HealthNet TPO works in 14 out of 17 provinces in Burundi, a buildup that has been gradual. A substantial part of the mental health and psychosocial support activities is carried out with Dutch government funding. Some evaluation remarks on relevance of the programme:
The programme has gone through four phases, including a pilot phase. Each phase resulted in the integration of mental health and psychosocial support services in more and more provinces:
Pilot phase: 2000-2001
First phase: 2001-2004
Second phase: 2005-2007
In the second phase of the programme, direct services of psychosocial assistants were reduced in the western provinces and certain responsibilities were taken over by trained community volunteers. Also a training programme for psychosocial assistants of the Ministry of Solidarity was conducted in two Northern provinces of Muyinga and Kirundo. Three new provinces in the south were added, where psychosocial support counsellors were trained and psychosocial activities were established. The approach of the mental health component was two pronged:
Third phase: 2007-2008 (see the right column)
While psychosocial assistance in the three Western provinces was fully integrated into the services of community volunteers, in the Northern provinces of Kirundo and Muyinga the psychosocial assistance was integrated into services of the Ministry of National Solidarity (implemented by their psychosocial assistants working with the centres for Family Development (CDF) with supervision of HealthNet TPO). In the Southern provinces of Bururi, Makamba and Rutana psychosocial assistants were mobilizing community volunteers to take over the direct service delivery. The Ministry of National Solidarity took over psychosocial care in the province of Rutana.
This delegation to more community based structures consisted of training, ‘on the job coaching’ and supportive supervision by experienced psychosocial counsellors of HealthNet TPO. Psychiatric care was decentralized and integrated into primary health care services of the provincial hospitals in the provinces of Kirundo, Muyinga and Gitega as static clinics. HealthNet TPO has continued to provide technical assistance, supervision, psychotropic drugs and follow up of monitoring system. Mental health clinics are functioning in Ruyigi, Cankuzo, Kayanza, Muramvya, Bubanza and Cibitoke.
Fourth phase: 2008
Mental health services have been integrated into the primary health care in the provinces of Kirundo, Muyinga, Gitega, Makamba, Rutana, Karuzi and Bururi and lately also in Mwaro and Cankuzo province.
Recent activities: 2009-2011
During this period HealthNet TPO has maintained the programme following the successful period from 2000 to 2008. However this has taken place in a more project focused manner. The general programme building on the previous phases has been carried out emphasizing the following results:
In summary, the system of identification and management of people with mental health disorders within the health care system is improving through the collaboration between community structures and health facilities. But the next big step is to continue with mental health integration until district level and continue training of health centres in mental health diagnosis and strengthen referral systems to the hospital. Therefore continuous efforts need to be made to strengthen the collaboration between communities, health centers and hospitals.
In 2010, an estimated 35,000 community members of both local associations and international organizations received training in psychosocial awareness and service delivery, while 1,500 people were trained to provide psychosocial care. As a result, local associations, structures and authorities now have adequate capacity to develop their own programmes and provide psychosocial support.
Donors: Dutch Ministry of Foreign Affairs, UNHCR, War Child, Unicef, Care.
Aim: Improving the mental health of the population through the integration of mental health care services into primary health care services.
It is our aim that awareness of mental disorders and effective community management of people with mental disorders has increased, and the link with the health system for referral of more severe cases is made: mental health is now to be recognized as one of the priorities by the national and provincial health authorities. HealthNet TPO continues to provide supervision for services in these hospitals. Awareness raising programmes and counselling are delivered for specific vulnerable groups and address victims of sexual and gender based violence, child soldiers or prisoners. The programme contains two subprojects for children and refugees based on the same principles.