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 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

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:

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

  1. Federal Democratic Republic of Ethiopia Ministry of Health. National Mental Health Strategy, 2012/13 – 2015/16. Addis Ababa: Ministry of Health; 2012.
  2. mhGAP-Ethiopia Working Group. Mental Health Gap Action Programme in Ethiopia: final document. Addis Ababa: Ministry of Health, Ethiopia; 2010.

Research

Tools

Multimedia

Reports

Comments

Submitted by Willis A. Yansine on Monday, 18th January 2016
I ready want to do some online couse in mental health

Submitted by Shamaila Usmani on Tuesday, 19th January 2016
Hi Willis, Here is a great resource for some mental health courses: http://www.pitt.edu/~super1/assist/topicsearch.htm#G. We are also in the process of collating similar lectures for global mental health on this site so please stay tuned! I also recommend our courses forums thread (http://mhinnovation.net/forum) as MHIN members often share related online courses here.
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