Human resource development for mental health services in Afghanistan : a case study approach
Date of Award
Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)
Community Health Sciences
Most of Afghans have suffered from poverty and displacement due to prolonged war and with war mental health has become a major public health issue. Therefore, mental health services are amongst top priorities of the MoPH. However, Afghanistan has limited skilled professionals for mental health services. Thus, there is need to review the existing documents and explore stakeholders perspective on human resources development of mental health services. The purpose of this study was to identify areas for strengthening of human resource development for mental health services to improve mental health of Afghan population. Methodology: This was a qualitative descriptive case study. Three methods were used for data collection from July to August 2013. Initially the purposive documents review was carried out to find policy level initiatives and gaps. Secondly, eighteen interviews were conducted with purposively selected key-informants from MoPH, NGOs and INGOs and two FGDs were conducted with purposively selected Kabul mental health hospital service providers using semi-structured guidelines. The transcribed data were thematically analyzed in NVivo-10 software. Findings: Documents review and IDIs and FGDs responses have revealed that there are policy and program level initiatives and gaps for human resource development. The policy level initiatives include, mental health is in the first tire of MoPH priorities, integrated with primary health care, National Mental Health Strategic Plan (NMHSP) exists and human resource development is encompasses as the sixth components of this plan. Unfortunately there are drawbacks at policy level. The foremost is less resources for human resource development in mental health. Second, human resource development (psychiatrists, clinical psychiatric nurses and clinical psychologists) and services for mental health did not well and explicitly elaborated for secondary and tertiary levels in any guideline neither in EPHS nor in (NMHSP). Furthermore no package exists for tertiary level. In program level initiatives include, short term trainings, training tools are developed, coordination between Mental Health Department and Human Resource Development iv Department exist to create a database to scrutinize mental health primary and refresher training for health facilities staff and installing counselor's positions in MoPH human resource set-up, mental health residency program is initiated in central and regional hospitals, mhGAP WHO strategy implementation started as a pilot project in three provinces and mental health project initiated for institutionalization and standardization of Kabul mental health hospital. However, shortcomings are existed in program level. First, mental health has not been integrated in 2/3 of BPHS health facilities yet and personnel need trainings for capacity building, inefficient cadres at secondary and tertiary levels, Residency program do not have expert trainers. For clinical psychologists, psychiatric nurses and psychosocial counselors in institutes any section not exist to train new generation. Conclusion: In Afghanistan, there is a critical gap in human resource development and scarcity of skilled professionals for mental health services. This study highlighted initiatives and gaps at policy and program levels on human resource development for improvement of mental health services. Furthermore this study provided recommendations and policy implications for restructuring mental health policy, strategic plan and health packages.
Hedayat, E. (2014). Human resource development for mental health services in Afghanistan : a case study approach (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.