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WHO Member States Section II Section II A – B – A C – D – C E – I – E J – M – J WHO Member States N – R – N S T – Z – T 49 Mental Healthatlas © 2005 World Health Organization Afghanistan GENERAL INFORMATION Afghanistan is a country with an approximate area of 652 thousand sq. km. (UNO, 2001). Its population is 24.926 million, and the sex ratio (men per hundred women) is 107 (UNO, 2004). The proportion of population under the age of 15 years is 43% (UNO, 2004), and the proportion of population above the age of 60 years is 5% (WHO, 2004). The literacy rate is 47% for men and 15% for women (UNESCO/MoH, 2004). The country is a low income group country (based on World Bank 2004 criteria). The proportion of health budget to GDP is 5.2%. The per capita total expenditure on health is 34 international $, and the per capita government expenditure on health is 18 interna- A – B – A tional $ (WHO, 2004). The main language(s) used in the country is (are) Pashtu, Dari Persian and Turkic. The largest ethnic group(s) is (are) Pashtun (nearly half), and the other ethnic group(s) are (is) Tajik, Hazara and Uzbek. The largest religious group(s) is (are) Sunni Muslim (five sixths). The life expectancy at birth is 41.9 years for males and 43.4 years for females (WHO, 2004). The healthy life expectancy at birth is 35 years for males and 36 years for females (WHO, 2004). EPIDEMIOLOGY Some studies on refugees are available. Mukhamadiev (2003) studied the prevalence of depression in 908 Tadjik refugee women in Afghanistan and found a high prevalence of endogenous depression (28.6%). A 1.5 year follow-up showed good prognosis in subjects who had subsyndromal depression, but not in those with endogenous depression. Rasekh et al (1999) found that symptoms that met the diagnostic criteria for anxiety, depression and PTSD were common in 160 Afghan women (including 80 women cur- rently living in Kabul and 80 Afghan women who had recently migrated to Pakistan) during the Taliban regime. Mghir et al (1995) used the Structured Clinical Interview for DSM-III-R to detect mental illness among 38 children and young adults and identified depression and PTSD in more than one-third of the subjects. MENTAL HEALTH RESOURCES Mental Health Policy A mental health policy is present. The policy was initially formulated in 1986. The components of the policy are advocacy, promotion, prevention, treatment and rehabilitation. The new Afghan Government has identified mental health as one of five health priorities. Since 1986, there has been no new Government policy regarding mental health and the old mental health policy is still followed. The policy outlines prevention, treatment and rehabilitative facilities for mentally ill patients. Substance Abuse Policy A substance abuse policy is present. The policy was initially formulated in 1988. A new policy on Drug Demand Reduction was formulated in 2002. National Mental Health Programme A national mental health programme is present. The programme was formulated in 1988. The national mental health programme has the following objectives: provision of mental health care to all, integration of mental health with primary care and community care, services for special population, especially the war-affected. It also outlines services, training, administrative strategies and approaches for promotion of mental health and provision of services for the war-affected. It advocates the development of a nucleus of trained mental health professionals to act as ‘master trainers’ for primary health care physicians and health workers in their respective provinces in order to ensure at least a minimum provision of mental health services. National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is present. It was formulated in 1996. Mental Health Legislation There is a mental health legislation. The latest legislation was enacted in 1997. Mental Health Financing There are budget allocations for mental health. Details about expenditure on mental health are not available. The primary source of mental health financing is out of pocket expenditure by the patient or family. The country has disability benefits for persons with mental disorders. Disability support services are provided for persons with physi- cal, psychiatric, intellectual, sensory or age-related disabilities (or a combination of these) which are likely to continue for a minimum of six months and reduces independent functioning to the extent that ongoing support is required. Mental Health Facilities Mental health is not a part of primary health care system. Actual treatment of severe mental disorders is not available at the primary level. Community level workers from the local population (villages) have been involved in providing integrated health care for the last 8 years. Regular training of primary care professionals is not carried out in the field of mental health. Two mental health manuals were pre- pared in Dari for primary health care doctors and other staff in 1998. WHO has organized mental health training for primary health care physicians. NGOs are running training courses for primary health care doctors, nurses and midwifes, village health volunteers and traditional birth attendants. 