Scaling up community-based services and improving quality of care in the state psychiatric hospitals: the way forward for Ghana

Objective: This paper aims to explore the options available for developing community-based care and improving the quality of care in psychiatric hospitals in Ghana. Method: Semi-structured interviews (SSIs) and focus group discussions (FGDs) were conducted with a cross-section of stakeholders including health professionals; researchers; policy makers; politicians; users and carers. The SSIs and FGDs were recorded digitally and transcribed verbatim. Apriori and emergent themes were coded and analysed with NVivo version 7.0; using a framework analysis. Results: Psychiatric hospitals in Ghana have a mean bed occupancy rate of 155. Most respondents were of the view that the state psychiatric hospitals were very congested; substantially compromising quality of care. They also noted that the community psychiatric system was lacking human and material resources. Suggestions for addressing these difficulties included committing adequate resources to community psychiatric services; using psychiatric hospitals only as referral facilities; relapse prevention programmes; strengthening psychosocial services; adopting more precise diagnoses and the development of a policy on long-stay patients. Conclusion: There is an urgent need to build a credible system of community-based care and improve the quality of care in psychiatric hospitals in Ghana

From mental health policy development in Ghana to implementation: what are the barriers?

Objective: This paper identifies the key barriers to mental health policy implementation in Ghana and suggests ways of overcoming them. Method: The study used both quantitative and qualitative methods. Quantitatively; the WHO Mental Health Policy and Plan Checklist and the WHO Mental Health Legislation Checklist were employed to analyse the content of mental health policy; plans and legislation in Ghana. Qualitative data was gathered using in-depth interviews and focus group discussions with key stakeholders in mental health at the macro; meso and micro levels. These were used to identify barriers to the implementation of mental health policy; and steps to overcoming these. Results: Barriers to mental health policy implementation identified by participants include: low priority and lack of political commitment to mental health; limited human and financial resources; lack of intersectoral collaboration and consultation; inadequate policy dissemination; and an absence of research-based evidence to inform mental health policy. Suggested steps to overcoming the barriers include: revision of mental health policy and legislation; training and capacity development and wider consultation. Conclusion: These results call for well-articulated plans to address the barriers to the implementation of mental health policy in Ghana to reduce the burden associated with mental disorders

Aids in Ghana; 1986-1989: epidemiological aspects

Surveillance of AIDS in Ghana began in 1985 following the formation of the National Technical Committee on AIDS. Surveillance is based on passive reports from health institutions all over the country. The case definition adopted was that of the World Health Organization clinical case definition for Africa. This was slightly modified for Ghana in October 1988. By the end of December 1989; 1;226 cases of AIDS had been reported to the Ministry of Health. 971 (79.2 per cent) of the cases were female and 225 (20 per cent) male. The mean ages for males and females were 34.2 and 32.4 years respectively. Only 17 cases (1.4 per cent) were aged less than 15 years old. Whilst there was a female preponderance in reported AIDS cases at the beginning of the epidemic in 1986; significant changes have occurred in the male:female ratio; underscoring the fact that HIV transmission in the country is mainly by heterosexual contact