PRIMARY HEALTH CARE SERVICES

Primary Health Care Services Development Social Welfare Service Special Programmes Finance and Procurement Tertiary Health Care and Clinical Support Services Policy, Planning and Human Resources Development Human Resources Management and General Services Health Care Technology & Facility Management Atomic Energy & Radiation Protection Authority Health Information & Research General Management Pharmaceutical Services

Director: Naemi Shoopala
Telephone: +264 61 203 2700
Cell: +264 811221920
Fax: +264 61 203 2706
Email: Naemi.Shoopala@mhss.gov.na
Windhoek

Objectives

To translate and oversee the implementation of Health policies and programmes as an integral part of the health care delivery network based on the strategy and philosophy of Primary health care. Primary Health Care services are provided at communities, clinics, health centres and district hospitals. There are five divisions: Epidemiology; Public and Environmental Health Services; Family Planning; Information, Education and Communication (IEC); Disability Prevention and Rehabilitation.

The Services Include

1. The promotion of proper nutrition and adequate supply and utilization of safe water.
2. Reproductive health including maternal, child care and family planning
3. Immunizations against the major infectious diseases
4. Promotion of basic housing and proper sanitation
5. Prevention and control of locally endemic diseases
6. Appropriate treatment of common diseases and conditions
7. Education training concerning prevailing health and social problems in the communities and the methods of preventing and controlling them
8. Community based services

NATIONAL MENTAL HEALTH SERVICES

1. Administration

The national Mental Health Program is a unit within the Disability Prevention and Rehabilitation Division under the Primary Health Care Directorate.

The Mental health Program has the responsibility to promote mental health, prevent mental disorders, treat and rehabilitate affected individuals and families.
The National Mental Health Program aims to improve the standard of mental health care through a comprehensive Mental Health Care services and building of the capacity on mental health of all health care providers as well as the introduction of a strong community based mental health care program.
This program was established in 1995 as a section under sub division disability prevention, Division Disability Prevention and Rehabilitation, PH CS, by the ministry to address the issue of Mental Health Care delivery in the Country.

Its functions are:

Policy formulation, strategic planning, technical-support to all levels, implementation, monitoring and evaluation of the mental health activities.
This includes planning for human resource training.
Qualified psychiatric nurse currently heads the Mental Health Program.
The establishment of this unit provides the foundation on which future mental health services can be built.

2. Services

Mental health services are currently available at the following institutions:

2.1 Windhoek Mental Health Care Centre (National Referral Center)

The Windhoek Mental Health Care Centre is a department under the Windhoek Central Hospital. This Centre provides outpatient and inpatient services to adults and children, with a civil psychiatry bed capacity of one hundred and twenty four beds (124).

2.2.The Forensic Psychiatric Service

Unit is located in the same Centre and has eighty four (84) beds.
Outpatient clinic that provides service to a minimum of 45 patients on Monday and Wednesdays.

Out reach clinics around Windhoek are conducted from Monday to Friday at average 20 patients per day.
The Centre has the following full range of professionals, but their numbers are insufficient.
1. PSYCHIATRISTS X 2
2. MEDICAL OFFICERS X 3
3. CLINICAL PSYCHOLOGISTS X 2
4. TRAINED PSYCHIATRIC REGISTERED NURSES X 36
5. REGISTERED NURSES X 3
6. ENROLLED NURSES X 45
7. OCCUPATIONAL THERAPISTS X 4
8. SECURITY ORDERLIES X 27
9. PRISON OFFICERS 13
10. Social workers x 2

2.3. The Oshakati Psychiatric Unit

Located in Oshana region, Oshakati intermediate Hospital. This unit is serving Oshana, Oshikoto, Omusati and Ohangwena regions
It is having a bed capacity of 80) beds, but admits up to ninety (90) patients per day.
There is a large outpatient clinic that provides service to a minimum of 100 patients per day. This unit has the following professionals:
1. PSYCHIATRISTS X 1
2. CLINICAL PSYCHOLOGISTS X 0
3. MEDICAL OFFICER X 1
4. TRAINED PSYCHIATRIC REGISTERED NURSES X 7
5. REGISTERED NURSES X 7
6. ENROLLED NURSES X 18
7. OCCUPATIONAL THERAPISTS X 1
8. SOCIAL WORKERS X 1

The above specialized staff are therefore not sufficient.

