7(H). Inadequate staffing


The CRPD places a duty on the Zambian government to establish a mental health system which is at least staffed so that patients are safe. This entails training professionals so that they are aware of patients’ rights.147 The Persons with Disabilities Act obliges the Ministry of Health to “include the study of disability and disability-related issues in the curriculum of training institutions for health professionals to develop appropriate human resources to provide general and specialised rehabilitation services”.148

The Ministry of Health has encouraged people to become mental health professionals. Two psychiatrists were due to qualify in 2014, with another seven in training. The Ministry informed MDAC/MHUNZA of plans to introduce a two-year BSc for 40 clinical officers of psychiatry and registered mental health nurses in the coming years. No training was available for occupational therapy or for psychiatric social work.

The major problem with regards to mental health staff, however, is not the lack of training opportunities. It is the lack of people. During MDAC/MHUNZA’s investigation five psychiatrists were working in Lusaka. In the city there were two psychologists, two psychiatric social workers and no specialised occupational therapists. There were no psychiatrists outside Lusaka. Access to psychologists was limited, and those that did exist tended to look after patients in the nearest hospital, rather than providing therapy in the community. Social workers and occupational therapists were in scarce supply.149 The whole country has around 200 clinical officers. These people are not doctors but have a diploma with specialisation in psychiatric care that entitles them to screen, prescribe and administer medication. There are only 200 registered mental health nurses. Non-specialised and lower grade staff members filled the massive staffing gap.

Staff said that psychiatry was off-putting to many potential staff, in part because of stigma.150 Low levels of staffing lead to serious human rights violations. Nurses said that they did not feel safe on the wards because there were so few nurses on duty. An acute ward at Chainama Hills Hospital had between 30 and 60 patients, with just two trained nurses or clinical officers and one nursing assistant on duty at any one time. At Kabwe, the male ward had up to 16 patients plus family members, with only one nurse on duty, and sometimes there were no staff on duty at all. Nurses complained about their deplorable working conditions and they noted that psychiatric wards had far poorer conditions than other wards, raising mental health equity issues.

147 Article 4(1)(i) of the CRPD.

148 Section 29, PWDA 2012.

149 Various studies have identified the problem of a lack of staff in Zambian psychiatric services. For example, one study showed there were 0.44 mental health personnel per 100,000 head of population working in public or private facilities in Zambia, predominately based at the Chainama Hills Hospital. Alice Sikwese et al., “Human Resource challenges facing Zambia’s mental health care system and possible solutions: Results from a combined quantitative and qualitative study” (International Review of Psychiatry, 22 (2010): 550–557).

150 See also Kapungwe et al., MHAPP Research Programme Consortium, “Mental illness – stigma and discrimination in Zambia”, 192–203.

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