Mental Health care in poor resource settings what can or should be done? an experience from Aceh-Indonesia

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

2. The contents

Situation of Aceh before 2004

Tsunami 2004

(Mental) health programmes

Pasung

Now

3. Indonesia

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

7. After the Tsunami

MoU Heilsinski, December 15, 2006

8. Health care Reconstructions



Building new hospital and health posts
Training and re-training the health officers
(nurse, midwife, GP)
„Mental health programmes“

9. Pasung!

13. 
We have some 18.000 cases like this, how do
we start?

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

15. 12
10
8
Column 1
Column 2
Column 3
6
4
2
0
Row 1
Row 2
Row 3
Row 4

16. The Programme:

Network between trained nurse

Case finding

Family of the patient

Mental health cadre

Referral system

Local social health Insurance


20. Theoretically

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

23. However

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

25. Terima Kasih