Mental health still grossly underfunded but there are glimmers of hope

A StrongMinds mental health facilitator (center) speaks with former patients in Uganda. StrongMinds has treated more than 25,000 Ugandan women for depression with group talk therapy. Photo: Kevin Di Salvo

This was originally published on Global Health TV on February 28, 2018.

The problem with mental health and substance abuse in Africa and other developing countries is not that awareness has not been raised about these huge contributors to the global burden of disability.

Annually since 2009, the World Health Organization (WHO) Mental Health Gap Action Programme has been meeting to scale up services for mental, neurological and substance use disorders.

In 2013, the World Health Assembly adopted the WHO’s Mental Health Action Plan 2013-2020, which is designed to provide guidance for national action plans in all resource settings.

And most notably in 2015, world leaders recognized the importance of mental health and substance abuse in the newly minted Sustainable Development Goals. Within Goal 3 (the health goal) of the 17 SDGs, there is a target for mental health and another target for substance abuse. Here are the Goal 3 targets.

So mental health has finally been given a hard-fought and much-deserved seat at the global health table. It just has not been given much money or resources.

Faith community steps up its commitment to family planning

Twelve faith leaders read a statement of support for family planning from a larger group of faith leaders attending the International Conference on Family Planning in Indonesia in January 2016.

This was originally published on Global Health TV on Feb. 23, 2016.

NUSA DUA, BALI, Indonesia — To some, it may have been an incongruous image — twelve faith leaders, representing all the major religions of the world, standing on the stage at the closing ceremony of the International Conference on Family Planning (ICFP) here. After all, everyone knows that most religious leaders are against family planning, right?

That was never true, and now it’s becoming even less true. The twelve leaders represented 85 religious leaders and representatives of faith-based organizations (FBOs) who came to Bali from 26 different countries to discuss best practices and scaling up services to help families achieve what they like to call “the healthy timing and spacing of births” during a two-day Faith Pre-Conference.

It might surprise some to know that this support is not just for natural family planning, but extends to all forms of modern contraception with the single exception of sterilization, which is not approved by all types of Islam. All other modern methods are acceptable to all the religions represented at ICFP — Buddhist, Christian, Confucian, Hindu, Jewish and Muslim.

In Africa, gap between need and funding of mental health is huge

Adolescent boys in talk therapy group near Kampala, Uganda. Credit: StrongMinds

This was originally published on Global Health TV on June 29, 2015.

Sean Mayberry has spent his entire life surrounded by mental illness. As a child and an adult, people close to him have endured this affliction. But he had an epiphany when he happened upon a young man behind a farmhouse in Uganda, sitting in his own excrement and digging in the dirt.

“It was a turning point for me,” he recalls. “I left that young man knowing that I had to do something for the mental health of that continent.  He gave me the courage to try to make a difference for some of his mentally ill brothers and sisters.”

Pauline Muchina is dealing with mental illness in her family in Kenya. Her 50-something sister lost her job due to depression and had to come home to live with her mother. She is now on medication and attends counseling.

Muchina also has a nephew suffering from depression. While in a government hospital, he was chained to a bed for one week and his condition got worse. Now the family has found a private rehabilitation center for him. He is getting better but it is costing the family $2,500 for six months. Muchina’s family is middle-class and can pay the treatment (with difficulty), but the vast majority of Kenyans could never afford such expensive treatment.

Mental disorders and substance abuse are the third greatest contributor to the global burden of disability with 23% of the burden – greater than cardiovascular disease or cancer.

Young people most affected by HIV finally gain a seat at the table

Link Up aims to improve the sexual and reproductive health and rights of more than one million young people living with and most affected by HIV in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda. Here's a group of young people above in Ethiopia. Credit: International HIV/AIDS Alliance

This blog was originally published by the Huffington Post on Dec. 1, 2014.

Earlier this year, young Ugandans saw an opportunity to influence the HIV response in their country by coming together to determine their priorities for the New Funding Model of the Global Fund to Fight AIDS, Tuberculosis and Malaria, a major funder of HIV programs.

