Malawi is a country with an approximate area of 118 thousand sq. km. (UNO, 2001). Its population is 12.337 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 75.5% for men and 48.7% 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 7.8%. The per capita total expenditure on health is 39 international $, and the per capita government expenditure on health is 14 international $ (WHO, 2004). The main language(s) used in the country is (are) English and Chichewa. The largest ethnic group(s) is (are) Chewa, and the other ethnic group(s) are (is) Nyanja, Tumbuko and Yao. The largest religious group(s) is (are) Christian, and the other religious group(s) are (is) Muslim. The life expectancy at birth is 39.8 years for males and 40.6 years for females (WHO, 2004). The healthy life expectancy at birth is 35 years for males and 35 years for females (WHO, 2004).
There is a paucity of epidemiological data on mental illnesses in Malawi in internationally accessible literature. Carr et al (1994) compared characteristics of patients abusing marijuana with those of matched psychiatric patients and found that the abusers of marijuana (chamba) were more likely to be living in areas that grew chamba, less likely to be raised by natural parents and more likely to be educated. MacLachlan et al (1998) conducted focus groups to elicit responses from 44 male and 10 female psychiatric patients about their perceptions of marijuana (chamba) use in Malawi. Peltzer (1998) compared PTSD symptomatology among torture survivors from Malawi and refugees from Sudan in Uganda and found that among Africans somatic numbing was more common than psychic numbing as outlined in DSM-IV criteria. Simukonda and Rappsilber (1989) found high levels of anxiety among a group of male nursing students. They felt stressed about role differences between nurses and other male health workers.
MENTAL HEALTH RESOURCES
Mental Health Policy A mental health policy is present. The policy was initially formulated in 2002.
The components of the policy are advocacy, promotion, prevention, treatment and rehabilitation. Provision of comprehensive and accessible mental health care services is the main goal of the policy. It hopes to do so through the inclusion of mental health in the National Health Plan and integration of mental health in primary health care. Human resource development is also a component of the policy.
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 1999.
National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is present. It was formulated in 1995.
Mental Health Legislation The Mental Treatment Act was amended in 1968. Currently, the Act is being reviewed. The latest legislation was enacted in 1959.
Mental Health Financing There are budget allocations for mental health. The country spends 2% of the total health budget on mental health. The primary sources of mental health financing in descending order are tax based and grants. The country does not have disability benefits for persons with mental disorders. Mental disorders are not considered a disability.
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. Regular training of primary care professionals is carried out in the field of mental health. In the last two years, about 1000 personnel were provided training. In medical undergraduate training, students are encouraged to consider how they may address mental health issues through the many and varied roles which doctors in resource poor countries must fulfil (administrator, trainer, primary health care doctor, and hospital physician). Training of general health workers in mental health issues is planned in 3 regions. There are community care facilities for patients with mental disorders. Currently, the district mental health care provides community mental health services throughout the country. These centres are staffed by psychiatric nurses. Plans are under way to provide for monitoring and supervisory visits to all districts.
Psychiatric Beds and Professionals
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
There is one occupational therapist and 2 psychiatric clinical officers. Mental health services are now provided at central level, Zomba Mental Hospital, district hospitals and non-governmental hospitals and also at the health centre level, though the latter is not fully developed. Although, there are only few mental health professionals available in the country, general duty doctors are not deployed to the mental health services area. About 300 psychiatric nurses have been trained and posted in district health centres. Management guidelines and protocols are being developed.
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.
Programmes for Special Population The country has specific programmes for mental health for minorities, refugees and disaster uroductive Health Survey (2003)affected 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, lithium. Procyclidine is available.