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A Collaboration of the Forum on Neuroscience and Nervous System Disorders and the African Science Academy Development Initiative; Board on Health Sciences Policy; Institute of Medicine. Strengthening Human Resources Through Development of Candidate Core Competencies for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary. Washington (DC): National Academies Press (US); 2013 Oct 8.

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Strengthening Human Resources Through Development of Candidate Core Competencies for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary.

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MNS DISORDER PROVIDERS

For discussion and for purposes of providing a summary of the candidate core competencies, the various providers who care for patients with MNS disorders were grouped into four main categories: (1) community/lay workers; (2) non-specialized, non-prescribing practitioners; (3) non-specialized prescribing practitioners; and (4) specialized practitioners (see Table 1). Definitions for each type of provider were modified from the WHO health worker classification chart7 based on various participant comments throughout the plenary and breakout sessions (Appendix C). The definitions include potential relationship roles with other providers as discussed by workshop participants. Workshop discussions also included potential treatment environments where providers might be found in SSA. The list of treatment environments was compiled by the workshop rapporteurs based on individual participants comments during the breakout sessions and is not meant to be comprehensive (see Table 2).

TABLE 1. Provider Classifications and Abbreviations.

TABLE 1

Provider Classifications and Abbreviations.

TABLE 2. Provider Treatment Environments Compiled Based on Suggestions from Individual Workshop Participants.

TABLE 2

Provider Treatment Environments Compiled Based on Suggestions from Individual Workshop Participants.

Traditional and Faith Health Practitioners

Workshop discussions included the role of traditional and faith health practitioners in the treatment and care of patients with MNS disorders. Unlike other provider types, traditional health practitioners were not able to participate in all breakout sessions, and no faith health practitioners were able to attend the workshop. Without this voice represented more widely during the discussions, many participants were concerned that inclusion of candidate core competencies for traditional and faith health practitioners would be inappropriate. Therefore, these providers have not been included in the list of candidate competencies presented in this summary.

Several participants emphasized that these providers play an important health care role throughout SSA but that no formal relationship between the health system and traditional health practitioners currently exists. The need to engage traditional health practitioners, and the need for functional referral pathways in all directions between the peer/service users, community health workers, and traditional practitioners was stressed by many participants. A large number of participants, including Lydia Matoka, a traditional health practitioner from Kenya, noted that in SSA, most rural area patients turn to traditional health practitioners first.

It was noted by several participants that traditional health practitioners can play an important role in encouraging treatment-seeking behaviors by providing community members with examples of how treatment has been helpful. For epilepsy, these providers might be able to offer counseling to help patients deal with perceived supernatural elements they may believe have a role in their disease (e.g., through mediation with ancestors).

Elliot Makhatini, a participant from South Africa, said one of the tertiary institutions in his area holds an annual forum for doctors, specialists, and traditional health practitioners to interact and give presentations on different kinds of illnesses. This helps to foster communication, mutual understanding, and respect. Another participant noted that in his experience, traditional health practitioners want to work with clinicians. To improve patient care, Matoka urged participants to integrate traditional medicine into the management of MNS disorders in SSA.

Copyright 2013 by the National Academy of Sciences. All rights reserved.
Bookshelf ID: NBK174483

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