Nepal hosts 4th Annual PRIME Meeting
Contributors: Nagendra Luitel, Amit Makan
More than 13% of the global burden of disease is due to mental illness, of which 75% of people affected by mental illness live in Low and Middle-Income Countries (LMIC). According to World Health Organization (WHO), up to 4 out of every 5 people with mental illness in low resource settings go without mental health care. Lack of access to mental health services and human resources in mental health has kept these people out from mental health services. The 6 year UKAID-funded PRogramme for Improving Mental health carE (PRIME) is a response to this.
The 4th Annual PRIME meeting was hosted by Nepal's PRIME partner, TPO Nepal, in April 2014. The Kathmandu-based meeting provided a platform for each country team (including Ethiopia, India, Nepal, South Africa and Uganda), cross-country partners (WHO, Centre for Global Mental Health, BasicNeeds and the Perinatal Mental Health Project) and the management team to provide feedback on their progress in terms of integrating mental health into maternal and primary health care, and to co-ordinate the planning of the scaling-up phase of the programme. In additionl, the meeting was successful in facilitating a number of capacity building initiatives, including data management and research writing workshops.
The mental health situation is very fragile in impoverished countries like Nepal. Mental health services in rural areas is very limited where 85% of the total population resides. Little attention is given to mental health by the government. The government of Nepal has allocated only 0.8% of the gross health budget for mental health. There is only one mental hospital in the country with mental health department in few other district hospitals. There are 50 psychiatrists, and 22 psychiatric nurses in the whole country (Regmi, 2004). However, some non-governmental organizations have been providing psychosocial and psychiatric services in community level in ten districts of Nepal (WHO Mental health Atlas, 2005).
Although the mental health policy was formed in 1997, it has not yet been implemented. The policy content includes the integration of basic mental health services into primary health care centers, the establishment of human resources for mental health care, human rights for those living with mental illness and increasing awareness at the community level.
The WHO has emphasized on the integration of mental health services into primary health care centres in order to bring improvements in mental health care services.
Hence, we believe PRIME will contribute to lessening the burden of mental ii-health by generating world-class research evidence on the implementation and scaling up of treatment programmes for priority mental disorders in primary mental and maternal health care contexts, in low resource settings.
As a consortium of research institutions and Ministries of Health in five countries in Asia and Africa (Ethiopia, India, Nepal, South Africa & Uganda) with partners in the UK and World Health Organization (WHO), PRIME started in May 2011 and will be implemented until April 2017.
In Nepal, PRIME is being implemented in Chitwan district by Transcultural Psychosocial Organization (TPO) Nepal in collaboration with Government of Nepal, Ministry of Health and Population, and Netherlands based organization Healthnet TPO.
The program is divided into three phases viz. inception phase, implementation phase and scaling up phase, which is further described hereunder:
In the Inception phase (Year 1), we will develop an integrated mental health care plan comprising packages of mental health care for delivery in primary health care and maternal health care. The mental health care package is based on evidence based mhGAP guideline developed by WHO.
In the Implementation phase (Years 2-4), we will evaluate the feasibility, acceptability and impact of the packages of care in primary health care and maternal health care.
In the Scaling Up phase (Years 3-6), we will evaluate the scaling up of these packages of care at the level of administrative health units.