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IMC South Sudan 2015 MHPSS Situational Analysis

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IMC South Sudan 2015 MHPSS Situational Analysis International Medical Corps South Sudan Baseline Mental Health Situational Analysis March 2015 Table of Contents 1. Background 2. Methodology 3.4 Anticipated challenges in mental health PHC integration 3. Results 3.1 The Environment 3.1.1 Location and physical setting 4. Summary and Recommendations 3.1.2 Socio-economic profile 3.1.3 Socio-political environment Appendices 3.1.4 Socio-cultural attitudes towards Appendix A: Situational Analysis people with mental illness Information Framework and Data Sources 3.2 The Health System Appendix B: IMC MHPSS Situational 3.2.1 General health services Analysis Tool 3.2.2 Mental health services Appendix C: IMC Mental Health Knowledge and Attitudes Questionnaire 3.3 Mental Health Needs Appendix D: IMC PHC MH Integration 3.3.1 Prevalence of mental health Checklist problems and psychological distress 3.3.2 Psychosocial issues Acknowledgements The International Medical Corps South Sudan County Team as well as the Mental Health and Psychosocial Support Team have played a pivotal role in bringing this report to light. We especially wish to thank Dr Esubalew Wondimu, Gurusewak Khalsa and Erin Shedd for their invaluable assistance. Agany Majak, the national coordinator of the Global Mental Health PHC Integration Program has contributed substantially in the preparation of this report. We also wish to thank the many key informants who have shared valuable insights with us as well as International Medical Corps’ mental health specialists whose rapid assessment reports conducted earlier have contributed to much of the information included in this report. Contact This report was completed by Dr. Neerja Chowdhary, International Medical Corps Global Mental Health PHC Integration Project Coordinator. For questions regarding this report please contact: Dr. Inka Weissbecker, International Medical Corps Global Mental Health and Psychosocial Advisor ([email protected]) 1 1. Background “South Sudan’s political turbulence is akin to the chaotic structure of a stream of water from a tap: unpredictable from moment to moment……”1 This sentence best describes the political chaos and resulting internal conflict in South Sudan since it gained independence in 2011. Fighting in Juba erupted on the December 15, 2013, causing the deaths and displacement of thousands and a wave of insecurity throughout the country, which continues today, particularly in the fragile states of Unity, Jonglei, and Upper Nile. Currently, 2.5 million people face crisis/emergency levels of food insecurity and 1.5 million people are internally displaced by conflict.2 International Medical Corps is currently operating both mobile and static health care units and nutrition interventions to highly vulnerable populations across the three states. In addition, mental health programming is deemed as being essential to address and strengthen the coping mechanisms of the populations in the current crisis, to mitigate the effects of stress and trauma on individuals and to support the social cohesion of society at large. The overall objective of this situational analysis is to review mental health needs and services in South Sudan before International Medical Corps started supporting mental health services in order to have baseline information as a comparison against follow-up and to inform International Medical Corps’ longer term Mental Health and Psychosocial Support (MHPSS) programming in the region. The sites in which this situational analysis has been conducted, therefore, are the sites in which International Medical Corps is currently implementing its MHPSS programs i.e. Juba, Maban, Malakal, Awerial and Akobo. 2. Methodology The situational analysis collated information collected during initial rapid assessments by International Medical Corps’ psychiatrists conducted in April and May 2013, February 2014 and October 2014 and as well as data collected subsequently by the Global and National International Medical Corps program coordinators. The timelines of the different assessments are presented in the Gantt chart below: Assessment 2013 2014 2015 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Rapid Mental Health Situational Analysis, Apr International Medical Corps, Maban Mental Health in Health Facilities, May International Medical Corps South Sudan Rapid Mental Health Siutuational Analysis: Feb Awerial and Malakal Rapid Mental health Assessment: International Aug Medical Corps, Akobo and Juba Field visit by Global Project Coordinator Feb Data collection methods included desktop reviews as well as semi-structured interviews and focus group discussions with key informants. Appendix A provides the detailed situational analysis information framework and data sources that contributed to this report. The specific tools used for data collection included (Appendices B, C, D): 1 Alex de Waal. When Kleptocracy Becomes Insolvent: Brute Causes Of The Civil War In South Sudan. African Affairs, 2014, 113/452, 347–369. Downloaded from http://afraf.oxfordjournals.org/ 2 The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) South Sudan: Crisis Situation Report No.78 (as of 12 March 2015). 