50 Mental Healthatlas © 2005 World Health Organization AFGHANISTAN There are community care facilities for patients with mental disorders. Mental Health is included in Basic Package for Health Services (BPHS) which covers health service delivery up to district level. New treatment guidelines for common mental health disorder are being formulated (draft is ready). Four Community Mental Health Centers have been established in the capital, but further expan- sion is required. There are 2 general psychiatric rehabilitation centres with 160 beds. Psychiatric Beds and Professionals Total psychiatric beds per 10 000 population 0.055 Psychiatric beds in mental hospitals per 10 000 population 0.031 B – A Psychiatric beds in general hospitals per 10 000 population 0.024 Psychiatric beds in other settings per 10 000 population 0 Number of psychiatrists per 100 000 population 0.036 Number of neurosurgeons per 100 000 population 0.034 Number of psychiatric nurses per 100 000 population 0.07 Number of neurologists per 100 000 population 0.07 Number of psychologists per 100 000 population 0.09 Number of social workers per 100 000 population 0 Currently, there are no social workers, and there are only very few trained psychiatrists. Most doctors working as psychiatrists have either had in-service training or have attended short courses abroad. A three month diploma course was held in 1996 to train some doctors in psychiatry. Postgraduate training in psychiatry is not present. Psychologists get their training from Kabul University. Much of qualified manpower and technical expertise has left the country. Non-Governmental Organizations NGOs are involved with mental health in the country. They are mainly involved in treatment. The Afghan Government collaborates with non-governmental organizations to rapidly expand basic (mental) health services to underserved populations. Information Gathering System There is no mental health reporting system in the country. Each hospital maintains registry books on their inpatient and outpatient information. Quarterly reports are submitted by the mental hospital to the Ministry of Public Health. The country has no data collection system or epidemiological study on mental health. Programmes for Special Population The country has specific programmes for mental health for disaster affected population. There is a regular programme for traumatized children (trauma and grief programme) which is supported by UNICEF. Therapeutic Drugs The following therapeutic drugs are generally available at the primary health care level of the country: car- bamazepine, phenobarbital, amitriptyline, chlorpromazine, diazepam, haloperidol. The cost of medicines keeps fluctuating as the local currency is unstable due to the war. Over-the-counter sales of psychotropics occur. Other Information There is a shortage of staff due to the war and more international support is needed. A new Mental Health Unit under Primary Care Directorate was established in 2003 (it is not functional as yet). Since mental health is a component of the Basic Package for Health Services, guidelines and treatment protocol for common mental disorders in primary health care have been developed. Treatment guidelines for substance use have also been almost finalized. A strategy for integration of mental health services into primary care was finalized in 2004. Additional Sources of Information Mghir, R., Freed, W., Raskin, A., et al (1995) Depression and posttraumatic stress disorder among a community sample of adolescent and young adult Afghan refugees. Journal of Nervous & Mental Disease, 183, 24-30. Mohit, A., Saeed, K., Mubbashar, M., et al. (1999) Mental health manpower development in Afghanistan: a report on a training course for primary health care physicians. Eastern Mediterranean Health Journal, 5, 373-377. Mukhamadiev, D. M. (2003) Aspects of depressive states in repatriated female refugees. Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova, 103, 21-23. Rasekh, Z., Bauer, H. M., Manos, M. M., et al (1999) Women’s health and human rights in Afghanistan. JAMA, 280, 249-255. van de Put, W. (2002) Addressing mental health in Afghanistan. Lancet, 360, 41-42. Ventevogel, P., Azimi, S., Jalal, S., et al (2002) Mental health care reform in Afghanistan. Journal of Ayub Medical College, 14, 1-3. 51 Mental Healthatlas © 2005 World Health Organization Albania GENERAL INFORMATION Albania is a country with an approximate area of 29 thousand sq. km. (UNO, 2001). Its population is 3.193 million, and the sex ratio (men per hundred women) is 104 (UNO, 2004). The proportion of population under the age of 15 years is 27% (UNO, 2004), and the proportion of population above the age of 60 years is 10% (WHO, 2004). The literacy rate is 99.2% for men and 98.3% for women (UNESCO/MoH, 2004). The country is a lower middle income group country (based on World Bank 2004 criteria).
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