Mental Health care in poor resource settings
What can be done?

An experience from Aceh
Indonesia
Marthoenis
3 course of N...
The contents


Situation of Aceh before 2004



Tsunami 2004



(Mental) health programmes



Pasung



Now
Indonesia
Aceh


Current Population: 4,5 Million out of 237
millions in Indonesia



29 years military conflict



One the poores...
Tsunami 2004




Banda Aceh, Calang and Meulaboh were
among the hardest area hit by tsunami 2004
In total; 170.000 died ...
Tsunami 2004


Population Before the Tsunami was 4,271,000 (2004)
and as of 15 September 2005 was 4,031,589



Infrasctr...
After the Tsunami


MoU Heilsinski, December 15, 2006
Health care Reconstructions





Building new hospital and health posts
Training and re-training the health officers
(n...
Pasung!


We have some 18.000 cases like this, how do
we start?
Resources!:


Some 500 CMH nurses



Strong commitment from the local goverment


BUT



Regulation?



Mental Hospit...
12

10

8
Column 1
Column 2
Column 3

6

4

2

0
Row 1

Row 2

Row 3

Row 4
The Programme:


Network between trained nurse



Case finding



Family of the patient



Mental health cadre



Ref...
Theoretically
The Barriers
Saraceno et al 2007



Barrier 1: Low Political will



Barrier 2: Resistence to decentralization



Barri...
Aceh Health Insurance (2010)


Social health insurance to ensure all people
have access to proper health care!



Premiu...
However
Messages!


Mental health is sooooooooooooooo much
neglected



But we can do something!



Start from now



Start fr...
Terima Kasih
Mental Health care in poor resource settings
Mental Health care in poor resource settings
Mental Health care in poor resource settings
Mental Health care in poor resource settings
Mental Health care in poor resource settings
Mental Health care in poor resource settings
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Mental Health care in poor resource settings

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Mental Health care in poor resource settings
what can or should be done?

an experience from Aceh-Indonesia

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Mental Health care in poor resource settings

  1. 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. 2. The contents  Situation of Aceh before 2004  Tsunami 2004  (Mental) health programmes  Pasung  Now
  3. 3. Indonesia
  4. 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. 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. 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. 7. After the Tsunami  MoU Heilsinski, December 15, 2006
  8. 8. Health care Reconstructions    Building new hospital and health posts Training and re-training the health officers (nurse, midwife, GP) „Mental health programmes“
  9. 9. Pasung!
  10. 10.  We have some 18.000 cases like this, how do we start?
  11. 11. 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
  12. 12. 12 10 8 Column 1 Column 2 Column 3 6 4 2 0 Row 1 Row 2 Row 3 Row 4
  13. 13. The Programme:  Network between trained nurse  Case finding  Family of the patient  Mental health cadre  Referral system  Local social health Insurance 
  14. 14. Theoretically
  15. 15. 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?
  16. 16. 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
  17. 17. However
  18. 18. Messages!  Mental health is sooooooooooooooo much neglected  But we can do something!  Start from now  Start from your self  Start from a small thing
  19. 19. Terima Kasih

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