On Thursday May 21 2014, Gede’s Managing Director (John Minto) and Performance Director: Resource Mobilisation and Partnership Management (Godwin Etim) met with the Ambassador of the Kingdom of the Netherlands, His Excellency, Mr John Groffen. The meeting marked the latest stage in the Foundation’s partnership with the Embassy as Gede delivered HIV-AIDS testing and counselling services to Embassy staff over 2006-2008. During the course of the meeting, it was agreed that Gede would deliver, to Embassy staff, a session of its ‘Managing Stress in the Workplace Programme’ while the Ambassador also expressed interest in working with Gede to mark Mental Health Day on October 10 2015. The meeting also reflected on the innovative ways in which the Government of the Netherlands is currently pioneering the use of ICT to prevent and ‘treat’ a range of mental health conditions – something which the Government has used to help address the mental health treatment gap. Watch this space for further news about the partnership between the Embassy and Gede
Gede and Mental Health Awareness and Advocacy Foundation in Nigeria
On the 14th May 2015, Gede participated at the 8th Annual Stakeholders’ Council meeting of the Mental Health Awareness and Advocacy Foundation in Nigeria held in Ibadan, Oyo State. Participants, mainly members of Civil Society Organisations from the Federal Capital Territory, Abia, Benue, Delta, Kano, Kwara, Ogun and Lagos States presented reports from their various activities in promoting the objectives of the Council.
Discussions covered i) mental health leadership and Advocacy Programme ( mhLAP ) phase two- using anti-stigma campaign and WHO quality rights toolkits, ii) plan of action for coming years, and, iii) funding opportunities including the next phase of Australian Agency for International Development(AusAID) grants supporting the work of the Council.
Participants agreed to the current gaps existing in the promotion of mental health through awareness, advocacy and treatment and called for more representation of the group on the national level. Gede was invited and welcomed into the Council due to its relevance in the objectives of the group and recognised within its key role in promoting mental health through research, advocacy and policy influence. It is expected that a synergy between the council and the CSO coalition chaired by Gede in the FCT will enhance the needed collaboration supporting national response for mental health treatment and care.
Integration…The Holy Grail of the Mental Health Movement?
As readers of Gede blogs will know, one of the key objectives of the ‘mental health movement’ is to see the screening, treatment and referral of common mental disorders (mainly depression and alcohol abuse) integrated into health service delivery platforms 9including through HIV-AIDS Adherence Counsellors). Although the strategy tends to give relatively little consideration to the reasons why a mental health ‘treatment gap’ exists (and almost totally ignores options related to capacity building Facility based health workers through, for example, ICT and qualified members of the diaspora), the core focus tends to be on developing ways in which to ‘task shift’ in health systems (even though this language seems to have become the slightly more politically acceptable ‘task sharing’) – essentially looking at ways in which mental health can be integrated into the busy daily lives of health workers. This utterly admirable aim runs the risk, however, of being practically difficult to implement or even ‘sell’ to those health workers whose waiting rooms and spaces are already bulging with people who need purely biomedical treatment and care. And what is the implication on ‘time management’ when patients (‘clients’ in our modern parlance) show more problematic mental health symptoms? We all know that long marches have to start with a small step, but one of the key issues in terms of ‘task sharing’ is that the health workers themselves seem rarely to be engaged in these initiatives…
Where are NGOs headed?
One of the key strengths of NGOs is that they have, historically, offered a mid-point between Government and the private sector. In theory, they offer a pathway to ‘development’ which places a heavy and appropriate emphasis on issues such as community engagement, partnership building, transparency and accountability. If this is true, why have some recent commentators reflected on what seems to be a growing lack of trust between ‘the public’ (especially in high income settings) and NGOs themselves? Where does this come from? I have always suspected that one source comes from what is often seen as the NGO value-added – the way in which they are driven by Vision and Mission. From my own experience, NGOs of all descriptions tend to (every five years) undertake a calendar driven and largely useless ‘strategic review’ which spends several days reaffirming their Vision and Mission statements, at the end of which appears ‘the strategy’. This tends to be a relative waste of time as for most agencies, Vision and Mission are not really up for real debate. Instead, NGOs might be better engaged with the approach of strategy experts such as Richard Rumelt who appeals for ‘strategy’ to be based on a response to very specifically identified problems, challenges and/or opportunities which are identified in 'scientific' and rigorous ways which would challenge the relatively superficial analysis (often second-hand and out of date) of many NGOs. Watch this space for more about strategy in the coming weeks.
