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Gambia

The Republic of The Gambia has a population of around 1,776,000 million people and ranked 168 in the Human Development Index of the United Nations Development Program. 34% of the population is living below the poverty line and 18% of the population extremely poor. Population density is slightly more than 97 people per square mile, making The Gambia the fourth most densely populated country in Africa.  The above-mentioned factors depict a bleak situation for the health care system of the Gambia, especially mental health (HDR 2011).



Figure 1. Left: Urban, Rural and Total population in the Gambia, 1963 to 2003. Source: Department of Central Statistics, the Gambia. Right: Gambia`s position in West Africa, one of the smallest countries in Africa.

In recognition of the importance of empowering a broad base of stakeholders for self-advocacy this project has developed a national stakeholder council.   They are tasked with setting an appropriate advocacy agenda reflecting their experience in mental health in the context of service delivery and respect for human rights. This is the first time that such stakeholders have ever had such an opportunity to inform the national agenda on these issues.

Epidemiology of Mental Disorders
Communities in the Gambia are faced with numerous, mental, neurological, and psychosocial disorders that undermine development.  Based on prevalence rates from the World Mental Health Survey, 2004 it is estimated that approximately 27,000 people in the Gambia (or 3% of the population aged 15 years and more) is suffering from a severe mental disorder  and a further 91,000 (or 10% of the  population aged 15 years and more) are suffering from moderate to mild mental disorder. This means that at least 118,000 people in the Gambia (or 13% of the adult population) are likely to be affected by mental disorders which require varying degrees of treatment and care.



The Gambia has only one mental health institution with a capacity of 100 patients and currently has only one trained mental health nurse countrywide, no rehabilitation centre and almost zero services for the provincial population. One general nurse covers a whole shift at the country`s psychiatric hospital. 72% of patients are between the ages of 15 and 50 and 48% of patients are diagnosed with cannabis induced psychosis.

 

mhLAP Gambia is advocating for an equitable access to quality mental health care to all people in the Gambia with mental and substance disorders including vulnerable populations (children, women, the aged, migrants and refugees among others)

The Minister of health and Social Welfare states, “Training health and non - health staff on mental health will greatly cushion the services delivered at hospitals, major and minor health centres and more importantly at community level. It will discourage the inhumane treatment of the mentally ill and create an avenue for co-operation between the mental health services and other relevant sectors, e.g. the Judiciary, law enforcement agencies, religious leaders and traditional healers”.



In the Gambia, the mental health leadership and advocacy program (mhLAP) is collaborating with the W.H.O Gambia office and the association for the mentally disable Gambia. The health promotion officer of the WHO is the supervisor of the project in the Gambia.

From 2010 and 2011, 46 cases of sexual abuse of the mentally ill were documented. This lead to11 pregnancies but only 7 babies were accounted for by their families. The majority of these cases are recorded in the greater Banjul area with Bundung, Tallinding, Lamin, Banjul, Serekunda and Brikama topping the list.

What we are doing as mhLAP Gambia

  • Advocate for better mental health service delivery
  • Advocate for the basic human rights of the mentally ill to be respected.
  • Public sensitizations
  • New mental health legislation
  • Capacity building of health and non health staff.
  • Periodic national situational analysis on mental health.
  • Strengthening of advocacy groups
  • Meetings with editors of the print media to avoid using derogatory terms
  • Presentations at the university, NGO week, and VSO workshop.


Discussion with senior authorities at the Ministry of health: Director of health services, Director social welfare, head of psychiatric hospital etc.

  • Support to mental health groups like AMDG and country facilitator heading the advocacy group of VSO for 2012.


Mental health situational analysis

95% of the (432) respondent stated that mental health services are not available in their communities. Estimates indicate that about 0.64% of the health budget is spent on mental health. 1 Gambian train mental health Nurse, 1 psychiatric hospital, no mental health legislation, irregular supply of medications, Limited transportation facility, poor community mental health service, chaining and beating of patients at community and healers, Limited leadership in mental health etc.  Summary of the report is presented in the hierarchy below.





Study on health and disability

The objectives of this research were to:

 

  • Gain information on major challenges reported by health workers during service delivery to PWDs
  • Understand what PWDs and health workers think about the healthcare system service delivery for PWDs
  • Gather recommendations for duty bearers in relevant areas


This report summarizes data collected across the Gambia in 2012 from 228 health workers and 228 People with Disabilities (PWDs) on the challenges experienced by both parties during healthcare delivery, which affect quality health service provision. Most of the barriers relate to the capacity and attitudes of health workers, which are seen by both health workers and PWDs as inadequate.

The report shows an astonishing alignment between the numbers of health workers and PWDs who would like health workers to have training in the area of disability. 211 health workers surveyed requested capacity building, and 212 PWDs wanted health workers to have capacity building in the area of disability.

Challenges

  • The unwillingness of service users and their families to join advocacy efforts.
  • Limited institutional partnership to facilitate our programs.
  • Limited or even lack of political will in some cases towards improving services.
  • No policy guideline.

Drop the Chain and Cane

Updates on mhLAP activities in Gambia


Contact us on

Mr. Dawda Samba
Country Facilitator mhLAP
WHO Gambia,
Mental Health Advocate and Media Presenter
Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Tel: (+220) 9947043/6947043
Skype: dawdasamb
The Gambia, West Africa














Comments on our Training

I have been an advocate for 3 years now but I have never been so equipped like I did with this training and it will go to show even in my work as a radio presenter, even in areas that are not Mental Health related.

Lamin K. Sanyang, The Gambia

“The training has made me a better presenter and producer. I have written down topics that could be discussed on my programme. I also plan to reach out to the president’s wife NGO on the issue of mental health through the advocacy skills I have learnt from the training and then produce jingles in between programmes on mental health

Fatima Hassan, Markudi, Nigeria

 

“I am grateful for this opportunity to come to Nigeria and be part of this training, I feel greatly empowered”

Boniface Chitayi, Kenya

 

“I have attended lots of training but this mhLAP training has more positive impact on me than all other trainings I have attended. I have learnt the skills I need to advocate for mental health issues. I plan to factor in mental health into the district work plan in Sierra Leone

Hannah Bockarie, Sierra Leone

 

“The course was a great awakening. I feel a great burden in my heart because I now realize that there is much work to be done. I plan to adopt two PHCs in Osun state and offer free psychiatrist ser

Opakunle Tolulope, Osun, Nigeria

 

‘It was a nice multicultural experience from different African countries and a means of networking. Thank you very much’

Roseline –A – Okoth, University of Nairobi College of Health Sciences, Kenya

 

 

‘The course was very interesting, informative, educative and very interactive. The application of group work after every lecture also facilitates practical applicability of all the lectures. I have learnt various multidimensional means of promoting, preventing and carrying out advocacy for many areas of mental health disorders. I congratulate the organizers for a great work’

Dr. A.O Coker

‘Exposure to mental health care perspectives from various countries has given me a well rounded perspective of mental health care in Africa’

 

Aneshrey Moodley,  Consultant psychiatrist, South Africa

‘I had a good experience both with the facilitators and co-participants. This is more in terms of the multidisciplinary approach to mental health issues. There was clear absence of over simplified assumptions for professional convenience (psychiatrists).’

 

Akpoju Ogbole Samuel, Programme Officer, Nigeria

‘Learning took place formally during the session and during the group work. Significant learning also took place during informal interaction out of session learning about the experiences in different country. I feel better equipped to function in the stakeholder council and also in my work as head of a faith based health need’

 

Walter Carew, Executive Director, (CHASL) Sierra Leone

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