36. rwanda.jpg


36. kigali.jpg

Rwanda is a country with an approximate area of 26 thousand sq. km. (UNO, 2001). Its population is 8.481 million, and the sex ratio (men per hundred women) is 91 (UNO, 2004). The proportion of population under the age of 15 years is 45% (UNO, 2004), and the proportion of population above the age of 60 years is 4% (WHO, 2004). The literacy rate is 75.3% for men and 63.4% for women (UNESCO/MoH, 2004). The country is a low income group country (based on World Bank 2004 criteria). The proportion of health budget to GDP is 5.5%.

The per capita total expenditure on health is 44 international $, and the per capita government expenditure on health is 24 international $ (WHO, 2004). The main language(s) used in the country is (are) Kinyarwanda, French, English and Swahili. The largest religious group(s) is (are) Roman Catholic, and the other religious group(s) are (is) Protestant and Muslim. The life expectancy at birth is 41.9 years for males and 46.8 years for females (WHO, 2004). The healthy life expectancy at birth is 36 years for males and 40 years for females (WHO, 2004).

EPIDEMIOLOGY

There is a paucity of epidemiological data on mental illnesses in Rwanda in internationally accessible literature. Bolton et al (2002) estimated the prevalence of major depressive disorder among Rwandans 5 years after a civil war. They interviewed a random sample of 368 adults living in a rural community with the Hopkins Symptom Checklist and a locally developed functional impairment instrument. Using DSM-IV criteria they found that 15.5% met Criteria A, C, and E for current major depression. Depressive symptoms were strongly associated with functional impairment in most major roles for men and women. The authors conclude that a significant part of this population has seriously disabling depression. Keogh et al (1994) interviewed a group of 55 HIV infected women in 1988 and again in 1991 and found some differences in needs for services and noticed an increased acceptance by families of the status of the patient.

MENTAL HEALTH RESOURCES

Mental Health Policy A mental health policy is present. The policy was initially formulated in 1995. The components of the policy are advocacy, promotion, prevention and treatment.

Substance Abuse Policy A substance abuse policy is present. The policy was initially formulated in 1995.

National Mental Health Programme A national mental health programme is present. The programme was formulated in 1995.

National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is present. It was formulated in 2000.

Mental Health Legislation The draft of the mental health legislation is being prepared with WHO’s support. Details about the year of enactment of the mental health legislation are not available.

Mental Health Financing There are budget allocations for mental health. The country spends 1% of the total health budget on mental health. The primary sources of mental health financing in descending order are private insurances, social insurance, out of pocket expenditure by the patient or family and tax based. The country does not have disability benefits for persons with mental disorders.

Mental Health Facilities Mental health is a part of primary health care system. Actual treatment of severe mental disorders is available at the primary level. At the primary care level, the patients are diagnosed, referred and followed up.

Regular training of primary care professionals is carried out in the field of mental health. In the last two years, about 60 personnel were provided training. There are community care facilities for patients with mental disorders. Motivating staff to work in the community and reinforcing pro-community behaviour continues to be somewhat difficult.

Psychiatric Beds and Professionals

  • Total psychiatric beds per 10 000 population
  • Psychiatric beds in mental hospitals per 10 000 population
  • Psychiatric beds in general hospitals per 10 000 population
  • Psychiatric beds in other settings per 10 000 population
  • Number of psychiatrists per 100 000 population
  • Number of neurosurgeons per 100 000 population
  • Number of psychiatric nurses per 100 000 population
  • Number of neurologists per 100 000 population
  • Number of psychologists per 100 000 population
  • Number of social workers per 100 000 population
  • 0.2
  • 0.2
  • 0
  • 0
  • 0.03
  • 0.02
  • 0.8
  • 0
  • 0.3
  • 0

There are 200 other mental health personnel.

Non-Governmental Organizations NGOs are involved with mental health in the country. They are mainly involved in advocacy, promotion, prevention and rehabilitation.

Information Gathering System There is no mental health reporting system in the country. The country has data collection system or epidemiological study on mental health. The district hospitals send quarterly reports to the central level.

Programmes for Special Population There are no special services available.

Therapeutic Drugs The following therapeutic drugs are generally available at the primary health care level of the country: carbamazepine, phenobarbital, sodium valproate, amitriptyline, chlorpromazine, diazepam, haloperidol, biperiden.

Other Information Rwanda’s mental health delivery system is a tiered set-up. At the bottom are the community workers and health centres, followed by the district hospitals with capabilities to manage mental disorders. The third tier is formed by different speciality hospitals like the Ndera which is the main neuropsychiatric set-up.


Source: World Health Organization Mental Health Atlas