Developing and implementing mental health policy in Zanzibar, a low income country off the coast of east Africa
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BACKGROUND: The Zanzibar Ministry of Health and Social Welfare, concerned about mental health in the country, requested technical assistance from WHO in 1997. AIMS: This article describes the facilitation over many years by a WHO Collaborating Centre, of sustainable mental health developments in Zanzibar, one of the poorest countries in the world, using systematic approaches to policy design and implementation. METHODS: Based on intensive prior situation appraisal and consultation, a multi-faceted set of interventions combining situation appraisal to inform planning; sustained policy dialogue at Union and state levels; development of policy and legislation, development of strategic action plans, establishment of intersectoral national mental health implementation committee, establishment of national mental health coordination system, integration of mental health into primary care, strengthening of primary-secondary care liaison, rationalisation and strengthening of secondary care system, ensuring adequate supply of medicines, use of good practice guidelines and health information systems, development of services for people with intellectual disability, establishment of formal mechanism for close liaison between the mental health services and other governmental, non-governmental and traditional sectors, mental health promotion, suicide prevention, and research and development. RESULTS: The policy and legislation introduced in 1999 have resulted in enhanced mental health activities over the ensuing decade, within a setting of extreme low resource. However, advances ebb and flow and continued efforts are required to maintain progress and continue mental health developments. Lessons learnt have informed the development of mental health policies in neighbouring countries. CONCLUSIONS: A multi-faceted and comprehensive programme can be effective in achieving considerable strengthening of mental health programmes and services even in extremely low resource settings, but requires sustained input and advocacy if gains are to be maintained and enhanced.
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Work in Zanzibar concluded that health sector reforms focus on communicable diseases, and that specialists in these fields were resistant to include mental health in these reforms.
“Yet work in Zanzibar concluded that health sector reforms focus on communicable diseases, and that specialists in these fields were resistant to include mental health in these reforms 52 .”
From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [52]
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- Jenkins R International project on mental health policy and services. Phase 1: Instruments and country profiles International Review of Psychiatry 2004 16 15276933
- Mbatia J Jenkins R Mental Health Policy in Tanzania Psychiatric Services 2010 61 1028 1031 10.1176/appi.ps.61.10.1028 20889643 · DOI
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- Authors
- Jenkins, R., Mussa, M., Haji, S. A., Haji, M. S., Salim, A., Suleiman, S., Riyami, A. S., Wakil, A., & Mbatia, J.
- Affiliations
- King's College London (GB)
- Ministry of Health and Social Welfare (TZ)
- Corresponding author
- Jenkins, Rachel
- ORCID
- Jenkins, Rachel
- Venue
- International Journal of Mental Health Systems
- Published
- 2011
- Volume
- 5
- Issue
- 1
- Pages
- 6
- ISSN
- 1752-4458 (ISSN-L)
- PMC
- PMC3045977
- OpenAlex
- W2097411528
- Cited by
- 30
- References
- 20
- Citations by year
- 2026: 2 · 2024: 3 · 2023: 3 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 1 · 2018: 3 · 2017: 2 · 2016: 2 · 2015: 1 · 2014: 1 · 2013: 1 · 2012: 4
- FWCI
- 3.06
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- International Journal of Mental Health Systems (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- mental health policy, policy implementation, Zanzibar, low-income countries, WHO Collaborating Centre, mental health law, integration of mental health into primary care, mental health promotion, suicide prevention, intellectual disability services, intersectoral coordination, health information systems, technical assistance
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