National Capacity Building Program of Ethiopia
Project type: |
Program
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Objectives: |
To equip Ethiopia with necessary human resources to support mental health implementation and scale-up |
Brief description: |
Training for community health workers, primary care staff and all cadres of mental health specialists |
Project status: |
Ongoing
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Summary
Innovation summary
In Ethiopia’s public sector, approximately 40 psychiatrists, 3 mental health social workers, no clinical psychologists, no occupational therapists and an unknown number of psychiatric nurses serve a population of over 80 million.
The Ministry of Health (MOH) aims to support the implementation and rapid scale-up of mental health care through coordinated capacity-building of diverse cadres of workers:
- Mental health specialists:
- Four programs for bachelor’s-level psychiatric nurse training
- Two Masters-level programs for psychiatric practitioners
- Two Masters-level programs for clinical psychologists
- Post-graduate training of psychiatrists between Addis Ababa University and University of Toronto
- General health workers:
- Mental health curriculum and training developed for community-based health extension workers (HEWs)
- Scale-up of in-service training for nurses and health officers
- Researchers:
- “Sandwich model” for PhD study in Umeå University, Sweden
- In-country PhD program in mental health epidemiology at Addis Ababa University
Impact summary
- The number of psychiatrists has expanded from 12 to 40 in under 10 years
- 115 Masters-level psychiatric practitioners and over 490 psychiatric nurses will have graduated by 2014
Ethiopia’s capacity-building efforts have led to major increases in the human resources available to support mental health scale-up.
- National Capacity Building Program of Ethiopia
Innovation
Innovation details
The planned scale-up of mental health care outlined in the National Mental Health Strategy of the Federal Ministry of Health in Ethiopia is to be achieved by training general and primary health care workers to deliver mental health care.1 The MOH recognizes the need to build a multi-disciplinary, specialist mental health workforce to support scale-up across the health system.2
Special attention is given to developing clear career pathways to reduce “brain drain” of mental health professionals. Further, mental health research expertise is needed in order to evaluate the impact of scale-up and to develop a solid evidence base for culturally-appropriate, feasible, equitable, sustainable and cost-effective interventions. Thus the following capacity-building activities have been initiated:
Expansion of mental health specialists
Bachelor’s-level psychiatric nurse training
This program was started in 1983 in the only dedicated psychiatric hospital in Ethiopia (Amanuel Hospital) and has now been expanded to three regional cities (Gondar, Harrar and Mekelle).
Masters-level psychiatric practitioner training
Two programs are now available within Ethiopia. The first was started in 2009 as a collaborative undertaking between Gondar University and Amanuel Hospital. The second is based in one of the regional universities (Jimma University).
Post-graduate psychiatric training
Training of psychiatrists within Ethiopia was initiated in 2003 as a collaborative undertaking between Addis Ababa University and the University of Toronto.
Master- level clinical psychology training
Masters in Clinical Psychology programs have commenced recently in Gondar University (2011) and the School of Psychology, Addis Ababa University (2012).
Expansion of general health workers trained in mental health care
Community-based health extension worker (HEW) upgrading
A new curriculum and training materials for upgrading 38,000 Rural and Urban Health Extension Workers in mental health care have been developed.
Nurse and health officer training
Several programs of in-service training are being scaled up, spearheaded by the Ministry of Health in collaboration with the World Health Organisation (for health centers), Johns Hopkins University-Teshai program and I-TECH – University of Washington and Management Sciences for Health (for HIV services specifically).
Expansion of mental health research capacity
PhD-level mental health research training
A highly successful sandwich model for PhD study in Umeå University, Sweden, has now expanded local capacity sufficiently to run an in-country PhD program in mental health epidemiology (Addis Ababa University, with support from King’s College London).
Key drivers
National Policy
Working within the framework of a national policy (the National Mental Health Strategy1) has been an important driver ensuring sustainability and a future-oriented focus.
Committed Partners and Stakeholders
The high level of commitment from mental health professions even prior to the adoption of the National Mental Health Policy helped to put capacity-building efforts in motion. In addition, mutually beneficial collaborative relationships with external institutions have helped to develop robust training programs, while keeping the needs and priorities of Ethiopia foremost.
Challenges
Coordination and lack of prioritisation across institutions have posed challenges.
Continuation
Ethiopia plans to continue building the mental health capacity of its health system by:
- Scaling up the training of primary care and general health workers so that 300 health centres will be equipped with health staff who are competent to deliver basic mental health care
- Enhancing curricula and training materials for the pre-service training of all cadres of health worker in mental health care
- Expanding training of the multi-disciplinary workforce to include mental health social workers and occupational therapists
Partners
- Addis Ababa University – (Ethiopia)
- Amanuel Hospital
- Federal Ministry of Education (Ethiopia)
- Federal Ministry of Health (Ethiopia)
- Gondar University (Ethiopia)
- Jimma University (Ethiopia)
- Johns Hopkins University-Tsehai programme (USA)
- King’s College London (UK)
- Management Sciences for Health (USA)
- Regional psychiatric units in Mekelle and Jimma
- Umeå University (Sweden)
- University of Toronto (Canada)
- University of Washington – I-TECH – (USA)
- World Health Organization (Switzerland)
Funders:
Training of psychiatric nurses, Masters-level practitioners, and general health workers is funded by the Ministries of Health and Education.
The Ethiopian Ministry of Education funds the training of psychiatrists, clinical psychologists and PhD-level mental health researchers through higher education institutions.
In-service training is supported by non-governmental and international organizations such as:
- Department for International Development (UK)
- Fondation D’Harcourt (Switzerland)
- Johns Hopkins University-Tsehai programme (USA)
- Management Sciences for Health (USA)
- University of Washington – I-TECH – (USA)
- World Health Organization (Switzerland)
Impact
Evaluation methods
Formal evaluation has not yet taken place, though some process indicators are available.
Cost of implementation
Cost evaluation has not yet been undertaken.
Impact details
The expansion of human resources in mental health has allowed decentralization of mental health services and integration into the primary health care delivery system. With the recent program of task-sharing with primary care workers, mental health care has become available even closer to patients’ homes, which has led to a substantial improvement in access to mental health care.
Ethiopia’s capacity-building efforts have led to major increases in the human resources available to support mental health scale-up, including:
Psychiatrists
- The number of psychiatrists has expanded from 12 to 40 in under 10 years
- Only three of the Ethiopia-trained psychiatrists have migrated overseas
Masters-level Psychiatric Practitioners
- A total of 115 will have graduated by the end of 2013 and are now taking up positions in hospitals across the country where previously there were no mental health specialists
Psychiatric Nurses
- An estimated 491 nurses have been trained to date, although the number retained in the public sector is not known
PhD Graduates
- Out of 10 Ethiopians trained to PhD level within the field of mental health, 7 are still working in Ethiopia
- A further 11 PhD students in mental health epidemiology are currently engaged in their studies in Addis Ababa University
References
- Federal Democratic Republic of Ethiopia Ministry of Health. National Mental Health Strategy, 2012/13 – 2015/16. Addis Ababa: Ministry of Health; 2012.
- mhGAP-Ethiopia Working Group. Mental Health Gap Action Programme in Ethiopia: final document. Addis Ababa: Ministry of Health, Ethiopia; 2010.