52. guinea bissau.jpg


52. bissau.jpg

Guinea-Bissau is a country with an approximate area of 36 thousand sq. km. (UNO, 2001). Its population is 1.537 million, and the sex ratio (men per hundred women) is 98 (UNO, 2004). The proportion of population under the age of 15 years is 47% (UNO, 2004), and the proportion of population above the age of 60 years is 5% (WHO, 2004). The literacy rate is 54.1% for men and 23.5% 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 5.9%. The per capita total expenditure on health is 37 international $, and the per capita government expenditure on health is 20 international $ (WHO, 2004). The main language(s) used in the country is (are) Portuguese (official). The largest religious group(s) is (are) indigenous groups, and the other religious group(s) are (is) Muslim. The life expectancy at birth is 45.7 years for males and 48.7 years for females (WHO, 2004). The healthy life expectancy at birth is 40 years for males and 42 years for females (WHO, 2004).

EPIDEMIOLOGY

There is a paucity of epidemiological data on mental illnesses in Guinea-Bissau in internationally accessible literature. A study by de Jong (1996) described the community mental health programme set-up in Guinea-Bissau. An epidemiological study was a part of the programme. A two-stage design was used to screen 351 consecutive adults and 100 children attending general health care set-ups in both rural and urban areas. Psychiatric disorders were present in 12% of the adults and 13% of the children attending a primary care centre. The commonest presentations were neuroses (74%). Psychoses were also common. Residence in rural/urban or war/no war zones was not significantly associated with occurrence of disorder. Overall, the programme showed a profitable cost/benefit ratio and a high sustainability over a 10-year period.

MENTAL HEALTH RESOURCES

Mental Health Policy A mental health policy is absent.

Substance Abuse Policy A substance abuse policy is absent.

National Mental Health Programme A national mental health programme is absent. All documents related to the national mental health programme were destroyed during the military conflict. A national mental health programme is being formulated with WHO support. It is likely to be ready for adoption in 2004-2005.

National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is present. It was formulated in 1984. After the introduction of the World Bank and International Monetary Fund Programme, the Essential Drug List Policy has suffered in more recent years.

Mental Health Legislation Details about the mental health legislation are not available.

Mental Health Financing There are budget allocations for mental health. The country spends 2.3% of the total health budget on mental health. The primary source of mental health financing is out of pocket expenditure by the patient or family.

The country does not have disability benefits for persons with mental disorders. Government employees with a medical attestation issued by the National Medical Committee receive their salaries.

Mental Health Facilities Mental health is not a part of primary health care system. Actual treatment of severe mental disorders is not available at the primary level. Patients with problems are sent to the mental health centre for treatment and follow-up. Regular training of primary care professionals is carried out in the field of mental health. A nation-wide intervention programme with training of health workers and repetitive supervisory visits was initiated. In 1984 itself, 150 health workers were trained in 5-day seminars. It was followed by the evaluation of the programme. By 1985, Guinea-Bissau was the first third world country to succeed in integrating a social-psychiatric programme into its basic health care services on a national level. In the next three years, 600 health workers were trained in order to compensate for transfers, deaths and emigration. Over 10 years, it sustained these efforts. In 1997, a programme was started to train primary care doctor and nurses in mental health, but it was interrupted due to the war. There are no community care facilities for patients with mental disorders. No community care exists due to lack of training and integration among workers. However, before the war, a community mental health programme was set up in 1983-84. The first part concentrated on epidemiological aspects. Subsequently, 850 primary health care workers were trained and supervised nationwide on their ability to manage mental disorders in patients.

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
  • 0
  • 0
  • 0
  • 0
  • 0
  • 0
  • 0
  • 0
  • 0

There are psychologists and social workers but they do not work in the area of mental health. In fact, two psychologists work in the Ministry of Health but not in the area of mental health. With support of WHO, one doctor initiated his specialization in Psychiatry in Cuba. The training will finish in October 2006. There was one mental health centre with 60 beds, but it was destroyed during the military conflict. After the Military Conflict, WHO helped in refurbishing two pavilions, which are being used for outpatient consultation and for inpatient care (2 rooms with 5 beds each and 2 other rooms for acute/emergency cases). Unfortunately the hospitalization unit is not functioning fully because of the inadequate support from the Government (electricity, water and security).

Non-Governmental Organizations NGOs are not involved with mental health in the country.

Information Gathering System There is no mental health reporting system in the country. The country has no data collection system or epidemiological study on mental health. The Work Plan for 2004/05 has suggested the inclusion of mental disorders in studies on the prevalence of non-communicable diseases.

Programmes for Special Population The country has specific programmes for mental health for refugees, disaster affected population, elderly and children. The Government, international organizations and NGOs help whenever there is a crisis and the situation demands activities for a special group of population.

Therapeutic Drugs The following therapeutic drugs are generally available at the primary health care level of the country: carbamazepine, phenobarbital, phenytoin sodium, amitriptyline, chlorpromazine, diazepam, fluphenazine, haloperidol, biperiden, carbidopa, levodopa. Hospital drugstores provide the drugs free. Other drugs are available from private pharmacies. Mental health centres obtain drugs from the central warehouse. The central drug deposit provides phenobarbital, haloperidol, amitriptylline, chlorpromazine and diazepam. Following the implementation of the Work Plan of 2002/03 and 2004/05 (supported by WHO) it is expected that the situation with regard to availability of psychotropics will improve.


Source: World Health Organization Mental Health Atlas