Posted on: 23 February 2023
CNWL received a grant from Health Education England last year to help Mirembe Hospital, Tanzania’s national mental health hospital, develop a community based mental health care service. Chris Bumstead, Coordinator for CNWL International Healthcare Partnerships, will be in Tanzania until April, delivering training and advocating for the resources and policies required to build this initiative. This will be the first of several blogs Chris shares about his progress in Tanzania.
12 February 2023
Myself and staff from Mirembe Hospital have been discussing the possibility of a community-based mental health service for the past eight years. So, it’s been fantastic to be back in Tanzania for the first time since the coronavirus pandemic started. The welcome and hospitality has, like usual, been as warm as the weather.
Why we are here
Developing a new service takes time, planning, additional resources and training. This will be the agenda for my extended stay until the beginning of April.
Currently, there is no established community mental health service in Tanzania, other than a very small handful of community mental health workers scattered across the country (there are 3 to cover the whole of the Dodoma region – an area roughly the size of London to Newcastle!). This is nowhere near the necessary resource amount to meet the demand for early intervention and follow-up care.
Fortunately, the national lead for mental health at the Ministry is the former director of Mirembe Hospital, Dr Erasmus Mndeme. He is a firm supporter of the concept of community-based care and a strong ally within the Ministry of Health. Mental health services in Tanzania receive approximately 6% of the total health budget. This is totally inadequate for the country’s needs. Our challenge therefore is to persuade the Ministry to allocate a more realistic and proportionately balanced budget for hospital and community mental health services.
What we’ve achieved
Three weeks ago, I arrived with Sara Edwards and Paulina Yanez who have been my CNWL companions. They have supported me to train a group of sixteen ‘champions’ who will continue to deliver training to their colleagues at Mirembe hospital and local district hospitals. They, in turn, have trained a group of 13 staff members at Mirembe and a further 22 at two district hospitals in the Dodoma region.
The training we’ve delivered so far has focused on mental health, substance use, good practice of recovery-based, user-involved care planning, and the delivery of safe and effective interventions in the community. In other sessions, we’ve explored risk assessment and management, motivational interviewing and psycho-social interventions amongst other topics – a very full programme!
Sara and Paulina have now left Tanzania but will continue to be involved in the project through mentoring groups and training online. Prior to leaving, we all had a meeting with Dr Paul Lawala, Director of Mirembe Hospital. In this meeting, we gave feedback and discussed our report on the training, our impressions and observations, and most importantly, the suggestions of the Mirembe and District Hospital staff for possible next steps.
Moving forward, I shall be working with the Mirembe staff in small working groups over the next few weeks to address documentation and communication, referral criteria for the community service, team operational issues, the ongoing training programme for Mirembe and other districts nationally, and the ongoing partnership with CNWL. I also hope to have some meetings at the Ministry of Health with Dr Lawala.
Wish us luck! There’ll be more to follow.
We will be setting up mentoring groups to assist in the work ahead, so if anyone is interested in being involved in this please contact me at c.bumstead@nhs.net
