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Mental Health in AfghanistanDecades of violent civil war and political unrest have debilitated Afghanistan’s healthcare system and led to the populations’ exceedingly high rates of mental illness. In 2004, Afganistan’s Ministry of Public Health (MOPH) declared mental health in Afghanistan a top priority. Today, the National Strategy for Mental Health (NSMH) is taking a multifaceted approach to improving the mental health of Afgan citizens.

The National Strategy for Mental Health aims to provide a “community-based, comprehensive” system with “access to treatment and follow up of mental illness and related conditions.” One of the primary goals of this system is to integrate mental health services into Afghanistan’s Basic Package of Healthcare Services (BPHS). Within the first 10 years of mental health integration into the BPHS, 70% of patients utilizing mental health services reported “significant improvement.” Other developing countries may wish to follow Afghanistan’s lead and to begin implementing their own mental health initiatives.

Women in Taliban-controlled Areas

Mental health surveys of Afgan women in Taliban-controlled areas exemplify the link between stress and mental illness. Women living in these areas report experiencing gender segregation and violent treatment. This includes restricted employment and education as well as domestic abuse and lack of health resources.

A survey of 160 Afghan women during the 1996-2001 Taliban regime showed many Afgan women suffer from mental illness. The survey results displayed that out of the 160 women,

  • 42% had PTSD symptoms

  • 97% had major depression

  • 86% had severe anxiety

Additionally, Afgan women living in Taliban-controlled areas suffered from depression at almost three times the rate of women living in non-Taliban-controlled areas (78 % versus 28 %).

Integration of Mental Health Services

In many countries, mental health support falls under general health funding, which results in very little direct funds for necessary mental health resources. However, as a result of successful integration by the Afghan government and restructuring of its healthcare system, resources for mental health in Afghanistan are available within the national healthcare infrastructure. The critical decision to absorb mental health in Afghanistan into general health has allowed mental health training to become a priority among all general physicians in addition to specialists.

The National Institute of Mental Health reports that people suffering from mental illness can potentially die anywhere from 13 to 30 years before their counterparts with no mental health problems. The integration of mental illness into general health equips primary physicians with the resources and training to diagnose and treat conditions. Transferring training and resources to primary health caregivers makes mental health services more accessible to the general public.

Afghanistan’s NSMH recognized that medication alone cannot fix mental health problems in Afghanistan. Medication treats the symptoms of trauma, not the source. This can lead to social isolation. This research led the NSMH to switch from a strictly medical treatment plan to a biopsychosocial treatment plan. This provides patients with counseling services, including stress management and domestic violence training for community health workers and teachers.

Impact of Mental Health Services

Before 2004, there were no psychiatrists working for the government. Furthermore, mental health receives less than 1% of physician training. After the integration of mental health services into the BPHS, each district hospital in Afghanistan has a full-time mental health physician who has received a two-month training in psychiatric care.

In regions that previously had no access to mental health services, there are now health facilities with health workers trained in identifying mental health disorders and creating treatment plans. These facilities can provide services for up to 60,000 people. Between 2002 and 2012, when mental health service programs were implemented, more than 900 community health workers and hundreds of doctors, nurses and midwives received training in mental health services.

Furthermore, in 2001, only 10% of the Afghan population lived within a one hour walk from a health facility. The BPHS increased the presence and accessibility of health facilities serving mental health in Afghanistan. Afterward, the overall patient visits to health facilities grew from two million to more than 44 million per year, which shows that the facilities were utilized frequently. In 2004, 22% of the health facilities served a minimum of 750 new patients per month. In 2008, 85% did.

Economic Incentive

Especially in developing countries, prioritizing mental health creates a more sustainable economy. According to the World Health Organization, depression and anxiety account for $1 trillion per year of lost or diminished output in the global economy. Additionally, when workplaces do not provide mental health resources, they lose the equivalent of 45 years of work per year. Mental health consequences on the economy and a population’s health are even greater in low-income countries due to the increased prevalence of stigmatization, superstition and treatment inaccessibility.

In addition to ethical incentives, governments have economic incentives to provide mental health services and resources because there is an economic advantage to having a healthy workforce. A failure to recognize and support populations suffering from mental health problems leads to a loss in economic productivity. Globally, every $1 that is invested in mental health disorder treatment translates to $4 in productivity and well-being.

Global Investment

Afghanistan’s next goal is to increase access to the BPHS for the remaining quarter of the population who still struggle to acquire health care. The growth of the BPHS and the Afghan government’s promise to expand its services to reach every citizen requires some economic input from international donors; however, the BPHS does not intend to rely on international donors forever. The World Bank, European Union and United States Agency for International Development (USAID) have been the largest donors to Afghanistan’s BPHS since the creation of the BPHS. However, each has diminished their contributions over the years.

