United Republic of Tanzania is a country with an approximate area of 945 thousand sq. km. (UNO, 2001). Its population is 37.671 million, and the sex ratio (men per hundred women) is 98 (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 85.2% for men and 69.2% 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 4.4%. The per capita total expenditure on health is 26 international $, and the per capita government expenditure on health is 12 international $ (WHO, 2004). The main language(s) used in the country is (are) Swahili and English. The largest ethnic group(s) is (are) African, and the other ethnic group(s) are (is) Arab. The largest religious group(s) is (are) Christian in the mainland and Muslim in Zanzibar, and the other religious group(s) are (is) Muslims and indigenous groups in the mainland.
The life expectancy at birth is 45.5 years for males and 47.5 years for females (WHO, 2004). The healthy life expectancy at birth is 40 years for males and 41 years for females (WHO, 2004).
Bondestam et al (1990) conducted a population survey on 10 776 randomly selected subjects in Zanzibar and found epilepsy in 4.9/1000 and psychotic disorder in 3.2/1000 of the population. Matuja et al (1995) reported on the prevalence of psychiatric disorders among 205 consecutive patients referred to a psychiatric unit over a 2 year period. Classification was done according to ICD-10. The ratio of males to females was found to be 1.6:1. A large number of cases were referrals from other departments of the same hospital and the remaining were from dispensaries and other hospitals. A fifth of the patients had consulted traditional healers prior to referral which was often delayed. The commonest presentations were psychosis (36.6%, of which three fourth were schizophrenia), neurosis (19.5%), seizures (16.6%), substance abuse (8.8%) and organic mental disorders (5.3%). Headache, sexual disorders and conduct disorders were also seen. Comorbid physical illness was present in 17%. Ndosi and Mtawali (2002) studied puerperal psychosis among 86 hospital inpatients using standardized questionnaires and ICD-10 criteria. The study was conducted prospectively over 2 years, and clinical progress was monitored. The mean age of patients was 23.6 years; the majority was primiparous women. Anaemia and infection were the major comorbid physical illnesses. The prevalence of puerperal psychosis was 3.2/1000 births. Organic psychosis was found in four-fifths of the mothers and schizophrenia in 8.1%. Most mothers received social support from their extended families. Ndosi and Kisesa (1997) examined the clinical notes of deceased patients in the same psychiatric unit over a 5 year period and found that functional psychoses (52.7%), organic psychoses (37.6%), epilepsy (6.2%) and puerperal psychosis (2.1%) were the main diagnosis among those who died. Two-thirds of patients were males, and the main cause of mortality in about half the patients was infectious diseases.
MENTAL HEALTH RESOURCES
Mental Health Policy A mental health policy is present. The policy was initially formulated in 1990. The components of the policy are advocacy, promotion, prevention, treatment and rehabilitation. The mental health policy is integrated into the national health policy of 1990.
Substance Abuse Policy A substance abuse policy is present. The policy was initially formulated in 1995. A substance abuse policy is a part of the drug control legislation.
National Mental Health Programme A national mental health programme is present. The programme was formulated in 1980. The programme was developed with the help of WHO and the Danish Development Agency.
National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is present. Details about the year of formulation are not available.
Mental Health Legislation A draft of an updated mental health legislation was initiated in 2000. The final draft has been placed before the parliament for approval in 2005. The latest legislation was enacted in 1958.
Mental Health Financing There are budget allocations for mental health. The country spends 7% of the total health budget on mental health. The primary sources of mental health financing in descending order are tax based and grants. A greater proportion of funding of mental health care is done by districts than was the case earlier. This makes the task of obtaining reliable figures on financing even more difficult. The country has disability benefits for persons with mental disorders. Psychiatric patients are exempt from cost sharing charges for treatment.
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. Most mental patients in Tanzania are initially seen in primary care facilities, dispensaries and health centres or traditional healing practices. Primary mental health care is provided by mental health nurses and general health workers. Some regions provide follow-up psychiatric care to patients as a part of primary health care. Regular training of primary care professionals is carried out in the field of mental health. There are community care facilities for patients with mental disorders. Regional mental health coordinators run community-based care for the mentally ill. There are 119 districts with district mental health coordinators. Psychiatric rehabilitation villages in 6 regions accommodate a total of between 80-100 patients at any given time. They provide ‘agriculture psychiatric rehabilitation’, sheltered living conditions for homeless psychiatric patients, continued treatment and training facilities in interpersonal relationships and a sheltered working place. The villages are managed by mental health nurse, nursing assistants, artisans and agriculturists who are responsible for the farms. A psychiatrist and medical social worker makes weekly visits. Each patient stays for an average period of 6 months with a range of 3 months to 2 years. Besides these, there is a network of traditional healers. The decentralized programme reaches about 20% of the population. External evaluation of the programme was carried out in 2 regions and it was found to be cost effective as it helped to decrease bed occupancy rates.
Psychiatric Beds and Professionals
psychiatric beds per 10 000 population
beds in mental hospitals per 10 000 population
beds in general hospitals per 10 000 population
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
In recent years, less than 50% of mental health nurses provide mental health care. There are 10 assistant medical officers in psychiatry. There are 3 centres at the tertiary care level. At this level, there is also a forensic psychiatric unit. In addition, there are 11 regions with psychiatric units with 30-50 general psychiatry beds, which provide care at the secondary level.
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. All regions send yearly statistics of mental patients attended at regional hospitals. Audit of inpatient records for the years 2001-2003 showed that the following disorders were common: neuropsychiatric disorders (47.2%), functional psychosis (34.5%), anxiety disorders, intellectual disability and alcohol and drug abuse. The country has data collection system or epidemiological study on mental health. The data collection system was developed for primary care facilities. In 2004, a pilot epidemiological study on mental health was conducted in Dar es Salaam.
Programmes for Special Population The country has specific programmes for mental health for refugees, disaster affected population and indigenous population. There are no specialized services for substance dependence or children. Family life education programmes in schools have a component of prevention of substance abuse. Similar programmes are being extended into colleges and community institutions with the help of grants from UNDCP and the Government of Finland.
Therapeutic Drugs The following therapeutic drugs are generally available at the primary health care level of the country: phenobarbital, amitriptyline, chlorpromazine, diazepam. Availability of psychotropics are variable. More psychotropics are available in large urban centres. There are very few drugs available in the primary care level.
Other Information An inventory that covers mental health services in Tanzania mainland has been completed. It covers all 20 regions’ reports.