Diaspora and Mental Health
It is relatively common to read that the key issue in many low and middle income countries, in terms of mental health, is the ‘treatment gap’ – essentially, the difference between the number of people who need mental health care (many) and the availability of those with the skills to provide it (few). There is an underlying belief that the way to address this gap is through ‘task shifting’ (or ‘sharing’ as it has become politically correct to state) within (eg) primary health care settings and while this might have merit, there is one group almost totally ignored in the various considerations of the key issues – the role of the diaspora. As has been shown in many countries, the role of experts who have left one country to go and live in another can be engaged through ‘virtual medicine’ with the use of, often, relatively low bandwidth connectivity. In the case of Nigeria, Gede is currently talking to partners to see how members of the diaspora (initially based in London, UK) could be engaged to help mentor facility based health workers – Drs and Adherence Counsellors. Watch this space.
ICT and Mental Health
I have often found it strange that while so many people in the world seem to have embraced mobile telephony as a daily part of their lives, NGOs in particular seem to struggle with the positive impact which modern technology can make. Although it is possible to read about the work of ICT research institutions along with the use of various apps produced here and there, practical examples (which are long term) of ICT seem few and far between. Recently, however, Gede has been reaching out to the UK based Medicine Africa (www.medicineafrica.com) which is currently working on systems building work in resource poor settings such as Somaliland where their use of ICT is making a real difference in terms of healthcare delivery. Given the much talked about 'treatment gap' within mental health in low and middle income countries, we can probably expect to see more emphasis on the uses of ICT in future. After all, with so many mental health experts residing in high income countries, why aren't they being engaged through ICT? jminto@gedefoundation.org
HIV-AIDS Test Results-What Happens When The Test Results are Positive?
One of the important – and pressing – emerging issues with regards to HIV-AIDS is focused on assessing ‘what happens’ to someone’s mental health immediately after they are told that they are HIV positive. In low and middle income countries, HIV-AIDS Counselling can tend to focus on rather general psychosocial support, while a growing volume of research is starting to indicate that highly specific support might very well be needed in a significant number of cases. This again shows the importance of ensuring that people who are diagnosed with HIV-AIDS are provided with the most appropriate support – even more so given that, thanks to medical advances, people living with HIV-AIDS are expected to live increasingly long lives
Mental Health and Positive Living
Today, the 13th May 2015, Gede Foundation Mental Health Dialogue Session hosted CSOs and engaged in a discussion on Mental Health and Positive Living with the Lead discussant being Ms Cynthia Linda Omeka, of the Organization for Positive Productivity. She made a strong case for the position of mental health for positive living infected and affected persons by saying that the first medicine for HIV positive individual is the state of the mind. A lot of discussion later centered on issue of disclosure and the psychological issues of rejection, anxiety, fear associated with it. Watch this space for more Mental Health Dialogue Session News.
Gede's Board Meeting
Earlier in the year, Gede held a Board meeting, during which a globally renowned mental health expert (and new Board Member), Dr Brandon Kohrt (http://globalhealth.duke.edu/people/faculty/kohrt-brandon), shared in the same view of engaging the diaspora to train facility based health workers as a way of addressing the 'treatment gap' existing in care and management of those accessing HIV-AIDS services.
During the same meeting, a long-standing Board Member Dr Yoku Shawtaylor has this to say-‘I have been a Board Member of the Gede Foundation for several years now and I am encouraged by the strides we have taken over the past 10 years to bring health services to the most vulnerable in our communities. Our health delivery services for AIDS-HIV treatment and ancillary support for education were innovative and trail-blazing. When we embarked on AIDS-HIV services, we were pioneers in Nigeria and West Africa for that matter. We made an impact through outreach, treatment services and social support for the most needy.
Now, Gede Foundation has mustered the chutzpah to confront another health issue that has long been neglected in our communities. Our focus on mental health aims to shed the requisite light on the lack of services and problems of access within our communities for mental health services. What is more important, we are trying to create an open dialogue about mental health – to foster greater understanding about mental health care and to focus more attention on how we can provide better care to those who need it. Join us in this endeavor’.
Prevalence Survey
13 May 2015
Today, Gede’s Managing Director (John Minto) and Performance Director: Research and Advocacy (Cynthia Ticao) along with ten Interviewers recruited for the forthcoming Prevalence Survey (of depression, alcohol abuse and suicidality in a sample of 1200 people living with HIV) visited Hospitals in Asokoro and Gwagwalada in order to meet the Teams who will be responsible for contacting and tracking Interviewees over a four month period of data collection. The meetings allowed Interviewers to become more familiar with their ‘workplace settings’ and helped to fine tune arrangements for ways in which Interviewees will be contacted for the survey. Final preparations are currently being made for the Survey which is expected to start collecting data towards the end of May