Training, attitudes and practice of district health workers in Kenya

  • Florence A. Muga
  • Rachel JenkinsEmail author



The 1994 mental health policy in Kenya was rooted in the concepts of Primary Health Care articulated at Alma Ata, and required that mental health care be decentralized to all levels of the health care system, and delivered by all cadres of health staff rather than just mental health specialists. However, effective implementation of this policy was likely to be influenced by the degree to which the training, attitudes and practice of health staff was consistent with and supportive of the mental health policy.


This article therefore reports a study conducted in 1997, which examined the training, attitudes and practice of district level health staff in relation to mental health care and compared them with the national mental health policy of 1994.


A semi-structured questionnaire was sent to the medical superintendents of all district hospitals in Kenya, for distribution to respondents from each cadre of health staff. A total of 148 health workers from 28 districts out of 44 eligible districts (63%) responded.


District health workers did not think general health workers ought to manage most psychiatric patients, even if they were capable of doing so, preferring a system where these patients were managed by specialists and were not admitted into general wards. They also tended to equate mental illness with psychosis.


Despite their training in mental health care and their theoretical knowledge of the principles of Primary Health Care, the attitude and mental health care practice of most health workers were in keeping with a more medical model of health care, emphasising pharmacological treatment and expecting psychiatric patients to conform to the standard Sick Role. This orientation, being at variance with the orientation of the 1994 mental health policy, may have contributed to difficulties in implementation of the policy.

Key words

mental health policy training attitudes practice district health workers primary health care 


