’s model has five levels. Here is the layout of UNICEF’s model and its application in a public health context:

  1. Individual: An individual’s various traits and identities make up this level of the Social Ecological Model. These characteristics have the capacity to influence how a person behaves. Age, education level, sexual orientation and economic status are some of the many attributes noted at this interval. These factors are important to consider when constructing public health strategies, as characteristics such as economic status are linked to an individual’s ability to access healthcare.
  2. Interpersonal: The relationships and social networks that a person takes part in also have great potential to impact behaviors. Families, friends and traditions are key players at the interpersonal stage of the model. Using therapy or intervention, one can promote healthy relationships at this interval. Discouraging violence between individuals also comes into play here.
  3. Community: This level of the Social Ecological Model focuses on the networks between organizations and institutions that make up the greater community. These associations include businesses and functions of the “built environment,” such as parks. Community structures are often important in determining how populations behave and what customs they uphold. It is important to understand the community level to determine where health behaviors originate.
  4. Organizational: Organizations are instrumental in the development of behaviors as they often enforce behavior-determining regulations and restrictions. A school, for example, controls the dissemination of knowledge. This influence is significant when it comes to communicating information about safe health practices.
  5. Policy/Enabling Environment: Policies and laws that are instigated at local, national and global levels make up the broadest level of the Social Ecological Model. These policies have the potential to impact large numbers of people. A policy outlining a U.S. malaria aid budget, for example, will have far-reaching global effects for decades.

The Social Ecological Model is useful in the creation of sustainable solutions for at-risk individuals and societies. One approach to public health that considers many of the model’s levels is the practice of social change communication (SCC). Communities use SCC to facilitate discussions about beneficial and harmful practices in societies and to encourage people to speak about individual and communal problems. A health-based SCC discussion could cover anything from strategies developed to reduce pneumonia rates in babies to changing an outdated and potentially harmful social ritual.

SCC allows individuals and communities to influence shaping fairer, healthier societies. Its use of the Social Ecological Model ensures that the strategies it develops are implemented across a society.

Through SCC and other approaches, public health organizations are creating long-term solutions to the problems that plague individuals, societies and countries today. Only in understanding the numerous factors that influence harmful behavior can experts hope to tackle such problems effectively.

Sabine Poux

Photo: Flickr