2 1. An adapted version of the WHO/UNHCR (2012) Assessing Mental Health and Psychosocial Needs and Resources - Toolkit for Humanitarian Settings, specifically, the checklist for integrating mental health in primary care in humanitarian settings and the Participatory assessment: perceptions by general community members 2. A Knowledge and Attitudes questionnaire adapted from the following sources: a. US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA, 2010). Health Styles Population survey. Conducted annually in the United Stated by Porter Novelli and adapted from British Omnibus National Survey. b. Scottish Government (2008). Well? What Do You Think?: The Fourth National Scottish Survey of Public Attitudes to Mental Wellbeing and Mental Health Problems. c. Afghanistan Ministry of Public Health (MOPH). Basic Package of Health Services, Mental health Training attitude survey. d. IMC Iraq Mental Health Attitudes Survey (described in: Sadik, S., Bradley, M., Al-Hasoon, S., & Jenkins, R. (2010). Public Perception of Mental Health in Iraq. International Journal of Mental Health Systems 2010, 4:26). (adapted from Weller 1998, does contact with people with mental illness affect nurses) e. Questions suggested for Afghanistan by IMC Afghanistan Technical Team. 3. Field guides for semi- structured interviews prepared based on themes to be explored for this report. Informed consent was obtained from all key informants who were interviewed. Data collected was entered and analyzed using Microsoft Excel software. All qualitative data was analyzed using theme coding analysis. 3. Results 3.1. The Environment 3.1.1. Location and physical setting South Sudan, officially the Republic of South Sudan, is a landlocked country in northeastern Africa that gained its independence from Sudan in 2011 following a referendum that passed with 98.83% of the vote. South Sudan is divided into ten states, which correspond to three historical regions: Bahr el Ghazal, Equatoria, and Greater Upper Nile. It is covered in tropical forest, swamps, and grassland. The White Nile passes through the country, passing by Juba. 3.1.2 Socio-economic profile South Sudan has a population of approximately 8 to 10 million (the exact figure is disputed) and a predominantly rural, subsistence economy. This region has been negatively affected by war for all but 10 of the years since 1956, resulting in serious neglect, lack of infrastructure development, and major destruction and displacement. The economy of South Sudan is one of the world's most underdeveloped with South Sudan having little existing infrastructure and the highest 3 maternal mortality and female illiteracy rates in the world as of 2011. The major ethnic groups present in South Sudan are the Dinka at more than 1 million (approximately 15 percent combined), the Nuer (approximately ten percent), the Bari, and the Azande. While inter-ethnic warfare predates the war of independence, since December 2013 up to 10,000 people are estimated to have been killed in the inter-ethnic Dinka-Nuer fighting. 3.1.3. Socio-political environment Mental Health Policy and Legislation The policy statement on mental health as part of the South Sudan Health Policy (2006-2011) asserts that mental health is an integral part of public health and that the Ministry of Health will work with the social and other sectors to develop a flexible integrated system of accountable, accessible, and equitable mental health care and support services particularly at the community level. It states that “a mental health strategy will be developed that will include advocacy, legislation and human rights, planning, financing and organization of services, quality, the use of psychotropic medicines and how to address the mental health of people of all ages including children and adolescents” (Government of South Sudan, 2007). To date, a draft Mental Health Strategy for South Sudan has been developed in a collaboration between WHO and the Ministry of Health (MoH, Dec, 2011) and is currently under review. It outlines six strategic components: 1. Strengthening leadership and political commitment for mental health 2. Scaling up integration of mental health in primary health care2 3. Strengthening secondary and tertiary care mental health services 4. Identifying and prioritizing vulnerable persons 5. Inter-sectorial coordination
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