Between 2003 and 2009, each of their individual financial contributions funded about one-third of the BPHS resources for mental health in Afghanistan. These contributions also supported technical and infrastructural support by funding construction and renovation of health facilities as well as road work projects to increase accessibility for rural populations. Between 2010 and 2012, USAID cut its contributions from $4.5 billion to $1.8 billion. Until the MOPH finds permanent funding for mental health in Afghanistan, the funding will come from donors, taxation, public spending and out of pocket pay for patients.

To fully universalize accessible and affordable mental health resources, the world, and particularly global leaders such as the United States, must continue to invest in mental health and commit to fighting poverty worldwide. Reducing global poverty reduces civil unrest, which decreases the rate of mental health problems. The World Bank, European Union and United States Agency for International Development (USAID) are the largest donors to Afghanistan’s BPHS. Continuing global support for mental health strategies helps not only poverty-stricken countries address mental health needs, but supports the global economy by increasing each populations’ well-being and productivity.

Nye Day
Photo: Flickr

Centers of Excellence
Egypt and the United States have recently become dependent on each other in order to assist in each other’s growth, developments and establishments, showing a strong partnership between the two countries. The United States Agency for International Development (USAID) has collaborated with Egypt to create three academic Centers of Excellence that will focus on research about agriculture, energy and water. In order to begin the process of these academic Centers of Excellence, universities in the United States and Egypt had to form partnerships to focus on each focal point.

Academic Center of Excellence in Agriculture

The United States’ Cornell University and Egypt’s Cairo University are partners for the Academic Center of Excellence in Agriculture (COEA). This is a $30 million dollar, five-year collaborative project that will enhance curricula and research in order to train and equip Egyptian students with the right tools to improve agricultural production in Egypt’s future.

There are three main components of this specific center. The first is the instructional innovation and curriculum development of the academic center. The partnership will establish a new interdisciplinary Master of Science program that will be work-force oriented. This center will also grant opportunities to youth, women and disadvantaged students. The second component is to engage in high quality applied research. The last component includes exchanges, training and scholarship programs.

Academic Center of Excellence in Energy

The next $30 million dollar, five-year collaborative partnership is between the Massachusetts Institute of Technology and Ain Shams University. This will be the Academic Center of Excellence in Energy (COEE). MIT and Ain Shams University will work to build research, education and entrepreneurial capacity to address Egypt’s most pressing energy-related issues.

This academic Center of Excellence has four major components to it. The first is the teaming up of Egyptian faculty and students with interdisciplinary researchers across MIT to develop renewable energy solutions. The next component is to advance and scale up sustainable projects. These universities will also use their partnership to facilitate connections between university researchers and key industrial players in the region to expand Egypt’s solar and wind usage, in addition to other forms of clean energy. Lastly, there will be an emphasis on involving Egyptian women and people with disabilities in the university and providing programs and education for them.

The Center of Excellence in Water

The Center of Excellence in Water (COEW) is a partnership between the American University in Cairo and Alexandria University. The COEW is also a $30 million dollar, five-year collaborative project. These universities are still developing their partnership.

The Centers of Excellence was designed by the USAID and the Ministry of Higher Education and Scientific research with the goal of driving public and private sector innovation, modernization and competitiveness. This $90 million dollar investment will create partnerships between Egyptian public universities and U.S. universities, update university curricula and teaching methods, establish undergraduate and graduate level scholarships and implement exchange programs to foster cross-border learning. This is a breakthrough in education and the professional industry which will work to enhance Egypt as a whole.

– Lari’onna Green
Photo: Flickr

girls in Malawi
The United States Agency for International Development will spend between $4.5 million and $10.4 million to encourage girls in Malawi to use birth control.

This plan intends to prevent pregnancy and STDs, especially HIV.

Part of USAID’s “Girls’ Empowerment through Education and Health Activity” plan, this grant will endow sexual and reproductive health and family planning education for young girls in Malawi. It seeks to combat the lack of HIV and sexual and reproductive health education and services.

The grant explains that “sexual acts that resulted in a pregnancy also place girls at risk for leaving school and/or contracting HIV.” Females, especially young girls, are disproportionately affected by HIV compared to men. In 2010, the HIV occurrence rate for girls between the ages of 15 and 19 was 4.2 percent as opposed to 1.3 percent for males.

The grant calls for more resources to teach about sexual reproductive health, HIV and family planning. USAID has stated it is important for young women to know correct information about these topics.

However, the 2010 Malawi Demographic and Health Survey exposed that even though there has been an increase in the use of modern family planning in Malawi, the HIV rate has remained.

Access to birth control and other methods does not appear to be a problem for women in Malawi.  However, Malawi ranks tenth in the world for the number living with HIV/AIDS, and ninth worldwide for the number of fatalities from HIV/AIDS.

The grant also aims to improve literacy skills for girls and access to schooling. The grant states that this will lead to more achievement for girls in school.

This initiative in Malawi is one more step in encouraging Family Planning 2020’s aim to provide 120 million more women and girls with contraceptives by 2020.

Colleen Moore

Sources: CNS News, Life Site
Photo: USAID