  1. 1.
    Abas M, Baingana F et al (2003) Common mental disorders and primary health care: current practice in low-income countries. Harv Rev Psychiatry 11(3):166–173PubMedCrossRefGoogle Scholar
  2. 2.
    Abas M, Mbengeranwa OL et al (2003) Primary care services for depression in Harare, Zimbabwe. Harv Rev Psychiatry 11(3):157–165PubMedCrossRefGoogle Scholar
  3. 3.
    Abiodun O (1989) Psychiatric morbidity in a primary health care centre in a rural community in Nigeria. Cent Afr J Med 34(4):372–377Google Scholar
  4. 4.
    Abiodun OA (1991) Knowledge and attitude concerning mental health of primary health care workers in Nigeria. Int J Soc Psychiatry 37(2):113–120PubMedCrossRefGoogle Scholar
  5. 5.
    Abiodun OA (1993) A study of mental morbidity among primary care patients in Nigeria. Compr Psychiatry 34:10–13PubMedCrossRefGoogle Scholar
  6. 6.
    Acland S (2002) Mental health series in primary care: the case of Nepal. In: Cohen A, Kleinman A, Saraceno B (eds) World mental health casebook: social and mental health programs in low-income countries. Kluwer, Academic/Plenum Press, New York, pp 121–152Google Scholar
  7. 7.
    Adewuya AO, Oguntade AA (2007) Doctors’ attitude towards people with mental illness in Western Nigeria. Soc Psychiatry Psychiatr Epidemiol 42(11):931–936PubMedCrossRefGoogle Scholar
  8. 8.
    Adewuya AO, Oguntade AA (2007) Doctors’ attitude towards people with mental illness in Western Nigeria. Soc Psychiatry Psychiatr Epidemiol Aug 24 (Epub)Google Scholar
  9. 9.
    Al-Faris E, Al-Subaie A et al (1997) Training primary health care physicians in Saudi Arabia to recognize psychiatric illness. Acta Psychiatr Scand 96:439–444PubMedCrossRefGoogle Scholar
  10. 10.
    Al-Jaddou H, Malkawi A (1997) Prevalence, recognition and managment of mental disorders in primary health care in Northern Jordan. Acta Psychiatr Scand 96:31–35PubMedCrossRefGoogle Scholar
  11. 11.
    Angermeyer MC, Breier P et al (2005) Public attitudes toward psychiatric treatment. An international comparison. Soc Psyschiatry Psychiatr Epidemiol 40(11):855–864 CrossRefGoogle Scholar
  12. 12.
    Angermeyer MC, Matschinger H (2005) Labelling stereotype discrimination. Soc Psychiatry Psychiatr Epidemiol 40(5):391–395PubMedCrossRefGoogle Scholar
  13. 13.
    Becker SM (2004) Detection of somatization and depression in primary care in Saudi Arabia. Soc Psychiatry Psychiatr Epidemiol 39(12):962–966PubMedCrossRefGoogle Scholar
  14. 14.
    Chinnayya H, Chandrashekar C et al (1990) Training primary care health workers in mental health care: evaluation of attitudes towards mental illness beofre and after training. Int J Soc Psychiatry 36(4):300–307PubMedCrossRefGoogle Scholar
  15. 15.
    Clark C, Parker E et al (2005) Rural generalist nurses’ perceptions of the effectiveness of their therapeutic interventions for patients with mental illness. Aust J Rural Health 13(4):205–213PubMedCrossRefGoogle Scholar
  16. 16.
    Cohen CI (1993) The biomedicalization of psychiatry: a critical overview. Commun Ment Health J 29(6):509–521CrossRefGoogle Scholar
  17. 17.
    Cohen A (2001) The effectiveness of mental health services in primary care: the view from the developing world. World Health Organization, GenevaGoogle Scholar
  18. 18.
    Cooper N, Stevenson C et al (1996) Integrating perspectives on health. Open University Press, Milton KeynesGoogle Scholar
  19. 19.
    Dhadphale M, Ellison R et al (1983) The frequency of psychiatric disorders among patients attending semi-urban and rural general out-patient clinics in Kenya. Br J Psychiatry 142:379–383PubMedGoogle Scholar
  20. 20.
    Dhadphale M, Ellison RH (1983) The frequency of mental disorders in the outpatients of two Nyanza hospitals. Cent Afr J Med 29:29–32PubMedGoogle Scholar
  21. 21.
    Division of Mental Health Ministry of Health Kenya (1994) The first Kenya National Mental Health Programme of Action for the next ten years and beyond. Ministry of Health Kenya, NairobiGoogle Scholar
  22. 22.
    Engel GL (1977) The need for a new medical model: a challenge for biomedicine. Science 196(4286):129–135PubMedCrossRefGoogle Scholar
  23. 23.
    Engel GL (1992) How much longer must medicine’s science be bound by a seventeenth century world view? Psychother Psychosom 57(1–2):3–16PubMedCrossRefGoogle Scholar
  24. 24.
    Freedman AM (1995) The biopsychosocial paradigm and the future of psychiatry. Compr Psychiatry 36(6):397–406PubMedCrossRefGoogle Scholar
  25. 25.
    Hall BA (1996) The psychiatric model: a critical analysis of its undermining effects on nursing in chronic mental illness. ANS Adv Nurs Sci 18(3):16–26PubMedGoogle Scholar
  26. 26.
    Hall A, Williams H (1987) Hidden psychiatric morbidity: Part II: Training health care workers in detection: a pre- and post-study at Karanda Mission Hospital. Cent Afr J Med 33(11):255–258PubMedGoogle Scholar
  27. 27.
    Hall A, Williams H (1987) Hidden psychiatric morbidity, Part 1. A study of prevalence in an outpatient population at Bindura Provincial Hospital. Cent Afr J Med 33:239–243PubMedGoogle Scholar
  28. 28.
    Harding TW, Climent CE et al (1983) The WHO collaborative study on strategies for extending mental health care; II: the development of new research methods. Am J Psychiatry 140:1474–1480PubMedGoogle Scholar
  29. 29.
