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Madagascar is a country with an approximate area of 587 thousand sq. km. (UNO, 2001). Its population is 17.901 million, and the sex ratio (men per hundred women) is 99 (UNO, 2004). The proportion of population under the age of 15 years is 44% (UNO, 2004), and the proportion of population above the age of 60 years is 5% (WHO, 2004). The literacy rate is 73.6% for men and 59.7% 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 2%. The per capita total expenditure on health is 20 international $, and the per capita government expenditure on health is 13 international $ (WHO, 2004). The main language(s) used in the country is (are) Malagasy and French. The largest ethnic group(s) is (are) Merina and Betsileo, and the other ethnic group(s) are (is) Betsimisaraka, Bara, Tsimihety, Sakalava, etc. The largest religious group(s) is (are) indigenous groups, and the other religious group(s) are (is) Christian, Muslim and sects like Jesosy Mamonjy. The life expectancy at birth is 54.4 years for males and 58.4 years for females (WHO, 2004). The healthy life expectancy at birth is 47 years for males and 50 years for females (WHO, 2004).

EPIDEMIOLOGY

There is a paucity of epidemiological data on mental illnesses in Madagascar in internationally accessible literature. A national survey carried out in 2003 showed that disabilities were diagnosed in 8% of the population. One-fifth of the disabled people had mental (intellectual) deficiencies and 2.3% had mental illness (psychic deficiencies) (MoH, 2004). Ratsifandrihamanana and Terrnova (1961) analysed 92 cases of delirium in a mental hospital and compared the symptoms with those seen in European patients.

MENTAL HEALTH RESOURCES

Mental Health Policy A mental health policy is present. The policy was initially formulated in 2000. The components of the policy are advocacy, promotion, prevention, treatment and rehabilitation.

Substance Abuse Policy A substance abuse policy is absent.

National Mental Health Programme A national mental health programme is present. The programme was formulated in 2000.

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 mental health law dates back to the 19th century. The latest legislation was enacted in 1838.

Mental Health Financing There are budget allocations for mental health. The country spends 0.82% of the total health budget on mental health. The primary sources of mental health financing in descending order are tax based, out of pocket expenditure by the patient or family, social insurance and private insurances. The country has disability benefits for persons with mental disorders. Persons suffering from mental illness can avail 6-12 months of leave.

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. Mental health is being integrated into districts. Regular training of primary care professionals is carried out in the field of mental health. Training models and tools are being worked out. There are no community care facilities for patients with mental disorders.

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
  • 0.17
  • 0.08
  • 0.08
  • 0.01
  • 0.08
  • 0.013
  • 0.3
  • 0.08
  • 0.03
  • 0.02

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

Information Gathering System There is mental health reporting system in the country. The country has no data collection system or epidemiological study on mental health. A documentation centre is being planned.

Programmes for Special Population The country has specific programmes for mental health for children. There are also programmes for workers in the enterprise having alcohol abuse problems and programmes on epilepsy.

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


Source: World Health Organization Mental Health Atlas