7(A). History and context

English

Formal mental health care was introduced in the late 1920s and admissions and discharge were set out in the Mental Disorders Ordinance 1951. Little has changed since these colonial era origins, and the ethos of confinement plagues the mental health system today.104 As antipsychotic medications became available and affordable, the Chainama Hills Hospital opened in 1962 as the country’s only mental hospital. In 1981 the government tried to integrate mental health into primary healthcare. This was unsuccessful because it was underfunded and there was resistance from Chainama Hills Hospital staff who wanted to continue working in the hospital.105

In 1992 the government initiated the “Basic Health Care Package”, but mental health was not listed as a priority.106 Although the Zambian cabinet adopted a mental health policy in 2005,107 there was no stakeholder participation, the policy was not evidence-based, and contained no analysis about the needs of people with mental health issues.108 As a result the document had little traction and led to little change.

Improvements to mental health services were listed amongst the objectives of the National Health Strategic Plan 2011–2015.109 De-centralisation of mental health services to district level was planned through the Ministry of Community Development, Mother and Child Health. This too, seems to have made no difference. Mental health provision continues to be centralised at Chainama Hills Hospital and seven other government-run hospitals dotted around the country.110 There are very few mental healthcare services in primary healthcare.111 A handful of non-governmental organisations provide small-scale mental health support services, ranging from peer support to rights advocacy.112 Monitors found evidence of only four mental health service-user groups that have been active in providing peer support, livelihood services or rights advocacy. They are increasingly consulted by the government on legislative and policy development.113

Funding allocated to mental health services is excruciatingly low. According to the 2013 national budget analysis, 11.3% of the country’s budget is spent on health.114 This falls short of the 15% required by the Abuja Declaration.115 Of the 11.3%, Zambia spends less than one percent on mental health.116 It is difficult to track how even this small sum is spent, because most mental health units receive funding to cover the items which they “need”; they have no annual budget as such.117

The government covers approximately 60% of each person’s healthcare costs, with the remaining 40% met by development partners and patients’ fees.118 The Department of Mental Health at the Ministry of Health receives an estimated 300,000 Kwacha (approximately 36,000 EUR) per year to run mental health programmes across the country. Therefore, of the 11.3% national health budget mental health gets 0.008%. It is therefore heavily reliant on external funding from donors such as the World Health Organization and the UK Department for International Development.119


104 Ministry of Health, Mental Health Policy (Lusaka: MoH, 2005).

105 Information from the 2005 Mental Health Policy, 4.

106 Interview with John Mayeya, Director of Mental Health, Ministry of Health, 3 February 2014. See also Civil Society for Poverty Reduction, An Easy Look at Zambia’s Poverty Reduction Strategy 2002–2004 (Lusaka: CSPR, undated).

107 Republic of Zambia, Ministry of Health, Mental Health Policy (Lusaka: MoH, 2005).

108 Jason Mwanza et al., “Mental Health Policy Development and Implementation in Zambia: A situation analysis”, 54 30 March 2008, supra note 71.

109 Republic of Zambia, Ministry of Health, National Health Strategic Plan 2011–2015 (Lusaka: MoH), Objective 5.1.2.10.

110 Other hospitals identified as providing outpatient mental health services are University Teaching Hospital (Lusaka), Choma General Hospital (Choma), St Francis Hospital (Katete District) and Senanga General Hospital (Senanga District).

111 There have been several general health care reforms since the late 1980s, focusing on decentralisation to regional and district health structures. See, Catharina Hjortsberg and Chris N. Mwikisa, “Cost of access to health services in Zambia” (Health Policy and Planning, 17 (2002): 71–77); and Jason Mwanza et al., “Mental Health Policy Development and Implementation in Zambia: A situation analysis”, supra note 71; M. A. Omar et al, Mental health and Poverty Research Programme Consortium (MHaPP) “Mental health policy process: A comparative study of Ghana, South Africa, Uganda and Zambia”, (International Journal of Mental Health Systems 4 (2010):24).

112 Mental Health Association of Zambia, Mental Health Users Network of Zambia, Christian Organisation for the Mental Patients, Saint Francis Mission Livingstone and Prisons Care and Counselling Association.

113 The four groups who have been consulted are Mental Health Users Network of Zambia, Mental Health Association of Zambia, Care Ministry for the Mentally Ill and Christian Organisation for the Mental Patients. Some of these include professionals and carers as members of the group.

114 Zambia’s 2013 National Budget Analysis, available online at: http://www.africaymca.org/k2africannews/item/1194-zambias-2013-national-budget-analysis (last accessed: 09.07.2014).

115 In April 2001, African Union countries met in Abuja, Nigeria, and pledged to increase government funding for health to at least 15% of GDP. In its 2012 Universal Periodic Review by the UN Human Rights Council, the Zambian government said it would take all necessary steps to honour its commitment under the Abuja Declaration.

116 Jason Mwanza et al., “Mental Health Policy Development and Implementation in Zambia: A situation analysis” 30 March 2008.

117 Interview with John Mayeya, Director of Mental Health, Ministry of Health, 3 February 2014.

118 Jason Mwanza et al., Mental Health Policy Development and Implementation in Zambia: A situation analysis. 30 March 2008.

119 Supra note 118.

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