Some services are also provided at the district hospitals. Currently services are not community-based and inadequately integrated into primary health care.
Private practitioners also provide mental health services in Namibia, but these services are limited to those who can afford them.
Doctors, nurses, psychologists and occupational therapists in private practice refer some clients and patients to the mental health care unit in Windhoek.

The number of those individuals suffering from mental disorders who seek the services of traditional healers is unknown.

3. REFERRAL SYSTEM

Patients from outside Windhoek are first handled at their nearest health facilities.
The responsible doctors follow referral guidelines sent out to all regions by the psychiatrist. According to these guidelines, the patient should first be treated for at least 72 hours in the service at which they present.
After 72 hours if there is no improvement in the patient’s condition, the doctor should refer the patient to the psychiatrist. However, there are still problems experiences in the referral system, because the health professionals at the peripheral level are not sufficiently skilled and lack the competence to handle the mentally ill patients.

4. AVAILABILITY OF PSYCHOTROPIC MEDICATION

Psychotropic medication in Namibia is made available, according to the Namibian Essential Medicines List (NEMLIST). The list has a sufficient range of drugs for the treatment of the mentally disordered individuals who require medication. These drugs are available through district hospitals.

5.MENTAL HEALTH LEGISLATION

Mental health services are provided under the Mental Health Act, Act no 18 of 1973.
A new Bill is in the advanced stages of development. This is an essential element of reform that is needed as part of the implementation of the mental health policy.

6. NATIONAL POLICY FOR MENTAL HEALTH

This policy was launched in 2005.
7. TECHNICAL PROGRAMME AREAS:
1. Continuous awareness creation on promotion of Mental Health and Mental Disorders
2. Orientation on the content of the Mental Health Policy in all the regions.
3. Capacity building on Mental Health Care providers through in service training at all levels.
4. Restructuring, refocusing and re organization of mental health services toward Vision 2030 sub regional strategy and recommendations.

8. CONSEQUENCES AND IMPLICATIONS OF THE CURRENT SITUATION

From the available data it is estimated that only a small percentage of mentally disordered individuals are receiving appropriate evidence-based mental health services. This situation is attributed to various factors, but the most important ones are listed below:
1. Limited skilled mental health care professionals
2. Inability to accurately diagnose mental disorders
3. Inaccessibility of available services
4. Ill-informed belief systems about the causes, as well as the treatment of mental disorders
5. Lack of follow up and after care
6. Lack of rehabilitation programmes and facilities
7. Lack of regional level management representation for mental health

9. MAIN ISSUES TO BE RESOLVED OVER THE NEXT 2-5 YEARS
1. Capacity building of health care providers in mental health
2. Improvement of quality of care of the present mental health institutions
3. Identification of mental health topics for a research.
4. Supervision and monitoring
5. Evaluation of the programme for re-planning.
6. Mid and end term services evaluation and continuous monitoring of the implementation process
7. Finalization of the development of Mental Health Bill.
8. Overall structural review and reorganization of mental health care services.

10. CONCLUSION

Specialized mental health services are available at the Windhoek Mental Health Care Center and Oshakati Psychiatric Unit. Some services are also provided at the district hospitals.
Treatment outcomes of mental health services depend on early detection and intervention, as close to home as possible and with the involvement of the family. To achieve successful outcomes, there is a need to decentralize and integrate the mental health services into the existing primary health care systems, as well as to develop community-based services.
These services can be delivered with the right quality and quantity of human resources, improved referral systems and allocation of proportionate financial resources.