    Harding TW, De Arango MV et al (1980) Mental disorders in primary health care: a study of their frequency in four developing countries. Psychol Med 10:231–241PubMedGoogle Scholar
  30. 30.
    Hart N (1985) The sociology of health and medicine. Causeway Press, OmskirkGoogle Scholar
  31. 31.
    Ignacio LL, de Arango MV et al (1983) Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries. Am J Public Health 73(9):1081–1084PubMedGoogle Scholar
  32. 32.
    Ignacio LL, de Arango MV et al (1989) Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries: a follow-up study. Int J Epidemiol 18(3):669–673PubMedCrossRefGoogle Scholar
  33. 33.
    de Jong J (1996) A comprehensive public mental health programme in Guinea-Bissau: a useful model for African, Asian and Latin American countries. Psychol Med 26(1):97–108PubMedCrossRefGoogle Scholar
  34. 34.
    Jorm AF, Mackinnon A et al (2005) Structure of beliefs about the helpfulness of interventions for depression and schizophrenia. Soc Psychiatry Psychiatr Epidemiol 40(11):877–883PubMedCrossRefGoogle Scholar
  35. 35.
    Komiti A, Judd F et al (2006) The influence of stigma and attitudes on help seeking from a GP for mental health problems. Soc Psychiatry Psychiatr Epidemiol 41(9):738–745PubMedCrossRefGoogle Scholar
  36. 36.
    Lauber C, Nordt C et al (2005) Recommendations of mental health professionals and the general population on how to treat mental disorders. Soc Psychiatry Psychiatr Epidemiol 40(10):835–843PubMedCrossRefGoogle Scholar
  37. 37.
    Lethoba KG, Netswera FG et al (2006) How professional nurses in a general hospital setting perceive mentally ill patients. Curationis 29(4):4–11PubMedGoogle Scholar
  38. 38.
    Mavundla TR (2000) Professional nurses’ perception of nursing mentally ill people in a general hospital setting. J Adv Nurs 32(6):1569–1578PubMedCrossRefGoogle Scholar
  39. 39.
    Mavundla TR, Uys LR (1997) The attitudes of nurses towards mentally ill people in a general hospital setting in Durban. Curationis 20(2):3–7PubMedGoogle Scholar
  40. 40.
    Mechanic D (1974) Politics, medicine and social science. Wiley, New YorkGoogle Scholar
  41. 41.
    Mohit A (1998) Mental health in the Eastern Mediterranean Region of the World Health Organization with a view of the future trends. East Mediterr Health J 5:231–240Google Scholar
  42. 42.
    Muga F (1990) Psychiatric morbidity among women in polygamous and monogamous marriages: a comparative study. University of Nairobi, NairobiGoogle Scholar
  43. 43.
    Muga F, Jenkins R (2008). Health care models guiding mental health policy in Kenya 1965–1997. Soc Psychiatry Psychiatr Epidemiol (submitted)Google Scholar
  44. 44.
    Muga F, Jenkins R (2008) Health care models used by the general public in Kenya, and their compatibility with health policy and health services. Soc Psychiatry Psychiatr Epidemiol (submitted)Google Scholar
  45. 45.
    Murthy R, Wig N (1983) The WHO collaborative study on strategies for extending mental health care, IV: a training approach to enhancing the availability of mental health manpower in a developing country. Am J Psychiatry 140(11):1486–1490PubMedGoogle Scholar
  46. 46.
    Ozmen E, Ogel K et al (2006) Public opinion and belief about the treatment of depression in urban Turkey. Soc Psychiatry Psychiatr Epidemiol 40(11):869–876CrossRefGoogle Scholar
  47. 47.
    Parsons T (1951) The social system. Routledge and Kegan Paul, LondonGoogle Scholar
  48. 48.
    Parsons T (1975) The sick role and the role of the physician reconsidered. MMFO/Health Soc 53:257–278Google Scholar
  49. 49.
    Patel V, Abas M et al (2001) Depression in developing countries: lessons from Zimbabwe. Br Med J 322(7284):482–484CrossRefGoogle Scholar
  50. 50.
    Penayo U, Kullgren G et al (1990) Mental disorders among primary health care patients in Nicaragua. Acta Psychiatr Scand 82(1):82–85PubMedCrossRefGoogle Scholar
  51. 51.
    Petersen I (1999) Training for transformation: reorientating primary health care nurses for the provision of mental health care in South Africa. J Adv Nurs 30(4):907–915PubMedCrossRefGoogle Scholar
  52. 52.
    Phillips D (1990) Health and health care in developing countries. Longman, EssexGoogle Scholar
  53. 53.
    Qureshi NA, Van Der Molen HT et al (2006) Effectiveness of a training programme for primary care physicians directed at the enhancement of their psychiatric knowledge in Saudi Arabia. Educ Health (Abingdon, England) 19(1):52–60Google Scholar
  54. 54.
    Riedel-Heller SG, Matschinger H et al (2005) Mental disorders—who and what might help? Soc Psychiatry Psychiatr Epidemiol 40(2):167–174PubMedCrossRefGoogle Scholar
  55. 55.
    Siegler M, Osmond H (1974) Models of madness, models of medicine. Macmillan, New YorkGoogle Scholar
  56. 56.
    Tyrer P, Steinberg D (1987) Models for mental disorder: conceptual models in psychiatry. Wiley, ChichesterGoogle Scholar
  57. 57.
    World Health Organization (1978) Primary health care: report of the international conference on primary health care 1978; September 6–12, 1978; Alma-Ata USSR. World Health Organization, GenevaGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.University of Papua New GuineaPort MoresbyPapua New Guinea
  2. 2.WHO Collaborating Centre, Institute of Psychiatry, King’s College LondonLondonUK

Personalised recommendations