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Mental Health care in poor resource settings
1. Mental Health care in poor resource settings
What can be done?
An experience from Aceh
Indonesia
Marthoenis
3 course of NCDs
Kobenhavn Universitet
rd
4. Aceh
Current Population: 4,5 Million out of 237
millions in Indonesia
29 years military conflict
One the poorest province in Indoenesia
One of the lowest HDI in Indonesia
5. Tsunami 2004
Banda Aceh, Calang and Meulaboh were
among the hardest area hit by tsunami 2004
In total; 170.000 died and 500.000 homeless
6. Tsunami 2004
Population Before the Tsunami was 4,271,000 (2004)
and as of 15 September 2005 was 4,031,589
Infrasctructures and local government were collaps
Main general hospital was destroyed
14. Resources!:
Some 500 CMH nurses
Strong commitment from the local goverment
BUT
Regulation?
Mental Hospital : Only one with 350 beds
6 Psychiatrists for 4.4 million population
16. The Programme:
Network between trained nurse
Case finding
Family of the patient
Mental health cadre
Referral system
Local social health Insurance
21. The Barriers
Saraceno et al 2007
Barrier 1: Low Political will
Barrier 2: Resistence to decentralization
Barrier 3: Difficulties in integrating Mental Health in PHC
Barrier 4: weak Human resurce capacity and development
Barrier 5: Mental health Leadership often lack of public health
skills
What is missing here?
22. Aceh Health Insurance (2010)
Social health insurance to ensure all people
have access to proper health care!
Premium paid by the local goverment
Problem
Similar number of resource while the
demand of health service is inreasing
Moral hazard
24. Messages!
Mental health is sooooooooooooooo much
neglected
But we can do something!
Start from now
Start from your self
Start from a small thing