The meeting included young members of “key populations,” including people living with HIV, people who use drug, sex workers, transgender persons, men who have sex with men, fisher folk and truckers, and was facilitated by young women living with HIV. These young people are rarely consulted in a meaningful way in the design and implementation of HIV/AIDS programs, even programs targeting them, in Uganda and globally.

These priorities were eventually shared in the form of a Young Key Populations Priorities Charter. The priorities identified provided a template for action that, if accepted by the Global Fund, could lead to more effective programming for young people, increased engagement by young people in policy development and national planning processes and, ultimately, genuine change on the ground.

This is one example of how young people, and particularly those living with HIV and from these key populations, are starting to engage meaningfully in the design and implementation of HIV/AIDS programs meant to help them, something long past due.

Justified focus on Ebola should not compromise efforts against other diseases that kill more people

This blog originally appeared on Global Health TV on Sept. 23, 2014.

Ebola is a terrible disease that has already infected 5,335 people and killed 2,630 as of Sept. 14, according to the World Health Organization (WHO), and threatens to kill many more thousands before its rampage of destruction is slowed down or stopped. WHO designated it as a global emergency on Aug. 8.

“This Ebola epidemic is the largest and most severe and most complex we have ever seen in the nearly 40-year history of this disease,” said Margaret Chan, director-general of the WHO. “This is a global threat that requires global coordination to get it done. We can and we will bring the Ebola epidemic under control.”

Yet another of its terrible legacies may be that it will distract attention and resources from other diseases that are killing far more people.

We will not banish AIDS until we banish stigma

Eugene comes to a drop-in center for men who have sex with men.

This originally appeared on the ONE Campaign Blog on July 23, 2014.

Earlier this year, I met Eugene and Dominique at a drop-in center for men who have sex with men (MSM) outside Nairobi, Kenya.

Eugene, 23, comes to the center regularly to get condoms, lubricants and HIV counseling and testing, and has brought other gay men to the center. So far, he is HIV-negative.

Dominique, 26, also frequents the center. He was treated for a sexually-transmitted infection, and gets tested there every month. He, too, is HIV-negative.

In Kenya, most gay men are very much in the closet, due to the strong stigma against them. Many of these men would not have access to health services if not for the handful of drop-in centers in Nairobi, Kisumu and other urban centers for the simple reasons that most health facilities are not gay-friendly. Quite the contrary. Thus, most MSM have no access to gay-friendly services.

Kenya quietly takes public health approach with HIV most at-risk groups

Chief Rose Ayere talks to a group of injecting drug users in Nairobi.

This was originally published on Global Health TV on May 27, 2014.

NAIROBI and KISUMU, Kenya — Anti-gay legislation recently signed into law in Uganda and Nigeria has alarmed organizations implementing HIV prevention in Africa, fearing that such laws will further stigmatize and marginalize at-risk populations already hard to reach with health services.

So when I traveled to Kenya this month to interview men who have sex with men (MSM), injecting drug users (IDUs), and people working in programs trying to help them supported by the International HIV/AIDS Alliance, I wondered whether I would encounter “the next Uganda” in gay rights. I did not, but what I did find surprised me.

Markets have a role in malaria treatment

By sheer serendipity, I happened to pick up a copy of The Guardian (link text), my favorite British newspaper, in London last Thursday and saw an interesting piece on the challenges in providing malaria treatment by Sarah Boseley, the Guardian health editor. I thought Sarah captured very well the dire lack of Coartem malaria treatment in most of the country. But I was dismayed by the way she suddenly turned against the role of the market in providing such treatment at the very end of her story, even after admitting the failure of the public sector to do so and praising the ability of companies like Coca-Cola to make their products widely available.

So I felt compelled to challenge her dissing of the potential for markets to contribute to health care in developing countries, and today my letter was published in The Guardian.

And here is the story of my own encounter with malaria treatment in Uganda based on my trip to Uganda in 2008, and which I cited in my letter.